From the William Harvey Research Institute, Queen Mary University of London, London (PD, AP, RMP, TEFA), University Hospitals Birmingham NHS Foundation Trust, Birmingham (WR), and Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK, Acute, Critical & Perioperative Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK (MRE).
Eur J Anaesthesiol. 2022 Jun 1;39(6):533-539. doi: 10.1097/EJA.0000000000001619. Epub 2021 Nov 3.
Antimicrobial prophylaxis is commonly used to prevent surgical site infection (SSI), despite concerns of overuse leading to antimicrobial resistance. However, it is unclear how often antimicrobials are used and whether guidelines are followed.
To describe contemporary clinical practice for antimicrobial prophylaxis including guideline compliance, the rate of postoperative infection and associated side effects.
A prospective, multicentre, observational cohort study.
Twelve United Kingdom National Health Service hospitals.
One thousand one hundred and sixteen patients, aged at least 18 years undergoing specific colo-rectal, obstetric, gynaecological, urological or orthopaedic surgical procedures.
Compliance with guidelines for antimicrobial prophylaxis.
The primary outcome was SSI within 30 days after surgery. Secondary outcomes were number of doses of antimicrobials for prophylaxis and to treat infection, incidence of antimicrobial-related side effects and mortality within 30 days after surgery. Data are presented as number with percentage (%) or median with interquartile range [IQR].Results of logistic regression analyses are presented as odds ratio/rate ratio (OR/RR) with 95% confidence intervals (95% CIs).
1102 out of 1106 (99.6%) patients received antimicrobial prophylaxis, which was compliant with local guidelines in 929 out of 1102 (84.3%) cases. 2169 out of 51 28 (42.3%) doses of antimicrobials were administered as prophylaxis (median 1 [1 to 2] dose) and 2959 out of 5128 (57.7%) were administered to treat an infection (median 21 [11 to 28] doses). 56 patients (5.2%) developed SSI. Antimicrobial prophylaxis administered according to local guidelines was not associated with a lower incidence of SSI compared with administration outside guidelines [OR 0.90 (0.35 to 2.29); P = 0.823]. 23 out of 1072 (2.2%) patients experienced a side effect of antimicrobial therapy. 7 out of 1082 (0.6%) patients died. The median hospital stay was 3 [1 to 5] days.
Antimicrobial prophylaxis was administered for almost all the surgical procedures under investigation. However, this was not always compliant with guidelines. Further research is required to determine whether the amount of prophylactic antimicrobials could be safely and effectively reduced without increasing the incidence of SSI.
尽管人们担心过度使用会导致抗生素耐药性，但抗菌药物预防仍被广泛用于预防手术部位感染（SSI）。然而，目前尚不清楚抗菌药物的使用频率以及是否遵循了指南。
描述包括遵循指南情况、术后感染发生率和相关副作用在内的抗菌药物预防的当代临床实践。
前瞻性、多中心、观察性队列研究。
英国 12 家国民保健署医院。
1116 名年龄至少 18 岁、接受特定结肠直肠、产科、妇科、泌尿科或骨科手术的患者。
抗菌药物预防的使用。
术后 30 天内 SSI。次要结局为预防和治疗感染所需的抗菌药物剂量、抗菌药物相关副作用和术后 30 天内死亡率。数据以数量（%）或中位数（四分位距 [IQR]）表示。逻辑回归分析的结果以比值比（OR）/率比（RR）表示，并附有 95%置信区间（95%CI）。
1102 名患者（1106 名患者的 99.6%）接受了抗菌药物预防，其中 929 名患者（1102 名患者的 84.3%）的预防符合当地指南。5128 剂抗生素中有 2169 剂（42.3%）用于预防（中位数 1 [1 至 2] 剂），5128 剂中有 2959 剂（57.7%）用于治疗感染（中位数 21 [11 至 28] 剂）。56 名患者（5.2%）发生 SSI。与未遵循指南的抗菌药物预防相比，根据当地指南给予的抗菌药物预防与较低的 SSI 发生率无关[OR 0.90（0.35 至 2.29）；P=0.823]。1072 名患者中有 23 名（2.2%）发生了抗菌药物治疗的副作用。1082 名患者中有 7 名（0.6%）死亡。中位住院时间为 3 [1 至 5] 天。
几乎所有研究中的手术均给予了抗菌药物预防，但并非总是符合指南。需要进一步研究以确定在不增加 SSI 发生率的情况下，预防性使用的抗菌药物剂量是否可以安全有效地减少。
