Investigacion Sobre Antibioticos
Páginas: 14 (3436 palabras)
Publicado: 8 de noviembre de 2012
Antibiotic Management of Surgical-site Infections
Carlos A Mestres
European Infectious Disease, 2009;3(1):78-81
download pdf view ejournal
Surgical-site infections (SSIs) have been generally reported at rates of about 1% of patients but may affect as many as 20% in a limited number of European countries.1–6 A review of 48 European prevalence and incidence studies suggested that SSIs mayaffect between 2 and 5% of surgical patients, but concluded that it was difficult to pool or compare data from different studies due to disparities in study design, data collection and reporting.5 Differences in frequencies of types of adverse event between surgical specialities and risk factors should also be taken into account. Surveillance that monitors patients after they leave hospitaltypically uses a 30-day follow-up period, but a French multicentre study reported that 30 days was the median time of SSI occurrence.7
Most large-scale prevalence/incidence studies were carried out in the US, where a recent study of 723,490 inpatient surgical procedures identified 6,891 cases of SSI (1%), with a huge associated healthcare burden.8 SSIs accounted for an average 9.7 extra days inhospital at a cost of US$20,842 per case in the US study.8 The authors extrapolated their results to estimate a national cost of over US$900 million (406,730 additional hospital days), with a further cost of US$700 million for 91,613 readmissions for treatment.8 The additional time in hospital in this study is consistent with the above European review, which linked SSIs with an average additional 9.8days in hospital at a cost of €1,862–4,047 per case (2004 costs).5 The annual cost to European healthcare systems of an estimated 450,000–6,000,000 SSI cases was between €1.47 billion and €19.1 billion.5 SSIs are also linked with poor patient outcomes, and a reater than 2.5-fold increase in mortality has been reported compared with patients without an SSI.7
Factors Influencing Surgical-siteInfections
SSI rates depend on a number of factors related to the patient, procedure and institution. Patient risk factors include advanced age, obesity, smoking and chronic obstructive pulmonary disease (COPD).2,9–13 SSI risk is doubled at body mass index (BMI) values over 30kg/m2 compared with non-obese patients.2 Smoking has been linked with a more than 16-fold increase in SSI risk followingambulatory surgery (odds ratio [OR] 16.3, 95% confidence interval [CI] 1.58–175; p=0.019), and a six-fold higher rate following punch biopsy compared with neversmokers (12 versus 2%; p<0.05), although a recent study reported no difference in infection rates following minor skin surgery.9,12,13 Other risk factors include immunosuppression, for example following preoperativeirradiation.14 Institution size has also been linked to the risk of SSIs: a 12-month prospective study reported a 49% increased risk insmall community hospitals with under 1,500 procedures per year compared with medium-sized hospitals (1,500–4,000 procedures/year), but a 29% decreased risk in large hospitals (≥4,000 procedures/year).15Data from the Dutch nosocomial infection surveillance network suggest that this effectis due to prolonged duration of surgery by surgeons with low operation volumes.16
Antibiotic Prophylaxis
Prophylactic antibiotic administration is an established approach toreducing the risk of SSIs. A recent Cochrane review of 182 trials including 30,880 colorectal surgery patients concluded that pre-operative oral and intravenous antibiotics covering both aerobic and anaerobic bacteriacould reduce SSIs by at least 75%.17 The risk of antibiotic resistance emergence has encouraged widespread concern that antibiotics are over-prescribed for SSI prophylaxis, and guidelines advise restricting antibiotic use to high-risk patients and procedures.18 However, a recent systematic review of 21 meta-analyses of 256 clinical studies including 43,809 patients found no difference in risk...
Carlos A Mestres
European Infectious Disease, 2009;3(1):78-81
download pdf view ejournal
Surgical-site infections (SSIs) have been generally reported at rates of about 1% of patients but may affect as many as 20% in a limited number of European countries.1–6 A review of 48 European prevalence and incidence studies suggested that SSIs mayaffect between 2 and 5% of surgical patients, but concluded that it was difficult to pool or compare data from different studies due to disparities in study design, data collection and reporting.5 Differences in frequencies of types of adverse event between surgical specialities and risk factors should also be taken into account. Surveillance that monitors patients after they leave hospitaltypically uses a 30-day follow-up period, but a French multicentre study reported that 30 days was the median time of SSI occurrence.7
Most large-scale prevalence/incidence studies were carried out in the US, where a recent study of 723,490 inpatient surgical procedures identified 6,891 cases of SSI (1%), with a huge associated healthcare burden.8 SSIs accounted for an average 9.7 extra days inhospital at a cost of US$20,842 per case in the US study.8 The authors extrapolated their results to estimate a national cost of over US$900 million (406,730 additional hospital days), with a further cost of US$700 million for 91,613 readmissions for treatment.8 The additional time in hospital in this study is consistent with the above European review, which linked SSIs with an average additional 9.8days in hospital at a cost of €1,862–4,047 per case (2004 costs).5 The annual cost to European healthcare systems of an estimated 450,000–6,000,000 SSI cases was between €1.47 billion and €19.1 billion.5 SSIs are also linked with poor patient outcomes, and a reater than 2.5-fold increase in mortality has been reported compared with patients without an SSI.7
Factors Influencing Surgical-siteInfections
SSI rates depend on a number of factors related to the patient, procedure and institution. Patient risk factors include advanced age, obesity, smoking and chronic obstructive pulmonary disease (COPD).2,9–13 SSI risk is doubled at body mass index (BMI) values over 30kg/m2 compared with non-obese patients.2 Smoking has been linked with a more than 16-fold increase in SSI risk followingambulatory surgery (odds ratio [OR] 16.3, 95% confidence interval [CI] 1.58–175; p=0.019), and a six-fold higher rate following punch biopsy compared with neversmokers (12 versus 2%; p<0.05), although a recent study reported no difference in infection rates following minor skin surgery.9,12,13 Other risk factors include immunosuppression, for example following preoperativeirradiation.14 Institution size has also been linked to the risk of SSIs: a 12-month prospective study reported a 49% increased risk insmall community hospitals with under 1,500 procedures per year compared with medium-sized hospitals (1,500–4,000 procedures/year), but a 29% decreased risk in large hospitals (≥4,000 procedures/year).15Data from the Dutch nosocomial infection surveillance network suggest that this effectis due to prolonged duration of surgery by surgeons with low operation volumes.16
Antibiotic Prophylaxis
Prophylactic antibiotic administration is an established approach toreducing the risk of SSIs. A recent Cochrane review of 182 trials including 30,880 colorectal surgery patients concluded that pre-operative oral and intravenous antibiotics covering both aerobic and anaerobic bacteriacould reduce SSIs by at least 75%.17 The risk of antibiotic resistance emergence has encouraged widespread concern that antibiotics are over-prescribed for SSI prophylaxis, and guidelines advise restricting antibiotic use to high-risk patients and procedures.18 However, a recent systematic review of 21 meta-analyses of 256 clinical studies including 43,809 patients found no difference in risk...
Leer documento completo
Regístrate para leer el documento completo.