非β-乳糖抗生素的使用,β-乳糖过敏和手术部位感染
Prateek Agarwal1, Rohit Prem Kumar1, Louise-Marie Oleksiuk2
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
JAMA surgery
|October 1, 2025
概括
与β-lactams相比,使用非β-lactam抗生素的手术部位感染 (SSIs) 较高. 报告的β-乳酸过敏并没有独立增加SSI风险,突出了对精确过敏评估的需要.
科学领域:
- 传染病流行病学 传染病流行病学
- 手术感染预防 手术感染预防
- 抗生素管理局 抗生素管理局
背景情况:
- 手术部位感染 (SSIs) 是一个重大的全球健康和经济挑战.
- 虽然β-乳酸菌抗生素是手术预防的标准,但它们对非β-乳酸菌药物的优势仍在争论中,特别是在报告的β-乳酸菌过敏患者中.
研究的目的:
- 调查患者报告的β-乳酸过敏状态,抗生素选择 (β-乳酸与非β-乳酸) 和SSI发生率之间的关系.
- 分析这些跨不同外科专业的关联.
主要方法:
- 追溯性队列研究,利用来自四级健康中心的前性记录数据库.
- 包括2021年1月至2024年2月期间在10个外科专业进行的49279次手术.
- 对抗生素预防的分析 (β-乳糖与非β-乳糖),报告的β-乳糖过敏和30至90天的SSI发病率,控制患者人口统计和并发症.
主要成果:
- 使用非β-乳糖抗生素的手术显示出较高的SSI发病率 (2.2%),与使用β-乳糖 (1.3%;RR,1.69) 的手术相比.
- 报告的β-乳酸过敏患者也显示出较高的SSI发病率 (1.8%对1.3%;RR, 1.38).
- 在对共变量和β-乳酸过敏进行调整后,非β-乳酸使用仍然与增加的SSI风险相关 (OR, 1.33),而与β-乳酸过敏的关联变得无意义 (OR, 1.21). 整形外科手术显示,非β-乳糖的使用和SSI之间存在显著的关联 (OR,3.01).
结论:
- 与非β-乳糖替代品相比,β-乳糖预防与显著较低的SSI率有关.
- 报告的β-乳糖过敏似乎不是SSI风险的独立预测因素.
- 精确的过敏评估对于避免不必要使用替代抗生素和优化手术感染预防策略至关重要.
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