Infectious complications in GSW's through the gastrointestinal tract into the spine.

Abstract

Trans-gastrointestinal tract GSW's to the spine are devastating injuries with significant potential for infectious complications. We sought to address antimicrobial management of these injuries. We retrospectively analysed all patients with penetrating trauma through the GI tract into the spine admitted to a level I trauma centre from 1/02 to 12/09. Patients were excluded if they died within 24h. Patients received 24-48 h of peri-operative prophylactic antibiotics, except in damage control where antibiotics were continued until packs were removed. 51 patients were included. 94% were male with a mean age of 27 years. The mean ISS was 28 (9-50). The mean length of stay was 19 days (3-53) and mortality was 9.8%. The mean follow up period was 277 days (0-1765). There were 12 gastric, 25 small bowel, 26 colonic, and 4 esophageal injuries. There were 48 exploratory laparotomies, of which 12 were damage control procedures. 18 patients had no infections. There were 20 abdominal infections and 7 surgical wound infections. There were 23 infections not related to the abdomen. One patient developed a CNS infection 4 days after discharge despite receiving a two week course of piperacillin/tazobactam for Escherichia coli bacteremia during his initial hospital stay. There were no other CNS infections. Despite the potential for significant deep infections of the spine, standard antimicrobial prophylaxis is sufficient for the initial management of these patients.