泌尿器科周術期における抗菌薬の使用方法についてのアンケート報告

Abstract

泌尿器科周術期における抗菌薬の使用方法についてのアンケートを報告した.対象は, 全国242施設の泌尿器科医局で, 周術期の抗菌薬使用方法についてアンケート調査を行った.その結果, 149施設149名より回答(61.6%)を得た.149名の経験年数は平均18.9年, 149施設の泌尿器科病床数は平均22.4床, 泌尿器科常勤医師数は平均2.6人, 45施設(30%)で「周術期感染症阻止薬プロトコール」が規定されていた.抗菌薬投与のタイミングは「手術開始30分前～開始直前」が92%, 「術中の追加投与」は44%であった.抗菌薬はペニシリン/第1・2世代セフェムを第一選択としたのは消化管利用手術で78%, 他の術式で約90%, 投与期間は3日以内が60～90%であった.内服抗菌薬の追加投与は50～60%, 投与期間は消化管利用手術で7日以上, 他の術式では5～7日であった.以上, 泌尿器科医師の周術期感染阻止薬に対する意識は標準化されてきたと考えられた

In order to establish an acceptable guideline for prevention of perioperative infection following urologic surgery, a questionnaire survey on the theory of antimicrobial prophylaxis (AMP) was conducted among urologists in Japan in February 2004. A reply was obtained from 149 urologists working for institutes located all over Japan from Hokkaido to Kyushu areas. Ninety-two percent of the urologists agreed that AMP should be administered 30 min before an incision, and 44% replied that an additional dose of AMP is required in the case of prolonged intervention. Penicillins or the 1st or 2nd generation cephems were used by 89 to 93% of the urologists in operations not including bowel segments, while 78% preferred such AMP agents in the procedures including bowel segments. AMP was terminated within 3 days in 87% for genital operations, in 70 to 76% for laparoscopic operations, in 54 to 65% for other clean or clean-contaminated operations, and in 24% for operations without the bowel segments. Especially, 58% of the urologists continued AMP for more than 5 days after operations with urinary diversion using the intestine. When compared with the previous questionnaire survey by Shinagawa et al, our survey demonstrated that standard consensus of AMP has spread widely among urologists in Japan, although the recommendations published in Europe and United States are still controversial in Japan. Thus, further well-designed clinical trials are required to establish original guidelines in Japan.