University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA.
Surg Infect (Larchmt). 2022 May;23(4):332-338. doi: 10.1089/sur.2021.295. Epub 2022 Mar 7.
Antibiotic prophylaxis is a common, established practice at trauma centers worldwide for patients presenting with various forms of serious injury. Many patients simultaneously present with hemorrhage. The current guidelines by the Eastern Association for the Surgery of Trauma recommend re-dosing prophylactic antibiotic agents for every 10 units of blood products administered. However, these guidelines are only mildly supported by dated research. A literature search was completed through Medline EBSCO Host using antibiotic prophylaxis and transfusion as keywords. Articles judged to be relevant to the study question were selected for full-text review. Case studies were not included. Altogether, 18 articles were cited in our results through this process. Risk of infection increases in patients resuscitated with large volume of blood products. Animal models of trauma offered conflicting findings on whether blood loss and blood resuscitation altered tissue antibiotic concentrations compared with controls. Studies focused on antibiotic pharmacokinetics in non-trauma human patients revealed agreement surrounding reported decreases in serum and tissue concentrations, although there was discrepancy surrounding the clinical relevancy of the reported decreases. Trauma, hemorrhage, and transfusion impair the immune response resulting in increased incidence of infection. Both animal and human models of antibiotic pharmacokinetics show decreased serum and tissue concentrations during hemorrhage. However, available data are insufficient to conclude that trauma patients experiencing hemorrhage are at elevated risk of infection and thus require more frequent redosing of antibiotic agents than the current guidelines suggest. An upcoming, prospective study by our institution seeks to evaluate this question.
抗生素预防是世界范围内创伤中心对各种严重损伤患者的常见既定做法。许多患者同时伴有出血。东部创伤外科学会目前的指南建议，对于每输入 10 单位的血液制品，应重新给予预防性抗生素。然而，这些指南仅得到了过时研究的轻度支持。通过 Medline EBSCO Host 使用抗生素预防和输血作为关键字完成了文献检索。选择与研究问题相关的文章进行全文审查。不包括病例研究。通过这个过程，共有 18 篇文章被引用在我们的结果中。大量输血制品会增加感染风险。创伤动物模型对失血和血液复苏是否改变组织抗生素浓度与对照组进行了对比，得出了相互矛盾的结果。对非创伤患者的抗生素药代动力学的研究表明，虽然报告的减少量存在差异，但在报告的减少量的临床相关性方面存在一致性，血清和组织浓度都有所下降。创伤、出血和输血会损害免疫反应，导致感染发生率增加。抗生素药代动力学的动物和人类模型都显示在出血期间血清和组织浓度降低。然而，目前的数据还不足以得出结论，即经历出血的创伤患者感染风险更高，因此需要比当前指南建议更频繁地重新给予抗生素药物。我们机构即将进行一项前瞻性研究，旨在评估这一问题。
