Presentations

Abstract

Introduction:

The effectiveness of empiric antibiotic therapy in preventing postoperative infection, particularly in damage control surgery, is well documented and has long been established as standard practice. However, surgical site infections (SSIs)- an infection following an operation at an incision site or adjacent to the surgical incision- remain a significant cause of morbidity and mortality in patients undergoing traumatic exploratory laparotomy. Thus, maximizing the efficacy of perioperative antibiotic prophylaxis is of utmost importance in an effort to reduce patient discomfort, length of hospitalization, rehospitalization rates, medical costs and ultimately leads to improvement of community health outcomes at large. For years the studied institution utilized cefoxitin (Mefoxin) for perioperative antibiotic prophylaxis, but now has transitioned to a combination of ceftriaxone (Rocephin) and metronidazole (Flagyl) because of both evidence in literature of greater efficacy as well as ease of administration of a one-time dose that can provide extended perioperative coverage. The primary goal of this study is to further contribute to existing literature by comparing specific antibiotic usage and subsequent outcomes in patients at an academic level 1 trauma center undergoing traumatic exploratory laparotomy

Methods:

A retrospective chart analysis was performed on trauma patients who underwent trauma laparotomies at Sentara Norfolk General Hospital, the level 1 trauma and tertiary referral center for the Hampton Roads area of Virginia. The inclusion criteria included any trauma patient that received an exploratory laparotomy on admission admitted between January 2015 and March 2022 between the ages of 18 and 89. The exclusion criteria included any mortality within 7 days of admission, patients with open abdomens on index procedure or requiring a repeat exploratory laparotomy within 30 days postoperatively. Patient demographics, comorbidities, and perioperative antibiotics were documented. A chi-square test of independence was performed to examine the relation between antibiotic type and development of SSI, superficial SSI and deep SSI. A p-value below 0.05 was deemed statistically significant.

Results:

323 patients were analyzed that met our inclusion and exclusion criteria. 111 patients received Mefoxin, 212 patients received Rocephin and Flagyl. The proportion of patients who developed SSI was 16.2% for the Mefoxin group and 9.9% for the Rocephin and Flagyl group, X2 (1, N = 323) = 2.7, p = .098. The proportion of patients who developed superficial SSI was 9.0% for the Mefoxin group and 4.2% for the Rocephin and Flagyl group, X2 (1, N = 323) = 3.0, p = .084. The proportion of patients who developed deep SSI was 9.0% for the Mefoxin group and 7.5% for the Rocephin and Flagyl group, X2 (1, N = 323) = 0.21, p = .65.

Conclusion: Our retrospective study showed that there was no statistical difference in the development of superficial or deep surgical site infection between patients in the Mefoxin group when compared to the Rocephin and Flagyl group.