摘要:目的：評價圍手術期預防性應用抗菌藥物現狀及合理性。方法：采用回顧性調查的方法，隨機抽查2009年度Ⅰ類切口手術圍手術期病案500份，設計外科圍手術期預防性應用抗生素調查表，對預防用藥的適應證、用藥種類、聯合用藥、給藥時機及持續時間進行統計分析。結果：未使用抗生素5例，預防性使用抗生素495例，其中不合理80例（16.00％）。預防性使用抗生素總品規數為540，其中頭孢菌素類453例（83.89%），青霉素類（包括加酶抑制劑）26例（4.81%），喹諾酮類44例（8.15%）。選用頭孢唑啉鈉178例（32.96%）居第一位，頭孢替唑鈉第二，151例（2796%）。結論：Ⅰ類切口手術患者圍手術期預防性使用抗菌藥物較為合理，但仍存在用藥指征把握不嚴，抗菌藥物的選擇、抗菌藥物使用時間較長等問題，有待進一步規范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.
Objective To clarify the bacterial spectrum and drug resistance of different biliary diseases through bile culture results. Methods Patients who underwent surgical treatment and retained bile for cultivation at the Chinese PLA General Hospital between January 2015 and December 2016 were retrospectively collected. Clinical data such as bile bacterial culture and antibiotic sensitivity results, surgical reasons, and perioperative complications were recorded. Results A total of 272 patients were included, including 142 males and 130 females, aged (53.4 ± 14.1) years old. Intrahepatic and extrahepatic bile duct stones were the most common surgical cause, accounting for 32.4%. The positive rate of bile culture in benign diseases was 78.7%, which was higher than that in malignant diseases (48.5%). The infection related complications (30.0% vs. 6.7%), bile leakage rate (20.8% vs. 6.7%), and poor wound healing rate (24.0% vs. 0.0%) in the bile culture positive group were higher than those in the bile bacteria culture negative group (P<0.05). Among 183 patients with positive bile bacterial culture, a total of 294 strains of pathogenic bacteria were detected. There were 96 patients with single bacterial infection, 66 patients with two bacterial infections simultaneously, 18 patients with three bacterial infections, and 3 patients with four or more bacterial infections. Escherichia coli was the most common bacterium, accounting for 17.0%. There were differences in the positive rate of bile culture among patients with different etiologies (P<0.05). There were significant differences in the sensitivity rate of Enterococcus faecalis and Enterococcus faecalis for many antibacterial drugs. Conclusions There are differences in the positive rate of bacterial culture in the biliary tract of patients with different etiologies, and there is a possibility of mixed infection. It is necessary to select appropriate antibiotics for empirical treatment based on different etiologies. The use of antibiotics should be changed in a timely manner based on the results of bile culture.