心臟外科術(shù)后手術(shù)部位感染

1、心臟外科術(shù)后手術(shù)部位感染北京協(xié)和醫(yī)院加強(qiáng)醫(yī)療科杜斌手術(shù)部位感染的后果心臟外科手術(shù)后的手術(shù)部位感染流行病學(xué)危險(xiǎn)因素診斷微生物學(xué)普通外科手術(shù)SSI的危險(xiǎn)因素SSI發(fā)生率11.4%(2542237)預(yù)防使用抗生素的正確率63.5%SSI的獨(dú)立預(yù)測(cè)因素年齡(=1.2每增加10歲)傷口分類(lèi)(清潔—沾染=6.4污染=3.7感染=9.3)抗生素預(yù)防(=0.5)手術(shù)前住院日(=1.1每增加3天)手術(shù)持續(xù)時(shí)間(=1.5每增加60分鐘)惡性腫瘤(=1.7)

2、急診手術(shù)(=1.99)手術(shù)前住ICU時(shí)間(=2.6)手術(shù)前?2h應(yīng)用抗生素預(yù)防(=5.3)LizanGarciaMGarciaCaballeroJAsensioVegasA.Riskfactsfsurgicalwoundinfectioningeneralsurgery:aprospectivestudy.InfectControlHospEpidemiol1997May18(5):3105SSI的危險(xiǎn)因素–NNIS危險(xiǎn)指數(shù)污染或感染手

3、術(shù)美國(guó)麻醉師學(xué)會(huì)(ASA)術(shù)前評(píng)估為34或5手術(shù)時(shí)間超過(guò)75%百分位時(shí)間點(diǎn)(T)指根據(jù)NNIS調(diào)查手術(shù)時(shí)間的75%百分位ASA術(shù)前評(píng)估常見(jiàn)手術(shù)的T時(shí)間點(diǎn)SSI危險(xiǎn)分類(lèi):手術(shù)種類(lèi)和T時(shí)間點(diǎn)SSI的診斷SSI的微生物學(xué)SSI的微生物學(xué)SSI的微生物學(xué)預(yù)防性抗生素使用何種抗生素抗生素vs.安慰劑1GCvs.2GC2GCvs.3GC氨基糖甙類(lèi)抗生素的作用萬(wàn)古霉素的作用何時(shí)使用療程如何預(yù)防性抗生素Antibioticprophylaxisfcar

4、diothacicoperations–metaanalysisofthirtyyearsofclinicaltrialsbyBruceKreterMarkWoodsJThacCardiovSurg1992104:5909僅入選前瞻性隨機(jī)盲法及對(duì)照研究預(yù)防性抗生素Versus安慰劑對(duì)照安慰劑較優(yōu)頭孢唑啉Versus頭孢呋肟或頭孢孟多2GC較優(yōu)1GC較優(yōu)心臟外科的預(yù)防性抗生素結(jié)論預(yù)防性抗生素安慰劑SSI減少5倍2GC(頭孢孟多和頭孢呋肟)

5、頭孢唑啉SSI降低1.5倍預(yù)防性抗生素48小時(shí)無(wú)益心臟外科中2GCvs.3GC頭孢曲松2gm單劑vs.SSI相似頭孢孟多多劑量頭孢曲松vs.SSI相似頭孢孟多BadelPSchmuzigerM.[Antiinfectionprophylaxisincardiacsurgery:comparisonofsingledoseceftriaxonecefamoleinrepeatdoses]SchweizRundschMedPrax.1989

6、May3078(22):6435NeidhartPVelebitVGunningKSuterPM.Acomparativestudyofcefamoleceftriaxoneasprophylaxisincardiacsurgery.Infection1990MarApr18(2):1014.氨基糖甙的作用Efficacyofcefazolincefamolegentamicinasprophylacticagentsincardiac

7、surgery:resultsofaprospectiveromizeddoubleblindedtrialin1030patientsbyAllenB.KaiseretalAnn.Surg1987206:7917氨基糖甙的作用氨基糖甙的作用結(jié)論心臟外科中慶大霉素不應(yīng)作用預(yù)防性抗生素使用頭孢孟多頭孢唑啉針對(duì)胸骨和血管供體部位的深部感染CABG中預(yù)防性抗生素的藥代動(dòng)力學(xué)研究頭孢呋肟(n=30)每日一次體外循環(huán)過(guò)程中加用一劑單一劑量血清水平

8、2mgLx8hr萬(wàn)古霉素(n=30)每日一次體外循環(huán)過(guò)程中加用一劑單一劑量血清水平4mgLx24hr結(jié)論:單一劑量的頭孢呋肟(3g或1.5g)或萬(wàn)古霉素(1.5g)可以使血清濃度在CABG手術(shù)后數(shù)小時(shí)達(dá)到并維持足以預(yù)防感染的水平VuisaloSPokelaRSyrjalaH.IssingledoseantibioticprophylaxissufficientfconaryarterybypasssurgeryAnanalysisofp

9、eripostoperativeserumcefuroximevancomycinlevels.JHospInfect.1997Nov37(3):23747.預(yù)防性使用萬(wàn)古霉素vs.1GC萬(wàn)古霉素和利福平替代頭孢唑啉作為CABG預(yù)防性抗生素手術(shù)部位感染率(每100例手術(shù))10.5(95%CI8.2–13.3)to4.9(95%CI3.2–7.1)P.001估計(jì)12個(gè)月內(nèi)節(jié)約$576655(澳元)SpelmanDHarringtonGRu

10、ssoPWesselinghS.Clinicalmicrobiologicaleconomicbenefitofachangeinantibioticprophylaxisfcardiacsurgery.InfectControlHospEpidemiol.2002Jul23(7):4024.預(yù)防性使用萬(wàn)古霉素vs.頭孢菌素接受心臟或大血管手術(shù)的321名成年患者隨機(jī)化頭孢唑啉頭孢孟多或萬(wàn)古霉素結(jié)果SSI:萬(wàn)古霉素組3.7%(4)vs.頭

11、孢唑啉組12.3%(14)vs.頭孢孟多組11.5%(13)p=0.05萬(wàn)古霉素組心臟外科手術(shù)后無(wú)胸部傷口感染發(fā)生(p=0.04)術(shù)后平均LOS:萬(wàn)古霉素組最低(10.1天p0.01)頭孢唑啉組最高(12.9天)醫(yī)院獲得性MRSCoN在皮膚表面的定植無(wú)萬(wàn)古霉素耐藥葡萄球菌或腸球菌的定植或感染MakiDGBohnMJStolzSMetal.Comparativestudyofcefazolincefamolevancomycinfsurg

12、icalprophylaxisincardiacvularoperations.Adoubleblindromizedtrial預(yù)防性使用萬(wàn)古霉素vs.3GC頭孢曲松(n=97)單一劑量2gm總感染率13.4%SSI4%(n=4)萬(wàn)古霉素(n=103)500mgIVq6hx48h總感染率10.7%SSI5%(n=5)SalminenUSViljanenTUTValtonenVVetal.Ceftriaxoneversusvancomyc

13、inprophylaxisincardiovularsurgery.JAC199944:28790本研究說(shuō)明至少在萬(wàn)古霉素耐藥葡萄球菌感染率較低的醫(yī)院中心臟外科手術(shù)應(yīng)用單一劑量頭孢曲松即可達(dá)到足夠的效果心臟外科手術(shù)預(yù)防性應(yīng)用萬(wàn)古霉素的適應(yīng)證降低人工瓣膜置換或人工血管植入手術(shù)后移植物MRSCoN或腸球菌感染的危險(xiǎn)性近期應(yīng)用廣譜抗生素治療的患者進(jìn)行任何心血管手術(shù)MRS或腸球菌外科感染率很高的醫(yī)院中任何心血管手術(shù)預(yù)防性抗生素的時(shí)機(jī)短程(1劑至

14、2天)Vs.長(zhǎng)程(3至6天)長(zhǎng)程較優(yōu)短程較優(yōu)心臟外科的預(yù)防性抗生素結(jié)論預(yù)防性抗生素安慰劑SSI減少5倍2GC(頭孢孟多和頭孢呋肟)頭孢唑啉SSI降低1.5倍預(yù)防性抗生素48小時(shí)無(wú)益患兒心臟手術(shù)后的預(yù)防性抗生素術(shù)前手術(shù)留置胸腔引流管留置CVCPOD2Protocol1(n=786)Protocol2(n=1095)Protocol3(n=2039)頭孢唑啉開(kāi)胸患者手術(shù)后應(yīng)用萬(wàn)古霉素和慶大霉素直至胸腔引流管拔除MaherKOVerElzen

15、KBoveELetal.Aretrospectivereviewofthreeantibioticprophylaxisregimensfpediatriccardiacsurgicalpatients頭孢唑啉頭孢唑啉患兒心臟手術(shù)后的預(yù)防性抗生素???:p0.05protocol2vs.13?:p0.05protocol1vs.23MaherKOVerElzenKBoveELetal.Aretrospectivereviewofthre

16、eantibioticprophylaxisregimensfpediatriccardiacsurgicalpatients患兒心臟手術(shù)后的預(yù)防性抗生素接受心臟手術(shù)的患兒預(yù)防性抗生素可能需要應(yīng)用到胸腔引流管拔除時(shí)MaherKOVerElzenKBoveELetal.Aretrospectivereviewofthreeantibioticprophylaxisregimensfpediatriccardiacsurgicalpatie

17、nts高?；颊咝呐K手術(shù)后長(zhǎng)程預(yù)防性抗生素前瞻性隨機(jī)研究接受心臟手術(shù)的高?；颊呒词中g(shù)后低心排需要強(qiáng)心藥物和IABP支持研究組(n=28)對(duì)照組(n=25)頭孢唑啉x24h替卡西林克拉維酸x48h小劑量萬(wàn)古霉素停用IABP圍手術(shù)期出院NiederhuserUVogtMVogtPetal.Cardiacsurgeryinahighriskgroupofpatients:isprolongedpostoperativeantibioticpro

18、phylaxiseffectiveJThacCardiovSurg1997114:1628高?；颊咝呐K手術(shù)后長(zhǎng)程預(yù)防性抗生素結(jié)果早期病死率:25%(728)vs.32%(825)p=0.397明確感染:50%vs.68%p=0.265肺炎(n=22)全身性感染(n=8)胸骨傷口深部感染(n=2)凝固酶陰性葡萄球菌菌血癥(5vs.3)共計(jì)1158次細(xì)菌培養(yǎng)中(血培養(yǎng)n=389血管內(nèi)導(dǎo)管n=208支氣管吸取物n=411IABPn=42傷口分

19、泌物n=108)322(28%)次細(xì)菌生長(zhǎng)兩組間無(wú)顯著差異血管內(nèi)導(dǎo)管和IABP(13vs.11)NiederhuserUVogtMVogtPetal.Cardiacsurgeryinahighriskgroupofpatients:isprolongedpostoperativeantibioticprophylaxiseffectiveJThacCardiovSurg1997114:1628高?；颊咝呐K手術(shù)后長(zhǎng)程預(yù)防性抗生素結(jié)果對(duì)于心

20、臟手術(shù)的高危患者采用長(zhǎng)程預(yù)防性抗生素及小劑量萬(wàn)古霉素和替卡西林—克拉維酸不能減少感染并發(fā)癥小劑量萬(wàn)古霉素不能降低革蘭陽(yáng)性球菌引起血管內(nèi)導(dǎo)管定植和感染NiederhuserUVogtMVogtPetal.Cardiacsurgeryinahighriskgroupofpatients:isprolongedpostoperativeantibioticprophylaxiseffectiveJThacCardiovSurg1997114:

21、1628短程vs.長(zhǎng)程預(yù)防單一劑量頭孢呋肟預(yù)防阿莫西林和奈替米星聯(lián)合應(yīng)用4天KriarasIMichalopoulosAMichalisAetal.Antibioticprophylaxisincardiacsurgery.JCardiovSurg(Tino).199738(6):60510長(zhǎng)程預(yù)防性抗生素對(duì)心臟手術(shù)后肺炎的影響CarrelTPEisingerEVogtMetal.Pneumoniaaftercardiacsurgery

22、ispredictablebytrachealaspiratesbutcannotbepreventedbyprolongedantibioticprophylaxis心血管手術(shù)后長(zhǎng)程預(yù)防性抗生素HarbarthSSameMHLichtenbergDCarmeliY.ProlongedAntibioticProphylaxisAfterCardiovularSurgeryItsEffectonSurgicalSiteInfections

23、AntimicrobialResistance.Circulation.2000101:29162921心血管手術(shù)后長(zhǎng)程預(yù)防性抗生素HarbarthSSameMHLichtenbergDCarmeliY.ProlongedAntibioticProphylaxisAfterCardiovularSurgeryItsEffectonSurgicalSiteInfectionsAntimicrobialResistance.Circulat

24、ion.2000101:29162921預(yù)防性抗生素對(duì)抗生素耐藥的影響37例血管外科手術(shù)患者阿莫西林—克拉維酸x3天(group1)氧氟沙星甲硝唑x3天(group2)氧氟沙星甲硝唑x1天(group3)17例未行手術(shù)或未應(yīng)用抗生素患者(對(duì)照組)結(jié)果第1和2組皮膚葡萄球菌對(duì)下列抗生素的敏感性顯著下降:鄰氯青霉素(12.8%vs.23.6%)和氧氟沙星(0.5%vs.85%)第3組結(jié)果介于1和2組之間分子生物學(xué)分型提示患者社區(qū)來(lái)源的敏感菌

25、株被醫(yī)院獲得的耐藥菌株(遺傳學(xué)不相關(guān))所替代結(jié)論長(zhǎng)程預(yù)防性抗生素可導(dǎo)致耐藥菌定植應(yīng)盡量避免TerpstraSNodhoekGTVoestenHGJetal.RapidemergenceofresistantcoagulasenegativestaphylococciontheskinafterantibioticprophylaxisICU中抗生素預(yù)防的費(fèi)用及合并癥61%的預(yù)防性抗生素醫(yī)囑超過(guò)1天超過(guò)1天的預(yù)防性抗生素總費(fèi)用達(dá)$4489

26、3應(yīng)用預(yù)防性抗生素超過(guò)4天的患者更容易發(fā)生菌血癥和導(dǎo)管感染NamiasNHarvillSBallSMcKenneyMGSalomoneJPCivettaJM.CostmbidityassociatedwithantibioticprophylaxisintheICU.JAmCollSurg.1999Mar188(3):22530預(yù)防性抗生素的副作用回顧性病例對(duì)照研究病例(n=23):應(yīng)用預(yù)防性抗生素(PAT)的擇期手術(shù)患者且難辨梭狀芽孢

27、桿菌毒素(CDT)陽(yáng)性對(duì)照(n=39):年齡性別和手術(shù)相匹配結(jié)果PAT錯(cuò)誤83%vs.44%5.1(1.10–23.64)手術(shù)至最后一劑抗生素的平均時(shí)間間隔3.1vs.1.7天P0.05LOS16.5vs.10.2天P0.05結(jié)論擇期手術(shù)患者長(zhǎng)程使用PAT增加CDT陽(yáng)性的風(fēng)險(xiǎn)KreiselDSavelTGSilverALCunninghamJD.SurgicalantibioticprophylaxisClostridiumdiffic

28、iletoxinpositivity.ArchSurg.1995Sep130(9):98993局部抗生素和SSI目的圍手術(shù)期應(yīng)用莫匹羅星清除鼻咽部攜帶的金黃色葡萄球菌是否能夠有效預(yù)防SSI試驗(yàn)設(shè)計(jì)隨機(jī)雙盲安慰劑對(duì)照試驗(yàn)?zāi)チ_星(n=315)安慰劑(n=299)從入院時(shí)開(kāi)始使用直至手術(shù)當(dāng)日KalmeijerMDCoertjensHvanNieuwlBollenPM.SurgicalSiteInfectionsinthopedicSurge

29、ry:TheEffectofMupirocinNasalOintmentinaDoubleBlindRomizedPlaceboControlledStudy.ClinInfectDis200235:353–8局部抗生素和SSIKalmeijerMDCoertjensHvanNieuwlBollenPM.SurgicalSiteInfectionsinthopedicSurgery:TheEffectofMupirocinNasalOi

30、ntmentinaDoubleBlindRomizedPlaceboControlledStudy.ClinInfectDis200235:353–8預(yù)防性抗生素應(yīng)用現(xiàn)狀90%(193215)應(yīng)用預(yù)防性抗生素?fù)衿谑中g(shù)和急診手術(shù)無(wú)差異與缺乏證據(jù)的手術(shù)相比推薦使用經(jīng)驗(yàn)性抗生素的手術(shù)應(yīng)用預(yù)防性抗生素的比例較高(96vs.74%P=0.000006)盡管缺乏證據(jù)部分手術(shù)中仍然普遍應(yīng)用抗生素幾乎50%的手術(shù)中第一劑預(yù)防性抗生素未在正確時(shí)機(jī)應(yīng)用21

31、%的病例預(yù)防性抗生素24h非標(biāo)準(zhǔn)抗生素方案非常普遍FinkelsteinRReinhertzGEmbomA.Surveillanceoftheuseofantibioticprophylaxisinsurgery.IsrJMedSci1996Nov32(11):10937預(yù)防性抗生素應(yīng)用現(xiàn)狀81%至94%的病例應(yīng)用預(yù)防性抗生素適時(shí)應(yīng)用抗生素手術(shù)前?2hrs應(yīng)用抗生素SilverAEichnAKralJPickettGBariePPryV

32、DearieMB.Timelinessuseofantibioticprophylaxisinedinpatientsurgicalprocedures.TheAntibioticProphylaxisStudyGroup.AmJSurg1996Jun171(6):54852髖關(guān)節(jié)骨折患者不正確應(yīng)用預(yù)防性抗生素時(shí)機(jī)過(guò)遲(手術(shù)后2hrs)70%(247352)過(guò)早或在手術(shù)中10%直至手術(shù)結(jié)束才應(yīng)用首劑39%(91231)抗生素的選擇胃腸外

33、應(yīng)用1GC94%療程手術(shù)后24hrs78%不正確應(yīng)用預(yù)防性抗生素的預(yù)測(cè)指標(biāo)沒(méi)有預(yù)防性抗生素的書(shū)面醫(yī)囑非教學(xué)醫(yī)院手術(shù)時(shí)間較短ZoutmanDChauLWattersonJMackenzieTDjurfeldtM.ACanadiansurveyofprophylacticantibioticuseamonghipfracturepatients.InfectControlHospEpidemiol1999Nov20(11):75251.Pl

34、attRZaleznikDFHopkinsCCetal.Perioperativeantibioticprophylaxisfhernirhaphybreastsurgery.NEnglJMed.1990322:153160.2.MatuschkaPRCheadleWGBurkeJDGarrisonRN.Anewstardofcare:administrationofpreoperativeantibioticsintheoperati

35、ngroom.AmSurg.199763:500503.3.SilverAEichnAKralJetal.Timelinessuseofantibioticprophylaxisinedinpatientsurgicalprocedures.TheAntibioticProphylaxisStudyGroup.AmJSurg.1996171:548552.4.FinkelsteinRReinhertzGEmbomA.Surveillan

36、ceoftheuseofantibioticprophylaxisinsurgery.IsrJMedSci.199632:10931097.5.LizanGarciaMGarciaCaballeroJAsensioVegisA.Riskfactsfsurgicalwoundinfectioningeneralsurgery:aprospectivestudy.InfectControlHospEpidemiol.199718:31031

37、5.6.ZoutmanDChauLWattersonJetal.ACanadiansurveyofprophylacticantibioticuseamonghipfracturepatients.InfectControlHospEpidemiol.199920:752755.不正確的預(yù)防性抗生素改進(jìn)預(yù)防性抗生素應(yīng)用時(shí)機(jī)的方法Louisville退伍軍人醫(yī)療中心由不同人員應(yīng)用手術(shù)前抗生素病房護(hù)士1992至1994手術(shù)室麻醉醫(yī)生1995

38、正確的時(shí)機(jī)手術(shù)前抗生素在切開(kāi)皮膚前1小時(shí)內(nèi)應(yīng)用MatuschkaPRCheadleWGBurkeJDGarrisonRN.Anewstardofcare:administrationofpreoperativeantibioticsintheoperatingroom.AmSurg1997Jun63(6):5003改進(jìn)預(yù)防性抗生素應(yīng)用的方法目的:評(píng)價(jià)自動(dòng)手術(shù)中報(bào)警對(duì)長(zhǎng)時(shí)間心臟手術(shù)應(yīng)用第二劑預(yù)防性抗生素的影響設(shè)計(jì):隨機(jī)對(duì)照評(píng)估者設(shè)盲試驗(yàn)患

39、者:接受超過(guò)4小時(shí)心臟外科手術(shù)的患者手術(shù)前已經(jīng)預(yù)防性應(yīng)用頭孢唑啉干預(yù):報(bào)警組(n=137):在術(shù)前預(yù)防性應(yīng)用抗生素后225分鐘手術(shù)室計(jì)算機(jī)自動(dòng)發(fā)出聲音和視覺(jué)報(bào)警信號(hào).30分鐘后要求巡回護(hù)士提醒是否已經(jīng)應(yīng)用第二劑預(yù)防性抗生素對(duì)照組(n=136)歷史對(duì)照組(n=480):研究前6個(gè)月ZatiGFlanaganHLJrCohnLHetal.Improvementofintraoperativeantibioticprophylaxisinpr

40、olongedcardiacsurgerybyautomatedalertsintheoperatingroom.InfectControlHospEpidemiol.2003Jan24(1):136.改進(jìn)預(yù)防性抗生素應(yīng)用的方法ZatiGFlanaganHLJrCohnLHetal.Improvementofintraoperativeantibioticprophylaxisinprolongedcardiacsurgerybyaut

41、omatedalertsintheoperatingroom.InfectControlHospEpidemiol.2003Jan24(1):136.預(yù)防性抗生素的現(xiàn)狀–心臟外科德國(guó)圍手術(shù)期預(yù)防除4家醫(yī)院外所有其他醫(yī)院(94%)均應(yīng)用1GC(n=3243%)或2GC(n=3851%)常常應(yīng)用24小時(shí)(n=6081%)預(yù)防性抗生素從不超過(guò)3天74%的醫(yī)院(n=55)對(duì)所有心臟手術(shù)均使用相同的預(yù)防性抗生素而26%的醫(yī)院(n=19)在部分患者

42、改變預(yù)防性抗生素多見(jiàn)于心臟移植預(yù)防性抗生素的改變根據(jù)藥敏結(jié)果(n=6385%)根據(jù)固定的時(shí)間表(n=710%)從不改變(n=45%)MarkewitzASchulteHDScheldHH.CurrentpracticeofperipostoperativeantibiotictherapyincardiacsurgeryinGermany.WkingGrouponCardiothacicSurgicalIntensiveCareMedi

43、cineoftheGermanSocietyfThacicCardiovularSurgery.ThacCardiovSurg.1999Dec47(6):40510.預(yù)防性抗生素的現(xiàn)狀–心臟外科德國(guó)手術(shù)后的經(jīng)驗(yàn)性治療總計(jì)應(yīng)用29種不同的抗生素分屬8個(gè)種類(lèi)一線(xiàn)二線(xiàn)和三線(xiàn)治療間無(wú)顯著差異以下情況除外?內(nèi)酰胺類(lèi)抗生素(碳青霉烯類(lèi)除外)的應(yīng)用逐漸減少?gòu)囊痪€(xiàn)的60%下降到三線(xiàn)的23%糖肽類(lèi)抗生素應(yīng)用逐漸增加從一線(xiàn)的5%升高到三線(xiàn)的18%ICU和普

44、通病房應(yīng)用相同抗生素:N=41(55%)預(yù)防和手術(shù)后治療選擇相同的抗生素:N=9(12%)聯(lián)合治療:N=12(16%)MarkewitzASchulteHDScheldHH.CurrentpracticeofperipostoperativeantibiotictherapyincardiacsurgeryinGermany.WkingGrouponCardiothacicSurgicalIntensiveCareMedicineoft

45、heGermanSocietyfThacicCardiovularSurgery.ThacCardiovSurg.1999Dec47(6):40510.心臟外科術(shù)后感染KriarasIMichalopoulosATurinaMGeroulanosS.Evolutionofantimicrobialprophylaxisincardiovularsurgery.心臟外科術(shù)后感染結(jié)果總感染率4.5–5.7%SSI1.1%(Range0.4–

46、2.5%)全身性感染0.8%(Range0.4–1.6%)肺炎2.0%(Range0.7–2.9%)泌尿系感染0.4%(Range0.0–1.4%)中心靜脈插管相關(guān)性感染0.4%(Range0.0–1.0%)30天病死率1.3%(Range0.4–2.0%)KriarasIMichalopoulosATurinaMGeroulanosS.Evolutionofantimicrobialprophylaxisincardiovularsu

47、rgery.心臟外科術(shù)后感染總結(jié)盡管采用預(yù)防性抗生素(1GC2GC或3GC)不同療程長(zhǎng)短也不盡相同但感染率均較低(range4.5–5.7%)由于單一劑量抗生素已成功用于心血管外科的預(yù)防因此術(shù)后無(wú)須使用抗生素除非術(shù)中或術(shù)后感染明確或發(fā)生嚴(yán)重的圍手術(shù)期并發(fā)癥KriarasIMichalopoulosATurinaMGeroulanosS.Evolutionofantimicrobialprophylaxisincardiovularsur