| Summary: | 碩士 === 國立臺灣大學 === 臨床藥學研究所 === 91 === Background: The incidence of surgical site infection (SSI) after coronary artery bypass grafting (CABG) is relatively low. However, its consequences could be devastating and carry high mortality rates. Preoperative antibiotics administration is effective in reducing the risk of SSI. The role of antibiotic prophylaxis has been established. However, the controversy persists about the optimal duration of prophylaxis. Literatures suggest that a 1-day course is safe and effective. There is little evidence supporting prolonged (≧2 days) antibiotic prophylaxis. In fact, it is still a common practice to continue prolonged antibiotic prophylaxis beyond 24 hours or to continue until all chest tubes are removed. The increasing risk of drug toxicity and substantial antibiotic resistance are of great concerns accordingly.
Methods: We performed a randomized control clinical trial to compare the efficacy of 1-day versus 3-day antibiotic prophylaxis in preventing SSI in a tertiary-care medical center. During June 2002 and March 2003, the patients who underwent CABG surgery and met the inclusion criteria were recruited and randomized to receive either 1-day antibiotic prophylaxis (1-day group) or 3-day antibiotic prophylaxis (3-day group). These patients were assessed daily during hospitalization and were followed up for one month postoperatively. The primary endpoint was SSI occurring up to 1 month after surgery. The definition of SSI was based on the criteria of the U.S. Centers for Disease Control (CDC). A logistic regression analysis was performed to find the potential risk factors of SSI.
Results: Among the 112 patients included in the study, fifty-eight were in the 1-day group and fifty-four in the 3-day group. Nine patients had SSI, four in 1-day group (6.9%) and five in 3-day group (9.3%). According to our logistic regression analysis, there was no sufficient evidence to show that 1-day or 3-day group had a higher probability of SSI than the other. All the patients of a particular participating surgeon had no SSI during this study. Unintended prolonged antibiotic use after surgery (beyond the protocol of 1-day or 3-day uses) had a direct association with SSI (O.R.: 77.5; 95% C.I.: 4.3-999.0). In addition, preoperative serum albumin (O.R.: 21.4; 95% C.I.: 1.2-383.0) and smoking (O.R.: 4.8; 95% C.I.: 1.1-21.3) had direct associations with SSI. On the other hand, preoperative intensive care, diabetes mellitus, surgeon and postoperative serum albumin were indirectly associated with SSI through their effects on the probability of having unintended prolonged antibiotic use after surgery. The participating surgeons were more prone to prolong antibiotic use after surgery in patients who had stayed in the intensive care unit before surgery or had diabetes mellitus, but less tendentious toward prolonged antibiotic use in patients who had higher values of postoperative serum albumin. One particular surgeon (versus the other four surgeons) has less tendency toward prolong the unintended use of antibiotic after surgery. Further analysis revealed that the greater the reduction of serum albumin level after surgery, the higher the probability of surgical site infection.
Conclusions: In this study there was no sufficient evidence to show that one-day or three-day antibiotic prophylaxis after CABG had a higher SSI rate than the other.
|
|---|
