To identify the risk factors for the development of postoperative septic complications in patients with intestinal perforation after abdominal trauma, and to compare the efficacies of single-drug and dual-drug prophylactic antibiotic therapy, we studied 145 patients who presented with abdominal trauma and intestinal perforation at two hospitals between July 1979 and June 1982. Logistic-regression analysis showed that a higher risk of infection (P less than 0.05) was associated with increased age, injury to the left colon necessitating colostomy, a larger number of units of blood or blood products administered at surgery, and a larger number of injured organs. The presence of shock on arrival, which was found to increase the risk of infection when this factor was analyzed individually, did not add predictive power. Patients with postoperative sepsis were hospitalized significantly longer than were patients without infection (13.8 vs. 7.7 days, P less than 0.0001). Both treatment regimens--cefoxitin given alone and clindamycin and gentamicin given together--resulted in similar infection rates, drug toxicity, duration of hospitalization, and costs.
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(1995). Transfusion Requirements in Critical Care: A Pilot Study. JAMA
273: 1439-1444
[Abstract]
Sauaia, A., Moore, F. A., Moore, E. E., Haenel, J. B., Read, R. A., Lezotte, D. C.
(1994). Early Predictors of Postinjury Multiple Organ Failure. Arch Surg
129: 39-45
[Abstract]
Duke, B. J., Modin, G. W., Schecter, W. P., Horn, J. K.
(1993). Transfusion Significantly Increases the Risk for Infection After Splenic Injury. Arch Surg
128: 1125-1132
[Abstract]
Agarwal, N., Murphy, J. G., Cayten, C. G., Stahl, W. M.
(1993). Blood Transfusion Increases the Risk of Infection After Trauma. Arch Surg
128: 171-177
[Abstract]
Nichols, R. L., Smith, J. W., Robertson, G. D., Muzik, A. C., Pearce, P., Ozmen, V., McSwain, N. E. Jr, Flint, L. M.
(1993). Prospective Alterations in Therapy for Penetrating Abdominal Trauma. Arch Surg
128: 55-64
[Abstract]
Page, C. P., Bohnen, J. M. A., Fletcher, J. R., McManus, A. T., Solomkin, J. S., Wittmann, D. H.
(1993). Antimicrobial Prophylaxis for Surgical Wounds: Guidelines for Clinical Care. Arch Surg
128: 79-88
[Abstract]
Bohnen, J. M. A., Solomkin, J. S., Dellinger, E. P., Bjornson, H. S., Page, C. P.
(1992). Guidelines for Clinical Care: Anti-infective Agents for Intra-abdominal Infection: A Surgical Infection Society Policy Statement. Arch Surg
127: 83-89
[Abstract]
Meakins, J. L.
(1991). Surgeons, Surgery, and Immunomodulation. Arch Surg
126: 494-498
[Abstract]
Schneider, R. P., Christou, N. V., Meakins, J. L., Nohr, C.
(1991). Humoral Immunity in Surgical Patients With and Without Trauma. Arch Surg
126: 143-148
[Abstract]
Dubrow, T., Schwartz, R. J., McKissock, J., Wilson, S. E.
(1991). Effect of Aerosolized Fibrin Solution on Intraperitoneal Contamination. Arch Surg
126: 80-83
[Abstract]
Winter, R. P., Weigelt, J. A.
(1990). Cervical Esophageal Trauma: Incidence and Cause of Esophageal Fistulas. Arch Surg
125: 849-852
[Abstract]
LANDIS, G. H.
(1990). Blood Use in Head and Neck Tumor Surgery. Arch Otolaryngol Head Neck Surg
116: 741-742
[Abstract]
Dellinger, E. P., Miller, S. D., Wertz, M. J., Grypma, M., Droppert, B., Anderson, P. A.
(1988). Risk of Infection After Open Fracture of the Arm or Leg. Arch Surg
123: 1320-1327
[Abstract]
Condon, R. E., Haley, R. W., Lee, J. T. Jr, Meakins, J. L.
(1988). Does Infection Control Control Infection?. Arch Surg
123: 250-256
[Abstract]
Dellinger, E. P., Wertz, M. J., Lennard, E. S., Oreskovich, M. R.
(1986). Efficacy of Short-Course Antibiotic Prophylaxis After Penetrating Intestinal Injury: A Prospective Randomized Trial. Arch Surg
121: 23-30
[Abstract]
SANDERS, C. V., GREENBERG, R. N., MARIER, R. L.
(1985). Cefamandole and Cefoxitin. ANN INTERN MED
103: 70-78
[Abstract]
