The duration of antibiotic administration in penetrating abdominal trauma

Abstract

Objectives of the study: The purpose of this study was to test the hypothesis that 24 hours of antibiotic therapy remains sufficient to reduce the incidence of surgical site infection in penetrating abdominal trauma.Design: This is a prospective, randomized equivalence clinical trial Setting: VietDuc and Sainpaul Hospital in Hanoi Vietnam Patients: Three hundred and twenty consecutive adult patients with penetrating abdominal trauma were recruited for this study. They were diagnosed penetrating abdominal trauma at emergency room with time from accident to hospital less than twelve hours and without immune depression or allergy to cefradin. They were stratified by colon injury and then randomly assigned into two treatment groups Intervention: The patients received intravenous (IV) cefradin twenty-four hours or five days respectively group I and II. At first, the patient was given 2g dose in the emergency department (ED) immediately after the determination of requirement for laparotomy, followed by q6 h administration for total of four doses or twenty doses. Cefradin is not redosed intraoperatively during prolonged surgery unless indicated by original q6h dosing interval.Main outcome measurements: The development of surgical site infection as defined by the Centers for Disease Control and Prevention was recorded. Hospital length of stay was a secondary endpoint.Results: Three hundred and twenty patients were valuable. There was no postoperative mortality. The duration of antibiotic had no influence on the rate of surgical site infection. The difference in surgical site infection rate between two groups was within the range of equivalence set up (95%C.I:-0.06 to 0.09). The equivalent of intra-abdominal infection between treated groups was also confirmed (95%C.I: -0.03 to 0.03). There was no statistically significant difference in overall length of hospitalization between groups (p=0.1). Patients were more likely to develop SSI when blood transfusion were more than 750 ml (OR: 3.5; 95%C.I: 1.45-8.48;p=0.005) or number of intra-abdominal organ injuries more than one (OR: 6.57; 95%C.I: 3.45-12.5;p<0.001) and colon injury (OR: 2.66; 95%C.I: 1.1-6.4;p=0.03). Blood transfusion more than 750 ml (p=0.001), vascular (0.006), Solid organ (p=0.036) and colon injuries (0.006) which were independent contributors to prolongation of hospital stay.Conclusion: Twenty four hours of intravenous cefradin versus five days of therapy made no difference in the prevention of surgical site infection or length of hospitalization. However, need further study to validate short course treatment on high risk patients such as colon, vascular or several organs injuries. Infection was associated with blood loss, number of intra-abdominal organs injured, and colon injury. Prolonged hospitalization was associated with blood loss, vascular, solid organ and colon injury.