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.
Injury. 2012 Jul;43(7):1058-60. doi: 10.1016/j.injury.2012.01.014. Epub 2012 Feb 4.
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.
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.
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.
Despite the potential for significant deep infections of the spine, standard antimicrobial prophylaxis is sufficient for the initial management of these patients.
经胃肠道穿入脊柱的枪弹伤会导致严重的损伤，并存在严重的感染并发症风险。我们旨在探讨此类损伤的抗菌药物管理策略。
我们回顾性分析了 2002 年 1 月至 2009 年 12 月期间，所有因穿透性胃肠道创伤而致脊柱损伤，并收入一级创伤中心的患者。如果患者在 24 小时内死亡，则将其排除在外。所有患者均接受 24-48 小时的围手术期预防性抗生素治疗，在损伤控制情况下，抗生素的使用持续至引流物移除。
共纳入 51 例患者，男性占 94%，平均年龄为 27 岁。ISS 平均为 28（9-50）分。平均住院时间为 19 天（3-53 天），死亡率为 9.8%。平均随访时间为 277 天（0-1765 天）。胃损伤 12 例，小肠损伤 25 例，结肠损伤 26 例，食管损伤 4 例。行剖腹探查术 48 例，其中 12 例为损伤控制性手术。18 例患者无感染，20 例发生腹部感染，7 例发生手术部位感染，23 例与腹部无关的感染。1 例患者在出院后 4 天因大肠埃希菌菌血症接受了为期 2 周的哌拉西林/他唑巴坦治疗后出现中枢神经系统感染，但无其他中枢神经系统感染。
尽管脊柱深部感染的风险较高，但标准抗菌药物预防策略足以用于此类患者的初始治疗。
