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Prophylactic antibiotics for penetrating abdominal trauma

  1. Martin Brand1,*,
  2. Jacque Goosen2,
  3. Andrew Grieve3

Editorial Group: Cochrane Injuries Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 13 JAN 2009

DOI: 10.1002/14651858.CD007370.pub2


How to Cite

Brand M, Goosen J, Grieve A. Prophylactic antibiotics for penetrating abdominal trauma. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007370. DOI: 10.1002/14651858.CD007370.pub2.

Author Information

  1. 1

    Melville, South Africa

  2. 2

    University of the Witwatersrand, Trauma Surgery, Johannesburg, Gauteng, South Africa

  3. 3

    University of the Witwatersrand, General Surgery/Trauma Unit, Johannesburg, Gauteng, South Africa

*Martin Brand, PO Box 291429, Melville, 2109, South Africa. martinbrand78@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 7 OCT 2009

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This is not the most recent version of the article. View current version (18 NOV 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient class I evidence to support the use of a single pre-operative broad spectrum antibiotic dose, with aerobic and anaerobic cover, and continuation (up to 24 hours) only in the event of a hollow viscus perforation found at exploratory laparotomy.

Objectives

To assess the benefits and harms of prophylactic antibiotics administered for penetrating abdominal injuries for the reduction of the incidence of septic complications, such as septicaemia, intra-abdominal abscesses and wound infections.

Search methods

Searches were not restricted by date, language or publication status. We searched the following electronic databases: the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2008 Issue 3), MEDLINE (Ovid), EMBASE (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), PubMed. Searches were last conducted in September 2008.

Selection criteria

All randomised controlled trials of antibiotic prophylaxis or treatment in patients with penetrating abdominal trauma versus no antibiotics or placebo.

Data collection and analysis

The authors performed the literature search independently, and screened all resulting abstracts for inclusion.

Main results

We identified no trials meeting the inclusion criteria.

Authors' conclusions

There is currently no information from randomised controlled trials to support or refute the use of antibiotics for patients with penetrating abdominal trauma.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Should prophylactic antibiotics be used in patients with penetrating abdominal trauma?

For over half a century antibiotics have been given to patients that have suffered from a penetrating injury to the abdominal peritoneal cavity in an attempt to decrease the incidence of post-operative wound infection, intra-abdominal infection and mortality. This review was designed to assess whether or not this practice is supported by robust evidence.

No randomised controlled trials could be found that met the inclusion criteria for this review. Therefore, there is no evidence to unequivocally support or refute this practice. Current guidelines are based on expert opinion rather than fact.

We recommend that a randomised control trial be designed to assess which patients would benefit from antibiotic prophylaxis, and which patients would not. Hopefully this would result in less unnecessary antibiotic use, and thus less antibiotic resistance.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防性抗生素用於穿透性腹部創傷

穿透性腹部創傷發生在腹腔破裂時。常規性的剖腹手術用於穿透性腹部創傷始於1800年,隨之第二次大戰第一次使用抗生素以對抗有關這些損傷之敗血症的併發症。這種做法的特點是減少敗血症相關的死亡率和發生率。然而,預防性抗生素來防止感染性併發症是有爭議的,因為迄今未有隨機的安慰劑對照試驗發表。而且也有抗生素預防法使用時機的反對意見。1972年Fullen提到術前使用抗生素者其術後感染率為7%至11%,術中抗生素的施行其感染率為33%至57%,而僅於術後施行抗生素其感染率為30%至70%。現行準則聲稱有充分的一級(class I)證據支持單一術前的廣效型抗生素劑量使用,以有氧及無氧覆蓋且持續使用(至24小時),前提是只有在剖腹探查術發現中空臟器穿孔的情形下使用。

目標

評估預防性抗生素實施於穿透性腹部損傷其效益及危險性,以減少敗血性的併發症發生率,如敗血症,腹腔膿瘡及傷口感染。

搜尋策略

檢索方式不限日期,語言或發表狀況。我們搜尋以下的電子資料庫:the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2008 Issue 3), MEDLINE (Ovid), EMBASE (Ovid), ISI Web of Science: Science Citation Index Expanded (SCIEXPANDED), ISI Web of Science: Conference Proceedings Citation Index Science (CPCIS), PubMed。最近一次檢索是在2008年9月。

選擇標準

穿透性腹部創傷患者使用抗生素預防法或治療,對照無抗生素或安慰劑組之所有的隨機對照試驗。

資料收集與分析

作者分別獨立執行文獻檢索並檢閱所有的結果摘要以納入研究。

主要結論

我們確認無試驗符合納入標準。

作者結論

目前尚未有來自隨機對照試驗其支持或反對穿透性腹部創傷患者使用抗生素的資訊。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

預防性抗生素應使用於穿透性腹部創傷患者嗎?:在過去半個世紀抗生素已使用於遭受腹腔穿透損傷的患者,以期減少術後傷口感染的發生率,腹腔感染及死亡率。這篇回顧的目的是評估這種作法是否可以經由健全的證據獲得支持。這篇回顧沒有發現符合納入標準的隨機對照試驗。所以沒有證據明確的支持或反對這種作法。現行的準則是依據專家建議而非事實。我們建議設計一個隨機對照試驗以評估何種病患將會受益於抗生素預防法,何種病患不會。期望此研究將減少不必要的抗生素使用,因而減少抗生素的抗藥性。