Penetrating Abdominal Trauma, Prophylactic Antibiotic Use in

Published 2012
Citation: J Trauma. 73(5):S321-S325, November 2012

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Authors

Goldberg, Stephanie R. MD; Anand, Rahul J. MD; Como, John J. MD; Dechert, Tracey MD; Dente, Christopher MD; Luchette, Fred A. MD; Ivatury, Rao R. MD; Duane, Therese M. MD

Author Information

From the Division of Trauma, Critical Care, and Emergency General Surgery (S.R.G., R.J.A., T.M.D., R.R.I.), Virginia Commonwealth University Medical Center, Richmond, Virginia; Department of Surgery (J.J.C.), Case Western Reserve University School of Medicine, Cleveland, Ohio; Trauma Surgery & Critical Care (T.D.), Boston University School of Medicine, Boston, Massachusetts; Division of Surgical Critical Care (C.D.), Emory University School of Medicine, Atlanta, Georgia; Division of General Trauma Surgery and Critical Care (F.A.L.), Loyola University Medical Center, Maywood, Illinois.

Address for reprints: Stephanie R. Goldberg, MD, Division of Trauma, Critical Care, and Emergency General Surgery, P.O. Box 980454, Richmond, VA 23298; email: sgoldberg@mcvh-vcu.edu.

Process

Identification of References

Using a search methodology similar to that used by Luchette et al.,[3] a MEDLINE search was performed to identify publications from 1973 to 2011 using the key words “antibiotic prophylaxis,” “penetrating abdominal injuries,” “abdominal injuries,” “complications,” “peritonitis,” “wound infection prevention and control,” “open abdomen,” “damage control laparotomy” (DCL), “pharmacokinetics,” and “trauma.” In addition, references included among the initial 1998 EAST guidelines were included.

Forty-four English language articles were included in this analysis; letters to the editor, case reports, and review articles were omitted. The bibliography of each article was also reviewed to identify additional publications that may not have been identified in the original MEDLINE query. The articles were reviewed by seven surgeons with expertise in trauma surgery, critical care, and acute care surgery who then collaborated to update the recommendations. This guideline was presented to the EAST membership for discussion and review at the annual EAST meeting in 2012.

Quality of the References

Each article was reviewed and classified according to the methodology established by the Agency for Health Care Policy and Research of the US Department of Health and Human Services. Additional criteria and specifications were used for Class I articles as described by Oxman et al.[4] This process is similar to that performed for the original PMG.[3]

Thus, the articles were classified as follows:

Class I: Prospective, randomized, double-blind study.

Class II: Prospective, randomized, nonblinded trial.

Class III: Retrospective series of patients or meta-analysis.

Recommendations

Level 1

  1. A single preoperative dose of prophylactic antibiotics with broad-spectrum aerobic and anaerobic coverage should be administered to all patients sustaining penetrating abdominal wounds.
  2. Prophylactic antibiotics should be continued for not more than 24 hours in the presence of a hollow viscus injury in the acutely injured patient.
  3. Absence of a hollow viscus injury requires no further administration of antibiotics.

Level 2

  1. There are no Level 2 recommendations.

Level 3

  1. In patients admitted with hemorrhagic shock, the administered dose of antibiotics may be increased twofold or threefold and repeated after transfusion of every 10 units of blood until there is no further blood loss.
  2. Aminoglycosides should be avoided because of suboptimal activity in patients with significant injuries if possible.

Scientific Foundation

Historical Background

Penetrating abdominal trauma results in a spectrum of injuries associated with various degrees of microbial contamination of the peritoneal cavity and tissues. The basic tenets of operative management are prompt control of hemorrhage and contamination coupled with early debridement of devitalized tissue and restoration of tissue perfusion and are central to minimizing both SSI and intra-abdominal infection. To help clarify the role of prophylactic antibiotics in penetrating abdominal trauma, the EAST PMG Committee developed a guideline on this topic that was published in 1998.[3] The guideline was based on the review of 39 articles in the literature from 1976 through 1997. The only Level I recommendation was that a single preoperative dose of antibiotics with broad-spectrum aerobic and anaerobic coverage was the standard of care for trauma patients sustaining penetrating abdominal wounds. No additional doses of antimicrobials were necessary if there was no bowel injury. A Level II recommendation supported the continuation of antibiotics for only 24 hours when there was a hollow viscus injury. In addition, Level 3 recommendations were made regarding alteration of antibiotic dosing for patients presenting with hemorrhagic shock.

A prospective randomized study comparing kanamycin and cephalothin with kanamycin and clindamycin in 1973 established the importance of broad-spectrum anaerobic and aerobic antimicrobial coverage for penetrating abdominal trauma.[6] This study was influential in the formulation of the 1998 guideline. The group receiving clindamycin, which provides anaerobic coverage, had a significantly lower infection rate (10%) compared with that of the cephalothin group (27%). The demonstrated difference was caused by a greater number of anaerobic infections in the cephalothin group (21%) compared with those in the clindamycin group (2%). This landmark article established the basis for the addition of antimicrobial agents that provided coverage of anaerobic organisms, in addition to aerobic organisms, for penetrating wounds of the intestinal tract.

Several studies have evaluated various antimicrobial agents regarding the specific pathogens that should be covered. Many of the antibiotics used in the earlier studies are no longer used in clinical practice. However, these prospective studies did demonstrate the need for broad anaerobic and aerobic coverage and are summarized in the previous guideline.[3]

Duration of Antibiotic Therapy

Despite the wide acceptance of the need for broad-spectrum antibiotics in penetrating wounds of the abdomen, the duration of antimicrobial therapy necessary to prevent SSIs remains controversial. The 1998 EAST guideline found evidence to support only a 24-hour course of antibiotics when there was a bowel injury.[3] Kirton et al.[7] confirmed this recommendation in a prospective, randomized, double-blind, placebo-controlled study, which compared the use of ampicillin/sulbactam for 24 hours versus 5 days. There was no difference in infection rates between the groups, supporting the recommendation made by the EAST PMG in 1998 that antimicrobial coverage for 24 hours is adequate. Independent risk factors for the development of postoperative surgical and nonsurgical site infections were noted to be both the total number of units of blood transfused and a Penetrating Abdominal Trauma Index (PATI) score greater than or equal to 25 (p = 0.001 and p = 0.003, respectively). However, an associated colonic injury was not found to be an independent risk factor for SSI. This Class I study provided additional evidence to support a Level I recommendation that antibiotics should not be continued for more than 24 hours in the presence of any hollow viscus injury. Another prospective randomized trial in 1999 compared cefoxitin for 24 hours versus 5 days in penetrating abdominal wounds and found no difference in overall infection rates; however, the infection rates were higher in patients with a blood pressure less than 90 mm Hg (shock) at admission or when there was an injury to the colon or central nervous system or two or more organ injuries.[8] A subsequent study also concluded that colonic injuries were associated with a higher rate of SSI regardless of the duration of antimicrobial treatment.[9]

Delgado et al.[10] compared the duration of antibiotics after penetrating abdominal wounds associated with a bowel injury and rates of infections. Although retrospective, the authors concluded that there was no reduction in infection rates when antibiotics were administered longer than 24 hours (18 of 76 vs. 3 of 21; p = 0.273). Risk factors for postoperative complications were defined as those who were transfused two or more units of blood, PATI score greater than or equal to 12, and operative time exceeding 2 hours. Furthermore, patients were stratified according to high and low risk for infection. In the 78 low-risk patients, there was no difference in infection rates when the antimicrobials were stopped after 24 hours (1 [6%] of 18 vs. 10 [17%] of 60, p = 0.219). In the high-risk patients, there was no significant difference observed in infection rates regardless of adherence to the EAST guidelines (2 [67%] of 3 vs. 8 [50%] of 16, p = 0.542).

Timing of Administration

Studies have suggested that infection can be best prevented if therapeutic doses of antimicrobials are present in tissues before or at the time of bacterial contamination, which is not feasible with traumatic injuries.[11–13] Therefore, prompt antimicrobial administration before laparotomy for trauma or as soon as feasible following gross contamination should be the goal.

Two studies in the early 1970s highlighted the benefit of early preoperative antibiotic administration and reduced SSI after penetrating trauma with intestinal injury. Fullen et al.[14] retrospectively reviewed 295 patients and correlated skin and intra-abdominal abscesses with timing of administration of antimicrobials (either preoperatively, intraoperatively, or postoperatively). There was a significant decrease in infection rates in the group receiving a preoperative dose (7%) compared with the intraoperative (33%) and postoperative groups (30%). A criticism of this study was the small number of patients in the preoperative group compared with the other two groups. The presence of a concomitant colon injury was associated with infection rates of 11%, 57%, and 70%, respectively, implicating colonic injury as an independent risk factor for SSI. This finding has since been questioned. These findings do corroborate those of Thadepalli et al.[6] who compared antibiotic administration at admission to the emergency department versus in the operating room. They concluded that a single preoperative broad-spectrum antibiotic dose with aerobic and anaerobic coverage resulted in the lowest rate of infection.

Administration of Additional Antibiotics During Prolonged Operations

To date, there are no studies that have evaluated the timing of additional doses of antibiotics intraoperatively because of duration of operation in patients with penetrating abdominal trauma.

DCL: Role of Prophylactic Antibiotics in the Open Abdomen

At the same time the original PMG was being developed in 1997, the concept of DCL was gaining popularity and being increasingly used in the management of severely injured patients.[15] Initially, there was concern that delayed closure of the abdomen would be an independent risk factor for subsequent infection. This argument was only strengthened by the high association of the “lethal triad” with patients undergoing DCL and the relationship between disseminated intravascular coagulopathy as a risk factor for infection. Despite the lack of scientific evidence, many trauma surgeons at that time continued antibiotics until the abdomen incision was closed, which frequently did not occur for several days. Our current review of the literature failed to identify any articles specifically addressing the role of prophylactic antibiotics when the laparotomy incision is left open, demonstrating a need for further research in this patient population.

Impact of Specific Mechanism of Penetrating Injury on Antibiotic Administration

Penetrating wounds are produced by high and low energy forces. They are typically classified as medium to high energy (gunshot wounds) and low energy (stab wounds). The degree of tissue damage varies by the specific mechanism, with the high-energy wounds creating the greatest degree of soft tissue damage that typically results in ischemic/necrotic tissue that is an ideal environment for bacteria to establish an infection. Few studies have controlled for the type of penetrating wound; however, all studies suggested that prophylactic antibiotics should not be continued for more than 24 hours when there is an intestinal injury.[3]

Dosing of Antibiotics in Hemorrhagic Shock

The original PMG made a Level III recommendation that repeated administration of antibiotics in patients with hemorrhagic shock should be considered because of the vasoconstriction and decreased tissue delivery of antibiotics. These recommendations were based on studies by Ericsson et al.[16] who found subtherapeutic antibiotic levels in trauma patients and an inverse correlation between increasing the dose of amikacin and infection rates. There remain insufficient clinical data to provide meaningful guidelines for reducing infectious complications in trauma patients with hemorrhagic shock. Thus, the 2012 guidelines have also maintained this Level III recommendation that antibiotic dosage may need to be increased twofold or threefold and repeated after every transfusion of 10 units of blood until there is no further blood loss.

Use of Aminoglycosides in Trauma Patients

Furthermore, the 1998 guideline recommended that aminoglycosides be avoided because of presumed altered pharmacokinetics of drug distribution in injured patients. This recommendation was supported by a study that demonstrated subtherapeutic aminoglycoside levels in trauma patients because of a greater volume of distribution from aggressive resuscitation.[17] Reed and colleagues[18] further studied the relationship between aggressive volume expansion, drug elimination, and antibiotic dosing in the postinjury period and demonstrated that antibiotic dosing should be high, rather than low, and should be dosed frequently during fluid resuscitation. A Level III recommendation is maintained in this article, but this may need to be readdressed in the future as resuscitation strategies evolve.

Evidentiary Table

The table included in this update consists of outcome studies arranged according to chronological class. Studies consist of those included in the previous 1998 outcomes table as well as more recent relevant studies (see table).[19–54]

Summary

Prophylactic antimicrobials have an important role in decreasing infection in patients with penetrating wounds of the abdomen when associated with an injury to a hollow viscus. Numerous studies demonstrate the importance of broad-spectrum aerobic and anaerobic coverage. Studies, to date, do not support more than 24 hours of antimicrobial coverage for prevention of infection associated with a hollow viscous injury.

Future Studies

Future studies are necessary to better understand risk factors associated with trauma-related infections and to determine the need for and duration of antimicrobial usage in the setting of DCL.

Disclosure

The authors declare no conflicts of interest.

References

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Table

Prophylactic antibiotics in penetrating abdominal trauma: Outcome data

Author & Reference

Title

Class

Antibiotics

#Pts

Duration (days)

Organs injured

%Infected

Bozorgzedeh A

Am J surg. 1999;177:125-131.

The duration of antibiotic administration in penetrating abdominal trauma

I

cefoxitin

148 152

24 hours

5 days

colon 24.3%

colon 26.3%

9/148 (6.1%)

9/152 (5.9%)

(intra­abdominal) p=NS

Cornwell EE

J. Gastrointest. Surg. 1999;3:648-653.

Duration of antibiotic prophylaxis in high-risk patients with penetrating

abdominal trauma: a prospective randomized trial

I

cefoxitin

31

 32

24 hours

 5 days

 

6/31( 19%)

12/32 (38%)

 

p=NS (intra­abdominal)

Fabian TC

Surgery. 1992;112:788-795

Duration of antibiotic therapy for penetrating abdominal trauma: a prospective trial

I

Cefoxitin

Cefotetan

Cefoxitin

Cefotetan

135 130 117 133

1

1

5

5

colon 28

colon 28

colon 26

colon 29

11

6

7

13

Fabian TC

Am J surg 1994;167:291-6

Superiority of aztreaonam/clindamycin compared with gentamicin/clindamycin in patients with penetrating abdominal trauma.

I

Gentamicin + Clindamycin

 

Aztreonam + Clindamycin

36

 

37

4/1

 

4/1

colon 9/hv 27

colon 8/hv 29

13

3

Fabian et al

Clin Ther. 1982;5:38­47.

 

 

Use of antibiotic prophylaxis in PAT

I

Cefotaxime (1 dose)

Cefotaxime (24 hrs)

Cefazolin (24 hrs)

117

127

116

1 dose

24 hours

24 hours

Colon/SB/

Solid Organs

20(17%)

13(10%)

11(9%)

Griswold JA

Am Surg 1993;59:34­

9

Injury severity dictates individulaized antibiotic therapy in penetrating

abdominal trauma

I

Cefoxitin

Ceftizomine

Mexlocillin

Cefoxitin

Ceftizoxime

Mexlocillin

25

23

20

6

13

15

6 or 12 hrs Primary repair, no shock, ? 3 organs 6 or 12 hrs Colostomy, shock? 3 organs

colon 5

colon 3 

colon 3

colon 5

 colon 3

colon 5

12

8.7

10

50

15

53

Heseltine PN

J Trauma 1986;26:241-5

The efficacy of cefoxitin vs. clindamycin/gentamicin in surgically treated stab

wounds of the bowel

I

Gentamicin + Clindamycin

Cefoxitin

41

34

?3

Colon

14/hv27

Colon &/hv 27

7

3

Jones et al

Ann Surg.

1985;201:576-585.

Evaluation of Abx

therapy following

PAT

I

Clinda/Tobra

Cefandole

Cefoxitin

85

78

94

2 days

2 days

2 days

Colon/SB/ Solid

Organs

20%

29%

13%

Kirton O, et al.

J Trauma.

2000;49:822-832

Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days

I

ampicillin/sulbactam preop and for 24 hours, then randomized ampicillin/sulbactam or placebo for an additional 4 days

317

1 vs 5 days

(5 days vs 1 day): duodenum (8 vs 7), stomach (30 vs 34), sb (50 vs 63, p < 0.03), colon (82 vs 80), combined (54 vs 72, p <= 0.05)

(5 days vs 1 day); IAA (11 vs 12), fasciitis (2 vs 1), peritonitis (2 vs 1), wound infection (1 vs 0)

Nelson RM

Arch Surg 1986;121:153-6

Single-antibiotic sue for penetrating abdominal trauma.

I

Tobramycin + Clindamycin

Moxalactam

85

78

5

5

colon 26/hv 54

Colon 30/hv 50

11

16

Nichols et al

N Engl J Med. 1984;311:1065-1070.

Risk of Infection after PAT

I

Cefoxitin/Placebo

Clinda/Gent

70

75

5 days

5 days

Colon/SB in all

14 (20%)

17 (23%)

P = ns

Schmidt AM

Chemotherapy. 1999.45;380-391.

A prospective, randomized comparison of single-vs-multiple dose antibiotic

prophylaxis in penetrating trauma

I

cefoxitin

ceftriaxone

98

97 

tid x 3 days

1 dose

majority

extremity

4%

5%

Sims EH

Am Surg. 1997; 63:525-535

How many antibiotics are necessary to treat abdominal trauma victims?

I

cefoperazone

ceftriaxone/flagyl

amp/gent/flagyl

101

95

95

1 dose to 5 days (determined by nature of injury)

colon 31%

jejunum 27%

stomach 16% (colon injury pattern not statistically significant between groups) 

8/101

2/95

5/95

 

Tyburski JG

Arch Surg. 1998;133:1289-1296.

A trial of ciprofloxacin and metronidazole vs gentamicin & metronidazole for penetrating abdominal trauma

I

cipro/flagyl

gent/flagyl

35

33

1 dose to

4 days

 

20%

15%

 

 

Crenshaw C

Surg Gynecol Obst 1983;156:289-294

A prosepective random study of a single agent versus combination antibiotics as therapy in  penetrating injuries of the abdomen

II

Cefamadole

Tobramycin + Cephalothin

49

45

?3

?3

colon 16

colon 16

6

11

Delgado, George et al

J Trauma. 2002;53:673-678

Characteristics of prophylactic antibiotic strategies afer penetrating abdominal trauma at a Level I trauma center: a comparison with the EAST guidelines

II

Cefazolin (27%), cefotetan (8%), cefoxitin (25%), clindamycin + gentamycin (4%), ampicillin+gentamycin+metronidazole (6%), ampicillin/sulbactam (21%), other (9%)

97

1 day vs 4 days

colon 54%, sb 60%, stomach 32%

colon 24%, sb 17%, stomach 27%

Dellinger EP

Arch Surg 1986;121:23-30

Efficacy of short-course antibiotic prophylaxis after penetrating intestinal injury. A prospective randomized trial.

II

Doxycycline + Penicillin G

Cefoxitin

Doxycycline + Penicillin G

Cefoxitin

31

30

25

28

12 hrs

12 hrs

5

5

colon 18/sb 13

colon 15/sb 15

colon 14/sb 11

colon 14/sb 14

16

17

24

11

Demetriades D Injury 1991;22:20-24

Short-course antibiotic prophylaxis in penetrating abdominal injureis: Ceftriaxone versus cefoxitin

II

Ceftriaxone

Cefoxitin

60

63

colon 2

hv 1

colon 12/hv 38

colon 13/hv 45

7

8

Ericsson CD

J Trauma 1989;29:1356-61

Prophylactic antibiotics in trauma: The hazards of underdosing

II

Amikacin + Clindamycin 1200

Amikacin + Clindamycin 1200

Amikacin + Clindamycin 600

47

52

51

1

3

3

colon 13

colon 14

colon 18

19

21 1

2

Fabain TC

Am J Med 1985;79:157-60

Antibiotics in

penetrating abdominal trauma. Comparison of ticarcillin plus clavulanic acid with gentamicin plus clindamycin

II

Gentamicin + Clindamycin

Ticarcillin/Clavulanate

32

53

1

1

 

all

all

13

2

Feliciano DV

Am J Surg 1986;152:674-81

Single agent cephalosporin prophylaxis for penetrating abdominal trauma. Results and comment on the emergence of the enterococcus

II

Cefotaxime

Cefoxitin

Maxalactam

124

149

153

2

2

2

colon 52/hv 101

colon 65/hv 117

colon 66/hv 111

2

13

7

Gentry LO

Ann Surg 1984;200:561-6

Perioperative antibiotic therapy for penetrating injuries of the abdomen

II

Cefamadole

Cefoxitin

Ticarcillin + Tobramycin

51

50

51

2

2

2

colon 22/sb 37

colon 21/sb 40

colon 26/sb 37

18

6

10

Hofstetter SR

J Trauma 1984;24:307-10

A prospective comparison of two regimens of prophylactic antibiotics in abdominal trauma: cefoxitin versus triple drug.

 II

Cefoxitin

Ampicillin + Clindamycin+ Aminoglycoside

69

50

1

1

hv 31

hv 25

14

18

Kreis DJ Jr

Surg Gynecol Obstet 1986;163:1-4

A prospective randomized study of moxalactam versus gentamicin and clindamycin in

penetrating abdominal trauma.

II

Gentamicin + Clindamycin

Moxalactam

22

20

>3

colon 2/hv 4

colon 2/hv 7

23

0

Lou MA

Am Surg 1985;51:580-6

Comparison of cefamandole and carbenicillin in preventing sepsis following penetrating abdominal trauma

II

Cefamandole

Carbenicillin

47

58

3 or 5

3 or 5

colon 13/hv 33

colon 15/hv 36

6.4

19

Lou MA

J Trauma 1988;28:1541-7

Safety and efficacy of mezlocillin: A single­durg therapy for penetrating abdominal trauma

II

Mezlocillin

Clindamycin + Gentamicin

74

73

colon 5-10

hv 2-10

no injury 1

colon 20/hv 49

colon 24/hv 48

9

10

Moore et al

Am J surg. 1983;146:762-765

Preoperative Antibiotics for Abd GSW: A Prospective Randomized Study

II

Amp/Amikacin/Clinda

PNC G/Doxy

Carbenicillin

30

26

30

1 day (no HVI), 3 day (SB), 5 day (Colon)

Colon/SB in all

6 (20%)

6 (23%)

5 (13%)

Odonnell V

Surg Gynecol Obset 1978;147:525-8

Evaluation of carbenicillin and a comparison of clindamycin and gentamicin combined therapy in penetrating abdominal trauma

II

Clindamycin + Gentamicin

Carbenicillin

66

60

no injury ?4 any injury

?6

colon 15 

colon 15

16

21

Oreskovich et al Arch Surg 1982;117:200-205.

Duration of preventative antibiotic administration for PAT

II

PCN G

Doxy

42

39

12 hours

5 days

Colon/SB/ Solid Organs

4 (9.5%)

3 (7.6%)

Posner MC

Surg Gynecol Obstet 1987;165:29-32

Presumptive antibiotics for penetrating

abdominal wounds

II

Mezlocillin

Clindamycin + Gentamicin

61

69

colon 5

hv 2

colon 14

colon 19

15

13

Reed et al

J Trauma. 1995;32:21-27.

The pharmacokinetics of prophylactic antibiotics in trauma

II

Clinda and Amikacin

28

3

Colon/SB/ Solid Organs  11% developed infections. All had significantly less volume distribution

N/A

 

Rosemurgy AS

J Clin Pharmacol 1995;35:1046-1051.

Ceftizoxime use in trauma celiotomy: pharmacokinetics and patient outcomes

II 

Ceftizoxime

53

 2

 

N/A

Rowlands BJ

Am J Surg

1984;48:791-5 

Comparative studies of antibiotic therapy after penetrating abdominal

trauma

 II

Cefamandole

Cefoxitin

Clindamycin + Tobramycin

Moxalactam

Clindamycin + Tobramycin

51

54

46

47

45

3

3

3

5

5

N/A

N/A

20

20

11

2

9

Rowlands BJ

J Trauma

1987;27:250-5

Penetrating abdominal trauma: The sue of operative findings to

determine length of

antibiotic therapy.

II

Tobramycin + Metronidazole

Tobramycin + Clindamycin

Tobramycin + Metronidazole

Tobramycin + Clindamycin

49

53

31

27

?3

?3

colon 21/sb

19

colon 32/sb

14

colon 1/sb 1

colon 0/sb 0

 

Salim A, et al.

World J surg 2008;32:471-75

Analysis of 178

penetrating stomach and small bowel injuries

II

Cefoxitin (18.5%), ampicillin/sulbactam (46.1%), zosyn (25.3%), other (10.1%)

178

73.6% had antibiotics for more than 24 hours

stomach (18.%), sb (86%), duodenum (5%), colon, (39.%), mesentery (13%), pancreas (6%), liver (23%), spleen (7%), kidney (8%), vascular (11%), diaphragm (24%) 

SSI 20%, wound infections 8%, intra-abdominal abscess 13%

Sims EH

J Trauma 1993;34:205-10

Piperacillin monotherapy compared with metronidazole and gentamicin combination in penetrating abdominal trauma

II

Gentamicin + Metronidazole

Piperacillin

89

33

94

30

5 to 15

5 to 15

2 2

colon 20

hv 40

colon 26

hv 49

8

0

7

0

Van Rensburg LC

J Trauma1991;31:1490­4

Ceftriaxone (Rocephin) in abdominal trauma.

II

Ceftriaxone + Metronidazole

290 (89% stabs)

1

colon 47/hv 129

1.4 (all infections), 0 deep

Weigelt JA

J Trauma 1993;34:579-84

Abdominal surigcal wound infection is lowered with improved perioperative enterococcus and bacteroides therapy.

II

Cefoxitin

Ampicillin/Sulbactam

309

283

1

1

colon 54

colon 57

17

9

Croce et al

J Trauma. 1998;45:649-655.

Impact of Stomach and

Colon Injuries on Intra-Abdominal Abscess and the Synergistic Effect of Hemorrhage…

III

Variable Regimens

812

1

Stomach

Colon

Colon

(11.8%) Stomach (12.5%) Both (23.5%)

Dellinger EP

Arch Surg 1984;119:20-7

Risk of infection following laparotomy for penetrating abdominal injury

 III

Penicillin + Tetracycline or Doxycycline

330

N/A

colon 78 hv 118

13

Dente CJ

J Trauma. 2000;49:628-637

Ostomy as a risk factor for posttraumatic infection in penetrating colon injuries:

univariate and

multivariate analyses

III

 

311

 

colon 100% (no rectal involvement)

78/311 (25%)

Hooker KD

J Trauma. 1991;31:1155-60

Aminoglycoside combinations versus beta-lactams alone for penetrating abdominal trauma

III

single beta-lactam

aminoglycoside combinatin

1094

862

1 dose to 6 days

 

0-50%

Odonnell VA

Am Surg 1978;44:574-7

Role of antibiotics in penetrating abdominal trauma

III

Cephalosporin/Penicillin/Chloramphenicol, Gentamicin

Kanamycin, Clindamycin, Gentamicin + Clindamycin

107

variable

?7

N/A

N/A

15.8

7.4

Previous version of this guideline

Penetrating Abdomnial Trauma, Prophylactic Antibiotics in (1998)

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