Department of Pharmacy Services, Hartford HealthCare, Hartford, Connecticut, USA.
Department of Research Administration, Hartford HealthCare, Hartford, Connecticut, USA.
Surg Infect (Larchmt). 2024 Jun;25(5):392-398. doi: 10.1089/sur.2024.010. Epub 2024 May 17.
Surgical site infections (SSIs) are common healthcare-associated infections, and national guidelines recommend that antimicrobial prophylaxis (AP) be administered 60 min prior to incision. However, there are limited data regarding the "most optimal" time for administration within the 60-min window. This was a multicenter, retrospective study of adult (≥18-year-old) patients that underwent an abdominal hysterectomy, colorectal surgery, or craniotomy and received AP within 60 min of incision. Incidence of SSI was compared between patients who received AP 0-30 versus 31-60 min of incision. In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. The results of our analysis support current national guidelines. Future investigation of different intervals (e.g., AP 15-45 min prior to incision) may be beneficial on the basis of pharmacokinetics of routinely prescribed AP.
手术部位感染（SSI）是常见的与医疗保健相关的感染，国家指南建议在切口前 60 分钟内给予抗菌预防（AP）。然而，在 60 分钟窗口内给药的“最佳”时间方面，数据有限。这是一项多中心、回顾性研究，纳入了接受腹部子宫切除术、结直肠手术或颅切开术且在切口前 60 分钟内接受 AP 的成年（≥18 岁）患者。比较了在切口前 0-30 分钟和 31-60 分钟接受 AP 的患者之间 SSI 的发生率。此外，还进行了一项预设的亚组分析，评估了 60 分钟时间框架内每 15 分钟间隔的 SSI 发生率。在主要分析中，纳入了 277 例患者，其中 233 例（84.1%）和 44 例（15.9%）在切口前 0-30 分钟和 31-60 分钟内接受 AP，分别有 6.0%（14/233）和 4.5%（2/44）的患者在主要分析中发生 SSI（p=0.703）。在次要分析中，137 例（49.5%）、95 例（34.3%）、34 例（12.3%）和 11 例（4.0%）患者分别在切口前 0-15、16-30、31-45 和 46-60 分钟内接受 AP。在各个 15 分钟间隔内，SSI 的发生率无差异（4.4%比 8.4%比 2.9%比 9.1%，p=0.487）。在本研究中发生 SSI 的 16 例患者中，5 例患者的培养物呈阳性，其中 3 例含有对抗生素预防（AP）具有耐药性的细菌。我们的分析结果支持当前的国家指南。基于常规规定的 AP 的药代动力学，对不同间隔（例如，在切口前 15-45 分钟给予 AP）进行进一步研究可能会有所帮助。
