The Prophylactic Use Of Antimicrobial On Interventional Therapy Of Primary Hepatocellular Carcinoma

Objective:To guild the perioperative antibiotic application specification in interventional therapy of hepatocellular carcinoma through the investigation and analysis of the difference between use and unuse of antimicrobial among infection rates,infection type, fever rate, the initial fever time, the length of fever time, the average and the highest fever temperature.Method:To collect the information of826patients with primary hepatocellular carcinoma interventional therapy in radiology department of Tianjin a certain line3hospital from2001January-2013September.The diagnosis of all patients were based on the diagnosis and treatment of standardized expert consensus.Laboratory tests such as liver and kidney function, four blood coagulation, blood routine test, blood sugar and alpha-fetoprotein and the Chest X-ray, electrocardiogram, abdominal computed tomography (CT) or magnetic resonance imaging (MRI) are examinated before surgery to definite tumor location, size and scope, etc.All patients of no surgery contraindications with ductal super select Insert the feeding artery of the tumor,with carboplatin plus fluorouracil/fluorine urea and mitomycin chemotherapy, with super liquefaction oil, gelatin sponge embolism or algae microspheres.825cases were successful and1was fail(vascular malformation),and4patients were dad.The drug type, name, dose, dosing way, total amount, duration and combination situation before and after surgery were recorded of users before intervention.After the surgery,we observe the temperature,record the blood routine(the total number of white blood cells and the proportion of neutrophils),clotting time,C reactive prolein, procalcitonin and signand we record them from the first day to the tenth in-patient or discharging from hospital.infected patients ared recorded the infection type and site.All infections are diagnoized by the standard of hospital infection ministry of health which is issued by the ministry of health in2001.Exclusion criteria:preoperative infections, Preoperative temperature above37.5centigrade or white blood cell count above10×109/L; Preoperative treatment with antimicrobial in1week. There are two stages of Intervention measures:The first stage since November2007:Medications and course of the treatment-Limit the fluoroquinolone drugs gradually and switch to the first generation cephalosporin class;Treatment courses consist of many days,3days gradually are shortened to2days,1day.The second stage since2011:Don’t prevent use of antimicrobial agents.The SPSS software is applicated for statistical analysis and chi-square test, Logistic regressionwas used in Count data comparison and Influence factors analysis.Rank sum test is used in abnormal distribution data comparison.Resulted:1.In From January2001to September2013, a total of826cases were with Transcatheter Arterial Chemoembolization and515cases were in application of antimicrobial.Among them, the first generation cephalosporin (cefazolin, ceftezole)241cases,the second generation cephalosporin(Cefuroxime, cephalosporins mino)3cases,the third generation cephalosporin(Ceftriaxone,cefodizime,cefotaxime, cefazolin)43cases and Fluoroquinolones(levofloxacin227cases、gatifloxacin1case)228cases.Before2008,the main parts are luoroquinolone83.4%(131/157) and the3rd generation cephalosporin12.1%(19/157);after2008,it,s the first generation cephalosporin65.6%(235/358).Before2008, The proportion of Medications is many days38.2%(60/184) and three days24.2%(38/184).Form2008to2011,the main part is one day66.7%(300/450).Since2011,almost no prophylactic use of antimicrobial1.6%(3/192).2.The infection types are the intestinal infection septicopyemia、upper respiratory infection (URI)、pulmonary infection、urinary infection Unexplained infections.Among27cases,the number of them is7,3,8,3,3,3.3.Among515cases in application of antimicrobial of826cases with Transcatheter Arterial Chemoembolization,22cases infected and infection rate is4.27percent(22/515); Among311cases without use of antimicrobial,5cases infected and infection rate is1.61percent(5/33);There is no significant difference between them (P>0.05).And the infection rate of2008,2008-2011,2011-2013is3.6%(5/138,4.4%(20/450),1.0%(2/192) respectively.4..Among515cases,241cases fever and fever rate is46.80percent(241/515);Among311cases,145cases fever and fever rate is46.62percent (145/311).There is no significant difference between them (P>0.05); The median of the initial fever time of them are both the third day and the quartile(P25,P75)are both (2,4);The median time of the length of fever time are both4days and the quartile(P25,P75)of them is(1,7)、(2,5)respectively.The average fever temperatures of them are both37.9centigrade; The quartile (P25, P75)of them are (37.6℃,38.2℃)、(37.6℃,38.3℃).