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

Abstract

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.

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

“…If hollow viscus injury is repaired within 12 h, antibiotics should be continued for ≤ 24 h [ 207 ].…”

Current status of initial antibiotic therapy and analysis of infections in patients with solitary abdominal trauma: a multicenter trial in Korea

“…Broad-spectrum antibiotics, which can be used against aerobic and anaerobic organisms, are preferred as initial antibiotics [6,20]. Second-generation cephalosporin is recommended, and third-generation cephalosporin is an alternative [7]. In this study, third-generation cephalosporin was most commonly used (31.5%) and second-generation cephalosporins were used next (25.0%).…”

“…Although this study did not include all hospitals in Korea, large hospitals including trauma centers participated in the study. The guidelines for the use of antibiotics for abdominal trauma in Korea were recently published [7]. Whether the antibiotics are used according to the guidelines should be confirmed, and the changes in the use of antibiotics and the differences in results must be analyzed through prospective studies.…”

“…Thus, the present study aimed to investigate the status of initial antibiotic therapy in patients with abdominal trauma. This is a pilot study before applying the guidelines about the use of antibiotics for abdominal injuries in Korea [7].…”

Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence

“…In 2019, the Korean Society of Acute Care Surgery published a guideline [ 19 ] about the use of antibiotics in patients with abdominal injuries. The authors stated that patients not requiring surgery do not need antibiotics (Level of recommendation 1A, according to GRADE recommendations [ 20 ], based on RCTs).…”