外科手术的抗生素预防用药（英文）Antibiotic Prophylaxis for Surgical Procedures.pptVIP

Antibiotic Prophylaxis for Surgical Procedures Bill Salzer University of Missouri-Columbia 9/29/07 salzerw@ Preventing Surgical Infections Antibiotic prophylaxis Drugs- which when, how many doses? Non antibiotic measures- evidence based Hair removal Normothermia Oxygen supplementation Normoglycemia Perioperative Normothermia 200 CRS patients Control: Routine intraoperative thermal care (mean temperature 34.7°C) Treatment: Active warming (mean temperature 36.6°C) Incidence of SSI Control 19% (18/96) Treatment 6% (6/104); P=0.009 Supplemental Oxygen 500 CRS patients 80% or 30% inspired oxygen during operation and for 2 hours post surgery All patients received prophylactic antibiotics Results Arterial and subcutaneous PO2 higher in 80% oxygen group Lower incidence of SSIs with higher supplemental oxygen (5.2% vs 11.2%; P=0.01) SSIs and Glucose Levels (cont) 1,000 cardiothoracic surgery patients with preoperative hemoglobin A1c (HbA1c) levels measured 300 known diabetic patients 42 with undiagnosed diabetes Incidence of SSI Diabetes (known and undiagnosed) 5.8% (20/342) Without diabetes 1.5% (10/658) Diabetes with HbA1c ≥8% 7.9% (10/126) Diabetes with HbA1c 8% 4.0% (7/174) SSIs and Post-op Glucose Levels SSIs and Glucose Levels Preoperative Strategies to Limit SSIs: Skin Surface Preparations Antiseptic showers Reduced bacterial counts by 3.5 log10 from baseline1 No evidence that they affect SSIs2 Skin preparation in the operating room (OR) Usually iodophors, alcohol-containing products, or chlorhexidine gluconate2 Antimicrobial Prophylaxis Antimicrobial agent to prevent or reduce infection Ideally Targeted antibiotic Narrow spectrum agent Targeting few pathogens Short term Surgical Prophylaxis- Principles Its not the tool it’s the craftsman You can’t kill everything Surgical wound and deeper infections Focus on likely pathogens-what are you cutting? Narrow spectrum, long half life drugs Dose timing- pre-incision, close Single pre-op dose adequate for most Good