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Arch Surg. 2002;137:537-542.

Hypothesis  For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures.

Design  Prospective nonrandomized study.

Setting  Surgical intensive care unit (SICU) of an academic hospital with a level I trauma center.

Patients  A population of 250 trauma patients who required an operation and SICU stay of 3 days or more received antibiotic prophylaxis by 1 antibiotic for 24 hours (SHORT group, n = 133) or 1 or more antibiotics for more than 24 hours (LONG group, n = 117).

Main Outcome Measures  Twenty-two outcome variables, including 9 conventional outcomes (eg, sepsis, septic shock, and organ failure) and 13 objective outcomes (days with temperature >38.5°C, days with white blood cell count >14.0 x10³/µL, positive cultures, cultures with antibiotic-resistant bacteria, SICU and hospital stay, and death).

Results  The LONG group included more patients with orthopedic injuries (60 patients [51%] vs 52 [39%], P = .05) and orthopedic operations (47 patients [40%] vs 30 [23%], P = .003) than did the SHORT group. No other difference was identified in compared characteristics between the 2 groups. There was no difference in any of the examined outcomes except for a higher incidence of resistant infections in the LONG group compared with the SHORT group (59 patients [50%] vs 47 [35%], P = .02). Patients with resistant infections stayed in the hospital longer (mean ± SD, 33 ± 18 vs 15 ± 11 days, P<.001) and had a higher mortality rate (13% vs 1%, P<.001) compared with patients without resistant infections. Prolonged prophylaxis by multiple antibiotics was an independent risk factor of resistant infection (odds ratio, 2.13, 95% confidence interval, 1.22-3.74; P = .008).

Conclusions  The prophylactic administration of more than 1 antibiotic for more than 24 hours following severe trauma does not offer additional protection against sepsis, organ failure, and death, but increases the probability of antibiotic-resistant infections.

From the Division of Trauma and Critical Care, Department of Surgery (Drs Velmahos, Toutouzas, Sarkisyan, Jindal, Karaiskakis, Katkhouda, Berne, and Demetriades) and the Department of Biostatistics (Dr Chan), University of Southern California and the Los Angeles County/University of Southern California Medical Center, Los Angeles.

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