多剤耐性グラム陰性菌時代の周術期外科的予防策

To present the current knowledge and recent developments regarding intravenous perioperative antibiotic prophylaxis (PAP) for patients undergoing abdominal surgery who are colonized with multidrug-resistant gram-negative bacteria (MDR-GN).

Surgical site infections (SSIs) are a frequent cause of postoperative morbidity and mortality in abdominal surgery. PAP is one of the key measures to reduce SSI rates. The number of patients colonized with MDR-GN is increasing globally. Recent evidence indicates that the combination of risk-adapted screening and targeted prophylaxis in patients being colonized with MDR-GN and undergoing elective abdominal surgery can substantially decrease SSI rates. Preoperative decolonization procedures have not been shown to be effective so far.

In cases of proven MDR-GN colonization, targeted prophylaxis reduces postoperative SSI rates in abdominal surgery. Further clinical research is necessary to more accurately define the risk collectives for MDR-GN colonization in order to optimize screening procedures and effectiveness of targeted prophylaxis. Furthermore, clinical research is needed to evaluate the effectiveness of innovative decolonization procedures and specific antibiotics to be used for targeted PAP in patients colonized with carbapenem-resistant bacteria.