Observatoire du médicament, des dispositifs médicaux et de l'innovation thérapeutique (OMEDIT) Pays de la Loire, 85, rue Saint-Jacques, 44093 Nantes, France.
Réseau Qualirel santé, 85, rue Saint-Jacques, 44093 Nantes, France.
Infect Dis Now. 2021 Mar;51(2):170-178. doi: 10.1016/j.medmal.2020.10.005. Epub 2020 Oct 14.
While regional monitoring of antibiotic use has decreased since 2011 by 3.2%, in some healthcare facilities a significant increase (+43%) has occurred. The purpose of this study was to assess regional antibiotic prophylaxis (ABP) compliance with national guidelines.
In 2015, 26 healthcare facilities, both public and private, were requested to audit five items: utilization of antibiotic prophylaxis, the antimicrobial agent (the molecule) administered, time between injection and incision, initial dose, number of intraoperative and postoperative additional doses. Seven surgical procedures were selected for assessment: appendicectomy (APP), cataract (CAT), cesarean section (CES), colorectal cancer surgery (CCR), hysterectomy (HYS), total hip arthroplasty (THA) and transurethral resection of the prostate (TURP). A statistical analysis of the 2303 records included was carried out.
The general rate of antibiotic prophylaxis compliance was 64%. The antimicrobial agent used and initial dose were in compliance with the guidelines for 93% and 97.4% of cases respectively, and administration of antibiotic prophylaxis was achieved 60minutes before incision in 77.6% of the records included. Regarding gastrointestinal surgery, amoxicillin/clavulanic acid was used in 32% of patients. In 26% of appendectomy files, administration occurred after incision, and one out of two files showed non-complaint perioperative and postoperative consumption.
Compliance with nationwide ABP guidelines is in need of pronounced improvement, especially with regard to time interval between injection and incision and the molecule prescribed. An action plan based on specific recommendations addressed to each establishment and an updated regionwide ABP protocol are aimed at achieving better and reduced consumption of antimicrobial agents.
自 2011 年以来，抗生素使用的区域监测减少了 3.2%，但在一些医疗机构，抗生素的使用量却显著增加（增加了 43%）。本研究旨在评估区域抗生素预防（ABP）与国家指南的一致性。
2015 年，要求 26 家公立和私立医疗机构审核 5 项内容：抗生素预防的使用情况、使用的抗菌药物（分子）、注射与切开之间的时间、初始剂量、术中及术后追加剂量的次数。选择了 7 种手术程序进行评估：阑尾切除术（APP）、白内障（CAT）、剖宫产（CES）、结直肠癌手术（CCR）、子宫切除术（HYS）、全髋关节置换术（THA）和经尿道前列腺切除术（TURP）。对包含的 2303 份记录进行了统计分析。
抗生素预防的总体合规率为 64%。使用的抗菌药物和初始剂量分别有 93%和 97.4%符合指南，在包含的记录中，77.6%的病例在术前 60 分钟内给予抗生素预防。对于胃肠道手术，有 32%的患者使用阿莫西林/克拉维酸。在 32%的阑尾切除记录中，给药发生在切开后，且两份记录中的一份显示不符合围手术期和术后使用规定。
需要显著改善全国范围内的 ABP 指南的遵守情况，特别是在注射与切开之间的时间间隔和规定的分子方面。针对每个医疗机构的具体建议制定行动计划，并更新区域 ABP 方案，旨在实现更好和减少抗菌药物的使用。
