单剂量头孢曲松和多剂量头孢呋辛预防手术部位感染效果和药物经济学研究

Single-dose ceftriaxone versus multiple-dose cefuroxime for prophylaxis of surgical site infection

目的 探讨单剂量头孢曲松和头孢呋辛连用 3d预防胃肠手术部位感染的效果并进行药物经济学分析。 方法 5所医院连续 30 5例胃和结肠、直肠切除术患者随机分为头孢曲松预防组 (n =15 3)和头孢呋辛预防组 (n =15 2 )。手术前 0 5～ 1 0h分别静脉滴注头孢曲松 (1g ,只用 1次 )和头孢呋辛 (0 75 g ,连用 3d)。观察和记录患者一般情况、手术有关情况、不良反应及术后感染情况 ,计算与抗感染有关的治疗成本并进行分析。 结果 二组患者具有可比性。未发现与抗生素相关的不良反应。头孢曲松组和头孢呋辛组患者术后分别发生 7例 (4 5 8% )和 14例 (9 2 1% )感染并发症 (P =0 992 ) ,其中手术部位 (切口、腹腔 )感染 12例 (3 93% ) :头孢曲松组 2例 (1 31% ) ,头孢呋辛组 10例 (6 5 8% ) ,差异有显著性意义 (χ2 =5 6 0 7,P =0 0 18)。其他部位 (肺、尿路 )感染分别为5例和 4例 ,差异无显著性意义 (P >0 0 5 )。二组患者用于预防和治疗术后感染的相关费用 ,头孢曲松组为 2 83 5元 ,头孢呋辛组为 811 1元 ,差异有非常显著性意义 (Z =14 5 1,P =0 0 0 0 )。发生手术部位感染的患者与未感染患者相比 ,用于抗感染的费用平均增加 1175元 ,住院天数平均延长 15d。结论 单剂量头孢曲松比多剂量头孢呋辛预?

Objective To compare the effects and pharmacoeconomics of single-dose of ceftriaxone versus 3-day cefuroxime prophylaxis in patients undergoing gastric or colorectal resection. Methods Three hundred and five consecutive patients with gastric or colorectal cancer from 5 medical centers were randomly divided into ceftriaxone group ( n =153, receiving intravenously 1 g ceftriaxone 0.5～1 h prior to operation only) and cefuroxime group ( n =152, receiving 0.75 g cefuroxime preoperatively and the same dose q8h for 3 d). The patients′ intra- and postoperative status, adverse responses and infectious complications were observed and documented, and pharmacoeconomic parameters were analyzed. Results The disease distribution, operative procedures and patients′ conditions in the 2 groups were comparable. No adverse responses to the test antibiotics were observed. Postoperative infectious complications occurred in 7 cases in the ceftriaxone group(4.58%) and 14 cases in the cefuroxime group (9.21%), respectively ( P =0.992), among which, 12 cases were surgical site infections (incisional, intra-abdominal): 2 cases in the ceftriaxone group(1.31%), and 10 cases in the cefuroxime group(6.58%), (χ 2=5.607, P =0.018). The direct cost related to prevention and treatment of surgical site infections was 283.5 RMB in the ceftriaxone group and 811.1 RMB in the cefuroxime group( Z =14.51, P =0.000). Conclusion Both ceftriaxone and cefuroxime are safe and effective for prevention of surgical site infections. Single-dose ceftriaxone prophylaxis is sufficient for gastric and colorectal operations, with a better cost-effectiveness ratio.