Antibiotic prophylaxis

抗生素预防
  • 文章类型: Journal Article
    背景:在腮腺区域手术中预防性使用抗生素仍然是争论的话题。这项研究的目的是阐明抗生素预防对腮腺区域手术中手术部位感染(SSIs)的影响。患者和方法:围手术期接受抗生素预防的患者被指定为第1组,而未接受抗生素预防的患者被分为第2组。根据不同的抗生素使用模式,将第1组病例进一步细分为三个亚组。收集患者的个人信息。临床数据,如手术时间,术后住院时间,切口感染状态,并记录抗生素使用情况。对所有数据进行组间比较和分析。结果:共纳入357例患者,基线特征无统计学差异。术前美国麻醉医师协会评分在组间没有显著差异(p=0.151),但是在国家医院感染监测(NNIS)指数值中存在显着差异(p=0.044)。此外,手术时间(p=0.001)和病理类型(p=0.016)有显著差异。1组术后住院时间长于2组(p<0.01)。1组术后SSI发生率低于2组,差异无统计学意义(2.55%vs.5.59%,p=0.141)。Logistic回归分析显示,恶性肿瘤,手术持续时间较长,较高的NNIS指数评分与术后SSI率呈正相关。同时,与不使用相比,三种不同的抗生素使用模式均与SSI发生呈负相关.结论:在腮腺手术中预防抗生素并没有显着降低SSI的发生率。如果有令人信服的理由使用预防性抗生素,术前单剂量可能是预防SSIs的相对可行的措施。
    Background: The prophylactic use of antibiotics in parotid region surgery continues to be a subject of debate. The aim of this study is to elucidate the impact of antibiotic prophylaxis on surgical site infections (SSIs) in parotid region surgery. Patients and Methods: Patients who received antibiotic prophylaxis during the peri-operative period were designated as group 1, whereas those who did not were categorized into group 2. Group 1 cases were further subdivided into three subgroups based on different antibiotic usage patterns. Patient individual information was collected. Clinical data such as surgical duration, post-operative hospital stay, incision infection status, and antibiotic usage were recorded. All data were compared and analyzed among different groups. Results: A total of 357 patients were included in the study, with no statistically significant differences in baseline characteristics. Pre-operative American Society of Anesthesiologists scores did not significantly differ between groups (p = 0.151), but there was a significant distinction in National Nosocomial Infection Surveillance (NNIS) index values (p = 0.044). Furthermore, surgical duration (p = 0.001) and pathology types (p = 0.016) differed significantly. The post-operative hospital stay in group 1 was longer than that in group 2 (p < 0.01). The post-operative SSI rate in group 1 was lower than that in group 2 without statistical significance (2.55% vs. 5.59%, p = 0.141). The logistic regression analysis showed that malignant tumors, longer surgical durations, and higher NNIS index scores correlated positively with post-operative SSI rates. Meanwhile, compared with non-use, all three different antibiotic use modes correlated negatively with SSI occurrence. Conclusions: Antibiotic prophylaxis in parotid gland surgery shows no significant reduction in SSI occurrence. If there is a compelling reason to administer prophylactic antibiotics, pre-operative single dose may be a relatively feasible measure for preventing SSIs.
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  • 文章类型: Journal Article
    B组链球菌(GBS)是一种革兰氏阳性细菌,常见于胃肠道和泌尿生殖道。怀孕期间GBS感染是全球孕产妇和新生儿发病率和死亡率的重要因素。本文旨在探讨GBS在妇产科领域引起的感染性疾病,以及与检测相关的挑战,治疗,预防GBS。
    Group B streptococcal (GBS) is a Gram-positive bacterium that is commonly found in the gastrointestinal tract and urogenital tract. GBS infestation during pregnancy is a significant contributor to maternal and neonatal morbidity and mortality globally. This article aims to discuss the infectious diseases caused by GBS in the field of obstetrics and gynecology, as well as the challenges associated with the detection, treatment, and prevention of GBS.
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  • 文章类型: English Abstract
    High quality bowel preparation is a necessary part of preoperative preparation for colorectal surgery and one of the keys to the success of surgery, which directly affects the quality of intraoperative procedures and postoperative recovery of patients. Conventional intestinal preparation mainly includes three aspects: preoperative dietary control, intestinal cleansing and prophylactic use of antibiotics. With the development of evidence-based medicine, the concepts and methods of bowel preparation have also changed. Long fasting is no longer advocated before surgery, and the traditional mechanical bowel preparation are also challenged. This article summarizes the application and research progress of different intestinal preparation methods before colorectal surgery, aiming to provide reference for clinical work of colorectal surgeons.
    高质量的肠道准备是结直肠术前准备的必要环节和手术成功的关键之一,直接影响术者术中操作质量和患者术后恢复。一般的肠道准备主要包括:术前饮食控制、机械性肠道准备与预防性使用抗生素三个方面。随着循证医学的发展,肠道准备的观念与方式也发生着变化,术前不再提倡长时间的禁食,传统的机械肠道准备方案也受到挑战。本文针对不同肠道准备方法在结直肠手术前的应用与研究进展进行总结,旨在为结直肠外科医生临床工作提供参考。.
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  • 文章类型: Journal Article
    目的:探讨下颌阻生第三磨牙拔除术后应用抗菌药物的预防效果及潜在危险因素。
    方法:一项队列试验。研究的地点和持续时间:口腔颌面外科,浙江大学医学院,口腔医院,杭州,中国,从2021年8月到2022年。
    方法:根据抗生素使用情况将下颌阻生第三磨牙患者分为两组。术后感染的主要结果变量,次要临床参数镇痛药摄入量,和其他变量(手术时间,冠周炎的病史,和伤口闭合)记录。
    结果:330例(n=330)中,术后感染发生率为3.64%(n=12);抗生素组(n=166)为3.01%,对照组为4.27%(n=164,OR=1.44,95%CI:0.49至4.06;p=0.54)。关于次要结果指标,抗生素组服用的镇痛药为5.40,对照组服用的镇痛药为5.95(95%CI=-0.21~1.30;p=0.16).对于那些术后感染的人,平均手术时间为22.83分钟,而那些没有术后感染的患者则为14.87分钟(95%CI=-0.26~15.67;p=0.04).当手术时间大于或等于15分钟时,它与更多的镇痛药使用有关(95%CI:-0.43至1.93;p<0.05),也包括冠周炎病史(95%CI=0.04~1.54;p=0.04).
    结论:在拔除下颌阻生第三磨牙后,抗生素对于预防术后感染或最大限度地减少镇痛需求是不必要的;手术时间和冠周炎对术后恢复具有抑制作用。
    背景:磨牙受累,抗生素,镇痛药,手术时间,冠周炎.
    OBJECTIVE: To explore the preventive efficacy of antibiotics following surgical removal of the impacted mandibular third molars and screen the potential risk factors.
    METHODS: A cohort trial. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Zhejiang University School of Medicine, Stomatology Hospital, Hangzhou, China, from August 2021 to 2022.
    METHODS: Cases with impacted mandibular third molar were divided into two groups based on antibiotics use. The primary outcome variable post-operative infection, secondary clinical parameter analgesics intake, and other variables (the operative time, the history of pericoronitis, and wound closure) were documented.
    RESULTS: The post-operative infections occurred in 3.64% (n = 12) of the 330 cases (n = 330); 3.01% in the antibiotic group (n = 166) and 4.27% in the control group (n = 164, OR = 1.44, 95% CI: 0.49 to 4.06; p = 0.54). Concerning secondary outcome measures, the analgesics that the antibiotic group took was 5.40, and the control group took was 5.95 (95% CI = -0.21 to 1.30; p = 0.16). For those with post-operative infections, the average operative time was 22.83 minutes, whereas for those without post-operative infections it was 14.87 minutes (95% CI = -0.26 to 15.67; p = 0.04). When the operative time was greater than or equal to 15 minutes, it was related to more analgesics use (95% CI: -0.43 to 1.93; p <0.05), also was the history of pericoronitis (95% CI = 0.04 to 1.54; p = 0.04).
    CONCLUSIONS: Antibiotics are unnecessary for preventing post-operative infections or minimising analgesic requirements following extraction of the impacted mandibular third molars; operative time and pericoronitis showed a suppressive influence on post-operative recovery.
    BACKGROUND: Impacted molars, Antibiotics, Analgesics, Operative time, Pericoronitis.
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  • 文章类型: Letter
    暂无摘要。
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  • 文章类型: Consensus Development Conference
    软骨肉瘤是第二常见的经手术治疗的原发性骨肉瘤。尽管文献中有大量的科学论文,关于诊断仍然存在重大争议,原发性肿瘤的治疗,亚型,和并发症。因此,需要就其日常治疗决定达成共识。2024年1月,伯明翰骨科肿瘤学会议(BOOM)试图获得来自50多个国家的300名代表的全球共识。会议侧重于这些关键领域,旨在根据不同地理区域的证据合并和专家意见,达成共识声明。并行,由于辅助治疗等因素,肿瘤重建中的假体周围感染(PJI)提出了独特的挑战,大曝光,以及手术的复杂性.会议就两阶段修订进行了辩论,抗生素预防,在接受化疗的患者中管理急性PJI,并确定伤口处理和同种异体移植重建的最佳策略。会议的目标不仅限于解决眼前的争议。它寻求促进出席会议的专家之间的全球合作,并鼓励未来的研究项目解决未解决的困境。通过突出分歧领域和促进合作研究努力,该计划旨在提高治疗标准,并有可能改善全球患者的结局.本文列出了会议中辩论的一些争议和问题。
    Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.
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  • 文章类型: Meta-Analysis
    剖宫产率正在增加,术后伤口感染是剖宫产(CS)后威胁健康的主要并发症。这项研究的目的是评估头孢唑林在剖宫产后不同时间的疗效。这项研究的目的是比较不同时间使用头孢唑啉对CS后感染的影响。CS中使用抗生素的时间可分为两组:皮肤切口前(SI)和脐带夹闭后(CC)。在这项研究中,在数据库中找到了268篇相关文章,最后,分析了10篇文章。本研究共纳入5256例剖宫产手术。伤口感染的数据,子宫内膜炎,分析尿路感染和发热。使用RevMan5.3对数据进行分析。结果表明,与CC后相比,SI前头孢唑林减少了伤口感染(比值比[OR],0.51;95%CI:0.37-0.69;p<0.0001)。与CC后相比,SI前预防性使用头孢唑啉可减少CS后的子宫内膜炎(OR,0.52;95%CI:0.35-0.77;p=0.001)。SI前预防性使用头孢唑啉与CC后CS后尿路感染无显著差异(OR,0.80;95%CI:0.50-11.28;p=0.35)。SI前预防性使用头孢唑啉与CC后CS后发热无显著差异(OR,0.60;95%CI:0.26-11.43;p=0.225)。SI前头孢唑啉可减少CS后伤口感染和子宫内膜炎。
    Caesarean section rate is increasing and postoperative wound infection is a major health-threatening complication after caesarean section (CS). The aim of this study was to evaluate the efficacy of Cefazolin at different time for post-caesarean delivery. The aim of this study was to compare the use of Cefazolin at different times on infections after CS. The time of antibiotic use in CS can be divided into two groups: before skin incision (SI) and after cord clamping (CC). In this study, 268 relevant articles were found in the database, and finally, 10 articles were analysed. This study included a total of 5256 cases of caesarean section. The data on wound infections, endometritis, urinary tract infections and fever were analysed. Perform an analysis of the data using RevMan 5.3. The results showed that cefazolin before SI reduced wound infection compared to after CC (odds ratio [OR], 0.51; 95% CI: 0.37-0.69; p < 0.0001). Cefazolin prophylactically used before SI reduce endometritis after CS compared to after CC (OR, 0.52; 95% CI: 0.35-0.77; p = 0.001). There was no significant difference in urinary tract infections after CS between cefazolin prophylactically used before SI and after CC (OR, 0.80; 95% CI: 0.50-11.28; p = 0.35). There was no significant difference in fever after CS between the prophylactic use of cefazolin before SI and after CC (OR, 0.60; 95% CI: 0.26-11.43; p = 0.225). Cefazolin before SI reduces wound infection and endometritis after CS.
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  • 文章类型: Systematic Review
    背景:越来越多的证据表明,机械肠道准备(MBP)对减少择期结肠切除术后并发症的影响很小。这项研究调查了选择性结肠切除术前MBP的必要性。
    方法:在PubMed,奥维德,和Cochrane图书馆,以确定比较选择性结肠切除术前没有准备的MBP效果的研究,直到2023年5月26日。收集手术相关结果并随后进行分析。主要结果包括吻合口漏(AL)和手术部位感染(SSI)的发生率,使用ReviewManager软件(v5.3)进行分析。
    结果:分析包括14项研究,包括七个RCT,5146名参与者。人口统计学信息在各组之间是一致的。两组间AL差异无统计学意义(P=0.43,OR=1.16,95%CI(0.80,1.68),I2=0%)或SSI(P=0.47,OR=1.20,95%CI(0.73,1.96),I2=0%),其他结果也没有显著差异.对口服抗生素使用的亚组分析显示结果没有显着变化。然而,在右结肠切除术的情况下,未准备组的SSI发生率显着降低(P=0.01,OR=0.52,95%CI(0.31,0.86),I2=1%)。在其他亚组分析中没有发现显著差异。
    结论:目前的证据有力地表明,择期结肠切除术前的MBP在减少术后并发症方面没有显著的益处。因此,在选择性结肠切除术前放弃MBP是合理的,无论肿瘤的位置。
    BACKGROUND: Growing evidence demonstrates minimal impact of mechanical bowel preparation (MBP) on reducing postoperative complications following elective colectomy. This study investigated the necessity of MBP prior to elective colonic resection.
    METHODS: A systematic literature review was conducted across PubMed, Ovid, and the Cochrane Library to identify studies comparing the effects of MBP with no preparation before elective colectomy, up until May 26, 2023. Surgical-related outcomes were compiled and subsequently analyzed. The primary outcomes included the incidence of anastomosis leakage (AL) and surgical site infection (SSI), analyzed using Review Manager Software (v 5.3).
    RESULTS: The analysis included 14 studies, comprising seven RCTs with 5146 participants. Demographic information was consistent across groups. No significant differences were found between the groups in terms of AL ((P = 0.43, OR = 1.16, 95% CI (0.80, 1.68), I2 = 0%) or SSI (P = 0.47, OR = 1.20, 95% CI (0.73, 1.96), I2 = 0%), nor were there significant differences in other outcomes. Subgroup analysis on oral antibiotic use showed no significant changes in results. However, in cases of right colectomy, the group without preparation showed a significantly lower incidence of SSI (P = 0.01, OR = 0.52, 95% CI (0.31, 0.86), I2 = 1%). No significant differences were found in other subgroup analyses.
    CONCLUSIONS: The current evidence robustly indicates that MBP before elective colectomy does not confer significant benefits in reducing postoperative complications. Therefore, it is justified to forego MBP prior to elective colectomy, irrespective of tumor location.
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  • 文章类型: Journal Article
    抗生素在基于假体的乳房手术中预防包膜挛缩是临床实践中常见的。然而,目前缺乏关于该领域抗生素使用有效性的高质量证据。为了确定2023年1月之前的所有相关研究,在PubMed进行了全面的文献检索,Embase,WebofScience,科克伦图书馆,和Medline数据库。然后对提取的数据进行荟萃分析。分析中保留了14项研究。根据结果,围手术期抗生素预防与非抗生素预防相比,未降低包膜挛缩(RR1.15,95%CI0.82~1.59,p=0.55)或手术部位感染(RD0.01,95%CI-0.01~0.03,p=0.59)的风险.在预防包膜挛缩方面,延长抗生素预防和围手术期抗生素预防之间没有统计学上的显着差异,无论是按患者人数计算(RD0.01,95%CI-0.01至0.02,p=0.87)还是按总程序计算(RD0.00,95%CI-0.00至0.01,p=0.88),或控制手术部位感染(RR1.05,95%CI0.77-1.44,p=0.27)。此外,局部抗生素冲洗并没有降低感染风险(RR0.61,95%CI0.34-1.08,p=0.29)和包膜挛缩,无论患者数量(RR0.41,95%CI0.27-0.63,p=0.18)或手术总数(RR1.29,95%CI0.73-2.28,p<0.01)。目前的证据表明,在基于假体的乳房手术中,全身和局部抗生素预防可能无法预防包膜挛缩。当最大程度地减少手术部位感染的发生时,应谨慎考虑使用额外的抗生素来减轻包膜挛缩。
    Antibiotics Prophylaxis to prevent capsular contracture in prosthesis-based breast surgery is common in clinical practice. However, there is currently a dearth of high-quality evidence concerning the effectiveness of antibiotic usage in this field. To identify all pertinent studies prior to January 2023, a comprehensive literature search was conducted in the PubMed, Embase, Web of Science, Cochrane Library, and Medline databases. The extracted data was then subjected to meta-analysis. Fourteen studies were retained in the analysis. According to the results, perioperative antibiotic prophylaxis did not reduce the risk of capsular contracture (RR 1.15, 95% CI 0.82-1.59, p = 0.55) or surgical-site infection (RD 0.01, 95% CI - 0.01 to 0.03, p = 0.59) compared to nonantibiotic prophylaxis. There was no statistically significant difference between extended antibiotic prophylaxis and perioperative antibiotic prophylaxis in terms of preventing capsular contracture, whether calculated by patient numbers (RD 0.01, 95% CI - 0.01 to 0.02, p = 0.87) or by total procedures (RD 0.00, 95% CI - 0.00 to 0.01, p = 0.88), or controlling surgical-site infection (RR 1.05, 95% CI 0.77-1.44, p = 0.27). Additionally, topical antibiotic irrigation did not decrease the risk of infection (RR 0.61, 95% CI 0.34-1.08, p = 0.29) and capsular contracture, regardless of patient number (RR 0.41, 95% CI 0.27-0.63, p = 0.18) or total number of procedures (RR 1.29, 95% CI 0.73-2.28, p < 0.01). Current evidence revealed that both systemic and topical antibiotic prophylaxis may not provide benefits in preventing capsular contracture in prosthesis-based breast surgery. When the occurrence of surgical-site infections is minimized to the greatest extent, the administration of additional antibiotics for reducing capsular contracture should be carefully and judiciously considered.
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  • 文章类型: Journal Article
    背景:胰十二指肠切除术(PD)后手术部位感染(SSI)的发生率仍然相对较高。这项回顾性研究的目的是评估哌拉西林-他唑巴坦作为围手术期预防性抗生素对PD患者器官/空间SSI的疗效。
    方法:纳入并回顾性分析了2018年1月至2022年12月期间接受PD的47例连续患者。采用单因素和多因素分析确定器官/空间SSI的独立危险因素。根据预防性抗生素的使用,以1:1的倾向评分匹配(PSM)分析比较两组的术后并发症。
    结果:根据围手术期预防性使用抗生素,所有407例患者分为头孢曲松组(n=192,47.2%)和哌拉西林他唑巴坦组(n=215,52.8%).围手术期抗菌药物选择为独立危险因素之一的脏器/空间SSI率为31.2%(OR=2.837,95CI=1.802~4.465,P<0.01)。PSM之后,组间基线特征相似.同时,在PSM前后,哌拉西林他唑巴坦组的器官/空间SSI发生率均显著低于头孢曲松组(P<0.05)。
    结论:采用哌拉西林-他唑巴坦作为PD患者的围手术期预防方法可显着降低器官/空间SSI。
    BACKGROUND: The occurrence of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is still relatively high. The aim of this retrospective study is to evaluate the efficacy of piperacillin-tazobactam as perioperative prophylactic antibiotic on organ/space SSI for patients underwent PD.
    METHODS: Four hundred seven consecutive patients who underwent PD between January 2018 and December 2022 were enrolled and analyzed retrospectively. The univariate and multivariate analysis were used to identify independent risk factors of organ/space SSI. Postoperative complications were compared between the two groups according to the use of prophylactic antibiotics by a ratio of 1:1 propensity score-matched (PSM) analysis.
    RESULTS: Based on perioperative prophylactic antibiotic use, all 407 patients were divided into the ceftriaxone group (n = 192, 47.2%) and piperacillin-tazobactam group (n = 215, 52.8%). The rate of organ/space SSI was 31.2% with the choice of perioperative antibiotics (OR = 2.837, 95%CI = 1.802-4.465, P < 0.01) as one of independent risk factors. After PSM, there were similar baseline characteristics among the groups. Meanwhile, the piperacillin-tazobactam group had a significant lower rate of organ/space SSI compared to the ceftriaxone group both before and after PSM(P < 0.05).
    CONCLUSIONS: The adoption of piperacillin-tazobactam as perioperative prophylaxis for patients underwent PD reduced organ/space SSI significantly.
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