术后抗生素,结果和资源使用在患有性尾炎的儿童中
Shannon L Cramm1, Dionne A Graham2, Martin L Blakely3
1Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA surgery
|February 7, 2024
概括
手术后的抗生素并没有降低非穿孔尾炎和,或排泄性发现的儿童的手术部位感染 (SSI) 率. 这项研究表明,目前的抗生素实践可能对这些患者不必要.
科学领域:
- 儿科手术 儿科手术
- 传染性疾病 传染性疾病
- 抗微生物药物管理委员会
背景情况:
- 在非穿孔性尾炎中,癌性,性和排泄性 (GSE) 发现与儿童更高的手术部位感染 (SSI) 风险和资源利用有关.
- 术后抗生素在预防SSI和优化这种儿科群体中抗菌药物的使用中的作用需要澄清.
研究的目的:
- 为了比较患有非穿孔性尾炎的儿童和接受手术后抗生素与未接受抗生素的儿童的SSI率和GSE发现.
主要方法:
- 使用美国外科医生学院国家外科质量改进计划 (NSQIP) - 儿科尾切除的回顾性队列研究,来自16家医院的有针对性的数据.
- 数据包括手术报告和抗生素使用,患者的选择基于经过验证的非穿孔性尾炎与GSE发现的手术内标准 (2015年7月至2020年6月).
- 分析包括医院一级的观察到预期的SSI率的比较和患者一级的倾向性得分匹配,以评估基于抗生素暴露的SSI率.
主要成果:
- 在医院水平的SSI观察到预期的比率和术后抗生素使用的速度或持续时间之间没有发现相关性.
- 在倾向匹配的患者水平分析中 (404名儿童),接受手术后抗生素 (1.5%) 和未接受抗生素 (2.0%) 之间的SSI率相似.
- 术后使用抗生素时SSI的几率比为0.75 (95% CI,0.16-3.39;P=.70).
结论:
- 手术后的抗生素给药没有显示出降低非穿孔性尾炎儿童SSI率的益处,这些儿童的非穿孔性尾炎显示GSE发现.
- 研究结果表明,在这种特定的儿科尾炎亚组中,可能不需要常规使用术后抗生素,这支持了抗菌药物管理工作.
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