Risk of Infection after Penetrating Abdominal Trauma

Abstract

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.

Stress responses and innate immunity: aging as a contributory factor

“…In many studies of trauma, a range of multiple traumas, such as motor accidents, gunshot wounds or stabbings, have been studied in which age would not be a significant variable in the sample group studied (Caplan & Hoyt, 1985;Papia et al, 1999). In other studies, age has been described as one of several risk factors contributing towards infection after trauma (Nichols et al, 1984;Bochicchio et al, 2002). Our own work has examined the incidence of infection and immune function after mild trauma, looking at young people with a single limb fracture compared with elderly patients with a fractured neck of femur (Butcher et al, 2003).…”

“…If the normal response to stress, namely the production of stress hormones, was the main factor affecting the decline in immunity in response to stress, then you would predict that markers of immune suppression, such as infection, would be similar in the young and elderly. However, several studies have shown age to be a significant factor for risk of infection after severe and mild trauma (Nichols et al ., 1984;Saito et al ., 2003;Thomas & Hall, 2004). We discuss here the impact of aging on the body's response to stress and how this might synergize with the age-associated decline in immune function (immune senescence) to produce an exaggerated and detrimental response to stress in the elderly.…”

Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes

“…1,8,22 Identifying independent risk factors for infection in trauma patients is a difficult task. However, in multivariate analyses, older age, type of trauma (blunt or penetrating), the presence of shock, the number of affected organs, [25][26][27][28] spinal cord injury, the requirement for mechanical ventilation, the use of central catheters, multiple transfusions and several surgical procedures have been reported to be substantial risk factors for infection in trauma patients. Undergoing a surgical procedure in the first 24 hours after admission offers a protective benefit against the development of an infection.…”

Preventing surgical site infections

“…A single dose of parenterally administered antibiotic, given just before abdominal exploration for penetrating abdominal trauma, is associated with a low postoperative infection rate in patients with no observed gastrointestinal leakage. 12 If gastrointestinal leakage is identified at the time of the operation, continuing the antibiotic agents for 1 to 3 days is usually recommended. It is important to use antibiotic agents with both facultative and anaerobic activity.…”