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在非心脏外科手术中遵守外科手术期间抗生素和手术部位感染的指导方针
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
概括
美国传染病学会 (IDSA) 对抗生素选择和再剂量指南的不遵守是常见的,并增加了手术部位感染 (SSI) 的风险. 提高对IDSA指导方针的遵守程度可能会减少SSI.
科学领域:
- 传染性疾病 传染性疾病
- 外科手术的结果
- 抗生素管理局 抗生素管理局
背景情况:
- 手术部位感染 (SSI) 仍然是一个挑战,尽管广泛遵守手术护理改进项目 (SCIP) 准则.
- 美国传染病学会 (IDSA) 的指导方针提供了一个比SCIP更全面的方法来治疗手术中的抗生素使用.
研究的目的:
- 为了确定IDSA指南中的特定抗生素管理指标的不遵守是否与SSI的风险增加有关.
- 评估偏离IDSA抗生素建议对患者结局的影响.
主要方法:
- 一项全国性的多中心横截面研究分析了超过119,000名接受非心脏手术的患者的数据.
- 数据来自多个质量注册表,包括多中心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.
- 使用层次的通用线性混合模型来评估IDSA抗生素指标的不遵守与SSI发生之间的关联.
主要成果:
- 不遵守至少一个IDSA抗生素指标发生在26.1%的病例中.
- 总体而言,不遵守IDSA指导方针与SSI风险更高有显著的相关性 (RR,1.34).
- 具体的不坚持,包括错误的抗生素选择 (RR, 1.43) 和不充分的手术内再剂量 (RR, 1.12),显示出与SSI有显著的关联.
结论:
- 不遵守IDSA针对抗生素选择和手术内再剂量的指导方针是普遍存在的,并且与增加SSI风险有关.
- 目前遵守SCIP时间指标并不能完全减轻SSI风险.
- 加强对IDSA推的抗生素实践的遵守,有可能减少SSI的发生率.
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