Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Association Between Prophylactic Antibiotic Use and Surgical Site Infection Based on Quality Assessment Data in Korea

요양급여적정성 평가자료를 이용한 예방적 항생제 사용과 수술부위 감염 발생의 관련성 연구

  • Kim, Kyoung-Hoon (Health Insurance Review & Assessment Service) ;
  • Park, Choon-Seon (Health Insurance Review & Assessment Service) ;
  • Chang, Jin-Hee (Health Insurance Review & Assessment Service) ;
  • Kim, Nam-Soon (Department of Preventive Medicine, Dongguk University College of Medicine) ;
  • Lee, Jin-Seo (Division of Infectious diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Choi, Bo-Ram (Health Insurance Review & Assessment Service) ;
  • Lee, Byung-Ran (Health Insurance Review & Assessment Service) ;
  • Lee, Kyoo-Duck (Health Insurance Review & Assessment Service) ;
  • Kim, Sun-Min (Health Insurance Review & Assessment Service) ;
  • Yeom, Seon-A (Health Insurance Review & Assessment Service)
  • 김경훈 (건강보험심사평가원) ;
  • 박춘선 (건강보험심사평가원) ;
  • 장진희 (건강보험심사평가원) ;
  • 김남순 (동국대학교 의과대학 예방의학교실) ;
  • 이진서 (한림대학교 의과대학 강동성심병원 감염내과) ;
  • 최보람 (건강보험심사평가원) ;
  • 이병란 (건강보험심사평가원) ;
  • 이규덕 (건강보험심사평가원) ;
  • 김선민 (건강보험심사평가원) ;
  • 염선아 (건강보험심사평가원)
  • Received : 2009.07.23
  • Accepted : 2010.02.08
  • Published : 2010.05.31
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Abstract

Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

Keywords

References

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