Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, while antibiotics were first used in World War II to combat septic complications associated with such injuries (Poole 1944). In 1972 Fullen noted a 7-11% post surgical infection rate with pre-operative antibiotic administration, a 33-57% post surgical infection rate with intra-operative antibiotic administration, and a 30-70% post surgical infection rate with only post-operative antibiotic administration (Fullen 1972). Approximately 20% of all penetrating abdominal wounds result in colonic injuries, and, consequently, aerobic and anaerobic flora are frequently cultured from septic complications. The most common organisms include Escherichia coli (E. coli), enterobacter species, Klebsiella species, Bacteriodes fragilis (B. fragilis) and Clostridia species (Fabian 1993). Dellinger observed that antibiotic regimens that excluded any anaerobic coverage resulted in incidences of infection of between 20-26%, versus an incidence of 7-14% when anaerobic cover was given (Dellinger 1991). According to current guidelines, there is sufficient class I evidence to support the use of a single pre-operative broad-spectrum antibiotic dose (Luchette 2000), with aerobic and anaerobic cover (Thadepalli 1973), with continuation of up to only 24 hours, in the event of a hollow viscus perforation found at exploratory laparotomy (Luchette 2000).
Why it is important to do this review
The aim of this review is to assess the benefits and harms of prophylactic antibiotics administered for penetrating abdominal injury in order to reduce the incidence of septic complications, such as septicaemia, intra-abdominal abscesses and wound infections. In undertaking this review we also aim to determine whether or not current guidelines are evidence-based, and to what extent further research is required.