KEBIJAKAN PENGGUNAAN ANTIBIOTIKA PROFILAKSI UNTUK MENCEGAH INFEKSI LUKA OPERASI DI RUMAH SAKIT (THE USE OF ANTIMICROBIAL PROPHYLAXIS TO PREVENT SURGICAL SITE INFECTIONS IN HOSPITAL)

Abstract

ABSTRACT Background: Surgical site infections (SS\u27s) are a major source of morbidity in hospi¬tals which occur in 2-5% of patients after clean extra-abdominal surgeries (e.g., tho¬racic and orthopedic surgery) and in up to 20% of patients undergoing intra-abdomi¬nal procedures. Studies following patients into the post discharge period have re¬ported even higher rates of postoperative infection. Antimicrobial prophylaxis admi¬nistered just before an operation begins could prevent intraoperative microbial con¬tamination and therefore minimize risk of surgical site infections. Objectives: This study aims to provide evidence on the effect of antimicrobial pro¬phylaxis for surgical procedures to reduce the incidence of surgical site infections. Method: a systematic review was carried out to analyze result of studies on antimi¬crobial prophylaxis for surgical procedures. The review was limited to evidence from Level 1A study designs. Eight relevant studies examining the use of prophylactic an¬tibiotics to prevent surgical site infections were identified, i.e. 6 meta-analyses and 2 systematic reviews. These reviews were of high quality and limited their source mate¬rial to randomized controlled trials. Results: All studies showed a marked reduction in the odds or relative risk of SSI when antibiotic prophylaxis was employed. Two meta-analyses in our review sug¬gested a trend towards lower rates of infection with use of broader-spectrum anti¬biotic rophylaxis, such as third generation cephalosporins. When compared with single dose prophylaxis, multiple dose prophylaxis generally did not result in significant ad¬ditional benefit. the risk of infection with single dose prophylaxis using long-acting antibiotics did not differ significantly from that seen with multiple-dose regimens. Conclusion: The use of antibiotic prophylaxis, administered in a timely manner, could significantly\u27prevent surgical site infections. The reviews suggest that broader spec¬trum antibiotics may be superior to limited-spectrum antibiotics for intra-abdominal or gynecologic surgeries. In addition, single-dose antibiotic prophylaxis appears to be at least as effective as multiple-dose regimens for a broad range of surgical procedures and may pose less risk to patients in terms of adverse events (e.g., C. difficile colitis) and less risk to the population in terms of microbial resistance. Keywords:antimicrobial prophylaxis, surgical site infections, meta-analysis, systematic review, efficaciou