全面认识外科感染 合理使用预防性抗生素

外科感染是一种使用抗菌药物解决不了的而常需外科干预的感染,其主要特点是皮肤和黏膜屏障有了破损、多种内源性致病微生物从破坏部分入侵致病。最常见的外科感染是切口部位感染导管相关血循感染、肺炎和泌尿道感染。外科切口部位感染的发生与外科切口各类密切相关,清洁、清洁—污染、污染和污秽四关的感染发生率分别约为2.1%、3.3%、6.4%和7.1%。预防外科感染可从三方面着手,提高宿主抵抗力;手术操作细致;加强围手术期处理,包括预防性抗生素等。预防性抗生系的适应证为Ⅱ、Ⅲ类切口,一般选择一代头孢菌素用于非厌氧菌污染的手术,二代头孢菌素用于厌氧菌污染的手术。应在手术前8小时内用药,并在术后24小时停药,给药方法是一次静脉滴入。此外还需注意提高外科创口的氧张力、保持体温、控制血糖、合理皮肤准备和掌握延迟性一期缝合的适应证等。

Complete Understood Surgical Infections and Resenably use of Prophylatic Antibiotics

Surgical infections is an infection that will not resolve with antimicrobial therapy alone but also requires surgical intervention. Surgical infection occur after a mechanical breach of normal eithelial barriers and often involve multiple organisms. In recent years, a consensus conference involving surgical site infections(SST),includes any infection that occurs in an operative site. There are many nonsurgical infections that typically occurs in hospitalized surgical patients,include catheter-related bloodstream infections,pneumonia and urinary tract infections.Prophylactic antibiotics are indicated for all GI,obsterical,gynecologic, vascular, and open-heart procedures,but for clean operations remains controversial. The ideal time for antibiotic adminis-tration is just before the incision because this regimen produces better tissues antibiotic concen-tration at both the beginning and end of the operation. In general, one can choose a 1st generation Cephalosporin for operations not expected to encounter araerobes and a second generation Cephalosporin with anaerobic activity for procedures in which anaerobic contamination is likely.