Abstract：
BACKGROUND: Surgical site infections are complications of surgical care that may be prevented with appropriate surgical antibiotic prophylaxis (SAP). SAP is the most common indication for antimicrobial use in Australian hospitals; however, it is associated with high rates of inappropriate use. Inappropriate SAP is associated with adverse consequences for both the patient and the community. The underlying reasons for inappropriate use, however, are not well delineated. Potential factors include the quality of the evidence base regarding SAP use and available guidelines.
METHODS: The literature review focused on research classified as having Level 1 evidence according to the National Health and Medical Research Council (NHMRC) evidence hierarchy. Findings were then compared to the current Australian recommended guidelines (Therapeutic Guideline: Antibiotic Surgical Prophylaxis).
RESULTS: Overall, 50 systematic reviews (SR) and meta-analysis (MAs) were identified for the review. The evidence examined highlights that first-generation cephalosporins are the antimicrobial agents of choice and single-dose prophylaxis is effective for the majority of surgical procedures included in this review. There is limited evidence pertaining to a specific optimal antimicrobial, dosing and timing. Thus, there is no overarching Level 1 evidence combining all elements for an optimal SAP regimen (i.e., choice of agent, dose, route and duration) to support individual Therapeutic Guideline: Antibiotic recommendations, although there may be Level 1 evidence for the individual elements.
CONCLUSIONS: Considerable evidence supports the use of SAP; however, there are gaps in the evidence behind recommendations for the most appropriate SAP regimen for different surgical procedures. Expert consensus guideline development aims to narrow these gaps, but guideline implementability and uptake are influenced by multiple factors including the comprehensiveness of the evidence. Further research is warranted to examine guideline implementability and uptake, and to identify problematic areas surrounding surgical prophylaxis prescribing.
METHODS: The literature review focused on research classified as having Level 1 evidence according to the National Health and Medical Research Council (NHMRC) evidence hierarchy. Findings were then compared to the current Australian recommended guidelines (Therapeutic Guideline: Antibiotic Surgical Prophylaxis).
RESULTS: Overall, 50 systematic reviews (SR) and meta-analysis (MAs) were identified for the review. The evidence examined highlights that first-generation cephalosporins are the antimicrobial agents of choice and single-dose prophylaxis is effective for the majority of surgical procedures included in this review. There is limited evidence pertaining to a specific optimal antimicrobial, dosing and timing. Thus, there is no overarching Level 1 evidence combining all elements for an optimal SAP regimen (i.e., choice of agent, dose, route and duration) to support individual Therapeutic Guideline: Antibiotic recommendations, although there may be Level 1 evidence for the individual elements.
CONCLUSIONS: Considerable evidence supports the use of SAP; however, there are gaps in the evidence behind recommendations for the most appropriate SAP regimen for different surgical procedures. Expert consensus guideline development aims to narrow these gaps, but guideline implementability and uptake are influenced by multiple factors including the comprehensiveness of the evidence. Further research is warranted to examine guideline implementability and uptake, and to identify problematic areas surrounding surgical prophylaxis prescribing.
摘要：
背景：手术部位感染是手术护理的并发症，可以通过适当的手术抗生素预防（SAP）来预防。SAP是澳大利亚医院使用抗菌药物最常见的适应症；然而，它与高比率的不当使用有关。不适当的SAP与患者和社区的不良后果有关。使用不当的根本原因，然而,没有很好的描绘。潜在因素包括有关SAP使用和可用指南的证据基础的质量。
方法：文献综述集中于根据国家健康与医学研究委员会（NHMRC）证据等级分类为1级证据的研究。然后将结果与当前澳大利亚推荐的指南（治疗指南：抗生素手术预防）进行比较。
结果：总体而言，确定了50篇系统评价(SR)和荟萃分析(MA)。所检查的证据表明，第一代头孢菌素是首选的抗菌药物，单剂量预防对于本综述中包括的大多数外科手术都是有效的。关于特定最佳抗菌剂的证据有限，剂量和时间。因此，没有总体的1级证据结合了最佳SAP方案的所有要素(即，代理人的选择，剂量,路线和持续时间)以支持个人治疗指南：抗生素建议，虽然个别元素可能有1级证据。
结论：大量证据支持SAP的使用；然而，对于不同的外科手术,建议采用最合适的SAP方案的证据存在差距.专家共识准则制定旨在缩小这些差距，但是指南的可实施性和可吸收性受多种因素的影响，包括证据的全面性。需要进一步的研究来检查指导方针的可实施性和可吸收性，并确定围绕手术预防处方的问题区域。
方法：文献综述集中于根据国家健康与医学研究委员会（NHMRC）证据等级分类为1级证据的研究。然后将结果与当前澳大利亚推荐的指南（治疗指南：抗生素手术预防）进行比较。
结果：总体而言，确定了50篇系统评价(SR)和荟萃分析(MA)。所检查的证据表明，第一代头孢菌素是首选的抗菌药物，单剂量预防对于本综述中包括的大多数外科手术都是有效的。关于特定最佳抗菌剂的证据有限，剂量和时间。因此，没有总体的1级证据结合了最佳SAP方案的所有要素(即，代理人的选择，剂量,路线和持续时间)以支持个人治疗指南：抗生素建议，虽然个别元素可能有1级证据。
结论：大量证据支持SAP的使用；然而，对于不同的外科手术,建议采用最合适的SAP方案的证据存在差距.专家共识准则制定旨在缩小这些差距，但是指南的可实施性和可吸收性受多种因素的影响，包括证据的全面性。需要进一步的研究来检查指导方针的可实施性和可吸收性，并确定围绕手术预防处方的问题区域。
