Characteristics of prophylactic antibiotic strategies after penetrating abdominal trauma at a level I urban trauma center: a comparison with the East guidelines.
BACKGROUND
Antibiotic prophylaxis, along with surgical intervention, is a key component in reducing infection in patients after penetrating abdominal trauma (PAT). Recent guidelines from the Eastern Association for the Surgery of Trauma (EAST) recommend that prophylaxis for < or = 24 hours is adequate for most patients. We compared antibiotic prophylaxis practices after PAT at our institution with EAST guidelines, quantified the incidence of infection, and identified risk factors for infection.


METHODS
This study was a retrospective review of patients with PAT requiring a therapeutic laparotomy between July 1998 and January 2001.


RESULTS
Antibiotic prophylaxis met EAST guidelines criteria in 21 of 97 patients (22%). There was a trend toward higher infection rates (18 of 76 vs. 3 of 21; = 0.273) when prophylaxis exceeded EAST recommendations. Multivariate analysis revealed blood transfusions to be the only predictor of infection (odds ratio, 6.9; 95% confidence interval, 2.42-19.95).


CONCLUSIONS
Despite prophylactic antibiotic use often exceeding EAST criteria, many patients still developed infection. Blood transfusion was the only significant risk factor for infection.
Delgado
George
G
Department of Pharmacy Services, Wayne State University, Detroit, Michigan, USA.
Barletta
Jeffrey F
JF
Kanji
Salmaan
S
Tyburski
James G
JG
Wilson
Robert F
RF
Devlin
John W
JW
D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D019072:Antibiotic Prophylaxis; D003428:Cross Infection / Q000517:prevention & control; D004064:Digestive System / Q000293:injuries; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D014946:Wound Infection / Q000517:prevention & control*; D014950:Wounds, Penetrating / Q000601:surgery*