Archives of surgery (Chicago, Ill. : 1960) · 2002
Severe trauma is not an excuse for prolonged antibiotic prophylaxis.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Velmahos George C, Toutouzas Konstantinos G, Sarkisyan Grant, Chan Linda S, Jindal Anurag, Karaiskakis Marios, Katkhouda Namir, Berne Thomas V, Demetriades Demetrios
Аннотация
HYPOTHESIS: For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures.
DESIGN: Prospective nonrandomized study.
SETTING: Surgical intensive care unit (SICU) of an academic hospital with a level I trauma center.
PATIENTS: A population of 250 trauma patients who required an operation and SICU stay of 3 days or more received antibiotic prophylaxis by 1 antibiotic for 24 hours (SHORT group, n = 133) or 1 or more antibiotics for more than 24 hours (LONG group, n = 117).
MAIN OUTCOME MEASURES: Twenty-two outcome variables, including 9 conventional outcomes (eg, sepsis, septic shock, and organ failure) and 13 objective outcomes (days with temperature >38.5 degrees C, days with white blood cell count >14.0 x10(3)/microL, positive cultures, cultures with antibiotic-resistant bacteria, SICU and hospital stay, and death).
RESULTS: The LONG group included more patients with orthopedic injuries (60 patients [51%] vs 52 [39%], P =.05) and orthopedic operations (47 patients [40%] vs 30 [23%], P =.003) than did the SHORT group. No other difference was identified in compared characteristics between the 2 groups. There was no difference in any of the examined outcomes except for a higher incidence of resistant infections in the LONG group compared with the SHORT group (59 patients [50%] vs 47 [35%], P =.02). Patients with resistant infections stayed in the hospital longer (mean +/- SD, 33 +/- 18 vs 15 +/- 11 days, P<.001) and had a higher mortality rate (13% vs 1%, P<.001) compared with patients without resistant infections. Prolonged prophylaxis by multiple antibiotics was an independent risk factor of resistant infection (odds ratio, 2.13, 95% confidence interval, 1.22-3.74; P =.008).
CONCLUSIONS: The prophylactic administration of more than 1 antibiotic for more than 24 hours following severe trauma does not offer additional protection against sepsis, organ failure, and death, but increases the probability of antibiotic-resistant infections.
DESIGN: Prospective nonrandomized study.
SETTING: Surgical intensive care unit (SICU) of an academic hospital with a level I trauma center.
PATIENTS: A population of 250 trauma patients who required an operation and SICU stay of 3 days or more received antibiotic prophylaxis by 1 antibiotic for 24 hours (SHORT group, n = 133) or 1 or more antibiotics for more than 24 hours (LONG group, n = 117).
MAIN OUTCOME MEASURES: Twenty-two outcome variables, including 9 conventional outcomes (eg, sepsis, septic shock, and organ failure) and 13 objective outcomes (days with temperature >38.5 degrees C, days with white blood cell count >14.0 x10(3)/microL, positive cultures, cultures with antibiotic-resistant bacteria, SICU and hospital stay, and death).
RESULTS: The LONG group included more patients with orthopedic injuries (60 patients [51%] vs 52 [39%], P =.05) and orthopedic operations (47 patients [40%] vs 30 [23%], P =.003) than did the SHORT group. No other difference was identified in compared characteristics between the 2 groups. There was no difference in any of the examined outcomes except for a higher incidence of resistant infections in the LONG group compared with the SHORT group (59 patients [50%] vs 47 [35%], P =.02). Patients with resistant infections stayed in the hospital longer (mean +/- SD, 33 +/- 18 vs 15 +/- 11 days, P<.001) and had a higher mortality rate (13% vs 1%, P<.001) compared with patients without resistant infections. Prolonged prophylaxis by multiple antibiotics was an independent risk factor of resistant infection (odds ratio, 2.13, 95% confidence interval, 1.22-3.74; P =.008).
CONCLUSIONS: The prophylactic administration of more than 1 antibiotic for more than 24 hours following severe trauma does not offer additional protection against sepsis, organ failure, and death, but increases the probability of antibiotic-resistant infections.