南區某醫學中心人工關節置換術之預防性抗生素使用評估

Preliminary Evaluation of Prophylactic Antibiotic for Procedures after Total Joint Replacement in a Medical Center in Southern Taiwan

戴慶玲(Ching -Ling Tai)

指導教授 ： 詹道明

高雄醫學大學/藥學院/藥學研究所/碩士(2003年)

摘要

針對人工關節置換術給予適當之預防性抗生素，可以有效降低術後傷口感染。本研究以回溯性方法共納入326位病患，1年之術後感染率為8.6％。
探討預防性抗生素的投予模式對人工膝關節置換術傷口感染的影響時，發現單獨於麻醉誘導期投予靜脈注射 cefazolin 500 mg可降低早期傷口感染率（P = 0.019）。而術後額外併用 gentamicin或將術後預防性抗生素延長至3天以上對預防術後傷口感染並無明顯影響（P = 0.356；P = 0.513）。
探討各項因素對傷口感染率的影響時發現感染發生者的體重明顯較重(P = 0.030)。以羅吉斯迴歸(Logistic Regression)分析對早期傷口感染影響的相關性，發現術前使用單獨靜脈注射抗生素有較好預防療效（Odd Ratio：0.122，95% Confidence intervals 0.024~0.619，P = 0.011）。而引流管留置天數愈多天，反而會增加傷口感染的機率（OR: 2.024，95% CI 1.091~3.754，P = 0.025）。
本研究發現「預防性抗生素」的投予模式，有許多額外的用藥如抗生素局部沖洗或抗生素-骨水泥混合劑的使用，與術後併用 gentamicin 或延長術後預防性抗生素使用天數至3天以上均不能降低傷口感染的發生率，反而會增加藥物費用的支出。

關鍵字

人工關節置換術 ； 預防性抗生素 ； 傷口感染

並列摘要

Prophylaxis antibiotics to the total joint arthroplasty can decrease the wound infection rate after surgery. This study retrospectively collected 326 patients. The wound infection rate within one year of following was 8.6%.
The impact of prophylaxis antibiotics was discussed in this study. The results showed that a single intravenous injection of 500 mg of cefazolin during the anesthesia induction phase significantly decreased the early wound infection rate (P = 0.019). An extra utility of gentamicin or a prolonged use of prophylaxis antibiotics greater than 3 days after surgery did not significantly decrease the early wound infection rate (P = 0.356；P = 0.513).
Prognostic factors were analyzed between the infected and non-infected groups. A significantly higher weight was found in the wound infected group (P = 0.030). By using Logestic Regression to analyze the independent factors from the multiple variables to the early wound infection rate, it indicated that a single intravenous injection of cefazolin before surgery results a significantly better prophylaxis (Odd Ratio : 0.122, 95% Confidence intervals : 0.024~0.619, P = 0.011), and a longer time of drainage tube retention causes a significantly higher incidence of wound infection (OR: 2.024, 95% CI: 1.091~3.754, P = 0.025).
In this study, we found many procedures of prophylaxis to prevent the wound infection may cause extra medical cost without a significant benefit. Those procedures include the use of local antibiotic irrigation, antibiotics impregnated bone cement, adding gentamicin to cephalosporins after surgery, and the prolonged use of antibiotics greater than 3 days after surgery.

並列關鍵字

total joint arthroplasty ； prophylaxis antibiotics ； wound infection

參考文獻

陸、參考文獻

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