How to reduce the irrational use of antibiotics in emergency surgery

IntroductionThe use of antibiotics is very frequent in emergency surgery as a key sector in dealing with acute surgical conditions. However, the problem of irrational application of antibiotics is more pronounced in emergency surgery, which not only increases the medical risks and burdens of patients, but also poses a threat to public health safety. It is therefore essential to reduce the irrational use of antibiotics in emergency surgery, requiring an integrated approach at multiple levels.II. Common manifestations of irrational use of antibiotics in emergency surgery(i) Inadequate preventive use1. Inaccuracy of indicatorsIn emergency surgery, there was no need for the preventive use of antibiotics for some clean operations, such as a simple slitting of the scalp, and a simple osteoporosis, but some doctors still routinely use them to prevent possible infections. This overuse increases the exposure and cost of patients to unnecessary drugs.Unjustified timing and treatmentThere is a problem of inappropriate timing of treatments for operations requiring the preventive use of antibiotics, such as open fractures that are more likely to be contaminated. Ideally, the drug is given within 0.5 – 2 hours before the surgery, but in practice there may be premature or late delivery. Moreover, the prophylactic use of antibiotics after an operation is too long and is not reasonably adjusted to the type of operation and the specific circumstances of the patient, resulting in patients receiving unnecessary antibiotics for long periods of time.(ii) Empirical drug blindness1. Neglect of pathogen distribution characteristicsEmergency surgeons often rely on experiential medications when dealing with patients in emergency situations. However, the distribution of common pathogens in emergency surgery at local hospitals is not fully taken into account in the choice of antibiotics. For example, in the emergency surgery of a district hospital, the high resistance of coliform to third-generation cystasy has led to an increase in treatment failure due to the habitual use of such drugs by doctors in the treatment of abdominal injuries.2. Failure to integrate the individual patientThere are individual differences among patients, such as age, underlying illness, immunization status, etc. These factors are sometimes not adequately taken into account in the empirical use of drugs. For example, in the case of older patients, the liver and kidney function may decline, but doctors choose antibiotics without adjusting the dose or choosing the appropriate drug, which increases the likelihood of adverse drug reactions.(iii) Irregular use of therapeutic drugs1. Excessive and late drug exchangeIn the course of treatment, the replacement of antibiotics is unreasonable. Some doctors have changed antibiotics too frequently and may change them for short periods of time, without seeing the obvious effects, without giving them sufficient time to develop. Conversely, in some cases where treatment is clearly ineffective or signs of drug resistance have not been replaced in a timely manner, delaying the situation.Unreasonable joint useCo-use of antibiotics is more common in emergency surgery for serious infections, but there is an unreasonable combination. For example, the joint use of antibiotics with similar mechanisms of action may increase the incidence of adverse reactions and the risk of drug resistance rather than the efficacy of treatment. There is a ban on co-use of antibiotics, which affects the stability and efficacy of drugs.III. Strategies to reduce the irrational use of antibiotics in emergency surgery(i) Increased education and training of doctors1. Regular delivery of academic lectures and training coursesHospitals should regularly organize lectures and training for emergency surgeons on the rational use of antibiotics. Infectious and pharmacological experts are invited to present updated guidelines on the use of antibiotics, the results of antibiotic surveillance and pharmacological knowledge of antibiotics. For example, the detailed description of antibacterial spectroscopy, adaptive certificates, adverse reactions, etc. of the different generational sepsis, provides a clearer basis for doctors to choose their medicines.2. Case analysis and discussionDoctors are taught lessons by analysing actual cases of unjustified use of antibiotics in emergency surgery. Cases of severe adverse reactions or treatment failures due to the improper use of antibiotics can be selected, and doctors can be organized to discuss and analyse the problems, such as faults in the use of drugs, the choice of drugs, the treatment process, etc., so as to improve their clinical decision-making.(ii) Improved guidelines and norms for the use of antibiotics1. Development of an exclusive guidance for emergency surgeryDevelop specific guidelines for the use of antibiotics, taking into account the characteristics of emergency surgery. (b) Identification of indicators for the use of preventive antibiotics, drug selection, timing and treatment of different types of emergency surgery (e.g., cleaning, cleaning – pollution, contamination). For example, in the case of open abdominal damage in a polluting surgery, the guide should include a detailed list of preferred and alternative antibiotics for possible pathogens (e.g. intestinal fungi, anaerobic bacteria, etc.).2. Updating of the guide to local realitiesTaking into account the differences in the resistance of pathogenic bacteria in different regions, hospitals should regularly collect and analyse local resistance data for surgical strains in emergency cases and update their antibiotic guidelines accordingly. For example, if there is a significant increase in the resistance to penicillin in local golden slurry, the guidelines should adjust the recommended drug for the treatment of the infection.(iii) Effective monitoring and feedback mechanisms established1. Use of information-based systems to monitor antibioticsHospitals have well-established information-based monitoring systems for the use of antibiotics in emergency surgery, which record in real time basic information on patients, diagnostics, names of antibiotics used, dosages, delivery routes, treatment programmes, etc. The use of abnormal antibiotics, such as overdoses, ultratherapy, irrational combinations, etc., is detected in a timely manner through large data analysis techniques.Regular feedback and assessmentThe results of antibiotics monitoring are regularly fed back to emergency surgeons and section managers. One-on-one communication and guidance is provided to doctors who have more problems with unreasonable application. At the same time, the overall use of antibiotics in emergency surgery is evaluated, trends and causes of unreasonable application are analysed and targeted improvements are developed.(iv) Enhanced multidisciplinary collaboration1. Cooperation between emergency surgery and pharmacologyThe Pharmacy Department arranges for clinical pharmacists to be involved in the clinical work of emergency surgery, including house searches, consultations, etc. Clinical pharmacists can assist doctors in developing sound antibiotics treatment programmes, providing professional guidance on the choice of drugs, dosage adjustments, drug interactions, etc. For example, when people in emergency surgery suffer from a combination of other diseases requiring multi-pharmaceutical use, clinical pharmacists can assess the interaction between drugs and avoid influencing the efficacy of antibiotics or increasing adverse effects as a result of their interaction.2. Collaboration with microbiology laboratoriesStrengthening of contact between emergency surgery and microbiological laboratories. Microbiology laboratories should as soon as possible test specimens for emergency surgery and provide timely and accurate feedback to doctors on pathogen culture and drug sensitivity tests. In cases of suspected infection, the parties discuss the selection of appropriate testing methods and timing, and increase the detection rate of pathogens to provide a basis for the accurate use of antibiotics.(v) Awareness-raising among patients and their families1. Health education activitiesIn emergency surgeries and waiting areas, patients and their families are informed about the rational use of antibiotics through information boards and brochures. Informing them that antibiotics are not a panacea, that doctors cannot be asked to use them at will, and that the dangers of the unreasonable use of antibiotics, such as increased antibiotic production, and adverse reactions, are not acceptable.Education in health-care communicationWhen providing an antibiotic prescription for patients in emergency surgery, the doctor is required to explain in detail to the patient and his/her family the reasons for the use of antibiotics, their possible effects and potential adverse effects. In particular, in the case of the preventive use of antibiotics, patients and their families need to be made aware that this is intended to reduce the risk of surgical infections, but not all operations need to be used. At the same time, the patient is advised to use the medication strictly in accordance with medical instructions and cannot reduce the dose or stop the drug.ConclusionsReducing the irrational use of antibiotics in emergency surgery is a long-term and difficult task, requiring the joint efforts of hospital management, emergency surgeons, pharmacological departments, microbiology laboratories and patients and their families. A combination of measures to improve the education of doctors, improve the use of guidelines, establish monitoring mechanisms, strengthen multidisciplinary collaboration and raise patients ‘ awareness can be effective in improving the rationality of the use of antibiotics in emergency surgery, reducing the medical risks to patients, reducing the generation and spread of drug-resistant bacteria and promoting the quality of emergency surgical care. This is essential for the health and safety of patients.