Severe trauma is not an excuse for prolonged antibiotic prophylaxis.
OBJECTIVE
For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures.


METHODS
Prospective nonrandomized study.


METHODS
Surgical intensive care unit (SICU) of an academic hospital with a level I trauma center.


METHODS
A population of 250 trauma patients who required an operation and SICU stay of 3 days or more received antibiotic prophylaxis by 1 antibiotic for 24 hours (SHORT group, n = 133) or 1 or more antibiotics for more than 24 hours (LONG group, n = 117).


METHODS
Twenty-two outcome variables, including 9 conventional outcomes (eg, sepsis, septic shock, and organ failure) and 13 objective outcomes (days with temperature >38.5 degrees C, days with white blood cell count >14.0 x10(3)/microL, positive cultures, cultures with antibiotic-resistant bacteria, SICU and hospital stay, and death).


RESULTS
The LONG group included more patients with orthopedic injuries (60 patients [51%] vs 52 [39%], P =.05) and orthopedic operations (47 patients [40%] vs 30 [23%], P =.003) than did the SHORT group. No other difference was identified in compared characteristics between the 2 groups. There was no difference in any of the examined outcomes except for a higher incidence of resistant infections in the LONG group compared with the SHORT group (59 patients [50%] vs 47 [35%], P =.02). Patients with resistant infections stayed in the hospital longer (mean +/- SD, 33 +/- 18 vs 15 +/- 11 days, P<.001) and had a higher mortality rate (13% vs 1%, P<.001) compared with patients without resistant infections. Prolonged prophylaxis by multiple antibiotics was an independent risk factor of resistant infection (odds ratio, 2.13, 95% confidence interval, 1.22-3.74; P =.008).


CONCLUSIONS
The prophylactic administration of more than 1 antibiotic for more than 24 hours following severe trauma does not offer additional protection against sepsis, organ failure, and death, but increases the probability of antibiotic-resistant infections.
Velmahos
George C
GC
Division of Trauma and Critical Care, Department of Surgery, University of Southern California and Los Angeles County/USC Medical Center, 1200 N State St, Room 9900, Los Angeles, CA 90033, USA. velmahos@usc.edu
Toutouzas
Konstantinos G
KG
Sarkisyan
Grant
G
Chan
Linda S
LS
Jindal
Anurag
A
Karaiskakis
Marios
M
Katkhouda
Namir
N
Berne
Thomas V
TV
Demetriades
Demetrios
D
D000328:Adult; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000188:drug therapy / Q000601:surgery
D000900:Anti-Bacterial Agents