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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