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非心臓外科手術における手術期間中の抗生物質と手術部位感染症のガイドライン遵守
Amit Bardia1, Hung-Mo Lin2,3, Xiwen Zhao3
1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA network open
|February 18, 2026
まとめ
抗生物質の選択と再投与に関する米国感染症学会 (IDSA) のガイドラインを遵守しないことは一般的であり,手術部位感染 (SSI) のリスクを高めます. IDSAのガイドラインの遵守を改善すると,SSIが減少する可能性があります.
科学分野:
- 感染症 感染症は感染症です.
- 外科手術の結果について
- 抗生物質の管理について
背景:
- 手術部位感染症 (SSI) は,外科ケア改善プロジェクト (SCIP) のガイドラインの広範な遵守にもかかわらず,依然として課題です.
- アメリカ感染症学会 (IDSA) のガイドラインは,SCIPよりも手術における抗生物質の使用に対するより包括的なアプローチを提供します.
研究 の 目的:
- IDSAのガイドライン内の特定の抗生物質投与メトリクスの非遵守が,SSIのリスクの増加と関連しているかどうかを判断する.
- IDSAの抗生物質推奨からの偏差が患者のアウトカムに与える影響を評価する.
主な方法:
- 全国規模,多センター,横断的な研究では,非心臓手術を受けた119,000人以上の患者のデータを分析しました.
- データは,マルチセンター外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科外科
- 階層的汎用線形混合モデルを使用して,IDSAの抗生物質指標への不遵守とSSIの発生との関連を評価しました.
主要な成果:
- 少なくとも1つのIDSA抗生物質メトリックへの不遵守は,症例の26.1%で発生しました.
- IDSAのガイドラインの全般的な不遵守は,SSIのより高いリスクと有意に関連していました (RR, 1.34).
- 抗生物質の誤った選択 (RR,1.43) と不適切な手術中の再投与 (RR,1.12) を含む特定の不服従は,SSIと有意な関連性を示しました.
結論:
- 抗生物質の選択と手術中の再投与に関するIDSAのガイドラインを遵守しないことが一般的であり,SSIのリスクの増加と関連しています.
- 現在のSCIPタイミングメトリックの遵守は,SSIリスクを完全に軽減しません.
- IDSAが推奨する抗生物質の実践の遵守を強化することで,SSIの割合を減らす可能性があります.
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