Prospective alterations in therapy for penetrating abdominal trauma.
In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (< or = 40%, low; 40% to 70%, mid; and > 70%, high) at surgical closure using a logistic regression formula based on four proved risk factors--age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.
Nichols
R L
RL
Department of Surgery, Tulane University, School of Medicine, New Orleans, La 70112.
Smith
J W
JW
Robertson
G D
GD
Muzik
A C
AC
Pearce
P
P
Ozmen
V
V
McSwain
N E
NE
Flint
L M
LM
D000007:Abdominal Injuries / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015313:Cefotetan / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002440:Cefoxitin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D004766:Enterostomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D014950:Wounds, Penetrating / Q000150:complications / Q000188:drug therapy* / Q000601:surgery
D015313:Cefotetan; D002440:Cefoxitin