RESUMEN
Surgical site infections (SSIs) remain a significant cause of morbidity and mortality in patients undergoing traumatic exploratory laparotomy. The goal of this study was to compare antibiotic usage and subsequent outcomes in patients undergoing traumatic exploratory laparotomy. A retrospective chart analysis and a chi-square test of independence were performed to examine the relation between preoperative cefoxitin versus ceftriaxone and metronidazole and the rate of SSI development. 323 patients were analyzed, 111 patients receiving cefoxitin and 212 patients receiving ceftriaxone and metronidazole. The proportion of patients who developed SSI was 16.2% for the cefoxitin group and 9.9% for the ceftriaxone and metronidazole group, X2 (1, N = 323) = 2.7, P = .098, thus displaying no statistical difference in the development of SSIs between patients in the cefoxitin group when compared to the ceftriaxone and metronidazole group.
Asunto(s)
Antibacterianos , Cefoxitina , Ceftriaxona , Laparotomía , Metronidazol , Infección de la Herida Quirúrgica , Humanos , Metronidazol/uso terapéutico , Metronidazol/administración & dosificación , Infección de la Herida Quirúrgica/prevención & control , Estudios Retrospectivos , Cefoxitina/uso terapéutico , Cefoxitina/administración & dosificación , Ceftriaxona/uso terapéutico , Masculino , Femenino , Adulto , Antibacterianos/uso terapéutico , Laparotomía/efectos adversos , Laparotomía/métodos , Persona de Mediana Edad , Profilaxis Antibiótica/métodos , Cuidados Preoperatorios/métodos , Resultado del Tratamiento , Traumatismos Abdominales/cirugía , Traumatismos Abdominales/complicacionesRESUMEN
CT imaging with rectal contrast historically has been a useful tool to help identify potential colon/rectal injuries; however, recent trends have shown less utilization of rectal contrast, in favor of IV contrast CT imaging alone. A retrospective review of patients with abdominal gunshot wounds was carried out to compare the two CT imaging techniques. An analysis of patients with colorectal injuries was conducted. Patients with IV contrast had a sensitivity of 84% and specificity of 96.8%. The PPV was 87.5% and NPV was 95.8%. In the IV and rectal contrast group, the sensitivity was 88.9% and specificity was 90.5%. The PPV was 80% and NPV was 95%. The proportion of missed injuries between the two was not statistically significant, p=0.18. The study suggests that while CT imaging with rectal contrast confidently identifies colon/rectal injuries, there are often secondary findings that will correctly prompt surgical exploration.
