Transition from contamination to infection: implications in colonic surgery.

After reviewing the processes leading from contamination to infection and its clinical implications I conclude that outcome after emergency colonic surgery in general is the result of three factors: elimination of the surgical problem; extent of preoperative physiological derangement; and the patient's immediate response to intensive care and surgery. Antibiotic treatment is important but secondary. For most patients with minor contamination and infection, including appendicitis and trauma, the duration of antibiotic administration following emergency surgery has been established to be one or at most four doses. Patients in the intensive care units need individualised treatment. There is a minor group treated outside intensive care units but with substantial infection where the duration should be re-evaluated in new trials, preferably by comparing short and long duration in randomised fashion.