背景：抗菌药物管理的原则促进药物在疗效方面的适当处方，安全,持续时间,和成本。抗生素耐药性通常是由不当使用引起的(例如，指示,选择,持续时间)。我们评估了手术感染治疗（Rx）或预防（Px）中抗菌药物持续时间的实践差异。假设：对于许多常见适应症，关于抗生素Px和Rx的持续时间缺乏共识。方法：向外科感染学会（SIS）分发了一份关于在各种情况下使用抗菌药物的调查。使用标准描述性统计来比较调查响应。使用香农指数比较了问答之间的异质性，表示为自然单位（纳特）。结果：63名SIS成员做出了回应，其中大多数（67％）在SIS中担任过领导职务，或作为年度会议主持人或讨论者做出了贡献；76％的人已经实践了五年以上。关于围手术期Px，超过80％的人认为单剂量足以满足大多数适应症，除坏疽性胆囊炎（40％单剂量，38％的术前+24小时）和腹股沟疝修补术需要肠切除术（70％单剂量）。在各种床边手术中使用抗生素Px的差异更大，受访者在不需要的情况下分开（范围，27%-66%)与单剂量(范围，31%-67%）。对于接受源控制手术或程序的住院患者，关于抗菌药物Rx持续时间的意见因适应症而异。20种适应症中只有2种取得了超过60%的共识，尽管有1类证据：呼吸机相关性肺炎7天（77%）。穿孔性阑尾炎4+1天（62%）。结论:除了围手术期抗生素Px,外科感染专家对抗生素的使用时间几乎没有共识，尽管有1类证据和一些可用的指导方针。这突出表明需要进一步进行高级别研究和更好地传播准则。
Background: The principles of antimicrobial stewardship promote the appropriate prescribing of agents with respect to efficacy, safety, duration, and cost. Antibiotic resistance often results from inappropriate use (e.g., indication, selection, duration). We evaluated practice variability in duration of antimicrobials in surgical infection treatment (Rx) or prophylaxis (Px). Hypothesis: There is lack of
consensus regarding the duration of antibiotic Px and Rx for many common indications. Methods: A survey was distributed to the Surgical Infection Society (SIS) regarding the use of antimicrobial agents for a variety of scenarios. Standard descriptive statistics were used to compare survey responses. Heterogeneity among question responses were compared using the Shannon Index, expressed as natural units (nats). Results: Sixty-three SIS members responded, most of whom (67%) have held a leadership position within the SIS or contributed as an annual meeting moderator or discussant; 76% have been in practice for more than five years. Regarding peri-operative Px, more than 80% agreed that a single dose is adequate for most indications, with the exceptions of gangrenous cholecystitis (40% single dose, 38% pre-operative +24 hours) and inguinal hernia repair requiring a bowel resection (70% single dose). There was more variability regarding the use of antibiotic Px for various bedside procedures with respondents split between none needed (range, 27%-66%) versus a single dose (range, 31%-67%). Opinions regarding the duration of antimicrobial Rx for hospitalized patients who have undergone a source control operation or procedure varied widely based on indication. Only two of 20 indications achieved more than 60%
consensus despite available class 1 evidence: seven days for ventilator-associated pneumonia (77%), and four plus one days for perforated appendicitis (62%). Conclusions: Except for peri-operative antibiotic Px, there is little
consensus regarding antibiotic duration among surgical infection experts, despite class 1 evidence and several available
guidelines. This highlights the need for further high-level research and better dissemination of
guidelines.
