МАРАТ ОСПАНОВ АТЫНДАҒЫ БАТЫС ҚАЗАҚСТАН МЕМЛЕКЕТТІК МЕДИЦИНА

реаниматология, соның ішінде балалар

анестезиология және реаниматологиясы

Лапаротомиялық аппендоэктомия операциясынан кейінгі инфекциялардың профилактикасы ретінде цеф III ді қолдану.



Орындаған: Юлдашев Э.А. 101 топ
Тексерген: Кошмагамбетова Г.К.

III дің эффективтілігін анықтау.

плацебомен салыстырғанда операциядан кейін болатын инфекциялық асқынулар қаупі төмендейді ме?

цеф III ;
С – плацебо;
О –операциядан кейінгі инфекция

қаупін төмендету.

– кездейсоқтық.

таңдау арқылы 2 топқа бөлеміз.
1 топқа- цеф III 2 топқа-

плацебо тағайындау

алу
Зерттеуге қатысатын науқастардың 35не цеф III, 35не плацебо тағайындау

науқастар.
Критерий исключения: Антибиотиктерге аллергиясы бар, зерттеуге келісім бермеген науқастар

в интересах пациента

for antibiotic prophylaxis before cesarean delivery may further reduce the

rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section.
METHODS:
In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks.
RESULTS:
The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). There were significant differences between the azithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P=0.02), wound infection (2.4% vs. 6.6%, P<0.001), and serious maternal adverse events (1.5% vs. 2.9%, P=0.03). There was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P=0.63).
CONCLUSIONS:
Among women undergoing nonelective cesarean delivery who were all receiving standard antibiotic prophylaxis, extended-spectrum prophylaxis with adjunctive azithromycin was more effective than placebo in reducing the risk of postoperative infection.

операциядан кейін болатын инфекция қаупі төмендейді ме?

– плацебо;
О –операциядан кейінгі инфекция қаупін төмендету.

кездейсоқтық.

стандартную антибактериальную профилактику, расширенного спектра действия для профилактики с дополнительной азитромицин более эффективен,

чем плацебо в снижении риска развития послеоперационной инфекции.

in the United States, 1991-1997. Obstet Gynecol. 2003;101:289–96. [PubMed]
2. Mugford M, Kingston J, Chalmers

I. Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources. BMJ. 1989;299:1003–6.[PMC free article] [PubMed]
3. Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003;9:196–203.[PMC free article] [PubMed]
4. DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13 2007. 165:1–209. [PubMed]
5. Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;555(Suppl):178S–184S.[PubMed]
6. American College of Obstetricians and Gynecologists ACOG practice bulletin no. 120: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011;117:1472–83. [PubMed]
7. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999: Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97–132. [PubMed]
8. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery: American Society of Health-System Pharmacists. Am J Health Syst Pharm. 1999;56:1839–88. [PubMed]
9. Centers for Medicare and Medicaid Services Physician Quality Reporting Initiative (PQRI) specifications document. 2008 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2008PQRI MeasureSpecifications123107.pdf)
10. Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ) 2001;43:1–668.[PMC free article] [PubMed]