(精选)Antibiotics in Trauma教学课件.pptVIP

Antibiotics in Trauma??? Tim Hardcastle Trauma Service Tygerberg Hospital / Stellenbosch University Introduction Evidence based review Rational antibiotic use in trauma Differentiate between: Prophylaxis (most commonly required) Therapy Propose local guideline Statement of the problem Multitude of studies relating to antibiotic use Use different drugs and doses Seldom use placebo as control Most are studies in “delayed” presentation What does the evidence reveal? Grading according to the “Sacket criteria” Level one evidence should be standard of care Level two evidence strongly advised as a guideline Level three optional clinician choice Chest drains No level 1 evidence to support / deny No level 2 evidence Level 3 evidence suggests single dose of 1st Generation Cephalosporin (Kefzol 1g IVI push) may decrease the incidence of nosocomial pneumonia, but not empyema 16/05/2005 Fractures Two types of fracture: open vs. closed Two types of management Closed reduction and POP ORIF Which antibiotics and how long therapy? Is there a difference in fracture severity Fractures Open fractures Any patient with metalwork Grade 1 2 maximum 24 hours (Level 1) First generation cephalosporin As soon as possible Grade 3 (Level 1 2) Cephazolin 1 or 2g alone X 72 hours or wound cover Add gram negative and anaerobe cover if severe contamination Practice management guidelines Base of skull fractures No evidence to support routine antibiotic prophylaxis or empiric therapy in cases without meningitis Irrespective of CSF leak Other open skull fractures treat as open fracture Cochrane database systemic review 25 January 2006 The Trauma Patient in ICU No empiric therapy without “Septic Screen” Broad spectrum cover empirically only in unstable patients (Level 3) Source-directed therapy in stable patients (Level 3) De-escalate to culture-directed therapy (Level 3) Avoid the 3rd Generation Cephalosporins