Woods R K, Dellinger E P
University of Washington Medical Center, Seattle, USA.
Am Fam Physician. 1998 Jun;57(11):2731-40.
Appropriately administered antibiotic prophylaxis reduces the incidence of surgical wound infection. Prophylaxis is uniformly recommended for all clean-contaminated, contaminated and dirty procedures. It is considered optional for most clean procedures, although it may be indicated for certain patients and clean procedures that fulfill specific risk criteria. Timing of antibiotic administration is critical to efficacy. The first dose should always be given before the procedure, preferably within 30 minutes before incision. Readministration at one to two half-lives of the antibiotic is recommended for the duration of the procedure. In general, postoperative administration is not recommended. Antibiotic selection is influenced by the organism most commonly causing wound infection in the specific procedure and by the relative costs of available agents. In certain gastrointestinal procedures, oral and intravenous administration of agents with activity against gram-negative and anaerobic bacteria is warranted, as well as mechanical preparation of the bowel. Cefazolin provides adequate coverage for most other types of procedures.
合理使用抗生素预防可降低手术伤口感染的发生率。对于所有清洁-污染手术、污染手术和污秽手术，均一致推荐进行预防。对于大多数清洁手术，预防被视为可选择的措施，不过对于某些满足特定风险标准的患者和清洁手术，可能需要进行预防。抗生素给药的时机对疗效至关重要。首剂应始终在手术前给予，最好在切开前30分钟内。在手术期间，建议在抗生素的一至两个半衰期时再次给药。一般不建议术后给药。抗生素的选择受特定手术中最常引起伤口感染的病原体以及可用药物的相对成本影响。在某些胃肠道手术中，有必要口服和静脉给予对革兰氏阴性菌和厌氧菌有活性的药物，以及进行肠道机械准备。头孢唑林对大多数其他类型的手术提供足够的覆盖。
