Velasco E, Thuler L C, Martins C A, Dias L M, Gonçalves V M
Comissão de Controle de Infecção Hospitalar do Hospital do Cãncer do Instituo Nacional do Câncer do Rio de Janeiro.
Rev Hosp Clin Fac Med Sao Paulo. 1997 Jul-Aug;52(4):209-16.
Perioperative antibiotic administration can decrease surgical morbidity, shorten hospitalization, while lowering the overall costs attributable to infections. Its use in surgery is widespread and often inappropriate. In this study, the authors evaluate the guidelines for selection and use of prophylactic antibiotics in surgical cancer patients at the Hospital of Cancer in Rio de Janeiro, Brazil. During 36 non-consecutive months, 1681 cancer patients submitted to surgical procedures were prospectively followed-up by members of the Hospital Infection Control Committee. The overall surgical site infection (SSI) and mortality rates were 17.7% and 4.8% respectively. Prophylactic antibiotics were used in 1262 elective surgeries (75.1%), and their use was not considered to be in accordance with the recommended protocol in 37.6% of the cases. The inadequate antimicrobial prophylaxis resulted in higher incidence of SSI than did prophylaxis in according to the protocol (21.7% vs. 16.4, Relative Risk 1.32; 95% Confidence Internal 1.05-1.67; p0.01). This study calls the attention for the need of a more strict and determined educational program in order to provide mechanisms for an adequate administration of prophylactic antibiotics to patients submitted to high-risk surgeries.
围手术期使用抗生素可降低手术发病率，缩短住院时间，并降低感染相关的总体费用。其在手术中的使用很普遍，但往往并不恰当。在本研究中，作者评估了巴西里约热内卢癌症医院外科癌症患者预防性抗生素的选择和使用指南。在36个非连续的月份里，医院感染控制委员会的成员对1681例接受手术的癌症患者进行了前瞻性随访。总体手术部位感染（SSI）率和死亡率分别为17.7%和4.8%。1262例择期手术（75.1%）使用了预防性抗生素，其中37.6%的病例其使用被认为不符合推荐方案。与按照方案进行预防相比，抗菌预防措施不当导致SSI发生率更高（21.7%对16.4%，相对风险1.32；95%置信区间1.05 - 1.67；p<0.01）。本研究提醒人们注意，需要开展更严格、更坚定的教育项目，以便为接受高风险手术的患者提供适当使用预防性抗生素的机制。
