Ann Surg Treat Res.  2019 Jan;96(1):1-7. 10.4174/astr.2019.96.1.1.

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

• Jang JY
• Kang WS
• Keum MA
• Sul YH
• Lee DS
• Cho H
• Lee GJ
• Lee JG
• Hong SK
• Korean Society of Acute Care Surgery (KSACS) Clinical Research Group

• KMID: 2429747
• DOI: http://doi.org/10.4174/astr.2019.96.1.1

Abstract

PURPOSE
A 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.
METHODS
Four 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.
RESULTS
Patients 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.
CONCLUSION
Although 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.

Keyword

Abdominal Injuries; Guideline; Antibiotic prophylaxis

MeSH Terms

Abdominal Injuries*
Advisory Committees
Anti-Bacterial Agents
Antibiotic Prophylaxis
Cephalosporins
Consensus
Humans
Korea
Shock, Hemorrhagic
Anti-Bacterial Agents
Cephalosporins

Reference

1. Goldberg SR, Anand RJ, Como JJ, Dechert T, Dente C, Luchette FA, et al. Prophylactic antibiotic use in penetrating abdominal trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012; 73:5 Suppl 4. S321–S325.

2. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting, and evaluation in health care. Prev Med. 2010; 51:421–424.

3. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma. 2011; 71:2 Suppl 2. S210–S234.

4. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50:133–164.

5. Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013; 8:3.

6. Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force. Chest. 2006; 129:174–181.

7. Fraser J, Drummond H. A clinical and experimental study of three hundred perforating wounds of the abdomen. Br Med J. 1917; 1:321–330.

8. Thadepalli H, Gorbach SL, Broido PW, Norsen J, Nyhus L. Abdominal trauma, anaerobes, and antibiotics. Surg Gynecol Obstet. 1973; 137:270–276.

9. Luchette FA, Borzotta AP, Croce MA, O'Neill PA, Whittmann DH, Mullins CD, et al. Practice management guidelines for prophylactic antibiotic use in penetrating abdominal trauma: the EAST Practice Management Guidelines Work Group. J Trauma. 2000; 48:508–518.

10. Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961; 50:161–168.

11. Alexander JW, Altemeier WA. Penicillin prophylaxis of experimental staphylococcal wound infections. Surg Gynecol Obstet. 1965; 120:243–254.

12. Fullen WD, Hunt J, Altemeier WA. Prophylactic antibiotics in penetrating wounds of the abdomen. J Trauma. 1972; 12:282–289.

13. Lack WD, Karunakar MA, Angerame MR, Seymour RB, Sims S, Kellam JF, et al. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orthop Trauma. 2015; 29:1–6.

14. Fabian TC, Croce MA, Payne LW, Minard G, Pritchard FE, Kudsk KA. Duration of antibiotic therapy for penetrating abdominal trauma: a prospective trial. Surgery. 1992; 112:788–794.

15. Dellinger EP, Wertz MJ, Lennard ES, Oreskovich MR. Efficacy of short-course antibiotic prophylaxis after penetrating intestinal injury. A prospective randomized trial. Arch Surg. 1986; 121:23–30.

16. Ericsson CD, Fischer RP, Rowlands BJ, Hunt C, Miller-Crotchett P, Reed L 2nd. Prophylactic antibiotics in trauma: the hazards of underdosing. J Trauma. 1989; 29:1356–1361.

17. Kirton OC, O'Neill PA, Kestner M, Tortella BJ. Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days. J Trauma. 2000; 49:822–832.

18. Velmahos GC, Toutouzas KG, Sarkisyan G, Chan LS, Jindal A, Karaiskakis M, et al. Severe trauma is not an excuse for prolonged antibiotic prophylaxis. Arch Surg. 2002; 137:537–541.

19. Solomkin JS, Mazuski JE, Baron EJ, Sawyer RG, Nathens AB, DiPiro JT, et al. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis. 2003; 37:997–1005.

20. Mazuski JE, Sawyer RG, Nathens AB, DiPiro JT, Schein M, Kudsk KA, et al. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: evidence for the recommendations. Surg Infect (Larchmt). 2002; 3:175–233.

21. Condon RE, Bartlett JG, Nichols RL, Schulte WJ, Gorbach SL, Ochi S. Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: results of controlled clinical trial. A Veterans Administration cooperative study. Am J Surg. 1979; 137:68–74.

22. Hofstetter SR, Pachter HL, Bailey AA, Coppa GF. A prospective comparison of two regimens of prophylactic antibiotics in abdominal trauma: cefoxitin versus triple drug. J Trauma. 1984; 24:307–310.

23. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013; 39:165–228.

24. Nichols RL, Smith JW, Klein DB, Trunkey DD, Cooper RH, Adinolfi MF, et al. Risk of infection after penetrating abdominal trauma. N Engl J Med. 1984; 311:1065–1070.

25. Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006; 355:2640–2651.

26. Malangoni MA, Song J, Herrington J, Choudhri S, Pertel P. Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg. 2006; 244:204–211.

27. Hakansson T, Raahave D, Hansen OH, Pedersen T. Effectiveness of single dose prophylaxis with cefotaxime and metronidazole compared with three doses of cefotaxime alone in elective colorectal surgery. Eur J Surg. 1993; 159:177–180.

28. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013; 14:73–156.

29. Meter JJ, Polly DW Jr, Brueckner RP, Tenuta JJ, Asplund L, Hopkinson WJ. Effect of intraoperative blood loss on the serum level of cefazolin in patients managed with total hip arthroplasty. A prospective, controlled study. J Bone Joint Surg Am. 1996; 78:1201–1205.

30. Polly DW Jr, Meter JJ, Brueckner R, Asplund L, van Dam BE. The effect of intraoperative blood loss on serum cefazolin level in patients undergoing instrumented spinal fusion. A prospective, controlledstudy. Spine (Phila Pa 1976). 1996; 21:2363–2367.