Penetrating abdominal trauma: the use of operative findings to determine length of antibiotic therapy.

Penetrating abdominal trauma is associated with a high incidence of postinjury infection which can be reduced by appropriate surgical management and short-term antibiotic therapy. Patients at high risk for developing infectious complications may be identified on the basis of operative findings and the duration of the postinjury antibiotic regimen determined. Colonic injury is the most important determinant of infectious complications. Number of other organs injured, age, and mode of injury have little or no additional impact on infection rates. Low-risk patients can be successfully managed with three perioperative doses of antibiotics. Nontrauma related nosocomial infections appear to be associated with trauma related infections in high-risk patients. Intravenous clindamycin plus tobramycin and metronidazole plus tobramycin for 72 hours postinjury are equally effective in reducing postinjury infections in "high-risk" patients.