Department of Surgery, University of California-Irvine, Orange, California, USA.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Surg Infect (Larchmt). 2022 Apr;23(3):232-247. doi: 10.1089/sur.2021.323. Epub 2022 Feb 23.
The principles of antimicrobial stewardship promote the appropriate prescribing of agents with respect to efficacy, safety, duration, and cost. Antibiotic resistance often results from inappropriate use (e.g., indication, selection, duration). We evaluated practice variability in duration of antimicrobials in surgical infection treatment (Rx) or prophylaxis (Px). There is lack of consensus regarding the duration of antibiotic Px and Rx for many common indications. A survey was distributed to the Surgical Infection Society (SIS) regarding the use of antimicrobial agents for a variety of scenarios. Standard descriptive statistics were used to compare survey responses. Heterogeneity among question responses were compared using the Shannon Index, expressed as natural units (nats). Sixty-three SIS members responded, most of whom (67%) have held a leadership position within the SIS or contributed as an annual meeting moderator or discussant; 76% have been in practice for more than five years. Regarding peri-operative Px, more than 80% agreed that a single dose is adequate for most indications, with the exceptions of gangrenous cholecystitis (40% single dose, 38% pre-operative +24 hours) and inguinal hernia repair requiring a bowel resection (70% single dose). There was more variability regarding the use of antibiotic Px for various bedside procedures with respondents split between none needed (range, 27%-66%) versus a single dose (range, 31%-67%). Opinions regarding the duration of antimicrobial Rx for hospitalized patients who have undergone a source control operation or procedure varied widely based on indication. Only two of 20 indications achieved more than 60% consensus despite available class 1 evidence: seven days for ventilator-associated pneumonia (77%), and four plus one days for perforated appendicitis (62%). Except for peri-operative antibiotic Px, there is little consensus regarding antibiotic duration among surgical infection experts, despite class 1 evidence and several available guidelines. This highlights the need for further high-level research and better dissemination of guidelines.
抗菌药物管理原则提倡根据疗效、安全性、持续时间和成本来合理开具药物。抗生素耐药性通常是由于不合理使用（例如，适应证、选择、持续时间）导致的。我们评估了手术感染治疗（Rx）或预防（Px）中抗菌药物持续时间的实践变异性。对于许多常见适应证，抗生素预防和治疗的持续时间缺乏共识。我们向外科感染学会（SIS）分发了一份关于各种情况下使用抗菌药物的调查问卷。使用标准描述性统计方法比较调查结果。使用香农指数（以自然单位表示）比较问题回答之间的异质性。 63 名 SIS 成员做出了回应，其中大多数（67%）在 SIS 担任过领导职务，或作为年会主持人或讨论者做出过贡献；76%的人已经行医超过五年。关于围手术期预防，超过 80%的人认为大多数情况下单次剂量就足够了，只有坏疽性胆囊炎（40%单次剂量，38%术前+24 小时）和需要肠切除的腹股沟疝修补术（70%单次剂量）除外。对于各种床边程序的抗生素预防使用，意见差异较大，受访者分为不需要（范围，27%-66%）和单次剂量（范围，31%-67%）。对于接受了源头控制手术或操作的住院患者，抗菌药物治疗持续时间的意见因适应证而异，差异很大。尽管有一级证据，但只有 20 个适应证中的两个获得了超过 60%的共识：呼吸机相关性肺炎的 7 天（77%）和穿孔性阑尾炎的 4 天+1 天（62%）。除围手术期预防性使用抗生素外，尽管有一级证据和一些现有指南，但外科感染专家对抗生素持续时间的共识很少。这凸显了进一步开展高级别研究和更好地传播指南的必要性。
