ﺑﺮرﺳﻲ اﺛﺮ آﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﭘﺮوﻓﻴﻼﻛﺘﻴﻚ در ﺟﻠﻮﮔﻴﺮي از ﻋﻔﻮﻧﺖ زﺧﻢ ﻣﺘﻌﺎﻗﺐ اﻋﻤﺎل ﺟﺮاﺣﻲ ﻏﻴﺮ اورژاﻧﺲ ﺗﻤﻴﺰ

Effect of Antibiotic Prophylaxis in Preventing Wound Infection in Elective Clean Surgical Procedures

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻋﻔـﻮﻧﺖ ﺯﺧـﻢ ﻣﺘﻌﺎﻗﺐ ﺍﻋﻤـﺎﻝ ﺟﺮﺍﺣﻲ، ﺷﺎﻳﻌﺘـﺮﻳﻦ ﻋﻔـﻮﻧﺖ ﺩﺭ ﺑﻴﻤـﺎﺭﺍﻥ ﺟـﺮﺍﺣﻲ ﻣﻲ ﺑﺎﺷـﺪ ﻛﻪ ﺣـﺪﻭﺩ 38 ﺍﺯ ﻛﻞ ﻋﻔـﻮﻧﺖ ﻫﺎﻱ ﺟـﺮﺍﺣﻲ ﺭﺍ ﺷﺎﻣـﻞ ﻣﻲ ﺷﻮﺩ ﺩﺭ ﻛﺘﺎﺏ ﻫﺎﻱ ﻣـﺮﺟﻊ ﺍﻋﻤﺎﻝ ﺟـﺮﺍﺣﻲ ﺭﺍ ﺑﻪ ﺍﻧﻮﺍﻉ ﺗﻤﻴـﺰ، ﺗﻤﻴـﺰ ـ ﺁﻟـﻮﺩﻩ، ﺁﻟـﻮﺩﻩ ﻭ ﻛﺜﻴـﻒ ﺗﻘﺴﻴـﻢ ﺑﻨﺪﻱ ﻣﻲ ﻛﻨﻨـﺪ ﻛﻪ ﻓﻘـﻂ ﺩﺭ ﮔـﺮﻭﻩ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺗﻤﻴـﺰ ـ ﺁﻟـﻮﺩﻩ ﻣﺼﺮﻑ ﺁﻧﺘﻲ ﺑﻴـﻮﺗﻴﻚ ﭘﺮﻭﻓﻴـﻼﻛﺘﻴﻚ ﺗﻮﺻﻴﻪ ﺷـﺪﻩ ﺍﺳﺖ ﻭ ﺩﺭ ﺍﻋﻤﺎﻝ ﺟـﺮﺍﺣﻲ ﺗﻤﻴـﺰ ﻣﺼـﺮﻑ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﭘـﺮﻭﻓﻴﻼﻛﺘﻴﻚ ﺑﻪ ﺟﺰ ﺩﺭ ﻣـﻮﺍﺭﺩ ﺧﺎﺹ ﺗﻮﺻﻴـﻪ ﻧﻤﻲ ﺷﻮﺩ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻳﻨﻜﻪ ﺩﺭ ﺣـﺎﻝ ﺣﺎﺿـﺮ ﺩﺭ ﻛﻠﻴﻪ ﺍﻋﻤـﺎﻝ ﺟـﺮﺍﺣﻲ ﻏﻴـﺮ ﺍﻭﺭﮊﺍﻧﺲ ﺗﻤﻴـﺰ ﺩﺭ ﺑﻴﻤـﺎﺭﺳﺘﺎﻥ ﻓﻴـﺮﻭﺯﮔﺮ، ﺁﻧﺘﻲ ﺑﻴـﻮﺗﻴﻚ ﭘﺮﻭﻓﻴﻼﻛﺘﻴﻚ ﺗﺠـﻮﻳﺰ ﻣﻲ ﮔـﺮﺩﺩ ﻛﻪ ﺍﻳﻦ ﻛﺎﺭ ﻣﻌـﺎﻳﺒﻲ ﺍﺯ ﻗﺒﻴﻞ ﺍﻟﻘﺎﺀ ﻣﻘـﺎﻭﻣﺖ ﺑﺎﻛﺘـﺮﻳﺎﻳﻲ ﻭ ﺗﺤﻤـﻞ ﻫـﺰﻳﻨﻪ ﺍﺿـﺎﻓﻲ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭ ﺭﺍ ﺑﻪ ﺩﻧﺒﺎﻝ ﺩﺍﺭﺩ، ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﺍﻳﻦ ﻫـﺪﻑ ﺻﻮﺭﺕ ﮔـﺮﻓﺖ ﻛﻪ ﺁﻳﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺁﻧﺘﻲ ﺑﻴـﻮﺗﻴﻚ ﭘﺮﻭﻓﻴـﻼﻛﺘﻴﻚ ﺩﺭ ﺍﻳﻨﮕـﻮﻧﻪ ﺍﻋﻤـﺎﻝ ﺟـﺮﺍﺣﻲ ﺩﺭ ﭘﻴﺸﮕﻴـﺮﻱ ﺍﺯ ﻋﻔـﻮﻧﺖ ﺯﺧـﻢ ﻣـﺆﺛﺮ ﺍﺳﺖ ﻳﺎ ﺧﻴـﺮ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺻﻮﺭﺕ ﻛﺎﺭﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﺍﺯ ﺧﺮﺩﺍﺩ ﻣﺎﻩ 1381 ﺗﺎ ﺍﺭﺩﻳﺒﻬﺸﺖ 1382 ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻓﻴﺮﻭﺯﮔـﺮ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ. ﺍﻭﻟﻴﻦ ﻣـﻮﺭﺩ ﺟﺮﺍﺣﻲ ﻏﻴـﺮ ﺍﻭﺭﮊﺍﻧﺲ ﺗﻤﻴـﺰ ﺑﺼﻮﺭﺕ ﺑﻠـﻮﻙ ﺗﺼﺎﺩﻓﻲ ﺍﻧﺘﺨﺎﺏ ﮔـﺮﺩﻳﺪ ﻭ ﺳﭙﺲ ﺑﺮ ﻣﺒﻨﺎﻱ ﺁﻥ ﺑﻠﻮﻙ ﻫﺎ ﺑﻪ ﻳﻜﻲ ﺍﺯ ﮔـﺮﻭﻩ ﻫﺎﻱ ﺩﺭﻳﺎﻓـﺖ ﻛﻨﻨﺪﻩ ﻭ ﻋـﺪﻡ ﺩﺭﻳﺎﻓﺖ ﻛﻨﻨﺪﻩ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﺗﻘﺴﻴـﻢ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ 121 ﺑﻴﻤﺎﺭ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 62 ﺑﻴﻤﺎﺭ 51/2 ﻫﻴﭽﮕﻮﻧﻪ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﺩﺭﻳﺎﻓﺖ ﻧﻜﺮﺩﻧﺪ ﻭ 59 ﺑﻴﻤﺎﺭ )48/8 ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﭘﺮﻭﻓﻴﻼﻛﺘﻴﻚ ﺩﺭﻳﺎﻓـﺖ ﻛﺮﺩﻧﺪ. ﺩﺭ ﻛﻞ ﺟﻤﻌﻴﺖ ﻣـﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 13 ﺑﻴﻤـﺎﺭ ﺩﭼﺎﺭ ﻋﻔـﻮﻧﺖ ﺯﺧﻢ ﻣﺤﻞ ﺟﺮﺍﺣﻲ ﺷﺪﻧﺪ ﻛﻪ 6 ﻧﻔﺮ ﺩﺭ ﮔـﺮﻭﻩ ﺩﺭﻳﺎﻓﺖ ﻛﻨﻨﺪﻩ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﻗـﺮﺍﺭ ﺩﺍﺷﺘﻨﺪ )4/95 ﺍﺯ ﻛﻞ ﺑﻴﻤـﺎﺭﺍﻥ( ﻭ 7 ﻧﻔﺮ ﺩﺭ ﮔـﺮﻭﻫﻲ ﻗﺮﺍﺭ ﺩﺍﺷﺘﻨﺪ ﻛﻪ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﻚ ﻣﺼﺮﻑ ﻧﻜـﺮﺩﻩ ﺑﻮﺩﻧﺪ )5/78 ﺍﺯ ﻛﻞ ﺑﻴﻤﺎﺭﺍﻥ(. ﺑﻴﻦ ﺩﻭ ﮔـﺮﻭﻩ ﺍﺯ ﻧﻈﺮ ﻓـﺮﺍﻭﺍﻧﻲ ﺑﺮﻭﺯ ﻔـﻮﻧﺖ ﻣﺤﻞ ﺯﺧـﻢ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺍﺧﺘﻼﻑ ﺁﻣﺎﺭﻱ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﺑﻪ ﺩﺳﺖ ﻧﻴﺎﻣﺪ( P=0.10)

Introduction & Objective: Post operative wound infection is the most common form of infection in surgical patients, containing about 38% of all surgical infections. In the text books surgical wounds are divided into 4 groups: clean, clean- contaminated, contaminated and dirty. Prophylactic antibiotic therapy is recommended only in clean -contaminated operations and is not routine in clean operations except for some special situations. However, prophylactic antibiotic therapy is used for all clean elective operations in Firoozgar hospital that has some disadvantages, including resistant strains of bacteria, and financial problems (extra cost) for patients. This study was done to determine whether antibiotic prophylaxis is an effective method in preventing wound infection in these operations or not. Materials & Methods: This interventional study (clinical trial) was done from June 2002 to May 2003 on 121 patients in Firoozager hospital. Patients who were candidate for elective clean surgical procedures divided into two groups, according to randomized numbers. Results: 62 patients (51.2%) received prophylactic antibiotic and 89 patients (48.8%) received no prophylaxis. Wound infection occurred in 13 patients (10.7%), 7 patients (5.78%) in Control group and 6 patients (4.95%) in antibiotic treatment group. There was no statistically significant difference between two groups. (P=0.1). Conclusions: According to results of this study, routine use of antibiotic prophylaxis is not recommended in clean elective operations.