心血管手术后的长期抗生素预防及其对手术部位感染和抗菌素耐药性的影响
S Harbarth1, M H Samore, D Lichtenberg
1Department of Epidemiology , Harvard School of Public Health, and Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. harbarth@a1.tch.harvard.edu
Circulation
|June 28, 2000
概括
在冠状动脉旁路移植 (CABG) 手术后超过48小时的抗生素预防 (ABP) 延长不会减少手术部位感染 (SSI). 然而,这种做法显著增加了抗菌素耐药性,应该避免这种做法.
科学领域:
- 心血管外科心血管外科
- 传染病流行病学 传染病流行病学
- 临床药房 临床药房
背景情况:
- 抗生素预防 (ABP) 是冠状动脉旁路移植 (CABG) 手术的标准.
- 目前的做法往往将ABP延长到48小时之外,尽管有证据支持更短的持续时间.
- 长时间的ABP对手术部位感染 (SSI) 和抗菌素耐药性的影响需要进一步研究.
研究的目的:
- 为了比较短期 (<48小时) 与长期 (>48小时) ABP在预防CABG手术后SSI的疗效.
- 评估ABP持续时间与获得抗菌素耐药性的发展之间的关联.
- 为心脏手术中使用ABP提供基于证据的指导方针.
主要方法:
- 这是一项为期四年的观察性队列研究,涉及2641名接受CABG的患者.
- 感染控制护士对SSI和抗菌素耐药性模式的前性监测.
- 多变量建模用于调整混因素.
主要成果:
- 总共有231次SSI (8.7%) 被记录下来,短期和长期ABP组之间没有显著差异 (调整的OR,1.2;CI,0.8至1.6).
- 长时间的ABP与获得抗菌素耐药性的风险增加显著相关 (调整的OR,1.6;CI,1.1至2.6).
- 证实了长时间使用ABP超过48小时的广泛使用.
结论:
- 在CABG手术后48小时以上的持续抗生素预防对于减少SSI是无效的.
- 长时间的ABP与发展获得的抗菌素耐药性的风险更高有关.
- 准则应建议将ABP限制在CABG后不到48小时以减轻耐药性和避免不必要的使用.
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