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7/27/2019 Dertermining the Use of Prophylactic Antibiotics in Breast
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Dertermining the use of prophylactic antibiotics in
breast cancer surgeries;a survey of practice
Research article; Acuna et Al 2012, BMC SurgeryAvailable from : http//www.biomedcentral.com
JOURNAL READING
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LATAR BELAKANG
Surgical Site infection (SSI)
Breast Cancer Surgery
PAs
Komplikasi- Lama perawatan- Biaya meningkat- Intervensi tambahan- Estetika
- Trauma psikologik
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LATAR BELAKANG
Efek merugikan kelangsungan hidup
Menunda adjuvant terapiSSI
PAs
Menjamin kualitassurgical treatment
cegah
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LATAR BELAKANG
Historically
PAs tidak perlu
Breast; soft tissue perifer
Tidak berhubungan visceral struktur
Clean surgical prosedur
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LATAR BELAKANG
Meskipun demikian Reported
Tingkat SSI BCS lebih tinggi 1,9-50%
Dibandingkan CSP lainnya
- PAs bermakna menurunkan tingkat SSI- Tujuan mengetahui penggunaan PAs
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KUISIONER1. In what city do you practice? Open answer.
2. What is your specialty? Choose one of the following: breastsurgery, surgical oncology, general surgery,gynecology/obstetrics, or plastic surgery
3. How many years of practice Open answerdo you have in breast surgery?
4. What type of practice Choose one of the following: Private or
do you have? private/academic5. What percentage of your cases Choose one of the following:corresponds to breast surgery? 75%
6. What is your monthly breast Choose one of the following:25 cases/month
7. Indicate from the following list of Select as many as are appropriate :breast surgical procedures in breast conserving surgery, localized excision.which cases you administer mastectomy, axillary lymph node dissectionprophylactic antibiotic: biopsy, reconstruction with flap,
sentinel lymph node, reconstruction with implantterminal conduct excision, and benign lesion
excision
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KUISIONER
8. Do you use prophylactic antibiotic Choose one of the following: yes or no.in all your breast surgeries?
9. What prophylactic antibiotic Open answerdo you use?.
10. If you use prophylactic antibiotic, Choose one of the following:how do you administer it? single pre-operative fixed-dose, single
preoperative fixed dose followed by a secondfixed dose if the surgery is prolonged, singlepreoperative fixed dose followed by one ormore postoperative fixed doses for >24 hours,or single preoperative weight-adjusted dose.
11. If you do not administer routine Select as many as are appropriate:prophylactic antibiotic, in what cases older age, obesity, cancer, smoking, diabetesdo you use it? mellitus, active skin disease, neoadjuvant
therapy, use of drains in situ, and surgical re-intervention
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HASIL88 orang ahli bedah terdistribusi,
47 responden memberikan jawaban 53,4%
40 responden menggunakan PAs 85,1%
60% menggunakan PAs pada mastektomi,diseksi nodul limfe axila dan ataurekonstruksi payu dara
Single dose preoperative (27,7%)
Single dose preoperative diikuti dosisKedua jika operasi memanjang (47,7%)
Single dose preoperative diikuti satu/dua dosisPost operasi > 24 jam (10,6 %)
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HASIL
Common breast surgical procedures in which breast surgeons use prophylactic antibiotics
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HASIL
Breast cancer patient characteristics reported to be taken into consideration for
targeted prophylactic antibiotic use in breast cancer surgery
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DISKUSIRincian pilihan obat respondensejalan dengan rekomendasi saat ini
Ng et al. Inggris amoksisilin-asam clavulonic lebih seringdaripada cephalosporins
Codina et al. 36% dari rumah sakit di
Spanyol lebih memilih cefazolin
Dulu, SSI BCS disebabkan olehstafilokokus dan streptokokus
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DISKUSI
Data terbaru 30-66,2% SSI BCSinfeksi non-staphylococcal
Codina et al. 36% dari rumah sakit diSpanyol lebih memilih cefazolin
cefazolin waktu paruh panjang, dinilai mampu secara signifikanmenurunkan SSI
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DISKUSIPola praktek serupa Spanyol, 9% dariRS BCS memperpanjang penggunaanPAs, 24 jam saat melakukan BCS
penelitian Pas hanya 24 jamcukup untuk mencegah SSI
Pemakaian PAs lama meningkatkan risikokekebalan kuman, infeksi nosokomial, diare,lebih tinggi biaya perawatan kesehatan
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KESIMPULAN
AHLI BEDAH berperan penting menurunkan angka kejadian SSI BCS
Survey ini sadar potensi SSI BCSTetapi lebih banyak ditentukan olehpenggunaan PAs yang tepat
PAs Tepat waktu dan tepat dosis
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TERIMA KASIH