瑞典脑肿瘤手术中的术前抗生素预防方案：一项准实验研究。
Preoperative antibiotic prophylaxis regimen in brain tumour surgery in Sweden: a quasi-experimental study.
机构信息
Department of Neurosurgery, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
出版信息
Acta Neurochir (Wien). 2020 Nov;162(11):2849-2856. doi: 10.1007/s00701-020-04309-6. Epub 2020 May 7.
BACKGROUND
There has been varied clinical practice concerning antibiotic prophylaxis in patients undergoing craniotomy. In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens.
METHODS
A quasi-experimental design was used. The sample consisted of 580 adult (> 18 years) patients operated 2012-2015, of which 375 received Cloxacillin (pre-intervention group) and 205 received Cefuroxime (intervention group). Primary endpoint was the incidence of surgical site infection (SSI) 12 months after surgery, while secondary endpoints were the need for reoperation due to SSI, the amount antibiotics used and the number of visits in the outpatient clinic related to SSI. A control group from another institution was reviewed to rule out clinical trial effects.
RESULTS
When analysed by intention to treat, the pre-intervention group had a significant higher incidence of SSI, 13.3% (50/375) vs 5.4% (11/205) in the intervention group (p < 0.01). A treatment per protocol analysis confirmed the result. The number of reoperations due to SSI were significantly reduced in the intervention group, 3.4% (7/205) vs 8.3% (31/375) (p = 0.02), as was the total antibiotic use (p = 0.03) and the number of visits in the outpatient clinic (p < 0.01). In the control group, the reoperation rate as result of SSI was lower (p = 0.02) prior to the opposite change from Cefuroxime to Cloxacillin, 1.8% (27/1529) vs 3.1% (43/1378).
CONCLUSION
In Sweden, Cefuroxime as prophylaxis in brain tumour surgery by craniotomy seems to be superior to Cloxacillin.
背景
在接受颅脑手术的患者中，抗生素预防用药的临床实践存在差异。在瑞典，经常使用氯唑西林和头孢呋辛。我们旨在研究这两种方案的临床效果。
方法
采用准实验设计。样本包括 2012-2015 年间接受手术的 580 名成年（>18 岁）患者，其中 375 名患者接受氯唑西林（干预前组），205 名患者接受头孢呋辛（干预组）。主要终点是术后 12 个月的手术部位感染（SSI）发生率，次要终点是因 SSI 再次手术的需求、使用抗生素的数量以及与 SSI 相关的门诊就诊次数。回顾另一家机构的对照组以排除临床试验的影响。
结果
意向治疗分析时，干预前组 SSI 发生率显著较高，为 13.3%（50/375），而干预组为 5.4%（11/205）（p<0.01）。基于方案的治疗分析结果证实了这一结果。干预组因 SSI 再次手术的例数明显减少，为 3.4%（7/205），而干预前组为 8.3%（31/375）（p=0.02），抗生素总使用量（p=0.03）和门诊就诊次数（p<0.01）也有所减少。在对照组中，在从头孢呋辛改为氯唑西林之前，SSI 的再次手术率较低（p=0.02），为 1.8%（27/1529），而改为氯唑西林后为 3.1%（43/1378）。
结论
在瑞典，头孢呋辛作为颅脑肿瘤手术的预防用药似乎优于氯唑西林。
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