JOURNAL READING

Dertermining the use of prophylactic antibiotics in breast cancer surgeries; a survey of practice

Research article; Acuna et Al 2012, BMC Surgery Available from : http//www.biomedcentral.com

LATAR BELAKANG
PAs Breast Cancer Surgery

Surgical Site infection (SSI) - Lama perawatan - Biaya meningkat - Intervensi tambahan - Estetika - Trauma psikologik

Komplikasi

LATAR BELAKANG
SSI
Menunda adjuvant terapi

Efek merugikan kelangsungan hidup

cegah

PAs

Menjamin kualitas surgical treatment

LATAR BELAKANG
Historically

PAs tidak perlu Breast; soft tissue perifer Tidak berhubungan visceral struktur Clean surgical prosedur

LATAR BELAKANG
Meskipun demikian

Reported

Tingkat SSI BCS lebih tinggi

1,9-50%

Dibandingkan CSP lainnya - PAs bermakna menurunkan tingkat SSI - Tujuan mengetahui penggunaan PAs

METODE
Metode survey online
Distributed between nov 2009-mar 2010

The breast surgeon member Of the colombian association Of mastology

kuisioner

Deskripsi analisa statistik dilakukan Dengan menggunakan SPSS 19,0

KUISIONER
1. In what city do you practice? 2. What is your specialty? Open answer. Choose one of the following: breast surgery, surgical oncology, general surgery, gynecology/obstetrics, or plastic surgery Open answer Choose one of the following: Private or private/academic Choose one of the following: <25%, 25 49%, 50 75%, or >75% Choose one of the following:<5 cases/month 5 15 cases/month, 16 25 cases/month, or >25 cases/month Select as many as are appropriate : breast conserving surgery, localized excision. mastectomy, axillary lymph node dissection biopsy, reconstruction with flap, sentinel lymph node, reconstruction with implant terminal conduct excision, and benign lesion excision

3. How many years of practice do you have in breast surgery? 4. What type of practice do you have? 5. What percentage of your cases corresponds to breast surgery? 6. What is your monthly breast surgery case load?,
7. Indicate from the following list of breast surgical procedures in which cases you administer prophylactic antibiotic:

KUISIONER
8. Do you use prophylactic antibiotic in all your breast surgeries? 9. What prophylactic antibiotic do you use?. 10. If you use prophylactic antibiotic, how do you administer it? Choose one of the following: yes or no. Open answer Choose one of the following: single pre-operative fixed-dose, single preoperative fixed dose followed by a second fixed dose if the surgery is prolonged, single preoperative fixed dose followed by one or more postoperative fixed doses for >24 hours, or single preoperative weight-adjusted dose. Select as many as are appropriate: older age, obesity, cancer, smoking, diabetes mellitus, active skin disease, neoadjuvant therapy, use of drains in situ, and surgical reintervention

11. If you do not administer routine prophylactic antibiotic, in what cases do you use it?

HASIL
88 orang ahli bedah terdistribusi, 47 responden memberikan jawaban 53,4%

40 responden menggunakan PAs 85,1%

60% menggunakan PAs pada mastektomi, diseksi nodul limfe axila dan atau rekonstruksi payu dara

Single dose preoperative (27,7%)

Single dose preoperative diikuti dosis Kedua jika operasi memanjang (47,7%) Single dose preoperative diikuti satu/dua dosis Post operasi > 24 jam (10,6 %)

HASIL

Common breast surgical procedures in which breast surgeons use prophylactic antibiotics

HASIL

Breast cancer patient characteristics reported to be taken into consideration for targeted prophylactic antibiotic use in breast cancer surgery

DISKUSI
Rincian pilihan obat responden sejalan dengan rekomendasi saat ini Ng et al. Inggris amoksisilinasam clavulonic lebih sering daripada cephalosporins Codina et al. 36% dari rumah sakit di Spanyol lebih memilih cefazolin Dulu, SSI BCS disebabkan oleh stafilokokus dan streptokokus

DISKUSI
Data terbaru 30-66,2% SSI BCS infeksi non-staphylococcal Codina et al. 36% dari rumah sakit di Spanyol lebih memilih cefazolin cefazolin waktu paruh panjang, dinilai mampu secara signifikan menurunkan SSI

DISKUSI
Pola praktek serupa Spanyol, 9% dari RS BCS memperpanjang penggunaan PAs, 24 jam saat melakukan BCS
penelitian Pas hanya 24 jam cukup untuk mencegah SSI

Pemakaian PAs lama meningkatkan risiko kekebalan kuman, infeksi nosokomial, diare, lebih tinggi biaya perawatan kesehatan

KESIMPULAN
AHLI BEDAH berperan penting menurunkan angka kejadian SSI BCS Survey ini sadar potensi SSI BCS Tetapi lebih banyak ditentukan oleh penggunaan PAs yang tepat PAs Tepat waktu dan tepat dosis

TERIMA KASIH