• 기본간호학회지
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• 제25권4호
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• pp.240-249
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• 2018

Purpose: The study was done to explore whether the duration of perioperative prophylactic antibiotics therapy influenced uncertainty of recovery in patients with elective laparoscopic uterine myomectomy. Methods: A prospective study was conducted using self-report questionnaires and electrical medical records for patients with uterine myomectomy. According to the length of the perioperative prophylactic antibiotics therapy, the patients were divided into three groups: single-dose antibiotic treatment group, short-term antibiotic treatment group, and long-term antibiotic treatment group. Data were collected from December 20, 2016 to July 31, 2017 from 161 patients who underwent laparoscopic myomectomy at a metropolitan city general hospital. Results: Level of uncertainty of recovery was $2.98{\pm}0.22$. The uncertainty was highest in the long-term antibiotic treatment group, followed by the short-term antibiotic treatment group and the single-dose antibiotic treatment group (F=89.40, p<.001). In the regression analysis, factors influencing uncertainty of recovery among uterine myomectomy patients were duration of perioperative prophylactic antibiotic therapy (${\beta}=.70$, p<.001) and duration of NPO (${\beta}=-.11$, p=.047) which explained 51.5% of the variance (F=83.75, p<.001). Conclusion: Based on these results, information including the administration of antibiotics before surgery should be provided to the patients to help reduce the uncertainty of postoperative recovery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권6호
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• pp.474-480
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• 2005

We evaluated the need for prophylactic postoperative oral antibiotic medication in extraction of asymptomatic impacted mandibular third molars. All patient didn't show sign of pain, inflammation, swelling and trismus at the time of extraction. In the experimental group, oral antibiotic medication(Amoxicillin) was carried out for 5 days postoperatively. In the control group, the patients received no antibiotic medication. All groups didn't use antibiotic irrigation solution. Rule of group composition randomized. The surgical technique was the same in all cases. Parameters that were evaluated were infection, pain, facial swelling, trismus. We could not find any significant difference between the experimental and control groups.(P<0.05) The results of our study show that post operative oral prophylactic antibiotic medication after the extraction of impacted mandibular third molars does not contribute to less infection, pain, facial swelling and increased mouth opening after surgery. Therefore we suggest that prophylactic postoperative oral antibiotic medication is not needed in extraction of asymptomatic impacted mandibular third molars.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.36-41
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• 2024

Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection (p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.

• 디지털융복합연구
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• 제14권6호
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• pp.325-333
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• 2016

본 연구는 일개 대학병원의 수술 예방항생제 사용의 실태 및 적정성 평가 주기별 변화를 분석, 향후 수술 예방항생제 사용 및 평가 지침에 대한 기초자료를 마련하는 것을 목적으로 시행되었다. 요양급여 적정성 평가가 시행된 첫해인 2007년 1차 평가부터 2008년, 2009년, 2010년, 2012년, 2014년을 조사기간으로 선정하였다. 본 연구를 위해 건강보험심사평가원의 요양급여 적정성 평가 자료를 이용하였으며, 위수술, 대장수술, 담낭절제술의 평가지표 중 최초 투여시기 1항목, 항생제 선택 3항목, 투여 기간 2항목의 연도별 변화 추이를 분석하였다. 분석결과, 항생제 투여일수는 위수술의 경우, 2007년 13.5일에서 2014년 1.5일로 감소하였고, 대장수술은 2007년 12.8일에서 2014년 1.5일로 감소하였다. 담낭절제술 또한 2007년 6.9일에서 2014년 0.6일로 감소한 것으로 나타났다. 위와 같은 결과를 토대로, 수술 예방항생제 사용의 질적 향상을 위하여 의료진들이 충분히 받아들일 수 있을 만한 권고사항(또는 지표) 의 마련 및 그러한 권고사항의 효율적인 배포와 전달을 위한 노력이 필요할 것으로 생각된다. 더불어 병원이 스스로 장애 요인을 파악하여 개선할 수 있도록 모니터링 제도 실시를 고려해 볼 수 있을 것이다.

• Archives of Plastic Surgery
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• 제43권6호
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• pp.590-594
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• 2016

Recently, the number of cases of animal bite wounds has increased significantly in concordance with an increase in the pet population around the world. The authors report two rare cases of osteomyelitis of the phalanx following cat and dog bites. On initial physical examination, signs of a severe infection were observed. Radiographs of both patients showed the presence of osteomyelitis, and in one of the patients, the diagnosis was confirmed with a bone biopsy. After use of empirical antibiotics, intravenous antibiotic therapy that matched the identified bacterium's sensitivity was initiated, and at the same time, secure dressing including debridement was performed to induce secondary healing. In addition, the patients were closely monitored with serial X-rays, and culture and blood test follow-up. One patient fully recovered without sequelae, but the other patient suffered a loss of distal interphalangeal joint motion. When dealing with bite wounds located on the hand, it is important to visit the hospital as soon as possible and receive the appropriate treatment early. Moreover, to prevent severe complications such as osteomyelitis, it is important to administer antibiotic therapy to which the cultured bacteria are sensitive, along with proper wound management and prophylactic antibiotic treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권1호
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• pp.46-54
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• 1995

Postoperative infection following orthognatic surgery is rare. When postoperative infections occur, the initial treatment consists of incision and drainage of the affected area, culturing to identify bacterial stains and verify antibiotic sensitivity, and the institution of the appropriate antibiotic regimen. Some plates and screws may eventually require removal, the initial therapy should be attempted to retain the plates and screws until adequete healing has taken place. In orthoganthic surgery, intra-operative complications as a lesion of inferior alveolar nerve, fracture of osteomised segments, incomplete sectioning, malposition of segments, haemorrhage may occur. The surgeon should be familiar with possible complications to be caused and how to manage them. Prevention of postoperative infection following the orthognathic surgery consists of minimal periosteal reflection, aseptic management of operation field, proper surgical technique, rigid fixation, prophylactic antibiotics.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권5호
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• pp.212-219
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• 2018

Objectives: The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition. Materials and Methods: The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed. Results: The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or followup (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106). Conclusion: Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.

• Clinical and Experimental Pediatrics
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• 제54권2호
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• pp.79-85
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• 2011

Purpose: We studied the differences in the antibiotic susceptibilities of the microorganisms that causeing urinary tract infections (UTI) in children to obtain useful information on appropriate drug selection for childhood UTI. Methods: We retrospectively analyzed the antibiotic susceptibilities of 429 microorganisms isolated from 900 patients diagnosed with UTI in the Department of Pediatrics, Chungbuk National University Hospital, from 2003 to 2008. Results: The most common causative microorganisms for UTI were Escherichia coli (81.4%), Klebsiella pneumoniae (8.4%), Enterobacter spp. (1.7%), and Proteus spp. (0.4%). E. coli showed relatively high susceptibility as compared to imipenem (100%), amikacin (97.7%), aztreonam (97.9%), cefepime (97.7%), and ceftriaxone (97.1%), while it showed relatively low susceptibility to gentamicin (GM) (79.0%), trimethoprim/sulfamethoxazole (TMP/SMX) (68.7%), ampicillin/sulbactam (33.0%), and ampicillin (AMP) (28.6%). There were no significant differences in the image findings for causative microorganisms. Conclusion: Gram-negative organisms showed high susceptibility to amikacin and third-generation cephalosporins, and low susceptibility to AMP, GM, and TMP/SMX. Therefore, the use of AMP or TMP/SMX as the first choice in empirical and prophylactic treatment of childhood UTI in Korea should be reconsidered and investigated further.

• 대한소아치과학회지
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• 제27권2호
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• pp.208-215
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• 2000

선천성 심장질환 환자는 감염성 심내막염에 감수성을 가지고 있고, 치과치료후에 균혈증에 의해서 감염성 심내막염이 발생할 수 있다. 따라서 선천성 심장질환 환자에 있어서 감염성 심내막염을 유발할 수 있는 치과치료를 시행 시에는 예방적항생제의 투여가 추천된다. 1997년 미국 심장학회에서는 감염성 심내막염의 예방을 위한 개정된 지침을 발표하였다. 개정된 지침은 예방적 항생제 투여의 적응증, 항생제의 선택, 투여용량 등에 있어서 이전의 지침과 차이가 있다. 이전의 지침은 출혈을 유발할 수 있는 모든 치과시술에 대해서 예방적 항생제의 투여를 추천하고 있으나 개정된 지침은 술자의 판단에 따라 심한 출혈이 있는 경우에만 예방적 항생제를 투여할 것을 추천하고 있다. 또한 이전의 지침에선 술전과 술후 2회의 예방적 항생제 투여를 추천하였으나 개정된 지침에서는 술후 투여가 없어지고 술전 1회만 예방적 항생제를 투여 할 것을 추천하고 있다. 본 증례는 미국심장학회에서 최근에 발표한 선천성 심장질환 환자의 치과치료시의 예방적 항생제 투여 지침에 따라서 3명의 선천성 심장질환 환아를 대상으로 치과치료 후 그 예후를 관찰한 것이다.

• Pediatric Infection and Vaccine
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• 제7권2호
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• pp.225-232
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• 2000

목 적 : 올바른 항생제의 사용을 위해서는 우선 항생제 사용 실태의 파악과 함께 검사실의 확충, 의료진의 협조 등 다양한 노력과 보완이 요구된다. 본 연구는 적절한 항생제 사용의 기반을 마련하고자 현재 시행되고 있는 항생제 사용 실태를 조사하였다. 방 법 : 전북대학교병원에 입원한 환자 총 1,833명을 대상으로 의무기록을 통하여 항생제의 사용 여부, 종류, 사용 기간, 용량, 항생제의 투약 시작 시기 및 투여 목적을 조사하였다. 결 과 : 전체 조사 대상 환자 1,833명 중 입원 기간 중 항생제를 사용한 환자는 1,231명으로 67.2%였으며, 계별로 살펴보면 내과계는 전체 1,014명 중 497명(49.0%)이 항생제를 사용하였고, 외과계는 819명 중 734명(89.6%)에서 항생제를 사용하였다. 전체 항생제를 사용한 환자 1,231명 중 706명(57.4%)에서 예방 목적으로 사용하였고, 525명(42.6%)에서 치료 목적으로 사용하였다. 항생제를 사용한 환자의 경우 사용된 항생제의 갯수를 살펴보면 총 1,231명 중 1가지 항생제를 사용한 경우는 125명(10.2%)이었으며, 2가지를 사용한 경우는 311명(25.3%), 3가지를 사용한 경우는 562명(45.6%), 4가지 이상을 사용한 경우는 233명(18.9%)으로, 70% 이상의 환자에서 3가지 이상의 항생제가 사용하였다. 사용 항생제의 종류는 ${\beta}$-lactam, aminoglycoside, quinolone, macrolide, 항진균제, metronidazole, clindamycin, trimethoprim-sulfamethoxazole, glycopeptide, 그리고 fosfomycin 등으로 아주 다양하였다. 전체적인 그룹별 사용률을 보면 ${\beta}$-lactam은 57.0%, aminoglycoside는 34.5%, quinolone은 3.6% 그리고 기타 그룹은 4.9%로, ${\beta}$-lactam과 aminoglycoside가 가장 많이 사용되었다. 결 론 : 대부분의 환자에서 2가지 이상의 항생제의 병합요법이 보편화되어 있다는 점은 진지하게 검토되어야 할 것으로 생각된다. 아울러 임상적으로 전신 세균 감염이 확실한 경우에도 원인 병원체를 찾아내기 위한 적극적인 노력이 부족한 경우도 상당수 있어 이에 대해서도 검사실과 함께 적극적인 개선의 노력이 필요할 것으로 생각된다. 수술 환자의 예방적 화학 요법에 대해서도 개선이 필요할 것으로 생각된다.