Department of Pharmacy, State University of New York Upstate University Hospital, Syracuse, New York, USA.
Department of Pharmacy, University of Virginia Health, Charlottesville, Virginia, USA.
Surg Infect (Larchmt). 2023 Mar;24(2):177-182. doi: 10.1089/sur.2022.253. Epub 2023 Jan 31.
Compliance with guideline recommendations for surgical antibiotic prophylaxis (SAP) in colorectal surgery, particularly redosing, has been suboptimal at many institutions including ours. This study aimed to evaluate if single-dose antibiotic prophylaxis with ertapenem improves compliance with guideline recommendations for SAP versus multiple-dose antibiotic prophylaxis in elective colorectal surgery. A retrospective, cohort study of the use of ertapenem compared with standard of care antibiotic agents was performed in adult patients undergoing elective colorectal surgery at an academic medical center between January 2020 and February 2022. The primary outcome was compliance with guideline-recommended SAP for colorectal surgery. The secondary outcome was surgical site infections (SSIs) within 30 days after surgery. A total of 135 patients were included in this study. Fifty-eight patients received single-dose antibiotic prophylaxis with ertapenem and 77 patients received multiple-dose antibiotic prophylaxis. Cefazolin plus metronidazole was the most common multiple-dose regimen (65 of 77). Single-dose antibiotic prophylaxis with ertapenem increased overall SAP compliance (96.6% vs. 64.9%; p < 0.001) as well as compliance with antibiotic administration within the recommended time period before incision (96.6% vs. 84.4%; p = 0.022), compliance with intra-operative antibiotic redosing when warranted (100% vs. 83.1%; p < 0.001), and compliance with guideline-recommended dosing (100% vs. 92.2%; p = 0.037). Surgical site infection rates were not statistically different between the groups (12.1% vs. 19.4%; p = 0.248). Single-dose antibiotic prophylaxis with ertapenem increased compliance with guideline-recommended SAP for elective colorectal surgeries. No statistically significant difference was observed in SSI rates regardless of the antibiotic regimen used.
在包括我们医院在内的许多机构中，外科抗生素预防（SAP）指南推荐的执行情况，特别是再次给药，并不理想。本研究旨在评估在择期结直肠手术中，与多剂量抗生素预防相比，单次给予厄他培南预防抗生素是否能提高 SAP 指南推荐的执行率。
在 2020 年 1 月至 2022 年 2 月期间，在一家学术医疗中心，对接受择期结直肠手术的成年患者进行了一项使用厄他培南与标准治疗抗生素药物的回顾性队列研究。主要结局是评估 SAP 指南在结直肠手术中的执行情况。次要结局是手术后 30 天内的手术部位感染（SSI）。
本研究共纳入 135 例患者。58 例患者接受了单次给予厄他培南的抗生素预防，77 例患者接受了多剂量抗生素预防。头孢唑林联合甲硝唑是最常见的多剂量方案（77 例中的 65 例）。单次给予厄他培南的抗生素预防显著提高了 SAP 整体执行率（96.6% vs. 64.9%；p<0.001），以及在切口前推荐时间段内给予抗生素的执行率（96.6% vs. 84.4%；p=0.022）、在需要时给予术中抗生素再次给药的执行率（100% vs. 83.1%；p<0.001）和指南推荐剂量的执行率（100% vs. 92.2%；p=0.037）。两组的 SSI 发生率无统计学差异（12.1% vs. 19.4%；p=0.248）。
单次给予厄他培南的抗生素预防可提高择期结直肠手术 SAP 指南的执行率。无论使用何种抗生素方案，SSI 发生率均无统计学差异。
