某综合医院神经外科围手术期抗菌药物合理性分析

窦欲晓; 胡学锋; 许健

doi:10.16766/j.cnki.issn.1674-4152.003201

某综合医院神经外科围手术期抗菌药物合理性分析

doi: 10.16766/j.cnki.issn.1674-4152.003201

1.
合肥市第八人民医院药剂科，安徽合肥 238000
2.
蚌埠医学院第一附属医院药剂科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2021A0801

详细信息

通讯作者:
许健，E-mail：xujian15855789032@163.com

中图分类号: R978.1 R969.3
计量
- 文章访问数: 97
- HTML全文浏览量: 31
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-28
- 网络出版日期: 2023-11-23

Rationality analysis of perioperative antibiotics in neurosurgery of a general hospital

DOU Yuxiao¹,
HU Xuefeng¹,
XU Jian^{2
, ,}

1.
Pharmacy Department of the Eighth People's Hospital of Hefei, Hefei, Anhui 238000, China

摘要

摘要: 目的评价合肥市第八人民医院神经外科围手术期预防性使用抗菌药物的适宜性。方法利用医院信息系统，随机选取2022年1—12月神经外科收治的手术患者62例，对其围手术期预防性使用抗菌药物进行评价与分析，主要评价内容包括抗菌药物的选择(一代、二代头孢菌素或头孢曲松，其中一代头孢菌素推荐头孢唑林，二代头孢菌素推荐头孢呋辛)、适应证(建议对接受颅脑手术的患者进行围手术期预防性使用抗菌药物，头皮肿物切除术等不经颅内的神经外科手术不推荐常规使用预防性抗菌药物)、使用剂量、首次预防用药给药时机以及抗菌药物的持续使用时间等。结果 62例患者年龄为(65.52±14.31)岁，男性45例(72.58%)，女性17例(27.42%)；62例患者中，Ⅰ类切口61例(98.39%)，Ⅱ类切口1例(1.61%)；有7例(11.29%)患者存在不必要的延长术后预防用药持续时间的现象；首次预防用药时机不合理的患者19例(30.65%)；预防用抗菌药物无指征的患者7例(11.29%)；所有入组患者中，只有29例(46.77%)在所有神经外科围手术期预防使用抗菌药物评价指标中都是合理的。结论合肥市第八人民医院神经外科预防性使用抗菌药物预防切口部位感染存在一些不足，需要进一步加强抗菌药物合理使用的宣传与管理。
- 神经外科 /
- 围手术期 /
- 抗菌药物
Abstract: Objective To evaluate the appropriateness of perioperative prophylactic antibiotic use in neurosurgery department of the Eighth People's Hospital of Hefei. Methods Using the hospital information system, 62 surgical patients admitted to the Department of Neurosurgery from January to December 2022 were randomly selected to evaluate and analyze their perioperative prophylactic antibiotic use. The main evaluation contents included the selection of antibiotics (the first and second generation Cephalosporin or Ceftriaxone, of which the first generation Cephalosporin recommended Cefazolin, and the second generation Cephalosporin recommended Cefuroxime), indications (it is recommended to use prophylactic antibiotics in the perioperative period for patients undergoing craniocerebral surgery, and routine use of prophylactic antibiotics is not recommended for Neurosurgery operations without intracranial access such as facial nerve microvascular decompression, scalp Benign tumor resection, etc.), dosage, timing of first prophylactic drug administration and duration of antimicrobial use. Results The age of 62 patients was (65.52±14.31) years, including 45 males (72.58%) and 17 females (27.42%). Among the 62 patients, 61 cases (98.39%) had Class Ⅰ incision and 1 case (1.61%) had Class Ⅱ incision. Seven patients (11.29%) unnecessarily prolonged the duration of postoperative prophylaxis; 19 patients (30.65%) had an inappropriate timing for the first preventive medication; There were 7 patients (11.29%) without indications for prophylactic use of antibiotics; Of all enrolled patients, only 29 cases (46.77%) were appropriate in all the evaluation indicators of perioperative prophylactic use of antibiotics in neurosurgery. Conclusion There are some deficiencies in the prophylactic use of antibiotics to prevent incision site infection in the neurosurgery department of the Eighth People's Hospital of Hefei. It is necessary to further strengthen the publicity and management of rational use of antibiotics.
- Neurosurgery /
- Perioperative period /
- Antibacterials

HTML全文

表 1 神经外科围手术期预防性使用抗菌药物合理用药评价标准

Table 1. Evaluation criteria for the rational use of prophylactic antibiotics in the perioperative period of neurosurgery

评价指标内容	评价标准
预防用抗菌药物适应证	建议对接受颅脑手术的患者进行围手术期预防性使用抗菌药物，头皮肿物切除术等不经颅内的神经外科手术不推荐常规使用预防性抗菌药物^[8]。
抗菌药物的选择	一代、二代头孢菌素或头孢曲松，其中一代头孢菌素推荐头孢唑林，二代头孢菌素推荐头孢呋辛。
抗菌药物的单次给药剂量	头孢唑林1~2 g，头孢呋辛1.5 g，头孢曲松1~2 g。
首次预防用药时机	术前0.5~1.0 h，必须使用临时医嘱，且临时医嘱中应注明“术前30 min”。
术后预防用药持续时间	术前0.5~1.0 h使用1次即可，最多可加用1次，但必须要在术后24 h之内执行完成，超过24 h视为不适宜^[9]。

下载: 导出CSV

表 2 神经外科围手术期预防性使用抗菌药物合理用药评价结果(n=62)

Table 2. Evaluation results of the rational use of prophylactic antibiotics in the perioperative period of neurosurgery (n=62)

评价结果	例数	占比(%)
合理，包括术后感染、预防用药转为治疗用药	29	46.77
首次预防用药时机不合理	19	30.65
预防用药持续时间超过24 h	7	11.29
预防用抗菌药物无指征	7	11.29

下载: 导出CSV

参考文献(19)

[1]	戴礼兰, 施明美, 张爱萍, 等. 某综合性医院连续三年多重耐药菌感染特点分析[J]. 中华全科医学, 2021, 19(3): 502-504. doi: 10.16766/j.cnki.issn.1674-4152.001846 DAI L L, SHI M M, ZHANG A P, et al. Characteristics of multidrug-resistant organism infections in a hospital for three consecutive years[J]. Chinese Journal of General Practice, 2021, 19(3): 502-504. doi: 10.16766/j.cnki.issn.1674-4152.001846
[2]	TKATSCHENKO D, HANSEN S, KOCH J, et al. Prevention of surgical site infections in spine surgery: an international survey of clinical practices among expert spine surgeons[J]. Global Spine J, 2022: 21925682211068414. DOI: 10.1177/21925682211068414.
[3]	LONG D R, BRYSON-CAHN C, PERGAMIT R, et al. 2021 young investigator award winner: anatomic gradients in the microbiology of spinal fusion surgical site infection and resistance to surgical antimicrobial prophylaxis[J]. Spine (Phila Pa 1976), 2021, 46(3): 143-151. doi: 10.1097/BRS.0000000000003603
[4]	CONEN A, RAABE A, SCHALLER K, et al. Management of neurosurgical implant-associated infections[J]. Swiss Med Wkly, 2020, 150: w20208. DOI: 10.4414/smw.2020.20208.
[5]	JIMÉNEZ-MARTÍNEZ E, CUERVO G, CARRATALÀ J, et al. A care bundle intervention to prevent surgical site infections after a craniotomy[J]. Clin Infect Dis, 2021, 73(11): e3921-e3928. doi: 10.1093/cid/ciaa884
[6]	华秋伟, 蔡强, 宋平, 等. 自发性幕上脑出血术后再出血相关因素及预防措施研究进展[J]. 中国医药, 2023, 18(3): 448-452. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202303028.htm HUA Q W, CAI Q, SONG P, et al. Research progress on related factors and preventive measures of postoperative rebleeding of spontaneous supratentorial intracerebral hemorrhage[J]. China Medicine, 2023, 18(3): 448-452. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202303028.htm
[7]	PICETTI E, BOUZAT P, CATTANI L, et al. Perioperative management of severe brain injured patients[J]. Minerva Anestesiol, 2022, 88(5): 380-389.
[8]	JAMES K. Perioperative risk assessment[J]. Br J Hosp Med (Lond), 2023, 84(6): 1-2.
[9]	KUNIHIRO N. Perioperative management in pediatric neurosurgery[J]. No Shinkei Geka, 2022, 50(6): 1132-1140. http://www.researchgate.net/publication/269845847_Perioperative_Management_in_Pediatric_Neurosurgery
[10]	CAMPIOLI C C, CHALLENER D, COMBA I Y, et al. Overview and risk factors for postcraniotomy surgical site infection: a four-year experience[J]. Antimicrob Steward Healthc Epidemiol, 2022, 2(1): e14. DOI: 10.1017/ash.2021.258.
[11]	CERAUDO M, PRIOR A, BALESTRINO A, et al. Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery[J]. Acta Neurochir (Wien), 2021, 163(2): 369-382. doi: 10.1007/s00701-020-04560-x
[12]	BADER E R, KOBETS A J, AMMAR A, et al. Factors predicting complications following cranioplasty[J]. J Craniomaxillofac Surg, 2022, 50(2): 134-139. doi: 10.1016/j.jcms.2021.08.001
[13]	ABIRI A, PATEL T R, NGUYEN E, et al. Postoperative protocols following endoscopic skull base surgery: an evidence-based review with recommendations[J]. Int Forum Allergy Rhinol, 2023, 13(1): 42-71. doi: 10.1002/alr.23041
[14]	YANG W J, WU X, LI Z Q, et al. Trends of intra-cranial bacterial infection in patients requiring emergency neurosurgery[J]. Surg Infect (Larchmt), 2020, 21(8): 677-683. doi: 10.1089/sur.2019.317
[15]	KWIATKOWSKI S, MULUGETA S, DAVIS S, et al. Optimizing preoperative antibiotics in patients with β-lactam allergies: a role for pharmacy[J]. Am J Health Syst Pharm, 2021, 78(Supplement_3): S76-S82. doi: 10.1093/ajhp/zxab218
[16]	CHEN J H, ZHANG W W, SHI Z H, et al. Infections under skin flap after cranioplasty and a simple effective treatment[J]. Turk Neurosurg, 2020, 30(6): 808-812. http://www.zhangqiaokeyan.com/journal-foreign-detail/0704029152122.html
[17]	TOMYCZ N D, PAYNE C, CHENG B C, et al. Prevention of implant-associated infection in neuromodulation: review of the literature and prototype of a novel protective implant coating[J]. Surg Infect(Larchmt), 2020, 21(4): 378-383. doi: 10.1089/sur.2019.075
[18]	NUSAIR A R, EL NEKIDY W S, REYNOLDS L, et al. Comprehensive approach to reduce surgical site infections in patients undergoing neurosurgical procedures[J]. Surg Infect (Larchmt), 2021, 22(2): 217-221. doi: 10.1089/sur.2020.020
[19]	SHIBAMURA-FUJIOGI M, ORMSBY J, BREIBART M, et al. Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study[J]. BMC Anesthesiol, 2021, 21(1): 124.