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Antibiotics for pelvic fracture

Michael Ferker xg2k2 at yahoo.com
Thu Apr 13 19:36:43 BST 2006


I'm not aware of any numbers, or studies done in that matter, on usage of prophylaxis in regards to the pelvis, but with the data available on the importance of pre-surgical prophylaxis, and the high risk of morbidity and costs as a result of failure to properly prophylactize. Considering the plethora of complex blood vessels all over the pelvis and the various trajectories that the traumatizing medium could've acted in.  A trauma to the pelvis is rarely clean, and so further consideration should be given to the various other issues that may appear once immediate damage to the pelvic area is to be prepared. There is a large risk of sepsis infection in blunt trauma or projectile trauma to the pelvis. Are there really enough statistics to contraindicate prophylaxis in areas where infection could be highest?
   
  Stone HH, Haney BB, Kolb LD, Geheber CE, Hooper CA. Prophylactic and preventive antibiotic therapy: timing, duration and economics. Ann Surg. 1979;189:691-699.
   
  Matuschka PR, Cheadle WG, Burke JD, Garrison RN. A new standard of care: administration of preoperative antibiotics in the operating room. Am Surg. 1997;63:500-503
   
  Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725-730.
   
  Bernard HR, Cole WR. The prophylaxis of surgical infection: the effect of prophylactic antimicrobial drugs on the incidence of infection following potentially contaminated operations. Surgery.
   
  I definitely agree that the risk of creating highly resistive bacteria as a result of raging preventive measures is scientifically unsound. But is failing to atleast try and prevent a potentially harmful and complicated infection reasonable enough without requiring statistical data as to its lack of harm? Are there any methods proven better to prophylaxize surgical infection without using ABs? This would definitely be a very welcome learning experience for myself. :-)
   
  -Mike F

docrickfry at aol.com wrote:
  I think many of us would like to see the data on which this pure conjecture is based--I understand the rationale that seems to make sense to you, but what is missing to justify such a potentially harmful intervention to the patient is the data showing it to be true. And again, as dictated by the tenets of science and evidence-based medicine, such intervention is not justified UNTIL benefit is shown. That is what is safest for the patient. Once again, we are the patient's worst enemy with regard to the terrible spread of antibiotic resistance and life threatening infections around the world.
ERF 

-----Original Message-----
From: Michael Ferker 
To: Trauma &, Critical Care mailing list 
Sent: Thu, 13 Apr 2006 09:45:41 -0700 (PDT)
Subject: Re: Antibiotics for pelvic fracture


A trauma that would lead to an acetabular fracture would most likely call for an 
AB regimen in the assumption that something might've gone in through the trauma. 
Considering that you don't always know exactly how, where, or with what the 
trauma was incurred, administering ABs ASAP would be the only clear way of 
inhibiting sepsis.

-Mike F

bensonblues at comcast.net wrote: Tim, The reference for A/Bs in pelvic fractures 
is Management of Trauma: Pittfalls and Practice, Walt and Wilson, 2nd Ed., 
pp596-7. " Efforts to prevent pelvic sepsis are important...it is not clear how 
long such antibiotics should be given, 4-6 days should be adequate." They also 
reference Siebel, et. al,: Pelvic Fracture, in Clinical Care and 
Pathophysiology, 1987; Peltier: Complications associated with fractures of the 
pelvis, J Bone Joint Surg 1965, and Trunkey, et al: Management of pelvic 
fractures in blunt trauma injury, J Trauma 1974. But, if you say they are not 
indicated, that's okay. Right or wrong, I'm a lowly ER doc who, if initially 
treating a blunt trauma victim with an acetabular fracture, would be be inclined 
to give antibiotics in the ED in anticiption of intraabdominal injuries. DB
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