Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter XI: Infection
United States Department of Defense
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Sepsis is the most common cause of death in patients who sustain penetrating abdominal trauma and survive initial surgical therapy. Prophylactic antibiotic therapy for such patients should be directed toward pathogens encountered in the lower gastrointestinal tract and should be administered perioperatively for 24 hours. A generally accepted regimen of combination antibiotic therapy consists of an agent effective against the anaerobes (clindamycin or metronidazole) and an aminoglycoside (gentamicin) effective against Gram-negative rods. Recent studies of antibiotic therapy following penetrating abdominal trauma suggest, however, that single agent therapy with cefoxitin is equally effective. Given the lack of nephrotoxicity with cefoxitin and considering that the battlefield casualty likely exhibits some degree of dehydration, this regimen represents an attractive alternative. A review of wounded patients in the Vietnam War revealed that abdominal wounds were the wounds that most frequently became infected (6.89%) following initial treatment). Penetrating abdominal wounds accounted for 24% of all wound infections but only 13% of all wounds.
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