cefamandole and Abdominal-Injuries

Topics: Abdomen; Abdominal Injuries; Abscess; Amikacin; Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Chloramphenicol; Clindamycin; Clinical Trials as Topic; Humans; Metronidazole; Rats; Ticarcillin

Postoperative infection accounts for significant morbidity and mortality following penetrating abdominal trauma. During a 2 1/2-year period, December 1980 through June 1983, 257 patients sustaining penetrating abdominal injury were initially treated at Parkland Memorial Hospital in Dallas. Following the patient's written consent, they were prospectively randomized to receive, prior to surgery, intravenous clindamycin 600 mg every 6 hours and tobramycin 1.2 mg/kg every 6 hours (CT), or cefamandole 1 gm every 4 hours (M), or cefoxitin 1 gm every 4 hours (C). The antibiotics were continued for 48 hours. Major organ injuries in the three groups were comparable. The overall infection rate was significantly less in the cefoxitin group (13%), compared to cefamandole at 29%, and was comparable to the combination of clindamycin/tobramycin at 20%. The most significant difference followed colon injury. There were 96 patients who sustained colon injuries and the infection rate was CT 33%, M 62%, and C 19% (p = 0.002). If nonoperative wound infections were excluded from the colon group and only severe infections were evaluated, the infection rate was CT 18%, M 38%, and C 13% (p = 0.021). The infection rate was higher in the shock patients and tended to increase as age increased. Enterococcus, Escherichia coli, and Klebsiella pneumoniae were the most frequent aerobes isolated along with anaerobes. Five of six Bacteroides isolates from major infections occurred in the cefamandole group; two of which were in bacteremic patients. The hospital stay corresponded with infection rates, being 11.4 days (CT), 13.1 days (M), and 9.4 days (C). The results of this study indicate that cefoxitin is comparable to the combination of clindamycin/tobramycin and superior to cefamandole when used before surgery in patients sustaining penetrating abdominal trauma. The study suggests that antibiotic coverage should be against aerobes and anaerobes. Routine administration of an aminoglycoside is unnecessary.

Topics: Abdominal Injuries; Abscess; Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clindamycin; Colostomy; Drug Therapy, Combination; Humans; Ileostomy; Middle Aged; Premedication; Prospective Studies; Random Allocation; Tobramycin; Wound Infection; Wounds, Gunshot; Wounds, Stab

One hundred and five patients with penetrating abdominal injuries were treated with single-antibiotic regimens. Forty-seven patients were treated with intravenous (IV) cefamandole and for comparison 58 patients were treated with IV carbenicillin previously shown to be effective against postoperative infections associated with abdominal trauma. The overall incidence of deep infection on a single antibiotic therapy was 8.6 per cent, including two patients on cefamandole alone (4.3%) and seven (12.1%) on carbenicillin alone. One in each antibiotic group died of sepsis with a total mortality of 1.9 per cent. The authors concluded that cefamandole when used alone was found to be safe and more effective than carbenicillin alone in preventing sepsis in patients with abdominal trauma.

Topics: Abdominal Injuries; Adult; Bacterial Infections; Carbenicillin; Cefamandole; Colon; Female; Fever; Humans; Infusions, Parenteral; Intestinal Perforation; Length of Stay; Male; Premedication; Prospective Studies; Random Allocation; Rectum; Wound Infection; Wounds, Penetrating

From 1979 through 1981, 152 patients with penetrating injuries of the intra-abdominal gastrointestinal tract were placed on one of three different perioperative antibiotic regimens in a prospective randomized fashion. The three regimens were A) cefamandole 2 grams every 4 hours, B) cefoxitin 2 grams every 6 hours, and C) ticarcillin 3 grams every 4 hours and tobramycin 1.5 mg/kg every 8 hours. Antibiotics were administered intravenously before and for 48 hours following surgical exploration and repair. The three treatment groups were similar with respect to age, average number of organ injuries, and distribution of organ injuries. Cefoxitin-treated patients experienced uneventful recoveries more often than cefamandole-treated patients (94% vs. 80.3%, p less than 0.05) when the incidence of gram-negative wound infection and intra-abdominal abscess formation was considered, while the number of patients who experienced uneventful recoveries in the ticarcillin-tobramycin group was not statistically different from the other two groups of patients. Bacteroides fragilis was isolated from three of the six abscesses occurring in the cefamandole-treated group, while no anaerobes were isolated from abscesses in patients treated with either of the other two regimens. The results of this study suggest that the most effective perioperative antibiotic regimen for patients with penetrating gastrointestinal wounds should possess activity against both aerobic and anaerobic flora of the bowel.

Topics: Abdomen; Abdominal Injuries; Abscess; Adult; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Ticarcillin; Tobramycin; Wounds, Penetrating

One hundred patients undergoing operation for penetrating and potentially contaminated wounds of the abdomen were given cefamandole or a combination of cephalothin-tobramycin by a random, single blind method as preventive therapy. Results were evaluable for 49 patients receiving cefamandole for a success rate of 93.9 per cent. The 45 evaluable results in the second group had a success rate of 88.9 per cent. Those in the single therapy group also required fewer days of treatment and of hospital confinement, resulting in lower per patient cost. Results of this study show cefamandole to be an efficacious alternative for surgeons seeking a single agent therapy.

Topics: Abdominal Injuries; Adolescent; Adult; Anti-Bacterial Agents; Cefamandole; Cephalosporins; Cephalothin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Tobramycin; Wound Infection; Wounds, Penetrating

Topics: Abdomen; Abdominal Injuries; Abscess; Amikacin; Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Chloramphenicol; Clindamycin; Clinical Trials as Topic; Humans; Metronidazole; Rats; Ticarcillin

Intrahepatic foreign bodies are extremely rare before 6 months of age. We reported a case of a 5-month-old boy with a needle-like foreign body in the liver. The foreign body was incidentally found in the right hepatic lobe on the x-ray image. He was asymptomatic, with neither a history of swallowing a needle nor an abdominal cutaneous scar. Three-dimensional reconstruction of spiral computed tomographic scan showed an intrahepatic needle, close to the base of the heart, with its proximal end close to the gallbladder fossae. Because of the localization of the needle and subsequent risks of complications, surgical removal was recommended. At laparotomy, a tiny scar was recognized in the upper surface of the right lobe of the liver, confirming the migration route. Postoperative course was uneventful, and the child was discharged on postoperative day 10 and is thriving perfectly 2 months after surgery. We reviewed the clinical issues of intrahepatic foreign bodies and briefly discussed its approach and implications.

Topics: Abdominal Injuries; Anti-Bacterial Agents; Asymptomatic Diseases; Cefamandole; Emergencies; Foreign Bodies; Foreign-Body Migration; Humans; Image Processing, Computer-Assisted; Incidental Findings; Infant; Laparotomy; Liver; Liver Function Tests; Male; Needles; Respiratory Tract Infections; Tomography, Spiral Computed; Wound Infection