Finkelstein R, Reinhertz G, Embom A
Department of Internal Medicine, Rambam Medical Center, Haifa, Israel.
Isr J Med Sci. 1996 Nov;32(11):1093-7.
In 1991, updated recommendations for the administration of antimicrobial prophylaxis in surgery were made extensively available to all surgical wards of our hospital. Two years later we surveyed the implementation of these recommendations in our institution. Inpatients undergoing surgical procedures during a 6 month period were prospectively evaluated for the indication, type, timing and duration of antibiotic prophylaxis. On each day of the study, data of patients who underwent surgery in the previous 24-48 h were obtained and monitoring was continued for up to 5 days. Of the 215 evaluated patients 193 (90%) received prophylaxis. This rate was similar for elective and emergency surgeries. The rate of prophylaxis in surgeries for which its use is recommended was significantly higher than in surgeries where compelling data for its use are not available (96 vs. 74%, P = 0.000006). However, many and important deviations of basic principles of antimicrobial prophylaxis in surgery were found. Prophylaxis was administered systematically in some types of surgery lacking compelling data for its use. In almost 50% of the surgical procedures the first dose of antimicrobial prophylaxis was not administered at the optimal timing; prophylaxis was continued for more than 24 h in 21% of the cases, and the use of unstandardized regimens was common. Despite the availability of local guidelines, the implementation of a hospital program with regard to antibiotic prophylaxis in surgery may be difficult. Further measures should be applied to achieve this goal.
1991年，我们医院向所有外科病房广泛提供了关于手术中抗菌药物预防应用的最新建议。两年后，我们对本院这些建议的实施情况进行了调查。对在6个月期间接受外科手术的住院患者，前瞻性地评估其抗生素预防的指征、类型、时机和持续时间。在研究的每一天，获取前24 - 48小时内接受手术患者的数据，并持续监测长达5天。在215名接受评估的患者中，193名（90%）接受了预防用药。择期手术和急诊手术的这一比例相似。推荐使用预防用药的手术中预防用药率显著高于无确凿使用依据的手术（96%对74%，P = 0.000006）。然而，发现手术中抗菌药物预防的基本原则存在许多重要偏差。在一些缺乏确凿使用依据的手术类型中系统性地给予了预防用药。在几乎50%的外科手术中，抗菌药物预防的首剂未在最佳时机给予；21%的病例预防用药持续超过24小时，并且使用未标准化方案的情况很常见。尽管有当地指南，但在手术中实施医院抗生素预防计划可能很困难。应采取进一步措施来实现这一目标。
