Hillock Nadine T, Raby Edward, Rawlins Matthew
School of Public Health, University of Adelaide, Adelaide, SA, Australia.
Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia.
Antimicrob Steward Healthc Epidemiol. 2025 Apr 23;5(1):e100. doi: 10.1017/ash.2025.71. eCollection 2025.
To investigate the use of rifampicin vials in Australian operating theaters (OT) to determine the method of administration and rationale for use.
Retrospective (2022 and 2023) OT usage data for rifampicin 600 mg vials were analyzed to compare trends in use between Australian hospitals and between jurisdictions. An audit of rifampicin vials used in OT during 2023 was conducted at a large tertiary hospital.
Fifty-nine of 248 hospitals (24%) contributing data to the National Antimicrobial Utilisation Surveillance Program recorded OT use of rifampicin vials during 2022 and 2023. Excluding hospitals with no usage, the median use was 7 vials/annum/per hospital (IQR: 2-32). A wide variation in use was seen between Australian states and territories. An audit of OT use in 2023 at a large tertiary hospital found poor documentation of topical use; in most cases, documentation was in the operation note only, with no documentation on the medication charts, medical notes, or the anesthetic record. Of 33 rifampicin vials used in 2023, documented topical use was identified for 10 individual patients only, 4 of whom had a confirmed infection (1 methicillin-resistant and 3 methicillin-susceptible).
Off-label, topical use of rifampicin during surgery is not uncommon in some Australian hospitals despite limited evidence of safety or efficacy. Given the potential for resistance, surgical use of rifampicin should be restricted to a named-patient basis, under the guidance of an infectious disease specialist/clinical microbiologist. Documentation of all medication use is recommended for patient safety.
调查利福平小瓶在澳大利亚手术室的使用情况，以确定给药方法和使用理由。
分析2022年和2023年利福平600毫克小瓶的手术室使用数据，比较澳大利亚各医院之间以及各辖区之间的使用趋势。2023年对一家大型三级医院手术室使用的利福平小瓶进行了审计。
在向国家抗菌药物使用监测计划提供数据的248家医院中，有59家（24%）记录了2022年和2023年手术室使用利福平小瓶的情况。排除无使用情况的医院后，每家医院每年的使用中位数为7瓶（四分位间距：2 - 32）。澳大利亚各州和地区的使用情况差异很大。2023年对一家大型三级医院手术室使用情况的审计发现，局部使用的记录不完善；在大多数情况下，记录仅在手术记录中，药物图表、病历或麻醉记录中没有记录。在2023年使用的33瓶利福平中，仅确定有10名个体患者有局部使用记录，其中4人确诊感染（1例耐甲氧西林，3例对甲氧西林敏感）。
尽管安全性或有效性证据有限，但在一些澳大利亚医院，手术期间超说明书局部使用利福平的情况并不少见。鉴于存在耐药的可能性，利福平的手术使用应在传染病专家/临床微生物学家的指导下，以指定患者为基础进行限制。为了患者安全，建议记录所有药物使用情况。
