cefoxitin 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

The epidemiology of penetrating abdominal trauma is changing to reflect an increasing incidence of multiple injuries. Not only do multiple injuries increase the risk of infection, a very high risk of serious infection is conferred by immunosuppression from hemorrhage and transfusion and the high likelihood of intestinal injury, especially to the colon. Optimal timing and choice of presumptive antibiotic therapy has been established for penetrating trauma, but duration has not been studied extensively in such seriously injured patients. The purpose of this study was to test the hypothesis that 24 hours of antibiotic therapy remains sufficient to reduce the incidence of infection in penetrating abdominal trauma.. Three hundred fourteen consecutive patients with penetrating abdominal trauma were prospectively randomized into two groups: Group I received 24 hours of intravenous cefoxitin (1 g q6h) and group II received 5 days of intravenous cefoxitin. The development of a deep surgical site (intra-abdominal) infection as well as any type of nosocomial infection, as defined by the Centers for Disease Control and Prevention, (ie, surgical site infections, catheter-related infections, urinary tract, pneumonia), was recorded. Hospital length of stay was a secondary endpoint. Statistical analysis included chi-square tests for coordinate variables and two-tailed unpaired t tests for continuous variables. The independence of risk factors for the development of infection was assessed by multivariate analysis of variance. Significance was determined when P <0.05.. Three hundred patients were evaluable. There was no postoperative mortality, and no differences in overall length of hospitalization between groups. The duration of antibiotic treatment had no influence on the development of any infection (P = 0.136) or an intraabdominal infection (P = 0.336). Only colon injury was an independent predictor of the development of an intraabdominal infection (P = 0.0031). However, the overall infection incidence was affected by preoperative shock (P = 0.003), colon (P = 0.0004), central nervous system (CNS) injuries (P = 0.031), and the number of injured organs (P = 0.026). Several factors, including intraoperative shock (P = 0.021) and injuries to the colon (P = 0.0008), CNS (P = 0.0001), and chest (P = 0.0006), were independent contributors to prolongation of the hospital stay.. Twenty-four hours of presumptive intravenous cefoxitin versus 5 days of therapy made no difference in the prevention of postoperative infection or length of hospitalization. Infection was associated with shock on admission to the emergency department, the number of intra-abdominal organs injured, colon injury specifically, and injury to the central nervous system. Intra-abdominal infection was predicted only by colon injury. Prolonged hospitalization was associated with intraoperative shock and injuries to the chest, colon, or central nervous system.

Topics: Abdominal Injuries; Adolescent; Adult; Aged; Antibiotic Prophylaxis; Cefoxitin; Cephamycins; Child; Female; Humans; Male; Middle Aged; Prospective Studies; Surgical Wound Infection; Time Factors; Wounds, Penetrating

In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (< or = 40%, low; 40% to 70%, mid; and > 70%, high) at surgical closure using a logistic regression formula based on four proved risk factors--age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.

Topics: Abdominal Injuries; Adult; Age Factors; Blood Transfusion; Cefotetan; Cefoxitin; Combined Modality Therapy; Drug Administration Schedule; Emergency Service, Hospital; Enterostomy; Female; Humans; Incidence; Infusions, Intravenous; Injury Severity Score; Laparotomy; Length of Stay; Logistic Models; Louisiana; Male; Middle Aged; Prospective Studies; Risk Factors; Surgical Wound Infection; Wounds, Penetrating

Antibiotics play a crucial role in reducing the risk of postoperative infection in patients suffering penetrating abdominal trauma. The infection rate for patients with these injuries ranges from 7% to 16%. Single agents with broad-spectrum activity have proven efficacy, but dosage and duration are still controversial. A prospective, double-blinded study was performed on 102 patients randomized to receive one of three antibiotics for a total of 12 hours: cefoxitin (3 doses, 31 patients); ceftizoxime (2 doses, 36 patients); or mezlocillin (3 doses, 35 patients). Two distinct groups at risk for postoperative infection were evident depending on the severity of injury: Group A were those with no colon injury or a colon injury that could be repaired, no evidence of shock, or fewer than 3 organs injured; Group B were those requiring a colostomy, evidence of shock on presentation, or three or more organs injured. All comparisons of the patient populations receiving the different antibiotics showed the two groups to be equivalent. The mean penetrating abdominal trauma index for Group A was 8.8 and 28.2 for Group B. The overall infection rate for Group A was 10.3% and 42.3% for Group B. There was a significant increase in infection rate for all antibiotics except ceftizoxime in Group B compared with group A. The penetrating abdominal trauma index was significantly higher in all patients who developed infection for all antibiotics. In addition, if the surgical wound was closed primarily, patients with colon injuries developed wound infections 71% of the time, and those with small-bowel injuries did so 30% of the time.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Abdominal Injuries; Adult; Cefoxitin; Ceftizoxime; Double-Blind Method; Female; Humans; Injury Severity Score; Male; Mezlocillin; Prospective Studies; Risk Factors; Surgical Wound Infection; Time Factors; Wound Infection; Wounds, Penetrating

The optimal duration of antibiotic use in penetrating abdominal trauma is incompletely defined. It is generally accepted that short-term antibiotics are appropriate for low-risk wounds. However, with colon injury and significant degree of injury, abdominal trauma index (ATI) more than 25, concern exists that short-term treatment is not adequate.. The study was a prospective double-blind trial of 24-hour treatment (cefoxitin or cefotetan) compared with 5-day treatment in 515 patients. Major abdominal infections (MAI) included abscess, necrotizing fasciitis, and diffuse peritonitis.. MAI occurred in 8% of those patients with 1-day therapy and 10% with 5-day therapy. Subgroup analysis of high-risk groups (colon wounds and ATI of more than 25) showed the following MAI rates: colon, 1-day therapy, 14%; 5-day therapy, 15%; ATI of more than 25, 1-day therapy, 17%; 5-day therapy, 30%.. Regardless of contamination and degree of injury, 24-hour antibiotic therapy is satisfactory for all penetrating abdominal trauma.

Topics: Abdominal Injuries; Adult; Analysis of Variance; Bacterial Infections; Cefotetan; Cefoxitin; Double-Blind Method; Drug Administration Schedule; Humans; Prospective Studies; Time Factors; Treatment Outcome; Wounds, Penetrating

This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.

Topics: Abdominal Injuries; Adult; Bacterial Infections; Cefoxitin; Ceftriaxone; Colon; Female; Humans; Male; Multiple Trauma; Postoperative Complications; Premedication; Prospective Studies; Risk Factors; Wounds, Penetrating

In this open, prospective, comparative study, 75 patients who sustained penetrating abdominal trauma were randomised to receive 1 of 3 antibiotic regimens preoperatively and for 3 to 5 days postoperatively. Group I received cefotaxime 2g 8-hourly, group II received cefoxitin 2g 6-hourly and group III received clindamycin (900 mg 8-hourly) and gentamicin 3 to 5 mg/kg/day in divided doses 8-hourly. The 3 groups were not statistically different in terms of age, sex, severity of injury, number of organs injured, colon injuries, shock, blood transfusions or positive intra-operative cultures. Septic complications occurred in 8% of patients in group I, in 4% of group II patients and in 8% of group III patients. Cefotaxime was the least costly regimen, followed by cefoxitin, then clindamycin and gentamicin. It may be concluded that single agent therapy with a broad spectrum cephalosporin is preferable to combination therapy on the basis of equivalent effectiveness, less toxicity and lower costs.

Topics: Abdominal Injuries; Bacterial Infections; Cefotaxime; Cefoxitin; Cephalosporins; Clindamycin; Costs and Cost Analysis; Drug Therapy, Combination; Gentamicins; Humans; Prospective Studies; Random Allocation; Wounds, Penetrating

Multiple studies have shown that the incidence of infectious complications after penetrating abdominal wounds are decreased by the perioperative administration of antibiotics. In this study of three separate single cephalosporin agents (cefotaxime, cefoxitin, and moxalactam) given for a 48 hour period in patients who sustained perforating gastrointestinal wounds, uncomplicated recoveries occurred in 93 percent of all patients. The rates of uncomplicated recovery were significantly different for the three groups; however, patients with major intraabdominal vascular injuries were more common in the cefoxitin-treated group. One disturbing feature was the presence of enterococci in 57 percent of isolates from wound infections and 60 percent of isolates from intraabdominal abscesses. Enterococci as sole isolates were found in one of two wound infections and three of four intraabdominal abscesses in the moxalactam-treated group.

Topics: Abdominal Injuries; Adult; Cefotaxime; Cefoxitin; Drug Evaluation; Female; Humans; Male; Moxalactam; Postoperative Complications; Prospective Studies; Random Allocation; Wound Infection; Wounds and Injuries

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

To determine the best antibiotic regimen to employ in patients undergoing laparotomy for trauma, a randomized prospective study was designed comparing cefoxitin alone with a triple-drug regime of an aminoglycoside, ampicillin, and clindamycin. One hundred nineteen consecutive patients sustaining abdominal trauma (97 penetrating; 22 blunt) were divided by date of admission to a 24-hour course of antibiotics. The overall infection rate was 16.0%, with 14.5% of the cefoxitin-treated patients, and 18.0% of the triple-drug-treated patients developing an infectious complication. Excluding remote site infections, the abdominal wound and intraperitoneal infection rates were 13.0% for cefoxitin-treated patients, and 12.0% for triple-drug-treated patients. There was one instance of oliguric renal failure questionably related to an aminoglycoside. It is concluded that a 24-hour course of cefoxitin is a safe and effective prophylactic antibiotic regime in patients undergoing laparotomy for trauma.

Topics: Abdominal Injuries; Adult; Aminoglycosides; Ampicillin; Cefoxitin; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Male; Prospective Studies; Random Allocation; Surgical Wound Infection

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

Two prospective, randomized trials of the efficacy of antibiotic regimens after penetrating abdominal trauma demonstrated that a combination of clindamycin and tobramycin was superior to cefamandole or cefoxitin in preventing postinjury wound infection but that no difference could be demonstrated between combination therapy (clindamycin plus tobramycin) and moxalactam. Infection was more likely to occur after a gunshot wound or with a high injury severity score and occurred after the 10th postinjury day only in those patients who received cefamandole or cefoxitin. There was a higher incidence of culture of B. fragilis in the latter groups as well as infections due to resistant organisms. Short-term antibiotic therapy for 72 hours with either tobramycin plus clindamycin or moxalactam appears adequate for the majority of patients after gunshot or knife wounds. The costs of these regimens to the patient were similar in our hospital. The most important single factor, however, in maintaining low infection rates after penetrating injury to the abdominal cavity is appropriate and timely surgical management.

Topics: Abdominal Injuries; Adolescent; Cefoxitin; Cephalosporins; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Moxalactam; Premedication; Prospective Studies; Random Allocation; Time Factors; Tobramycin; Wound Infection; Wounds, Gunshot; Wounds, Stab

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.

Topics: Abdominal Injuries; Adult; Age Factors; Bacterial Infections; Blood Transfusion; Cefoxitin; Clindamycin; Colon; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Perforation; Male; Prospective Studies; Risk; Shock, Traumatic; 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

Topics: Abdominal Injuries; Cefoxitin; Ceftriaxone; Humans; Prospective Studies; Wound Infection; Wounds, Penetrating

Patients who had contaminated traumatic perforations of the gastrointestinal tract and those with acute peritonitis resulting from acute surgical inflammatory conditions were treated with piperacillin or cefoxitin infused intravenously as single therapy for a minimum of five days. Thirty-four patients were given 4.5 grams of piperacillin every six hours and 26 patients, 2.0 grams of cefoxitin every six hours. In the piperacillin group, 63 organisms (34 aerobes and 29 anaerobes) were isolated from pretreatment cultures, while in the cefoxitin group, 73 organisms (35 aerobes and 38 anaerobes) were isolated. Clinical recovery was achieved in 31 of 34 patients receiving piperacillin therapy and in 24 of 26 patients receiving cefoxitin therapy. Organisms were found to be resistant to the respective drug in two piperacillin-treated patients and in one cefoxitin-treated patient, and the patients were given other antibacterial treatment. One patient from each treatment group died of causes unrelated to septic conditions. No serious adverse effects occurred from either antibiotic.

Topics: Abdomen; Abdominal Injuries; Adolescent; Adult; Aged; Cefoxitin; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Peritonitis; Piperacillin; Surgical Wound Infection

Recent studies showed high populations of both aerobes and anaerobes in penetrating abdominal trauma infections. Combined aminoglycoside-clindamycin therapy has resulted in infection rates of 7 to 10 per cent. However, high side-effect incidences of nephrotoxicity and ototoxicity have been attributed to the aminoglycosides. Cefoxitin is reportedly free of these side effects. In our study, 62 penetrating abdominal trauma patients requiring laparotomy were treated with cefoxitin pre- and postoperatively. The majority of the injuries, 75.8 per cent, involved small bowel and large bowel. Infections occurred in four patients of the total 62 (6.5%). Two side effects, a fever and a rash, subsided immediately after discontinuing cefoxitin; no ototoxicity or nephrotoxicity occurred. The safety and efficacy of cefoxitin alone versus aminoglycoside-clindamycin combination therapy was statistically compared in intestinal injuries only among two historical controls and our subgroup. Our infectious rate, 8.5 per cent, was comparable to 7.4 per cent and 10.4 per cent of the historical controls. We concluded that pre- and postoperative use of cefoxitin alone is as effective in the prevention of penetrating abdominal trauma infections as combined aminoglycoside-clindamycin therapy. Experience to date suggests that the use of a beta-lactam antibiotic such as cefoxitin may allow the physician to avoid the more serious side effects associated with the use of aminoglycosides in these patients.

Topics: Abdominal Injuries; Adolescent; Adult; Aminoglycosides; Anti-Bacterial Agents; Cefoxitin; Clindamycin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Surgical Wound Infection; Wound Infection; Wounds, Gunshot; Wounds, Stab