A Prospective Comparison of Two Regimens of Prophylactic Antibiotics in Abdominal Trauma

Hofstetter, Steven R.; Pachter, H. Leon; Bailey, Andrew; Coppa, Gene F.

doi:10.1097/00005373-198404000-00004

Cited by 45 publications

(7 citation statements)

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“…In this study, single-agent therapy with cefoxitin was shown to be as effective as combination therapies against single and combined infection. These data are supported by recent clinical studies in which therapy with cefoxitin was found to be equally effective as clindamycin plus an aminoglycoside (Gentry et al, 1984;Hofstetter et al, 1984 ;Nichols et al, 1984 ;Solomkin et al, 1984) and superior to cefamandole (Gentry et al, 1984;Jones et al, 1985) in the management of intraabdominal infection after trauma.…”

Section: Discussionmentioning

confidence: 66%

Pathogenicity of capsulate and non-capsulate members of Bacteroides fragilis and B. melaninogenicus groups in mixed infection with Escherichia coli and Streptococcus pyogenes.

Brook

1988

Journal of Medical Microbiology

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Summary.The relationships between capsulate and non-capsulate Bacteroidesfragilis strains and Escherichia coli, and between capsulate and non-capsulate strains of the B. melaninogenicus group and Streptococcus pyogenes, were studied in a subcutaneous abscess model in mice. Selective antimicrobial agents directed against either aerobic or anaerobic bacteria were used alone or in combination to explore the effect of eradication of one component of the mixed infection. Single agent therapy effective against both aerobic and anaerobic flora was also employed. Single therapy of mixed infection directed at the elimination of only one organism ( S . pyogenes, E. coli or Bacteroides sp.) caused significant reductions in the numbers of sensitive organisms and also smaller yet significant decreases in the numbers of insensitive organisms. However, the abscesses were not eliminated after such therapy. Combination therapy or use of a single agent (cefoxitin) directed against the aerobic and anaerobic components of the infection was more effective. Non-capsulate Bacteroides spp. became capsulate after passage in mice mixed with either S . pyogenes or E. coli. Therapy directed at the elimination of S . pyogenes and E. coli did not prevent the emergence of capsulate Bacteroides spp. These data demonstrate the synergy between all members of the B. fragilis group and E . coli and between the B . melaninogenicus group and S . pyogenes, and reiterate the need to direct antimicrobial therapy at the eradication of the aerobic and anaerobic components of mixed infections. IntroductionMembers of the Bacteroides fragilis group mixed with Escherichia coli are often isolated from intraabdominal infections (Brook, 1988), while members of the B. melaninogenicus group and Streptococcus pyogenes are frequently isolated from orofacial and respiratory infections (Brook, 198 1). Although the virulence of capsulate strains of B. fragilis is well established (Onderdonk et al., 1977; Brook et al., 1984a, b) the pathogenicity of other members of the B. fragilis and B. melaninogenicus groups requires further investigation.We have previously demonstrated the ability of "helper" organisms to assist in the emergence of capsulate Bacteroides spp. in vivo (Brook et al., 1983,

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Section: Discussionmentioning

confidence: 66%

Pathogenicity of capsulate and non-capsulate members of Bacteroides fragilis and B. melaninogenicus groups in mixed infection with Escherichia coli and Streptococcus pyogenes.

Brook

1988

Journal of Medical Microbiology

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“…For this reason, exclusive use of first generation cephalosporins is not effective as prophylactic antibiotic, and antibiotics to cover anaerobic bacteria are essential in cases of colon injury. Hofstetter et al [22] compared the combination of aminoglycoside, ampicillin, and clindamycin with cefoxitin alone in 119 patients who underwent abdominal surgery due to traumatic injury, and reported that the rates of surgical site infection were similar in both groups (12% vs. 13%), indicating that the exclusive use of second generation cephalosporin was possible in these patients. The 2012 Surviving Sepsis Campaign guideline recommended that empiric broad-spectrum antibiotics should be generally administered to patients with severe sepsis, and combination antibiotic therapy could also be used [23].…”

Section: Resultsmentioning

confidence: 99%

Antibiotic use in patients with abdominal injuries: guideline by the Korean Society of Acute Care Surgery

et al. 2019

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PurposeA task force appointed by the Korean Society of Acute Care Surgery reviewed previously published guidelines on antibiotic use in patients with abdominal injuries and adapted guidelines for Korea.MethodsFour guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Five topics were considered: indication for antibiotics, time until first antibiotic use, antibiotic therapy duration, appropriate antibiotics, and antibiotic use in abdominal trauma patients with hemorrhagic shock.ResultsPatients requiring surgery need preoperative prophylactic antibiotics. Patients who do not require surgery do not need antibiotics. Antibiotics should be administered as soon as possible after injury. In the absence of hollow viscus injury, no additional antibiotic doses are needed. If hollow viscus injury is repaired within 12 hours, antibiotics should be continued for ≤ 24 hours. If hollow viscus injury is repaired after 12 hours, antibiotics should be limited to 7 days. Antibiotics can be administered for ≥7 days if hollow viscus injury is incompletely repaired or clinical signs persist. Broad-spectrum aerobic and anaerobic coverage antibiotics are preferred as the initial antibiotics. Second-generation cephalosporins are the recommended initial antibiotics. Third-generation cephalosporins are alternative choices. For hemorrhagic shock, the antibiotic dose may be increased twofold or threefold and repeated after transfusion of every 10 units of blood until there is no further blood loss.ConclusionAlthough this guideline was drafted through adaptation of other guidelines, it may be meaningful in that it provides a consensus on the use of antibiotics in abdominal trauma patients in Korea.

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“…Apesar do desenvolvimento de novas drogas e suas associações, a sépsis continua como principal causa de morbidade e mortalidade tardias no trauma abdominal. 18,19 Outro fator que pode influenciar a evolução pós-operatória é a drenagem da cavidade abdominal. Em razão do acometimento mais freqüente das vísceras do andar supramesocólico e da dinâmica da distribuição dos líqui-dos intraperitoniais, a tendência é acumularem-se as secreções nos espaços subfrênicos.…”

Section: Discussionunclassified

Incidência de fístulas digestivas nos ferimentos toracoabdominais

Mantovani

Fontelles

Ajub

et al. 2000

Rev. Col. Bras. Cir.

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RESUMO:Os ferimentos penetrantes localizados na transição toracoabdominal (FTA), além da dificuldade diagnóstica, merecem especial atenção em relação à conduta adotada para o controle das complicações abdominais. Os autores analisaram 110 pacientes atendidos na Disciplina de Cirurgia do Trauma do Departamento de Cirurgia da UNICAMP, de 1988 a 1998, apresentando ferida penetrante toracoabdominal e submetidos à laparotomia exploradora com drenagem pleural fechada. As fístulas digestivas foram estudadas quanto à incidência, ao tratamento e à evolução pós-operatória. Do total de pacientes, 91 (82,7%) eram do sexo masculino e 19 (17,3%) do sexo feminino. A faixa etária situou-se entre 13 e 63 anos. Os FTA foram causados por projétil de arma de fogo (PAF) em 60 (54,5%) casos e por arma branca (FAB) em 50 (45,5%). As fístulas digestivas ocorreram em seis (5,4%) dos pacientes estudados, sendo quatro (3,6%) casos de fístula pancreática, um (0,9%) de fístula gástrica e um (0,9%) de fístula biliar, todos tratados de maneira conservadora, apresentando evolução favorável com resolução espontânea. INTRODUÇÃOEstudos conduzidos na área do trauma têm dirigido especial atenção às lesões penetrantes localizadas em topografia a mais variada, em especial, àquelas que acometem a transição toracoabdominal com comprometimento do músculo diafragma-torácico. Estas, apresentam características próprias, sobretudo no que se refere à dificuldade diagnóstica e ao tratamento adequado. As lesões de vísceras ocas que, freqüentemente, acompanham estes ferimentos, podem ocasionar contaminação da cavidade peritonial com possibilidade de estender-se ao espaço pleural. 1, 2, 3 Assim, nestes pacientes, não é rara a ocorrência de deiscência da sutura dos órgãos intra-abdominais atingidos, que leva ao aparecimento de fístulas digestivas, com graves repercussões hidreletrolíticas e nutricionais, responsáveis por elevadas taxas de morbidade e mortalidade. 4,5 As controvérsias quanto ao tratamento são compreensíveis, dadas as dificuldades, já referidas, relativas ao diagnóstico correto. Por outro lado, como duas cavidades são atingidas, muito se discute sobre a conduta quanto às prioridades e às vias de acesso cirúrgico, com intuito de reduzir as possíveis complicações que podem acometer estas cavidades.Tendo em vista estas dificuldades, foram revistos todos os casos de ferimentos toracoabdominais (FTA) ocorridos nos últimos dez anos, objetivando avaliar a incidên-cia, o tratamento e a evolução das fístulas digestivas que acometeram estes pacientes.

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A Prospective Comparison of Two Regimens of Prophylactic Antibiotics in Abdominal Trauma

Cited by 45 publications

References 0 publications

Pathogenicity of capsulate and non-capsulate members of Bacteroides fragilis and B. melaninogenicus groups in mixed infection with Escherichia coli and Streptococcus pyogenes.

Pathogenicity of capsulate and non-capsulate members of Bacteroides fragilis and B. melaninogenicus groups in mixed infection with Escherichia coli and Streptococcus pyogenes.

Antibiotic use in patients with abdominal injuries: guideline by the Korean Society of Acute Care Surgery

Incidência de fístulas digestivas nos ferimentos toracoabdominais

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