Weigelt J A, Easley S M, Thal E R, Palmer L D, Newman V S
Department of Surgery, St. Paul-Ramsey Medical Center, Minnesota 55101.
J Trauma. 1993 Apr;34(4):579-84; discussion 584-5. doi: 10.1097/00005373-199304000-00016.
Perioperative antibiotics decrease surgical wound infection (SWI) in trauma patients requiring abdominal exploration. This investigation evaluated 24 hours of cefoxitin or ampicillin/sulbactam used for early therapy in such patients. Patients were randomly assigned to one of two treatment groups. The primary endpoint evaluated was SWI, which was defined as purulent drainage or active wound treatment. Five hundred ninety-two patients were evaluated: 283 received ampicillin/sulbactam and 309 received cefoxitin. The incidence of wound infection among the ampicillin/sulbactam patients was 2% and among cefoxitin patients it was 7% (p < 0.004). The cefoxitin patients with colon injuries were analyzed (p < 0.007). The major difference between the two groups was an increased incidence of enterococcal infections in the cefoxitin-treated patients. A single broad-spectrum antibiotic given for 24 hour perioperatively effectively controls SWI. Use of ampicillin/sulbactam results in a significantly lower SWI rate than use of cefoxitin, which may be a result of improved enterococcal and Bacteroides coverage.
围手术期使用抗生素可降低需要进行腹部探查的创伤患者的手术伤口感染（SWI）发生率。本研究评估了头孢西丁或氨苄西林/舒巴坦用于此类患者早期治疗24小时的效果。患者被随机分配到两个治疗组之一。评估的主要终点是手术伤口感染，定义为脓性引流或积极的伤口处理。共评估了592例患者：283例接受氨苄西林/舒巴坦治疗，309例接受头孢西丁治疗。氨苄西林/舒巴坦组患者的伤口感染发生率为2%，头孢西丁组为7%（p<0.004）。对结肠损伤的头孢西丁组患者进行了分析（p<0.007）。两组之间的主要差异是头孢西丁治疗组患者的肠球菌感染发生率增加。围手术期使用单一广谱抗生素24小时可有效控制手术伤口感染。与使用头孢西丁相比，使用氨苄西林/舒巴坦可使手术伤口感染率显著降低，这可能是由于对肠球菌和拟杆菌的覆盖范围改善所致。
