Ronald P Rabinowitz1, Ali Tabatabai, Deborah M Stein, Thomas M Scalea. 1. Department of Medicine, University of Maryland School of Medicine, Infectious Diseases, R Adams Cowley Shock Trauma Center, Room T3N11, 22 S. Greene Street, Baltimore, MD 21201, USA. rabinow@umaryland.edu
Abstract
BACKGROUND: Trans-gastrointestinal tract GSW's to the spine are devastating injuries with significant potential for infectious complications. We sought to address antimicrobial management of these injuries. METHODS: We retrospectively analysed all patients with penetrating trauma through the GI tract into the spine admitted to a level I trauma centre from 1/02 to 12/09. Patients were excluded if they died within 24h. Patients received 24-48 h of peri-operative prophylactic antibiotics, except in damage control where antibiotics were continued until packs were removed. RESULTS: 51 patients were included. 94% were male with a mean age of 27 years. The mean ISS was 28 (9-50). The mean length of stay was 19 days (3-53) and mortality was 9.8%. The mean follow up period was 277 days (0-1765). There were 12 gastric, 25 small bowel, 26 colonic, and 4 esophageal injuries. There were 48 exploratory laparotomies, of which 12 were damage control procedures. 18 patients had no infections. There were 20 abdominal infections and 7 surgical wound infections. There were 23 infections not related to the abdomen. One patient developed a CNS infection 4 days after discharge despite receiving a two week course of piperacillin/tazobactam for Escherichia coli bacteremia during his initial hospital stay. There were no other CNS infections. CONCLUSION: Despite the potential for significant deep infections of the spine, standard antimicrobial prophylaxis is sufficient for the initial management of these patients.
BACKGROUND: Trans-gastrointestinal tract GSW's to the spine are devastating injuries with significant potential for infectious complications. We sought to address antimicrobial management of these injuries. METHODS: We retrospectively analysed all patients with penetrating trauma through the GI tract into the spine admitted to a level I trauma centre from 1/02 to 12/09. Patients were excluded if they died within 24h. Patients received 24-48 h of peri-operative prophylactic antibiotics, except in damage control where antibiotics were continued until packs were removed. RESULTS: 51 patients were included. 94% were male with a mean age of 27 years. The mean ISS was 28 (9-50). The mean length of stay was 19 days (3-53) and mortality was 9.8%. The mean follow up period was 277 days (0-1765). There were 12 gastric, 25 small bowel, 26 colonic, and 4 esophageal injuries. There were 48 exploratory laparotomies, of which 12 were damage control procedures. 18 patients had no infections. There were 20 abdominal infections and 7 surgical wound infections. There were 23 infections not related to the abdomen. One patient developed a CNS infection 4 days after discharge despite receiving a two week course of piperacillin/tazobactam for Escherichia coli bacteremia during his initial hospital stay. There were no other CNS infections. CONCLUSION: Despite the potential for significant deep infections of the spine, standard antimicrobial prophylaxis is sufficient for the initial management of these patients.
Authors: Arianna Zefelippo; Paola M Bertazzoni; Aldo M Marini; Paolo De Rai; Ettore Contessini-Avesani Journal: World J Emerg Surg Date: 2013-12-27 Impact factor: 5.469