引言抗菌药物预防,涉及外科手术前的短期抗生素疗程,建议尽量减少术后感染。儿科心脏手术被归类为清洁手术,尽管由于疾病严重程度和ICU住院时间延长,感染挑战仍然存在。抗菌预防措施各不相同,从单剂量到延长给药,直到导管被移除。通常持续24到48小时,它已经证明了减少感染的好处。尽管有这些做法,不确定性围绕着最优性质,定时,和管理期限。这种担忧通过抗生素过度使用导致的抗微生物耐药性升级而被放大。弱势儿科人群因不合理使用抗菌药物而承受更高的后果,有助于全球抵抗趋势。然而,儿科心脏手术缺乏明确的最佳预防方案.由于儿科研究的复杂性和人口多样性,进口成人指南可能不足。制定有效的预防方案对于接受心脏手术的儿童至关重要,鉴于全球抗生素过度使用和不断发展的耐药性。建立最佳的预防策略仍然是一个挑战,需要进一步研究基于证据的方案,以减轻这个脆弱的患者队列中的感染。方法本研究调查儿科心脏手术中抗生素的使用情况。对印度农村医院(2017-2018年)的100名患者的回顾性分析评估了抗生素模式,包括类型,剂量,持续时间,和坚持预防方案。结果在研究的儿科心脏手术患者队列中,观察到抗生素预防完全依从性(100%).然而,发现了偏差:30%的人过早接受抗生素治疗,30%与机构协议标准不一致.关于抗生素的选择,87%遵循医院政策,推荐头孢哌酮舒巴坦联合阿米卡星,9%的患者因脓毒症接受哌拉西林/他唑巴坦+阿米卡星治疗。根据临床记录,发生了不规则使用(22%)。此外,4%接受哌拉西林/他唑巴坦+替考拉宁,有一例不适当的高级抗生素使用。关于预防持续时间,只有27%的人遵守适当的时间表,40%超过48小时,表示扩展使用。出院时,显著比例(45例)接受抗生素处方.其中,73%是合理处方,而27%的人表现出不合理的抗生素使用。结论这项研究的结果为儿科心脏手术中的抗生素滥用问题提供了重要的启示。它强调迫切需要采取更严格的措施来规范和应对这一趋势。该研究强调了严格遵守已建立的抗生素预防方案和指南的重要性。这种依从性不仅具有提高患者护理整体质量的潜力,而且在应对不断升级的抗生素耐药性挑战方面发挥着关键作用。通过共同努力优化抗生素的使用,我们可以同时提高患者的治疗效果,并有助于持续对抗抗生素耐药菌株的出现,从而为后代保留这些重要药物的功效。
Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This
study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this
study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The
study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.