Velmahos G C, Jindal A, Chan L, Kritikos E, Vassiliu P, Berne T V, Demetriades D
Department of Surgery, University of Southern California and the Los Angeles County USC Medical Center, 90033, USA.
Int Surg. 2001 Jul-Sep;86(3):176-83.
After severe trauma, physicians frequently use multiple antibiotics for prolonged periods of time to prevent sepsis, based on intuition rather than scientific evidence. Over a 1-year period (January-December 1999) we included prospectively 112 critically injured patients who required an operation and/or chest tube insertion and stayed for more than 2 days in the intensive care unit (ICU). Of these patients, 46 received a single prophylactic antibiotic for 24 hours (group SING+SHORT), and 66 received one or more prophylactic antibiotics for more than 24 hours (group MULT+LONG), based on physician discretion. Twenty-seven outcome parameters were collected to compare the effect of the different prophylactic antibiotic regimens. The two groups were similar in regard to overall injury severity, age, gender, mechanism of injury, and physiologic condition on admission. However, more SING+SHORT patients had an abdominal operation (83% versus 62%, P = 0.02), and more MULT+LONG patients had an orthopedic operation (35% versus 15%, P = 0.03). There was no difference in sepsis (41% versus 42%, P = 1.0), organ failures (37% versus 50%, P = 0.18), mortality (7% versus 12%, P = 0.52), ICU stay (14 +/- 2.5 versus 16 +/- 2 days, P = 0.57), hospital stay (26 +/- 3 versus 28 +/- 2 days, P = 0.53), or any other outcome parameter. Independent risk factors for sepsis were blunt mechanism of trauma, Injury Severity Score > or = 25, and more than two units of blood transfused over the first 24 hours, but not the amount of prophylactic antibiotics given. In conclusion, we found that 24-hour prophylaxis with a single broad-antibiotic is as effective as prophylaxis for longer periods of time with multiple spectrum antibiotics for critically injured patients at high risk for sepsis.
严重创伤后，医生常常基于直觉而非科学证据，长时间使用多种抗生素来预防脓毒症。在1年期间（1999年1月至12月），我们前瞻性纳入了112例严重受伤且需要手术和/或胸腔置管并在重症监护病房（ICU）停留超过2天的患者。在这些患者中，根据医生的判断，46例接受了单种预防性抗生素治疗24小时（SING+SHORT组），66例接受了一种或多种预防性抗生素治疗超过24小时（MULT+LONG组）。收集了27项结局参数以比较不同预防性抗生素方案的效果。两组在总体损伤严重程度、年龄、性别、损伤机制及入院时的生理状况方面相似。然而，SING+SHORT组更多患者接受了腹部手术（83%对62%，P = 0.02），MULT+LONG组更多患者接受了骨科手术（35%对15%，P = 0.03）。脓毒症发生率（41%对42%，P = 1.0）、器官衰竭发生率（37%对50%，P = 0.18）、死亡率（7%对12%，P = 0.52）、ICU停留时间（14±2.5天对16±2天，P = 0.57）、住院时间（26±3天对28±2天，P = 0.53）或任何其他结局参数均无差异。脓毒症的独立危险因素为钝性创伤机制、损伤严重度评分≥25以及在最初24小时内输注超过2单位血液，但与预防性抗生素的使用量无关。总之，我们发现对于有脓毒症高风险的严重受伤患者，单种广谱抗生素24小时预防性用药与多种抗生素长时间预防性用药效果相同。
