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術後の抗菌剤の予防使用と結果

Kerri A McKie¹, Anoosha Moturu², Dionne A Graham³

¹Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

JAMA network open

|September 4, 2025

まとめ

乳房穴の修復後の術後の抗生物質予防は,手術部位の感染症,再手術,再入院を減少させなかった. この研究はこの抗生物質の日常的な使用に異議を唱え,小児外科治療における再評価の必要性を示唆しています

科学分野:

小児外科
感染症の予防
臨床的成果研究

背景:

術後の抗菌剤予防 (PAP) は,乳房穴修復後に一般的です.
これは小児外科における避けた抗生物質の使用の重要な源です
この特定の集団での日常的な使用を支持する証拠は限られている.

研究の目的:

術後の抗生物質予防と,小児の乳房穴修復後の主要なアウトカムとの関連性を評価する.
PAPを受けた患者と受けなかった患者の間での手術部位感染 (SSI),再手術,再入院の割合を比較する.
病院レベルのPAP使用率と感染/再手術/再入院率との関係を調査する.

主な方法:

141の病院でペクトス・エクスカバトムの修復を施された3552人の小児科患者による遡及的なコホート研究.
患者と手術要因に基づいて比較可能なグループを作成するために,傾向スコアマッチングが採用されました.
結果と相関を評価するために,混合効果モデルと病院レベルの分析が使用されました.

主要な成果:

対応したコホート (3168人の患者) では,30日間のSSI (1. 6% 対 1. 8%),再手術 (1. 6% 対 1. 7%) または再入院 (2. 6% 対 3. 6%) の割合において,PAPを投与された子供と投与されなかった子供との間に有意な差異は見られなかった.
病院レベルでの分析では,PAP使用率とSSI,再手術,再入院の観測比率との間には相関関係がないことが明らかになった.
PAPの平均期間は21. 6時間でした.

結論:

小児の乳房穴修復後の術後の抗生物質予防は,手術の結果の改善と関連していません.
これらの発見は,この患者グループにおける現在の標準的なPAPの実践に疑問を投げかけています.
小児胸部外科における抗生物質管理を精進するために,さらなる研究が必要になるかもしれません.

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