Perioperative infection

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  • 周術期感染症

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Abstract

For many years, the history of surgery has been a history of fighting infection. Perioperative infection is as a result of risk during the preoperative, intraoperative, or postoperative periods, Postoperative infection, related to intraoperative procedures, and patient management accompanied to an operation, generates after operation, and is the most common complication among Postoperative complication, It is no exaggeration to say how to make a satisfactory postoperative result is influenced by the reduction of postoperative infection. For past decades, granting a preoperative patient to be not infected, a large amount of strong-acting, broad-spectrum agent for an antibiotic prophylaxis in a long period of postoperative time could be considered for routine in the prevention. Based of misunderstanding, the overconfidence, and the blind belief to an antibacterial potential, resulted in an inappropriate use of antibiotic prophylaxis in surgical patients, and an evil influence on the development drug-resistant strain such as the increasingly serious problem of methicillin-resistant Staphylococcus aureus (MRSA) infections, With this as a turning point, which lead to improvements in the choice of prophylactic antibiotic agents, and its usage emphasized the necessity for taking appropriate measures and for taking fully consideration to the wound contamination class and the resident flora of the intestine and the other. The Japanese Society of Chemotherapy and The Japanese Association for Infections Disease jpintly published a recommendation handbook supported by scrutinized discussions and consensus meetings held in the congresses of surgery and/or chemotherapy, was published: Practical Recommendations for Antimicrobial Therapy. The keypoint is 1) the use of antibiotic prophylaxis which has sufficient antimicrobial activity for a target (expected) causative pathogens, and which could maintain homeostasis of resident flora neither superinfection nor a resistant strain can appear easily, and 2) clearly distinguish “prophylactic agents” and “therapeutic agents.” Administration of a prophylactic agent may be just started before operation, and requiring a short time of duration, should not exceed 3-4 days including the day of surgery. After 3 days, if a postoperative infection is found or suspected, therapeutic agent administration must be selected. The CDC has also already detailed recommendation to antimicrobial prophylaxis. There are, however, some problems in application those recommendations to Japan, because there are many differences in the management of surgery between Japan and Western countries. The author suggested an urgent need for randomized control trials and surveillance in the country based on these guidelines.

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