Abstract

SANABRIA, Álvaro; FRANCO, Jorge; PINILLA, Andrés  and  FLOREZ, Tania. Methods of presumptive antibiotic therapy in abdominal and thoracic penetrating trauma at a specialized center. rev. colomb. cir. [online]. 2005, vol.20, n.2, pp.66-75. ISSN 2011-7582.

Objective: To validate the methods of presumptive antibiotic prescription in patients with thoracic and abdominal trauma at a specialized center. Methods: Prospective cohort type study. Population: Patients older than 12 years admitted to the general surgery service of our institution. The following patients were excluded: a) those that died within 48 hours of admission, b) those that had undergone some type of surgical procedure at another institution before admission, c) pregnant women, d) patients with history of antibiotic allergy or that developed it during hospital stay, e) those that had surgical treatment prior to admission, f) patients with serum creatinine = 2 mg/dl, g) those that requested hospital discharge before antibiotic therapy, and h) those presenting clinical or paraclinical evidence of active infection at the time of admission. Measurement and variables: Patients had a daily follow-up by the investigators during hospital stay and up to 30 days following discharge, by direct examination or by telephone communication; the following variables were recorded in a specially designed format: date and hour of admission, age, sex, time elapsed between trauma and operation, mechanism and anatomical location of trauma, ASA classification, presence of shock at the time of admission, intraoperative findings, type of antibiotics utilized, dosage, interval between trauma and antibiotic administration, timing of administration in reference to surgery, operating time, use of intraoperative antibiotic, septic complications, and interval between trauma and detection of complications. Observation was independent of treatment, for wich the surgeon was responsible. Place: University of Antioquia - San Vicente de Paul University Hospital, Medellín, Colombia. Results: 230 patients were studied, 120 with thoracic trauma and 110 with abdominal or thoraco-abdominal trauma. Presumptive antiobiotics were used in 45.8% of patients with thoracic trauma and in 94.5% of patients with abdominal trauma. Antibiotics were administered postoperatively in72% of the patients with thoracic trauma and in 25% of those with abdominal trauma. Average duration of antibiotic therapy was 3.2 days in the thoracic trauma patients and 2.9 days in the abdominal truma patients. Non recommended antibiotics were utilized in 23% of patients with thoracic trauma and in 27% of patients with abdominal trauma. There was ample variability in dosage, frequency, and type of the prescribed antibiotic. Conclusions: Regardless of available recommendations on evidence- based use of presumptive antibiotics in trauma, there is poor adherence in surgical practice. Variability in the type of antibiotic prescribed, dosage, and frequency may elevate costs and incidence of antibiotics resistance. It becomes necessary to establish institutional protocols on the prescription of antibiotics.

Keywords : wounds and injuries; anti-bacterial agents; antibiotic prescription; drugs; abdomen; thoracic injuries.

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