Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan.
Project Research Center for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.
J Hosp Infect. 2022 Nov;129:189-197. doi: 10.1016/j.jhin.2022.06.017. Epub 2022 Jul 12.
Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use.
To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals.
This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'.
In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline.
Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.
外科抗菌预防（SAP）是抗菌药物使用的主要目的之一。
确定日本大学医院 SAP 指南的依从性。
这是一项回顾性队列研究，包括 15 家综合医院和 1 家牙科大学医院。对 18 种指定手术中的每 3 例进行评估，以确定其是否符合日本 SAP 指南：抗生素选择、给药时机、再给药间隔和 SAP 持续时间。如果所有项目都合适，则手术定义为“合适”。
共纳入 688 例（每例手术 22-45 例）。总体适当性为 46.8%（322/688），每种手术的适当性范围为 8.0%（2/25，心脏植入式电子设备植入）至 92.1%（35/38，远端胃切除术）。每个项目的适当性如下：术前/术中选择，78.5%（540/688）；给药时机，96.0%（630/656）；再给药间隔，91.6%（601/656）；术后选择，78.9%（543/688）；以及 SAP 的持续时间，61.4%（423/688）。医院的总体适当性范围为 17.6%（9/51）至 73.3%（33/45）。不适当的常见原因是持续时间较长（38.5%，265/688），以及手术前后选择抗菌谱不理想的抗生素（19.0%，131/688 和 16.9%，116/688），与指南相比。
手术和医院之间的指南依从性差异很大。有必要对日本医院的 SAP 进行大规模多中心监测，以确定不适当的手术、与适当性相关的因素以及手术部位感染的发生率。
