3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。https://note.mu/twin1980。

Preoperative oral antibiotic prophylaxis reduces surgical site infections after elective colorectal surgery: results from a before-after study

CIDから報告された、結腸手術に対する術前経口抗菌薬投与の検討。

 

tobramycin and colistin

 

academic.oup.com

 

感想

 

コリスチン前投与は、同意しずらいですね。

10年前にパブリッシュされていたら、受けれられたかもしれませんが、

コリスチンは、最終兵器の1つなので、、

 

実は、我々チームもCRE保菌患者の術前抗菌薬に使用検討しました。

 

Abstract

Background

Surgical site infections (SSI) are common complications after colorectal procedures and remain an important source of morbidity and costs. Preoperative oral antibiotic prophylaxis is a potential infection control strategy, but its effectiveness without simultaneous use of mechanical bowel preparation (MBP) is unclear. In this study, we aimed to determine whether preoperative oral antibiotics reduce the risk of deep SSI in elective colorectal surgery.

Methods

We performed a before-after analysis in a teaching hospital in the Netherlands. Patients who underwent surgery between January 2012 and December 2015 were included. On January 1 st, 2013, oral antibiotic prophylaxis with tobramycin and colistin was implemented as standard of care prior to colorectal surgery. The year before implementation was used as control period. The primary outcome was a composite of deep surgical site infection and/or mortality within 30 days after surgery.

Results

Of the 1,410 patients, 352 underwent colorectal surgery in the control period and 1,058 in the period after implementation of the antibiotic prophylaxis. We observed a decrease in incidence of the primary endpoint of 6.2% after prophylaxis implementation. When adjusted for confounders, the risk ratio for development of the primary outcome was 0.58 (95% CI 0.40 – 0.79). Other findings included a decreased risk of anastomotic leakage and a reduction of the length of postoperative stay.

Conclusions

reoperative oral antibiotic prophylaxis prior to colorectal surgery is associated with a significant decrease in SSI and/or mortality in a setting without MBP. Preoperative oral antibiotics can therefore be considered without MBP for patients undergoing colorectal surgery.

 

f:id:akinohanayuki:20181008012714p:plain