Policy sharing for the rational use of antibiotics in emergency surgery

IntroductionEmergency surgery is the front line of the hospital for all types of acute trauma, acute abdominal conditions, etc., and the application of antibiotics plays a key role in the treatment of patients. However, the unjustified use of antibiotics not only increases the patient ‘ s medical costs and lengths of hospitalization, but may also lead to the creation and spread of drug-resistant bacteria, with serious consequences for treatment. Therefore, the development and implementation of policies for the rational application of antibiotics is important for emergency surgery.II. Status and problems with the application of antibiotics in emergency surgery(i) Excessive preventive usePreventive use of antibiotics is necessary in emergency surgery, especially in the case of clean-pollution operations and pollution operations. However, there are some cases where the use of antibiotics, such as simple soft tissue cracks, is excessive inoculation during cleaning operations, with no clear signs of contamination, but still uses antibiotics. This increases patients ‘ unnecessary drug burden and potential adverse response risks.(ii) Unreasonable use of empirical drugsEmergency surgery is critical for patients, and doctors are often required to use experiential drugs before accurate pathogen tests are available. However, empirical drugs are sometimes not targeted and do not take fully into account the distribution of common pathogens and drug resistance in the region and in the hospital. For example, in emergency surgery in some community hospitals, for patients with open abdominal impairments, the high level of resistance to common quinone-type drugs in the local coli fungi is not taken into account, and the use of such drugs for experiential treatment results in poor treatment.(iii) Irregular use of medicationIn the case of patients with acute surgical infections, there is the problem of long or short medication. Some doctors are concerned about re-emerging infections and the long-term use of antibiotics after a marked improvement in the patient ‘ s symptoms, which can easily lead to herbs disorders and drug resistance. For some patients with complex conditions, such as multiple-injury co-infections, there is a risk of early withdrawal due to, inter alia, the need to discharge, leading to repeated infections.III. Policy content for rational use of antibiotics in emergency surgery(i) Strict control of indicators of preventive use1. Distinction of type of operationCleaning operations (e.g., osteoporosis) do not generally require the preventive use of antibiotics, except in the case of large-scale, long-term operations, which involve important organs of the dirty or implanted artificial materials. Cleaning – Contamination operations (e.g. gastrointestinal surgery) and pollution operations (e.g., open fractures) require a reasonable choice of antibiotics based on the level of contamination. For a clean-polluting operation, the drugs should be given within 0.5 – 2 hours before the operation, so that the local tissue at the time of the exposure to the surgical incision is at a level sufficient to kill the incision bacteria.Patient factor considerationsIn cases of emergency surgery with low immune functions (e.g. long-term use of sugar-coated hormones and basic diseases such as diabetes), the use of precautionary antibiotics could be relaxed, as appropriate, but there was still a need for careful choice of drugs and treatment.(ii) Optimizing the empirical drug programme1. Monitoring based on pathogen distribution and drug resistanceHospitals should regularly monitor the distribution of common pathogens and drug resistance in emergency surgery and provide timely feedback to emergency surgeons. For example, a pathogen culture and drug sensitivity analysis of patients infected with acute surgical trauma revealed high resistance rates to benzocrin in the region, so that the pre-optimal benzocrin should be avoided in the empirical treatment of suspected geroccus infections. At the same time, the empirical drug programme is adapted to the epidemiological characteristics of different seasons and regions.2. Combining clinical performance and infectionEmpirical use of medication varies among patients in emergency surgery in different areas of infection. In the case of skin soft tissue infections, common pathogens are yellow grapes and streptococcus, with the option of a generation of sepsis; for intraperitoneal infections, it may be caused by, inter alia, intestinal group displacement, which should be covered by grenacobacteria and anaerobic fungi, with the option of a joint gilline nitrazine. Empirical choice of antibiotics, such as head thalamus, that can pass through a blood-brain barrier, for patients with the appearance of infection in the central nervous system, such as headaches and vomiting.(iii) Regulating drug treatment1. Based on the condition and type of infectionFor mild infections such as simple acute beeweeding, it is sufficient to continue to use drugs for 2 – 3 days after the patient ‘ s temperature is normal and local symptoms have improved. For severe abdominal infections, such as amphibal peritonealitis, it is generally necessary to continue to use antibiotics for 5-7 days after the source of the infection has been effectively controlled (e.g. surgically removing the infection stoves). For chronic infections such as osteoporosis, the treatment may need to be extended to weeks or even months, during which the inflammation indicators and visual tests will need to be periodically reviewed to assess the efficacy of the treatment and decide when to stop.2. Dynamic assessment and adjustment of treatmentIn the course of treatment, doctors closely observe life signs, symptoms, laboratory tests (e.g. white cell count, C reaction protein, calcium calcium, etc.) and image performance. If the patient ‘ s condition improves rapidly, the treatment can be shortened as appropriate; if the condition is repeated or not improved, further examinations are required, such as re-examining pathogen culture and drug sensitivity tests, adjusting the type of antibiotics and the course of treatment.IV. Policy implementation and oversight mechanisms(i) Training and education of doctors1. Regular training in antibioticsHospitals should regularly organize training courses for emergency surgeons on the rational application of antibiotics, including new antibiotic pharmacological knowledge, reading of the latest drug-resistant surveillance report, and updating of guidelines for the treatment of common infections in emergency surgery in the region. Pharmacists, infectious specialists and case analysis could be invited to raise the theoretical level of emergency surgeons.2. Establishment of online learning platforms and appraisal mechanismsCreate an online learning platform that provides a wealth of antibiotic knowledge and facilitates ready learning by emergency surgeons. At the same time, there is a mechanism for regular examination of doctors for the rational application of antibiotics, the results of which are linked to their performance, promotion, etc., so as to enable them to actively study and acquire knowledge of the rational use of medicines.(ii) Real-time monitoring and feedback1. Establishment of an emergency surgical antibiotic use monitoring systemEstablish a real-time monitoring system for emergency surgical antibiotics, using the hospital information system. The system records the name of each patient using antibiotics, dosages, time of delivery, course of treatment, etc., and automatically analyzes whether there is an unreasonable use of drugs, e.g. overdose, over-treatment, etc. At the same time, the monitoring system is able to measure and rank the use of antibiotics by physicians in emergency surgery in order to detect problems among individual doctors.2. Timely feedback and interventionThe information is fed back to the relevant physician and head of section in a timely manner when the monitoring system finds that the use of the drug is unreasonable. In the case of minor unjustified drug use, doctors may be informed of the adjustment by means of a text message alert, a system alert, etc.; in the case of serious unjustified drug use, such as repeated violations of the drug policy leading to serious adverse reactions or drug-resistant infections, specialists should be organized to conduct consultations and discussions, to educate the responsible doctor critically and to request him to develop corrective measures.(iii) Multidisciplinary collaboration and communication1. Collaboration between emergency surgery and pharmacologyThe Pharmacy Department should arrange for the participation of clinical pharmacists in the inspection and consultation of emergency surgery. Clinical pharmacists can assist doctors in developing sound antibiotics treatment programmes, providing professional advice on the choice of drugs, dosage adjustments, interactions, etc. For example, when patients in emergency surgery use multiple drugs at the same time, clinical pharmacists can assess whether there are drug interactions that affect the efficacy of antibiotics or increase the risk of adverse reactions, and adjust drug programmes in a timely manner.2. Communication with microbiology laboratoriesEmergency surgeons should strengthen communication with microbiology laboratories. Upon receipt of samples from patients in emergency surgery, the microbiology laboratory should conduct pathogen culture and drug-sensitization tests as soon as possible and provide timely feedback of the results to doctors. In cases of suspected and complex infections, microbial laboratory technicians can discuss with emergency surgeons the selection of appropriate testing methods, improve the detection rate of pathogens and the accuracy of drug-sensitive tests, and provide a basis for accurate drug use.ConclusionsThe development and implementation of a policy for the rational use of antibiotics in emergency surgery is a systematic project that needs to be based on the rigorous control of precautionary indicators, the optimization of empirical drug use programmes and the regulation of therapeutic drug use. At the same time, effective implementation of the policy is ensured through improved implementation and monitoring mechanisms, including training of doctors, real-time monitoring and multidisciplinary collaboration. Only then will it be possible to improve the rationality of the use of emergency surgical antibiotics, reduce the risk of drug-resistant bacteria, improve the effectiveness and quality of treatment of patients and ensure the smooth operation of emergency surgical care.