Restricted Usage of Prophylactic Antibiotics in Extremely Low Birth Weight Infants for Early-Onset Sepsis as Quality Improvement Program

Seung-Hyun Shin,Hyo-Won Kim,Younghwa Jung,Seung Han Shin,Ee Kyung Kim,Han Suk Kim 대한신생아학회 2016 Neonatal medicine Vol.23 No.4

Purpose: The prevalence of antibiotics resistant bacterial infection among preterm infants has been increased due to indeliberate use of prophylactic broad spectrum antibiotics. The objective of this study was to assess the effectiveness of restricted usage of prophylactic antibiotics by comparing the incidence of culture proven early onset sepsis (EOS). Methods: This was a retrospective cohort study for extremely low birth weight infants who were born in Seoul National University Children’s Hospital during 2009-2014. The groups were divided into two periods, from 2009 to 2011 (period I) and from 2012 to 2014 (period II) based on the implementation on quality improvement activity since 2012. The indication of prophylactic antibiotics were; 1) umbilical vein catheter (UVC) insertion for resuscitation in delivery room, 2) prolonged preterm premature rupture of membrane >18 hours, 3) maternal fever during labor or sustained septic amniotic fluid. The incidence of EOS and the rate of empirical antibiotics usage were compared between two periods. Results: A total of 245 infants were admitted to the neonatal intensive care unit during the study period. Baseline demographics and clinical characteristics were similar between two periods except UVC insertion rate. The rate of empirical antibio- tics usage significantly decreased in period II (71.1% for period I vs. 56.4% for period 2, P=0.022). Incidence of EOS was not different between two periods whether pro- phylactic antibiotics use or not. Conclusion: Quality improvement for reducing prophylactic antibiotics use may be effective to reduce a use of antibiotics without increasing EOS.

Using Short-Term Prophylactic Antibiotics for Prevention of Infectious Complication after Endobronchial Ultrasound-guided Transbronchial Biopsy

( Bo-guen Kim ),( Byeong-ho Jeong ),( Sang-won Um ),( Hojoong Kim ),( Heejin Yoo ),( Seonwoo Kim ),( Kyungjong Lee ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) helps facilitate the diagnosis of peripheral lung lesions. However, the prevention of infectious complications after EBUS-TBB has not been well established. Therefore, we analyzed short term oral antibiotics effects on the prevention of infectious complications. Methods We retrospectively analyzed 484 patients from the Radial EBUS Registry. Patients who underwent EBUS-TBB from March 2018 to March 2019 did not receive prophylactic antibiotics (“no prophylactic” group, n = 233), while patients who underwent EBUS-TBB from April 2019 to March 2020 did receive prophylactics (oral amoxicillin/clavulanate for 3 days; “prophylactic” group, n = 251). Multivariable logistic regression was used to identify independent factors for infectious complications. Results The median age of the study population was 66 years (IQR: 59-74 years), and 58.9% were male. Slightly over half of the patients (54.4%) were previous or current smokers. In 13% (n = 63) of patients, the procedure was performed using a guide sheath. Infectious complications occurred in 12 (5.2%) and 2 (0.8%) cases in the no prophylactic and prophylactic groups, respectively. In multivariable analysis, infectious complication was significantly related with cavitation (adjusted odds ratio [aOR], 9.065; 95% confidence interval [CI], 2.229-36.861; p = 0.002), low-density attenuation (LDA) of the lesion (aOR, 14.791; 95% CI, 3.969-55.114; p < 0.001), and combined obstructive pneumonic consolidation (aOR, 11.663; 95% CI, 1.259-108.030; p = 0.031), but prophylactic antibiotics was not a statistically significant factor (aOR, 0.251; 95% CI, 0.048-1.309; p = 0.101). In subgroup analysis, infectious complication occurred less when prophylactic antibiotics were used in patients with at least one risk factors (22.4% vs. 0%, p = 0.005). Conclusions Prophylactic antibiotics helped reduce the incidence of infectious complications after EBUS-TBB, especially patients with risk factors, such as cavitation, LDA in the lesion, and combined obstructive pneumonic consolidation.

척추 수술에서 예방적 항생제 사용의 유용성

박정욱,정남수,서현석,임오경,전창훈 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.3

Study Design: Retrospective comparative study. Objectives: The aim of this study was to compare the efficacy of prophylactic antibiotics in spinal surgery for the occurrence of postoperative surgical site infection (SSI) and host immune reactions depending on various administration regimens and protocols. Summary of Literature Review: The superiority of one regimen or protocol of prophylactic antibiotics over others for SSI in spinal surgery has not been clearly demonstrated. We designed a controlled clinical trial to compare the occurrence of SSI with the changes of hematologic results depending on prophylaxis regimens and protocols. Materials and Methods: Between January 2007 and February 2011, two hundred consecutive patients who had undergone thoracolumbar/lumbar surgery for degenerative or traumatic disease were included. Postoperative protocol was altered for each group of fifty consecutive patients; 1st generation cephalosporins for 5-days (group A), 2nd generation cephalosporins for 5-days (group B),1st generation cephalosporins for 3-days (group C), and 2nd generation cephalosporins for 3-days (group D). Preoperative antibiotic prophylaxis was administrated within 1 hour prior to surgical incision with the same trial antibiotics. Intraoperative bacterial culture was performed from the surgical site. The occurrences of SSI were evaluated as either incisional or organ/space SSI. Serial changes in hematologic inflammatory markers (WBC, ESR, CRP) and DIC markers (fibrinogen, FDP, D-dimer) were compared until postoperative 2weeks. Results: The study groups were homogeneous regarding age, sex, body mass index, estimated blood loss, diabetes mellitus, smoking,diagnosis, baseline laboratory values, and type of surgery including instrumentation. Overall, 13 cases of incisional SSI (6.5%) and 3cases (1.5%) of organ/space SSI occurred. There was no difference in the occurrence of incisional and organ/space SSI among the 4groups (P=0.690, 0.799). Laboratory results revealed that postoperative changes in hematologic inflammatory markers and DIC markers were not influenced by prophylaxis regimens and protocols (all P>0.05). Conclusions: The occurrences of SSI and host immune responses were not influenced by postoperative antibiotics regimens and protocols. Hematologic investigation revealed that host immune responses did not depend on the type of prophylactic antibiotics. 연구 계획: 후향적 비교 연구. 목적: 수술 후 예방적 항생제의 투여 기간의 차이에 따른 수술부위감염의 발생률을 비교하고, 숙주의 면역 반응 변화나 조직 손상 정도를 반영하는 혈액학적 검사의 추적을 통해 수술 후의 상태 차이를 관찰하여, 항생제 투여 기간 절감의 유효성에 대한 면역학적 근거를 제공하고자 하였다. 선행문헌의 요약: 수술 전 정맥주사를 통한 예방적 항생제의 사용은 수술부위감염을 예방하는 효과적인 수단으로, 척추 수술 영역에서도 그 유효성이입증되었다. 그러나 예방적 항생제 제형에 따른 차이나 수술 후 투여 기간 연장의 효과에 대해서는 아직 논란이 되고 있다. 대상 및 방법: 2007년 1월부터 2011년 2월까지 본원에서 흉요추부 및 요추부의 퇴행성 질환 또는 외상성 질환에 대해 수술적 치료를 시행 받은 연속적인 200명의 환자를 대상으로연구를 계획하였다. 시기에 따라 순차적으로 1세대 cephalosporin 계열을 5일간 사용한 환자군을 A그룹, 2세대 cephalosporin 계열을 5일간 사용한 환자군을 B그룹, 1세대 cephalosporin 계열을 3일간 사용한 환자군을 C그룹, 2세대 cephalosporin 계열을 3일간 사용한 환자군을 D그룹으로 분류하였다. 예방적 정주항생제는 수술 부위 절개 1시간전에 사용하였으며, 수술 중 수술 부위에 대한 세균 배양 검사를 시행하였다. 각 대상 환자들의 성별, 나이,체질량 지수(body mass index), 흡연, 당뇨병 여부, 혈중 알부민 수치와 임파구 수치, 수술 전 진단명 등의 환자 정보와 수술 시간, 수술 종류, 유합 분절,예상 출혈량(estimated blood loss, EBL) 등 수술 정보를 수집하였다. 수술 부위 감염의 발생은 절개 부위 감염(incisional SSI)과 장기/강 부위 감염(organ/pace SSI)을 모두 포함하여 평가하였다.혈액학적 감염 표지자(Hematologic inflammatory marker)로 백혈구 수(WBC), 적혈구 침강 속도(ESR), C-반응단백질(CRP)를 수술 후 2주간 반복 확인하였으며, 파종성 혈관내 응고증(disseminated intravascular coagulation, DIC)의 표지자인 섬유소원(fibrinogen),섬유소 분절물(FDP), D-이합체(D-dimer)를 반복 확인하였다. 결과: 각 그룹은 환자의 나이, 성별, 체질량 지수, 예상 출혈량, 당뇨 유무, 흡연 유무, 수술 진단, 수술 전 혈액학적 검사 수치, 수술 술기 등에 있어서 차이를 보이지 않았다. 총 13례의 환자에서 절개 부위 감염이 발생하였고(6.5%), 총 3례의 환자에서 장기/강 부위 감염이 발생하였다(1.5%). 각 그룹간 감염의 발생에 있어서 통계학적으로 유의한 차이는 보이지 않았다(P=0.690, 0.799). 또한 수술 후 혈액학적 감염 표지자 및 파종성 혈관내 응고증 표지자의 변화는 예방적 정주항생제의 종류나 사용 기간에 영향을 받지 않았다(all P>0.05). 결론: 수술 부위의 감염은 수술 후 사용한 예방적 정주항생제의 종류나 기간에 영향을 받지 않았으며, 혈액학적 표지자들의 추적 관찰을 통해 확인한 숙주의 면역반응 역시도 예방적 정주항생제의 종류나 기간에 영향을 받지 않았다.

정규 제왕절개 수술시 예방적 항생제 요법에 관한 연구

민경수 ( Kyung Soo Min ),김홍서 ( Heung Seo Kim ),이민아 ( Min A Lee ),김용일 ( Yong Il Kim ),서영석 ( Young Seok Seo ),이기환 ( Ki Hwan Lee ),이윤이 ( Yun Ee Rhee ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9

Objective : To evaluate effectiveness of short-course administration of prophylactic antibiotics in elective cesarean section compared with multiple, long-course administration. Methods : Forty women undergoing elective cesarean section had prophylactic antibiotics administration preoperatively and 2 times more within 24 hours after operation. Forty women was control group who had antibiotics administration postoperatively 5 or 6 times with multiple regimens and 7 days more per oral. Postpartum complications including febrile morbidity, endometritis, wound infection, urinary tract infection were recorded, as were the duration of hospital stay and need for therapeutic antibiotics. Results : Postpartum complications including febrile morbidity, endometritis, wound infection and urinary tract infection had no difference between two groups significantly. Also, their hospital stay had no difference significantly. Conclusion : Prophylactic and short-course antibiotics administration in elective cesarean section is considered to have no difference in comparison with multiple, long-course post-operative administration. Short-course prophylactic antibiotics administration will reduce side effect of drugs and resistance. Also it will provide better cost effectiveness.

The Efficacy of Postoperative Prophylactic Antibiotics in Orthognathic Surgery: A Prospective Study in Le Fort I Osteotomy and Bilateral Intraoral Vertical Ramus Osteotomy

Sang-Hoon Kang,유재하,이충국 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.1

Purpose: This study examined the efficacy of the postoperative prophylactic antibiotics used in orthognathic surgery. The prevalence of surgical site infections (SSIs) was determined according to the use of postoperative prophylactic antibiotics. Patients and Methods: Fifty-six patients were divided into 2 groups. Each patient intravenously received 1.0g of a third- generation cephalosporin (Cefpiramide) 30 minutes before surgery. Among them, 28 patients in the control group received 1.0g Cefpiramide twice daily until the third day after surgery. The postoperative wounds were examined regularly for the presence of infectious signs. Results: There was no significant difference in the incidence of postoperative wound infections between patients who had received postoperative prophylactic antibiotic administration and those who had not (p=0.639). Conclusion: Prolonged prophylactic antibiotic use after orthognathic surgery may not be necessary, provided that there are no other significant factors for wound infections.

고관절 및 습관절 인공관절 전치환술에서 수술절개 1시간 이내 예방적 항생제 투여를 위한 프로토콜

송은규(Eun Kyoo Song),윤택림(Taek Rim Yoon),박상진(Sang Jin Park),박경순(Kyung Sun Park),정우빈(Woo Bin Jung) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.2

목적: 마취 유도 직후에 항생제를 투여하고, 잘못된 부위 수술을 막기 위한 타임 아웃 프로토콜에 추가적으로 수술절개 1시간 이내에 예방적 항생제 투여를 확인하는 항목을 첨가하여, 적절한 예방적 항생제 투여의 순응도를 높이고자 하였다. 대상 및 방법: 고관절 및 슬관절에 인공관절 전치환술을 시행 받은 환자 중 수술방으로 전실 직전에 예방적 항생제를 투여 받고 타임아웃 프로토콜만 시행 받은 150명의 환자(A 군)와, 마취 유도 직후에 예방적 항생제를 투여 받고 항생제 투여 확인란이 첨가된 프로토콜을 시행받은 150명의 환자(B 군)를 대상으로 하였으며, 예방적 항생제 주사와 수술 절개까지의 평균 시간 및 절개 1시간 이내 항생제 투여 비율을 조사하고 비교하였다. 결과: 항생제 투여와 수술 절개까지의 시간 및 순응도는 A군에서 평균 43분과 60.6%였으며, B군에서 평균 18분과 100%였다. 두 군간의 순응도는 의미있는 차이를 보였다(p<0.01). 결론: 마취 유도 직후에 항생제 투여와, 잘못된 부위 수술을 막기 위한 타임 아웃 프로토콜에 예방적 항생제 투여를 확신하는 항목을 추가한 새 프로토콜은 수술절개 1시간 이내에 정맥내 예방적 항생제 투여를 보장하는데 효과적이고 쉽게 적용할 수 있는 방법이다. Purpose: We aimed that compliance could be improved by new protocol ensuring the adequate timing of intravenous antibiotic delivery onto an already existing time out system used to ensure exact surgical site. Materials and Methods: A group of 150 patients was administered prophylactic antibiotics just before entering operation room and performed only time-out protocol. Other group of 150 patients was administered prophylactic antibiotics directly after anesthetic induction and perfomed new protocol inclusive of checklist ensuring appropriate timing of antimicrobial prophylaxis. We compared mean time from prophylactic administration to surgical incision and compliance. Results: The average time from administration of the antimicrobial prophylaxis to the surgical incision for patients who was performed only time-out protocol was 43 minutes and compliance was 60.6%. The average time from administration of the antimicrobial prophylaxis to the surgical incision for patients who was performed new protocol was 18 minutes and compliance was 100%. There was a significant difference in compliance of two groups. Conclusion: New protocol ensuring the adequate timing of intravenous antibiotic delivery combined with administration of the antimicrobial prophylaxis directly after anesthetic induction were effective and easily adaptable method to ensure compliance with appropriate timing of prophylactic antibiotics.

Mechanical Bowel Preparation and Prophylactic Antibiotic Administration in Colorectal Surgery: A Survey of the Current Status in Korea

강병모,이길연,박선진,이석환 대한대장항문학회 2013 Annals of Coloproctolgy Vol.29 No.4

Purpose: The usefulness of mechanical bowel preparation (MBP) in colon surgery was recently challenged by many multicenter clinical trials and meta-analyses. The objectives of this study were to investigate current national opinions about MBP and prophylactic antibiotics (PA) and to provide preliminary data for developing future Korean guidelines for MBP and PA administration in colorectal surgery. Methods: A questionnaire was mailed to 129 colorectal specialists. The questionnaires addressed the characteristics of the hospital, the MBP methods, and the uses of oral and intravenous antibiotics. Results: A total of 73 questionnaires (56.6%) were returned. First, in regard to MBP methods, most surgeons (97.3%) used MBP for a mean of 1.36 days. Most surgeons (98.6%) implemented whole bowel irrigation and used polyethylene glycol (83.3%). Oral antibiotic use was indicated in over half (52.1%) of the responses, the average number of preoperative doses was three, and the mean time of administration was 24.2 hours prior to the operation. Finally, the majority of responders stated that they used intravenous antibiotics (95.9%). The responses demonstrated that second-generation cephalosporin-based regimens were most commonly prescribed, and 75% of the surgeons administered these regimens until three days after the operation. Conclusion: The results indicate that most surgeons used MBP and intravenous antibiotics and that half of them administered oral PA in colorectal surgery preparations. The study recommends that the current Korean guidelines should be adapted to adequately reflect the medical status in Korea, to consider the medical environment of the various hospitals, and to establish more accurate and relevant guidelines.

임상적 의사결정시스템 도입 후 수술 시 예방적 항생제 사용 평가

이정원,권성희,안혜림,한옥연,나현오 한국병원약사회 2011 병원약사회지 Vol.28 No.1

Prophylactic antibiotics for surgical patients are used to prevent surgical site infections(SSIs). If they are not used appropriately, in addition to the risk of SSIs, emergence of antibiotics-resistant bacteria and demands on healthcare resource probably increase. In Seoul St. Mary’s hospital, we set up Prophylactic Antibiotics(PA) practice guidelines for surgery in 2007 and established Clinical Decision Support System(CDSS) which recommend kinds and dosage of antibiotics in October 2008. The objects of our study are to evaluate the usefulness of CDSS program and to find methods of its improvements. We reviewed the electronic medical record charts of patients who underwent gastric surgery,colon surgery, cholecystectomy, hip replacement, knee replacement, hysterectomy, hysterotokotomy or cardiac surgery. The primary outcomes are average duration of PA use(PAU), prescription rate of recommended PA and prescription rate of inappropriate PA. The secondary outcomes are administration rate of first PA within 60 minutes before incision and average duration of hospitalization. We compared historical group(before introduction of CDSS, January~February 2008) and intervention group(after introduction of CDSS, January~February 2009)As a result, patients are 283 person in historical group, 328 in intervention group and 611 intotal. Average duration of PAU is decreased from 6.6days to 4.8days(p<0.0001), Prescription rate of recommended PA is increased from 69.3% to 76.2%(p=0.053) as marginal value and prescription rate of inappropriate PA is a little improved but not significantly(15.9% vs 13.7%, p=0.39). Administration rate of first PA within 60 minutes before incision(89.8 % vs 92.4%, p=0.25) and average duration of hospitalization(8.4days vs 8.6days, p=0.73) are not statistically significant, too. Furthermore, there are many differences between operations in improvements outcomes. Therefore, it is necessary to encourage appropriate use of PA by being forced into using CDSS and giving feedback actively.

정규 결장수술 후 예방적 항생제로 2제 병용요법과 3제 병용요법의 비교

김윤석,이승현,안병권,백승언 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.1

Purpose: The use of prophylactic antibiotics is the current standard of care after elective colorectal surgery. The aim of this study was to compare the efficacy of antibiotic prophylaxis with dual antibiotic therapy and triple antibiotic therapy after elective colorectal surgery. Methods: We studied consecutive patients underwent elective colorectal surgery from January to June, 2007. Patients of triple-therapy group were administered second cephalosporin, metronidazole, and aminoglycoside for early 3 mo and dualtherapy group were administered second cephalosporin and metronidazole for next 3 mo. The prophylactic antibiotics were administered 2-3 doses for 24 hr after surgery. The surgery for diverticulitis, inflammatory bowel disease, and colon obstruction were excluded. Wound conditions were checked on alternate days during the hospital stay and follow up at least for 30 days after discharge. Results: Over 6 mo, 110 patients were enrolled (59 dual-therapy group, 51 triple-therapy group). In two group, sex, age, American Society of Anesthesiology score, body mass index, combined diseases, and location of disease were similar. Wound infection rate were 1.7% in dual-therapy group and 2.0% in triple-therapy group (P=1.0). Anastomotic leakage rate were 5.1% in dual-therapy group and 2.0% in triple-therapy group (P=0.622). Conclusion: The addition of aminoglycoside to dual antibiotic therapy, second cephalosporin-metronidazole showed on advantage in prevention of postoperative wound complications. Further studies are required to establish appropriate guideline of antibiotic prophylaxis after elective colorectal surgery. Purpose: The use of prophylactic antibiotics is the current standard of care after elective colorectal surgery. The aim of this study was to compare the efficacy of antibiotic prophylaxis with dual antibiotic therapy and triple antibiotic therapy after elective colorectal surgery. Methods: We studied consecutive patients underwent elective colorectal surgery from January to June, 2007. Patients of triple-therapy group were administered second cephalosporin, metronidazole, and aminoglycoside for early 3 mo and dualtherapy group were administered second cephalosporin and metronidazole for next 3 mo. The prophylactic antibiotics were administered 2-3 doses for 24 hr after surgery. The surgery for diverticulitis, inflammatory bowel disease, and colon obstruction were excluded. Wound conditions were checked on alternate days during the hospital stay and follow up at least for 30 days after discharge. Results: Over 6 mo, 110 patients were enrolled (59 dual-therapy group, 51 triple-therapy group). In two group, sex, age, American Society of Anesthesiology score, body mass index, combined diseases, and location of disease were similar. Wound infection rate were 1.7% in dual-therapy group and 2.0% in triple-therapy group (P=1.0). Anastomotic leakage rate were 5.1% in dual-therapy group and 2.0% in triple-therapy group (P=0.622). Conclusion: The addition of aminoglycoside to dual antibiotic therapy, second cephalosporin-metronidazole showed on advantage in prevention of postoperative wound complications. Further studies are required to establish appropriate guideline of antibiotic prophylaxis after elective colorectal surgery.

Prospective Control Study of Clinical Effectiveness of Prophylactic Antibiotics in Laparoscopic Cholecystectomy on Infection Rate

양재도,유희철 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.2

Purpose: This study evaluated the effectiveness of prophylactic antibiotics in elective laparoscopic cholecystectomy (LCC) for thereduction of postoperative infection rate. Materials and Methods: Elective LCC was performed on 529 patients at Jeonbuk National University Hospital between April 2015and August 2017. A total of 509 patients were enrolled based on the inclusion criteria. This prospective study compared the resultsfor antibiotic group (AG) (n=249, cefotetan 1 g, 1 dose/prophylactic) and non-antibiotic group (NAG) (n=260). Results: There were no significant differences in clinical characteristics between the two groups: AG and NAG (p=0.580, 0.782, and0.325, respectively). Levels of C-reactive protein were higher in NAG compared to AG at postoperative day 2 (16.6±24.2 vs. 24.2±40.6; p=0.033). There were no significant differences in white blood cell counts and erythrocyte sedimentation rate. Fever≥38°C on postoperative day 2 occurred in 3 (1.2%) and 9 (3%) patients in AG and NAG, respectively. One patient in each grouphad subhepatic fluid collection by abdominal computed tomography, but there was no evidence of infection. Two patients inNAG (3%) had serous wound drainage on postoperative day 14. Conclusion: Our results showed no significant differences in patients receiving or not receiving prophylactic antibiotics duringLCC. Therefore, it is not necessary to use prophylactic antibiotics during elective LCC in patients who meet the inclusion criteria.