為了解院內預防性抗生素使用情形，針對新竹馬偕紀念醫院外科之三項清淨術 式包括單純疝氣手術、甲狀腺切除手術及內固定器拔除手術之預防性抗生素使用情 形進行調查。以電腦資料庫篩選自民國 94 年 3 月至 7 月間接受院內三項術式，經 醫師診斷為清淨傷口的病患，依據院內制定預防性抗生素使用規範及利用設計的紀 錄表，以調閱病歷方式進行調查並訪問臨床從業人員蒐集相關資訊。以描述性統計分析各項因素百分比情形，包括是否有使用預防性抗生素、藥物選擇、術前給藥時 間、給藥劑量、術後使用天數以及傷口感染率等。
結果顯示 173 件個案中，64.2%有使用預防性抗生素，35.8%未使用預防性抗生素有使用預防性抗生素之111位病患中，術前藥物選擇皆為 cefazolin，未符合術 前 1 小時內給藥佔7.2%，劑量不適當佔 0.9%，術後延長使用天數佔 23.4%。在 62 位未使用預防性抗生素患者無感染，唯一感染是有使用預防性抗生素之內固定器拔除術病患， 傷口培養為 methicillin -resistant coagulase negative staphylococci (MRCNS)，感染率為2.33%。
本研究發現三項清淨術式術前使用預防性抗生素的有無和術後傷口感染呈無相關性，故建議可免用預防性抗生素。
In order to better understand how prophylactic antibiotics are being used in our hospital, we have conducted a study specifically targeting 3 types of clean surgeries, ie: simple herniorrhaphy, thyroidectomy, and removal of internal fixation of fractures. Case were selected from the computer database of the Hsinchu Mackay Memorial Hospital from the period between March 2005 and July 2005, from records of patients who were underwent clean wound surgery. According to the standard guideline of prophylactic use of antibiotics in our hospital, and utilizing a designed chart, data was collected by chart review and by interviewing the clinical staff as well. Descriptive statistical analysis was used on the factor percentages of the following: whether prophylactic antibiotics were used, which drugs were used, timing before operation the prophylactic antibiotics was given, drug dosage, for how many days was the drug used after the operation, and the rate of infection.
In the 173 cases included in the study, 64.2% (111/173) used antibiotic prophylaxis and 35.8% (62/173) did not. Among the 111 who used antibiotic prophylaxis, 7.2% did not receive within 1 hour before operation. The drug of choice for all preoperative patients was cefazolin. 0.9% received an inappropriate dosage. 23.4% received prolonged antibiotic use postoperative. Of the 62 patients who did not use prophylactic antibiotics, none developed an infection. The only case of infection was found in a patient who underwent surgery for removal of internal fixatio and also did use prophylactic antibiotics. The wound developed methicillin-resistant coagulase negative staphylococci, and the infection rate was 2.33%, well below the previously estimated infection rate of 1-5%.
This study found that the relationship between preoperative use of prophylactic antibiotics and postoperative infection, in the 3 types of clean surgeries has no probability of dependence, and thus recommended to forego the use of prophylactic antibiotics.
