Clinical practice guidelines for antimicrobial prophylaxis in surgery ~?????????????????????????~

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Clinical practice guidelines for antimicrobial
prophylaxis in surgery?????????????????????????
Am J Health-Syst Pharm. 201370195-283

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• ?????????,
• ASHP(American Society of Health-System
  Pharmacists)
• IDSA(Infection Diseases Society of America)
• SIS(Surgical Infection Society)
• SHEA(Society for Healthcare Epidemiology of
  America)
• ????????.

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• Level ?(evidence from large, well conducted,
  randomized, controlled clinical trials or
  meta-analysis)
• Level ?(evidence from small, well conducted,
  randomized, controlled clinical trials)
• Level ?(evidence from well conducted cohort
  study)
• Level ?(evidence from well conducted case control
  studies)
• Level ?(evidence from uncontrolled studies that
  were not well conducted)
• Level ?(conflicting evidence that tends to favor
  the recommendation)
• Level ?(expert opinion or data extrapolated from
  evidence for general principles and other
  procedure)

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???????????? 3g(??????2g???????1g) 50mg/kg??????? 0.8-1.3 2
?????? 2g 50mg/kg 1-1.9 2
??????? 2g 30mg/kg 1.3-2.4 4
?????? 2g 30mg/kg 1.2-2.2 4
?????? 1.5g 50mg/kg 1-2 4
??????? 1g 50mg/kg 0.9-1.7 3
?????? 2g 40mg/kg 0.7-1.1 2
?????? 2g 40mg/kg 2.8-4.6 6
???????? 2g 50-75mg/kg 5.4-10.9 NA
????????? 400mg 10mg/kg 3-7 NA
???????? 900mg 10mg/kg 2-4 6
?????? 1g 15mg/kg 3-5 NA
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??? ??????? ??????? ?????????????? ??????(???????)
??????? 400mg 6mg/kg 30 NA
??????? 5mg/kg 2.5mg/kg 2-3 NA
???????? 500mg 10mg/kg 6-8 NA
???????? 500mg 15mg/kg 6-8 NA
????????? 400mg 10mg/kg 8-15 NA
?????-?????? 3.375g Infants(2-9m)80mg/kg,children(gt9m and lt40kg)100mg/kg 0.7-1.2 2
??????? 15mg/kg 15mg/kg 4-8 NA
???????? 1g 20mg/kg 0.8-3 NA
???????? 1g 15mg/kg 6-10 NA
?????? 1g 15mg/kg 2-3 NA
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ?????????? ?? ??
????? ??????????? (?????????????) ?????????? (E.coli,Proteus species, klebsiella species) staphylococci, streptococci, enterococci, Bacteroids species ?????? ????????or??????? ????????or???????or???????? A
????? ????????????? (??????????????) ?????????? (E.coli,Proteus species, klebsiella species) staphylococci, streptococci, enterococci, Bacteroids species ?????? ????????or??????? ???????or???????or???????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ß????????? ?? ??
?? ???? E.coli,klebsiella species,enterococci ?????????(streptcocci, staphyrococci) ??????? ???????? ??????? ???????????????-?????? ????????or??????? ???????or???????or????????? ???????? ???????or???????? A
?? ??? (????) E.coli,klebsiella species,enterococci ?????????(streptcocci, staphyrococci) ?? ?? A
?? ??? (????) E.coli,klebsiella species,enterococci ?????????(streptcocci, staphyrococci) ??????? ??????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
?? ?? ??? ????? ß????????? ????
???? ???????????????????(B.fragilis,E.coli) Staphylococcus species streptococci, enterococcus species,P.aeruginosa ???????? ??????? ?????? ???????? ???????? ???????or???????or????????? ???????? ???????or???????? A
????(????) E.coli,Enterococcus species,streptococcus species P.aeruginosa,S.aureus,bacilli ?????? ???????? ????????or???????or???????? C
????(????) E.coli,Enterococcus species,streptococcus species P.aeruginosa,S.aureus,bacilli ?????? ????????? ???????? ?????? ???????? ????????or???????? C
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ß????????? ????
?????? Streptococci,staphylococcus species Enterococcus species,MRSA ?????? ???????????????? A
???? B.fragilis,E.coli ?????? ????????? ???????? ????????? ???????? ??????? ????????????????????? ???????? ????????or????????or???????? ???????? ????????or???????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ß???? ????? ????
??? ???? ??????? streptococi,Bacteroides species,Prevotella species,Fusobacterium species,Veillonella species,Enterobacteriaceae,staphylococci ???????? staphylococcus species,streptococcus species ?? ?? B
??? (?????????????)????????????? ??????? streptococi,Bacteroides species,Prevotella species,Fusobacterium species,Veillonella species,Enterobacteriaceae,staphylococci ???????? staphylococcus species,streptococcus species ????????????? ???????? C
??? ???????????? ??????? streptococi,Bacteroides species,Prevotella species,Fusobacterium species,Veillonella species,Enterobacteriaceae,staphylococci ???????? staphylococcus species,streptococcus species ??????????????? ??????????????? ??????/?????? ???????? A
?????????????????????????? ??????? streptococi,Bacteroides species,Prevotella species,Fusobacterium species,Veillonella species,Enterobacteriaceae,staphylococci ???????? staphylococcus species,streptococcus species ??????????????? ??????????????? ??????/?????? ???????? B
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Recommendation for Surgical Antimicrobial
Prophylaxis
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????? ?????? ???????S.aureus,coagulas(-)?????? MRSA,P.acnes, ?????? ????????? ??????? A
????? ???????? ???????S.aureus,coagulas(-)?????? MRSA,P.acnes, ?????? ????????? ??????? C
???? ?????????? (????????????????) ???????????S.aureus, ????staphylococci(S.epidermidis), ß-hemolyticstreptococci? ????S.aureus,S.epidermidis,VRE,MRSA ?? ?? C
???? ?????????? ?????????????? ?????? ????????? ??????? C
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ?????????? ?????
??????? S.aureus, S.epidermidis ?????? ???????????????? A
?????????(???????????) S.aureus, S.epidermidis ?????? ???????????????? A
?????? S.aureus, S.epidermidis ?????? ????????????????
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?? ??? ????? ????? ????? ????
????? ????????staphylococci,streptococci ,enterococci,lactobacilli,diphtheroids,E.coli, anaerobic streptococci,peptococcus species, peptostreptococcus species,Bacteroides species, Bacteroides bivius,B,fragilis,Fusobacterium species ???staphylococci,streptococci,E.coli, anaerobic streptococci,peptococcus species, peptostreptococcus species,Bacteroides bivius, Bß-hemolytic,streptococcus,urealyticum ??staphylococcus,enterococci ?????? ???????? ???????? A
????? ?????Staphylococci,streptococci,enterococci,lactobacilli,diphtheroids,E.coli,???streptococci,Bacteroidesspecies,Fusobacterium ?????????????entero,aerobicgram????Bactero ?????????gram????entericgram????anaerobes ????????????????????????????????? ???????? or??????????????? or???????or????????? ???????????????? or???????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ß???? ????? ????
?? coagulase(-), staphylococcus(epidermidis), gram()S.aureus,Streptococcus,Entero, P.acnes,Corynebacterium, gram(-)seratia, Klebsiella,P.mirabilis,P.aeruginosa ?????????-??????? ß-???????or?4?????????? (????????or????????) A
?? coagulase(-), staphylococcus(epidermidis), gram()S.aureus,Streptococcus,Entero, P.acnes,Corynebacterium, gram(-)seratia, Klebsiella,P.mirabilis,P.aeruginosa ?????????????100mg? intracameral??????1-2.5mg? ??????1mg??????????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ?????????? ?????
?? ???????? ???????????????????????????????????????gram-positive(S.aureus,coagulase-negative staphylococcus,propionibacterium acnes) ????????????? ?????????MRSA??????????? A
??????????????????????? ???????????????????????????????????????gram-positive(S.aureus,coagulase-negative staphylococcus,propionibacterium acnes) ????????????? ?????????MRSA??????????? A
?????? ???????????????????????????????????????gram-positive(S.aureus,coagulase-negative staphylococcus,propionibacterium acnes) ????????????? ?????????MRSA??????????? C
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ?????????? ?????
??????????????(?????????????????????) S.aureus,S.epidermidis ??????????????????? ?????????MRSA??????????? A
??????????? S.aureus,S.epidermidis ??????????????????? ?????????MRSA??????????? C
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ?????????? ?????
?????? ?????????????????????????????? ?????? ???????????????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
???? ??? ????? ?????????? ?????
???? ?????????????(??????????) ?????? ???????????????? A
???????? ????????????????????????????????? ?????? ???????????????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
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??????????????????(???????????) E.coli, ????????enterococci,S.aureus,coagulase-negative Staphylococcus species,groupA streptococcus species ????????????????-????????????????? ????????/or???????? A
????????????? E.coli, ????????enterococci,S.aureus,coagulase-negative Staphylococcus species,groupA streptococcus species ??????(????????????????????????????) ?????????????????/or???????? A
????? E.coli, ????????enterococci,S.aureus,coagulase-negative Staphylococcus species,groupA streptococcus species ???????????????????? ?????????????????????????or???????? A
????????????? S.epidermidis,P.aeruginosa ??????(????????????????????????????) ????????/or????????or???????????????/or????????or??????? A
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Recommendation for Surgical Antimicrobial
Prophylaxis
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?????????????or????? S.aureus,streptococci,staphylococci,??????(Serratia marcescens,Enterobacteriaceae,E.coli,Klebsiella species) ?????????????-?????? ???????????????? C