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OBJECTIVE:To provide reference for improving the rationality of perioperative prophylactic application of antibiotics in typeⅠincision operation of neurosurgery. METHODS:Medical records of 794 patients with typeⅠincision operation of neurosurgery were collected from our hospital during Jan.-Dec. 2016 in order to retrospectively investigate the perioperative prophylactic application of antibiotics and evaluate the rationality of drug use. RESULTS:Among all the 794 cases,433 used antibiotics for prophylaxis (single type was used in all cases),with utilization rate of 54.53％. Cefazolin(51.73％)and cefuroxime(21.48％)were the most frequently used antibiotics. The prophylactic application rate of 30 min-1 h before surgery was 85.45％ in 433 patients. Patients with prophylactic medication course≤24 h accounted for 68.36％. The main irrational drug use manifestations were long medication time(31.64％)and improper antibiotics selection(26.10％);other manifestations included improper medication timing(14.55％),etc. CONCLUSIONS:Unreasonable perioperative prophylactic application of antibiotics in typeⅠincision operation of neurosurgery exists in our hospital,such as improper drug selection,improper medication timing,long medication course. It is necessary to further strengthen the comprehensive interventions,so as to promote the rational use of antibiotics.
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OBJECTIVE:To systematically evaluate therapeutic efficacies of perioperative application of single-dose and multipie-dose of antibiotics for preventing surgical site infection after closed fractures patients receive incision and internal fixation,and to provide evidence-based reference.METHODS:Retrieved from PubMed,EMBase,CBM,Cochrane Library,CBM,CJFD,VIP and Wanfang database,RCTs about perioperative application of single-dose (trial group) and multiple-dose (control group) of antibiotics for preventing surgical site infection after closed fractures patients receive incision and internal fixation were collected.Meta-analysis was performed using Rev Man 5.3 statistical software after literature screening,data extraction and quality evaluation by improved Jadad.RESULTS:Finally 8 clinical studies were included,involving 3 457 patients.The results of Meta-analysis showed that there was no statistical significance in the rate of surgical site infection [OR=1.02,95％ CI(0.63,1.66),P=0.94)].Cefazolin stadies were included in subgroup analysis according to drug use,and results of Meta-analysis showed that there was no statistical significance in the rate of surgical site infection[OR=1.33,95％CI(0.55,3.20),P=0.52].CONCLUSIONS:Prophylactic application of single-dose of antibiotics is recommended for preventing surgical site infection after closed fractures patients receive incision and internal fixation.
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OBJECTIVE:To evaluate the effects of PDCA cycle management on perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department. METHODS:In retrospective analysis,512 discharge medical records, 861 ones and 1 070 ones were selected from our hospital before PDCA cycle management(Jan.-Dec. 2013,before intervention group), after first cycle of PDCA cycle management (Jan.-Dec. 2014,first intervention group) and after second cycle of PDCA cycle management(Jan.-Dec. 2015,second intervention group),respectively. The perioperative prophylactic application of antibiotics was analyzed comparatively before and after continuous intervention. RESULTS:After 2 cycles of PDCA cycle management intervention, the constituent ratio of internal fixation in orthopedics department increased significantly;utilization ratio of antibiotics,the rate of rational type,medication ratio 0.5-1 h before surgery,the rate of rational treatment course,the proportion of antibiotics use in accordance with indications increased from 50.20%,98.08%,93.77%,6.61%,82.10% to 58.41%,100%,99.04%,52.00%, 99.04%,respectively. The number of antibiotics type decreased from 4 to 2;the proportion of cephazolin increased significantly while that of clindamycin decreased significantly compared to before intervention. Postoperative prophylactic medication course decreased from(4.63 ± 2.42)d to(1.61 ± 0.75)d;the proportion of patients with medication course 72 h decreased significantly, with statistical significance (P<0.05). CONCLUSIONS:PDCA cycle management improves the rational rate of perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department in our hospital. The prophylactic medication course of our hospital is not yet fully controlled within 24 h so it should be further intervened.
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OBJECTIVE:To provide reference for rational prophylactic application of antibiotics in perioperative period of per-manent cardiac pacemaker implantation. METHODS:600 cases performed permanent cardiac pacemaker implantation in 2010(be-fore rectification),2012(during rectification)and 2014(after rectification)were randomly sampled from our hospital,and divided into control group,intervention group one and intervention group two. The prophylactic application of antibiotics was investigated and analyzed in 3 groups. RESULTS:For control group,intervention group one and intervention group two,the rates of rational type selection of antibiotics for prophylactic use were 7.25%,31.00% and 91.96%,respectively. The rates of rational medication timing of antibiotics for prophylactic use were 0,100% and 100%;average duration of prophylactic use decreased from (3.6 ± 1.2)d before intervention to(1.1±0.5)d and(1.0±0.2)d. There was no statistical significance in the incidence of postoperative infection(P>0.05). Compared with control group,average drug cost,antibiotics cost and drug ratio decreased significantly in in-tervention group,with statistical significane (P<0.05). CONCLUSIONS:Antibiotics special rectification is effective and improve the rational application of antibiotics in our hospital.
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OBJECTIVE:To standardize periooperative prophylactic application of antibiotics. METHODS:According to the characteristics of orthopaedic and parenchyma surgery,classifying evaluation table of typeⅠincision infection risk was designed sci-entifically and rationally. The individual application of antibiotics in surgery patients had been achieved through infection risk evalua-tion. High risk typeⅠincision patients used antibiotics rationally and low risk patients seldom used or didn’t use at all. RESULTS:Through using infection risks classifying table,the rate of antibiotics prophylactic application in typeⅠincision drops from 74.10%to 28.68%,and and the per capita duration of antibiotics prophylactic application shortened from 4.23 d to 2.21 d. The postopera-tive infection rate remained the same. CONCLUSIONS:Through infection risk classifying evaluation,individual application of anti-biotics can be achieved in surgery patients,so as to promote rational use of antibiotics for prophylactic use,reduce antibiotics dos-age and antibiotics abuse under the condition of controllable surgery infection.
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OBJECTIVE:To provide reference for the rational use of haemocoagulase hemostatic drugs in the clinic by under-standing the perioperative utilization. METHODS:In retrospective study,1 200 discharge records of perioperative prophylactic ap-plication of haemocoagulase hemostatic drugs were collected randomly during Jan.-Dec. 2014.,and then analyzed statistically in re-spects of consumption sum and amount,application,irrational drug use,etc. The cost of hemocoagulase accounted for 7.39% of total drug cost,among which Haemocoagulase agkistrodon for injection had the highest consumption amount and sum,with utiliza-tion ratio of 51.44%. Average medication time of hemocoagulase during perioperative period was 2.36d;maximal average cost of hemocoagulase was 684.52 yuan in ENT and head and neck surgery department/ stomatology department;ENT and head and neck surgery department/ stomatology department,urinary surgery department had long average medication time,being 3.85d and 3.50d. RESULTS:Only 39.42% haemocoagulase hemostatic drugs were reasonably used during perioperative period. The unreasonable manifestation included:improper medication time(52.15%), too long medication course after operation(35.75%),wrong usage (5.61%)and replacing various haemocoagulase hemostatic drugs without reason(5.06%). CONCLUSIONS:The striking phenome-non of irrational use of haemocoagulase hemostatic drugs during perioperative period is severely worrying,so we need to strength-en the standard management and pharmaceutical supervision and intervention by clinical pharmacists.
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OBJECTIVE:To investigate the effect of clinical pharmacist intervention on prophylactic application of antibiotics in cardiothoracic surgery. METHODS:Medical records of patients underwent cardiothoracic surgery were collected from our hospi-tal during Mar. to Apr. in 2014 (before intervention) and during Jun. to Jul. in 2014 (after intervention). Those were divided into pre-intervention group(n=115)and post-intervention group(n=119). The prophylactic application effect of antibiotics was com-pared before and after intervention. RESULTS:After intervention,the rates of prophylactic application were decreased significantly from 96.5% to 72.3%;the rationality rate of antibiotics selection was improved significantly from 27.9% to 94.2%;The course of prophylactic medication decreased significantly from(5.4±2.8)days to(2.3±1.8)days;the difference had statistical significance before and after intervention(P<0.01). The postoperative infection rate was decreased from 13.0% to 5.9%,the difference had no statistical significance(P=0.074). The average hospitalization time,average drug costs,and average hospitalization expenses were decreased significantly,the difference had statistical significance(P<0.05 or P<0.01). CONCLUSIONS:Clinical pharmacist inter-vention to prophylactic application of antibiotics in cardiothoracic surgery can control the infection effective and guarantee reason-able and safe use of drugs during perioperative period.
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Objective To investigate prophylactic application of antibacterial agents in perioperative period of vascular interven‐tional surgery in our hospital before and after intervention ,and to evaluate the effects of intervention measures .Methods One hun‐dred cases from March to May 2011 were selected as non‐intervention group ,and 100 cases from March to May 2012 after interven‐tion were selected as intervention group .Analysis was conducted on medical information of two groups by questionnaire about their antibiotic drugs use .we evaluated the the percentage of antimicrobial application ,drugs choice ,initial time of medicine treatment ,the course of medication and so on .Results The rational rate of antibacterial use increased from 6% (before intervention) to 99% (af‐ter intervention) (P<0 .01) .The rationality was improved significantly in respect of initial time of medicine treatment ,antibacterial agents and the course of medication .the percentage of antimicrobial application ,cost of antibacterials and the value of antibiotics use density (AUD) were decreased significantly .Conclusion The intervention of our hospital is feasible and effective ,and could signifi‐cantly improve the perioperative antibacterial application .