| BACKGROUDA serial of problems such as increasing of antibiotic resistance, medical care cost and toxicity and allergy caused by the antibacterial drug abuse have drawn more and more attention during the last decade. In China, irrational application of antibacterial agents is a common phenomenon in surgery, especially in type I incision.OBJECTIVEThis study aims to further understand the actual situation of the status of the prophylactic use of antimicrobial agents during perioperation for type I incision in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine. It also aims to explore the management measures of the rational prophylactic use of antimicrobial agents during perioperation for type I incision, and then to facilitate and support in order to improve the situation of the antimicrobial agents prophylactic use in type I incision.METHODS AND MATERIALSFrom2005to2012, the repeated cross-sectional survey and analysis were done in our hospital. In2005, the status of antimicrobial agents use in surgery of perioperation in our hospital was considered as baseline for the further survey. During2006to2012, survey and analyzing the clinical data of prophylactic use of antimicrobial agents of perioperation in type I incision were done repeatedly. SPSS19.0was used for statistics.RESULTSA total of1322patients (male698,52.8%; female624,47.2%) were selected from our hospital in2005, while the constituent ratio (CR) of elderly patients (≥60-year-old) was24.4%. These patients were distributed in department of plastic surgery (301), department of orthopedic (117), department of general surgery (135), department of oral surgery (298), department of ear and nose surgery (116), department of neurosurgery (102), department of vascular surgery (145), and department of ophthalmology (108).In2005, the antimicrobial prophylaxis rate was89.4%, and the rate of antibiotics use between0.5and2hours prior to operation was17.5%. The average day of antibiotics prophylactic use was3.8days. The third-generation cephalosporins, quinolones, and penicillin and its compound preparation were the most frequently used. The qualified rate of antibiotics type in antimicrobial prophylaxis was10.3%. The combination use of antibiotics was existed in106cases, which accounted for9.0%.From2006to2012, there were1568,1698,1636,1710,1750,1820, and1775patients who were respectively enrolled, while the CR of elderly patients was23.7%,23.9%,28.2%,26.1%,27.1%,26.1%, and24.5%, respectively.Antimicrobial prophylaxis rate during perioperation for type Ⅰ incision was92.2%,86.4%,82.4%,79.3%,63.3%,57.1%, and49.3%, respectively. The rate of antibiotics use in0.5to2hours prior to operate was18.2%,21.7%,24.6%,27.5%,45.1%,53.2%, and64.8%, respectively. The average duration of antibiotics prophylactic use were3.9days,4.2days,3.4days,3.2days,2.9days,2.8days, and2.5days, respectively. The qualified rate of antibiotics type in antimicrobial prophylaxis were14.2%,19.7%,53.9%,55.5%,83.3%,87.1%, and92.3%, respectively. The combination rate of antibiotics use were8.7%,8.4%,7.5%,7.9%,5.1%,4.5%, and3.2%, respectively. The results of logistic regression analysis indicated that the rate of antibiotics use in0.5to2hours prior to operate and the qualified rate of antibiotics type were related to age, ward, and year.From2008, antimicrobial prophylaxis rate, the average duration of antibiotics prophylactic use, and the qualified rate of antibiotics type in antimicrobial prophylaxis were significantly improved. In addition, the rate of antibiotics use in0.5to2hours prior to operate, and the combination rate of antibiotics use were also improved after2010.DISCUSSION AND CONCLUSIONThe correct use of antimicrobial agents in type Ⅰ incision should be with clear indications, correct types of drugs, appropriate duration, and synergistic combination. A serial of management measures carried out in the whole country and hospital could improve all these mentioned above. Based on a comprehensive understanding of the need of different populations about rational use of antimicrobial agents, all health administrative departments should work together at levels to contribute to the rational prophylactic use of antimicrobial agents during perioperation in type Ⅰ incision. |
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