泌尿器科領域における周術期感染症阻止薬術前単回投与の検討

Abstract

2007年1年間に施行した尿路内視鏡手術114症例, 清潔手術92症例, 準清潔手術20症例に対し, 周術期感染症阻止薬の術前単回投与を行い, 手術部位感染(SSI), 尿路感染(UTI), 遠隔感染(RI), 術後合併症の発生頻度を前方視的に調査した。その結果, 尿路内視鏡手術ではUTI発生率が2.7%で, RIは認めなかった。清潔手術での発生率はSSI:1.1%, RI:2.2%, UTI:0%, 準清潔手術ではSSI:5%, RI:0%, UTI:5%であった。よって, 泌尿器科領域における尿路内視鏡手術, 清潔手術, 準清潔手術に対する周術期感染症予防抗菌薬の効果は, 術前単回投与で十分に期待できると考えられた。

A single-dose ofantimicrobial prophylaxis (AMP) was administered parenterally for prevention of perioperative infection in a total of 206 urologic surgeries including 114 endoscopic-instrumental, 92 clean, and 20 clean-contaminated procedures between January and December, 2007, and surgical site infections (SSI), urinary tract infections (UTI), and remote infections (RI) were prospectively surveyed. The definition of a single-dose of AMP allowed the administration of a second dose of an antimicrobial during a surgical procedure that exceeded 3 hours but not parenteral or oral administration at the end of the procedure, in the recovery room, or at a later time over a period of more than 24 hours. UTI was observed in 3 cases (2.7%) after endoscopic-instrumental procedures and in 1 case (5%) after clean-contaminated procedures while no case was associated with UTI in clean procedures. SSI was seen in 1 case each after clean procedures (1.1%) and after clean-contaminated procedures (5%), and RI was seen in 2 cases (2.2%) after clean procedures. A single-dose regimen of AMP was effective for prevention ofperioperative infections including SSI, UTI, and RI in endoscopic-instrumental, clean, and clean-contaminated surgical procedures in urology.