Retrospektivna analiza protimikrobne zaščite pri operacijah zlomov kolka v Splošni bolnišnici Jesenice v letih od 2018 do 2021

Jakobčič, Maja (avtor), Kerec Kos, Mojca (mentor), Mavsar Najdenov, Brigita (komentor)

Zlom kolka je pogosta poškodba starostnikov. Zdravljenje je najpogosteje operativno, pri čemer je eden najtežjih zapletov okužba kirurške rane, ki jo preprečujemo s preventivnimi ukrepi, med katerimi je tudi pravilna protimikrobna zaščita. Veljavne slovenske smernice pri ortopedskih operacijah priporočajo cefazolin, v primeru preobčutljivosti za β-laktamske antibiotike ali kolonizacije s proti meticilinu odpornim Staphylococcus aureus pa se priporoča vankomicin. V analizi protimikrobne zaščite pri operacijah zloma kolka pri bolnikih, starejših od 18 let, ki so se v letih od 2018 do 2021 zdravili v Splošni bolnišnici Jesenice, nas je zanimala skladnost uporabljene protimikrobne zaščite z veljavnimi slovenskimi smernicami in pojavnost okužbe kirurške rane. V retrospektivno raziskavo smo vključili 785 bolnikov od tega je bilo 531 žensk (67,6 %). Povprečna starost bolnikov je bila 79,3 leta. Protimikrobna zaščita je bila izvedena skladno s smernicami pri 76,8 % bolnikov. Skladnost uporabe cefazolina s smernicami je bila 77,5 %. največjo skladnost smo ugotovili pri odmerku cefazolina (99,1 %), najslabšo pa pri odmernem intervalu cefazolina (72,1 %). Skladnost uporabe vankomicina s smernicami je bila 32,4 %, pri čemer smo ugotovili največje odstopanje od smernic pri času aplikacije prvega odmerka vankomicina, ki je bil skladen le pri 38,8 % bolnikov, največjo skladnost pa pri izbiri in odmerku vankomicina (94,3 %). Za izboljšanje skladnosti protimikrobne zaščite bi bilo potrebno usmeriti ukrepe ne le na področje predpisovanja, ampak tudi na področje organizacije dela na oddelku glede aplikacije protibakterijskih učinkovin pri protimikrobni zaščiti. Do okužbe kirurške rane je prišlo pri štirih bolnikih. Povzročitelj okužbe je bil pri treh Staphylococcus aureus, pri enem Staphylococcus epidermidis. Bolniki z okužbo kirurške rane so bili vsi starejši od 65 let, med njimi so bile tri ženske in en moški. Imeli so več kot pet pridruženih bolezenskih stanj in bili uvrščeni v razred ASA klasifikacije 2 ali več. Pri dveh je šlo za zlom stegneničnega vratu, pri enemu za intertrohanterni zlom in pri enemu za subtrohanterni zlom. V medicinski dokumentaciji je najpogosteje manjkal podatek o času aplikacije prvega odmerka protibakterijske učinkovine (8,9 %). Podatka o stanju kirurške rane ob opravljenem prvem kontrolnem pregledu ni bilo navedenega pri 42,4 % bolnikov. Neustrezna medicinska dokumentacija onemogoča ugotavljanje skladnosti poteka zdravljenja, spremljanje izidov zdravljenja in identificiranje odstopanj ob različnih zapletih ob zdravljenju.

• Jezik: Slovenski jezik
• Ključne besede: zlom kolka, protimikrobna zaščita, skladnost s smernicami, okužba kirurške rane, dejavniki tveganja, medicinska dokumentacija
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: FFA - Fakulteta za farmacijo
• Leto izida: 2022
• PID: 20.500.12556/RUL-141631
• Datum objave v RUL: 03.10.2022

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Retrospective analysis of the antimicrobial prophylaxis in hip fracture surgery in Jesenice general hospital in years 2018 to 2021

Izvleček

A hip fracture is a common injury in the elderly. In most cases, hip fractures are treated surgically, with surgical site infection as one of the most serious complications. Perioperative antimicrobial prophylaxis is part of preventive measures against complications with surgical site infection. In Slovenian guidelines, cefazolin is recommended as the first choice for perioperative antimicrobial prophylaxis in orthopedic procedures. Vancomycin is recommended as an alternative in case of hypersensitivity to β-lactams or in case of methicillin-resistant Staphylococcus aureus colonization. We performed a retrospective study to analyze the use of perioperative antimicrobial prophylaxis in patients aged 18 years and over, who underwent hip fracture surgery at Jesenice general hospital in the period from 2018 to 2021. The compliance of antimicrobial prophylaxis with applicable Slovenian guidelines, as well as the incidence of surgical site infection, were determined. We included a total of 785 patients, amongst whom 531 (67.6%) were women. Their average age was 79.3 years. In 76.8% of the included patients, the antimicrobial prophylaxis was in accordance with the guidelines. Antimicrobial prophylaxis with cefazolin was found to be compliant with Slovenian guidelines in 77.5%, with dosing of cefazolin as the most consistent observed parameter (99.1%), and dosing interval of cefazolin as the least (72.1%). Antimicrobial prophylaxis with vancomycin was found to be compliant with Slovenian guidelines in only 32.4%, with the time of administration of the first dose of vancomycin as the least compliant observed parameter (38.8%) and the choice of vancomycin and its dosing as the most consistent observed parameter (94.3%). These findings show, that in order to improve compliance of perioperative antimicrobial prophylaxis with guidelines, it is necessary to direct measures not only in the field of prescribing antibacterial drugs, but also in the area of work organization in hospital departments to ensure the timely application of antibacterial drugs. Surgical site infection occurred in four patients. Staphylococcus aureus was identified in three cases, Staphylococcus epidermidis in one. All patients with a surgical site infection were older than 65 years, among them three women and one man. All of them had five or more comorbid conditions and were assigned to the ASA 2 class or higher. Two patients had a femoral neck fracture, one patient had an intertrochanteric and one subtrochanteric fracture. The medical documentation was mostly deficient in terms of information on the time of the application of the first dose of an antibacterial drug (8.9%). At the first control examination after hospital discharge in 42.4% of patients, who came to the first check-up, there was no information on the condition of the surgical wound in the doctor's report. Patients with incomplete data in their medical records cannot be included in determining treatment compliance, monitoring treatment outcomes, and identifying deviations in various treatment complications.

• Ključne besede: hip fracture, antimicrobial prophylaxis, compliance with guidelines, surgical site infection, risk factors, medical records