在接受尿路转移囊切除术的患者中,术后抗生素预防的持续时间:一项随机临床试验
Maria C Thurnheer1, Astrid Schürmann1, Markus Huber2
1Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
JAMA network open
|October 18, 2024
概括
经过尿路转移的囊切除术后,24小时的周围手术抗生素预防 (PAP) 对于预防手术部位感染 (SSI) 的延长PAP是不劣的. 这一发现支持泌尿病学中的抗生素管理.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 传染性疾病 传染性疾病
- 手术瘤学手术瘤学
背景情况:
- 术后抗生素预防 (PAP) 对于减少手术部位感染 (SSI) 至关重要.
- 目前的指导方针建议在尿路转移的囊切除术中使用PAP24小时或更短时间,但最佳持续时间缺乏强有力的证据.
- 长期使用PAP是一种常见的,但可能不必要的做法.
研究的目的:
- 为了确定24小时的PAP是否与延长时间的PAP在预防尿道转移的囊切除术后90天内SSI方面没有劣势.
- 为了评估PAP持续时间对SSI发生率的影响,在接受尿路转移囊切除术的患者中.
主要方法:
- 一个单中心的非劣势随机临床试验,涉及成人患者接受选择性开放性囊切除术与尿路转移.
- 患者被随机分配,接受24小时PAP或延长PAP,直到导管和支架被移除.
- 主要终点是90天内SSI的发生率,二次终点是所有原因的死亡率.
主要成果:
- 在24小时PAP组 (8.4%) 和扩展PAP组 (12.2%) 之间没有观察到SSI率的显著差异.
- 风险差异的90%置信区间 (-11.1%至3.4%) 确定了24小时PAP的非劣势性.
- 在两组之间,所有原因的死亡率没有显著差异.
结论:
- 二十四小时外科手术期间的抗生素预防是一种安全有效的替代方案,可以延长时间预防囊切除后的SSIs.
- 这些发现支持实施更短的PAP持续时间,为泌尿外科手术中的抗生素管理工作做出贡献.
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