Promotion of Appropriate Use of Antimicrobial Prophylaxis Agents in Oral and Maxillofacial Surgery

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  • NISHIKAWA Atsushi
    Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • KODAMA Yasumitsu
    Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • NAGAI Takahiro
    Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences
  • TAMURA Takashi
    Division of Pharmacy, Niigata University Medical and Dental Hospital
  • TAKANO Misao
    Department of Clinical Laboratory, Niigata University Medical and Dental Hospital
  • UCHIYAMA Masako
    Division of Infection Control and Prevention, Niigata University Medical and Dental Hospital
  • TANABE Yoshinari
    Division of Infection Control and Prevention, Niigata University Medical and Dental Hospital
  • TAKAGI Ritsuo
    Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences

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Other Title
  • 口腔外科手術における予防的抗菌薬適正使用への取り組み
  • コウコウ ゲカ シュジュツ ニ オケル ヨボウテキ コウキンヤク テキセイ シヨウ エ ノ トリクミ

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Abstract

  No clear index is available for prophylactic antimicrobial administration during oral and maxillofacial surgery. Moreover, the correct use is little understood. Therefore, the antimicrobials used for oral and maxillofacial surgery are often empirically chosen based on the characteristics of the medical facility or the experience of the surgeon. In our department, we have recommended the prophylactic use of a first-generation cephalosporin rather than a second-generation cephalosporin since July 2011. Our first-generation cephalosporin recommendation is the result of a study conducted by the infection control team (ICT) in our hospital. To confirm whether or not this change represents appropriate use of antimicrobials, we determined the incidence of surgical site infections (SSIs) in malignant tumor cases (n=140), in which SSI occurs most frequently (4.7%) among all cases (n=1,160), and prophylactic antimicrobials were administered between January 2009 and December 2013. In this study, 3 SSI cases were found in the cefazolin (CEZ) group (4.8%), and 3 SSI cases in the cefotiam (CTM) group (4.1%). Because the incidence of SSIs in the CEZ and CTM groups did not differ, we showed that a first-generation cephalosporin can prevent SSIs during oral and maxillofacial surgery similar to a second-generation cephalosporin. The prophylactic antimicrobial dosing period and change to internal use antimicrobial, as well as other SSI risk factors, require investigation.<br>

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