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Antibiotics for pelvic fracture

Michael Ferker xg2k2 at yahoo.com
Thu Apr 13 23:24:22 BST 2006


What kind of data would then be appropriate in this case? Administration of prophylaxis that resulted in no obvious adverse side-effects, and at the same time, pt not being infected pre or post-op demonstrates an effectiveness of the prophylaxis. Either that, or the pt was simply fed anti-biotics when they were unnecessary. I offer that it would be irresponsible not to administer a prophylaxis simply to observe whether or not the patient would sepsize, and then treating it from there. 

I'm not aware of any data that would suggest potential microbes are developing mass immunities as a result of prophylactic doses of ABs. Infact, such a phenomenon may occur as a result of delayed infection, and then hammering a pt with anti-biotics post-contamination. (National Committee for Clinical Laboratory Standards. Methods for Dilution  Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically¾Third Edition. Approved Standard NCCLS Document M7-A3, Vol.  13, No. 25, NCCLS, Villanova, PA, December 1993.)

Perhaps I wasn't clear, or was misunderstood, but if you have a patient with multiple risk factors for sepsis, how else would you minimize risk of contamination especially if the patient will soon be en-route to surgery, where even more possible infections could take place.

-Mike F

docrickfry at aol.com wrote: Extrapolating one set of data in one circumstance to other different circumstances is not valid--thus, because CPR has shown benefit in patients suffering a medical arrest does not mean it is therefore beneficial for traumatic arrests, another classic misuse of that line of thinking--and even though prophylactic antibiotics are of benefit in certain settings (i.e. contaminated wounds) at preventing wound infection does NOT mean it is of benefit in burns, for instance, at preventing burn wound infection (which it does not) or at preventing peripancreatic infection in uncomplicated pancreatitis (which data shows it does not) just for a few examples.  They are of no benefit at preventing pneumonia in patients with chest trauma.  And on and on and on....It is not valid to make such assumptions in the absence of data, especially in the face of data refuting that assumption.
ERF
 
-----Original Message-----
From: Michael Ferker 
To: Trauma &, Critical Care mailing list 
Sent: Thu, 13 Apr 2006 11:36:43 -0700 (PDT)
Subject: Re: Antibiotics for pelvic fracture


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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