Ja. Griswold et al., INJURY SEVERITY DICTATES INDIVIDUALIZED ANTIBIOTIC-THERAPY IN PENETRATING ABDOMINAL-TRAUMA, The American surgeon, 59(1), 1993, pp. 34-39
Antibiotics play a crucial role in reducing the risk of postoperative
infection in patients suffering penetrating abdominal trauma. The infe
ction rate for patients with these injuries ranges from 7% to 16%. Sin
gle agents with broad-spectrum activity have proven efficacy, but dosa
ge and duration are still controversial. A prospective, double-blinded
study was performed on 102 patients randomized to receive one of thre
e antibiotics for a total of 12 hours: cefoxitin (3 doses, 31 patients
); ceftizoxime (2 doses, 36 patients); or mezlocillin (3 doses, 35 pat
ients). Two distinct groups at risk for postoperative infection were e
vident depending on the severity of injury: Group A were those with no
colon injury or a colon injury that could be repaired, no evidence of
shock, or fewer than 3 organs injured; Group B were those requiring a
colostomy, evidence of shock on presentation, or three or more organs
injured. All comparisons of the patient populations receiving the dif
ferent antibiotics showed the two groups to be equivalent. The mean pe
netrating abdominal trauma index for Group A was 8.8 and 28.2 for Grou
p B. The overall infection rate for Group A was 10.3% and 42.3% for Gr
oup B. There was a significant increase in infection rate for all anti
biotics except ceftizoxime in Group B compared with group A. The penet
rating abdominal trauma index was significantly higher in all patients
who developed infection for all antibiotics. In addition, if the surg
ical wound was closed primarily, patients with colon injuries develope
d wound infections 71% of the time, and those with small-bowel injurie
s did so 30% of the time. Therefore, it seems appropriate that patient
s with mild to moderate penetrating injuries to the abdomen require no
more than 12 hours of perioperative antibiotic coverage. In addition,
antibiotics with extended half-lives are more than adequate. The pene
trating abdominal trauma index appears to correlate well with the risk
of infection, and those patients with gastrointestinal tract violatio
n should have surgical wounds managed by delayed primary closure becau
se the risk of primary wound infection is unacceptably high.