O28 – Reduction of infectious complications following trauma laparotomy through use of a perioperative antibiotic protocol
Author(s):
Background: Patients who undergo trauma laparotomy are at high risk for infectious complications, with up to 50% sustaining some type of postoperative infection. Use of perioperative antibiotics in this population has not been optimized, particularly with regard to antibiotic redosing for blood loss or length of operation.
Hypothesis: A protocol for uniform use of antibiotics with long half-lives and appropriate spectrum of activity, coupled with scheduled redosing for high blood loss will decrease the rate of postoperative infections.
Methods: A pre-/post-intervention trial was carried out from November 2009-August 2013 in all patients undergoing laparotomy for acute trauma. No intervention was made during the first 24 months of the trial. During the subsequent 22 months, a protocol was implemented in which all trauma surgeons were requested to use ertapenem as the preferred antibiotic prior to incision, and to redose the antibiotic with each blood volume lost. Surviving patients were characterized as having no infection, a minor surgical site infection only, an infection related to laparotomy, or an unrelated infection such as pneumonia. The pre-/post-intervention groups were compared using Fisher’s exact test.
Results: A total of 134 patients were included in the pre-intervention cohort and 111 in the post-intervention cohort. The groups were similar with respect to demographics, mechanisms of injury, TRISS scores, and amount of blood transfused, with the post intervention group having a higher incidence of colonic injuries (28% vs 40%, p=.06). Use of ertapenem increased from 8% in the pre-intervention group to 55% in the post-intervention group (p=.0001). As shown in the Table, overall incidence of infections decreased by 37% in the intervention cohort, with a 39% decrease in infections directly related to laparotomy.
Conclusions: Use of the antibiotic protocol resulted in an overall reduction of all infectious complications, particularly in infections related directly to laparotomy.