Table 15 Clinical pathway for patients with post-traumatic is illustrated

Clinical signs and symptoms

• Fever

• Abdominal pain

• Abdominal tenderness

Laboratory markers

• Increased white blood cell

• C-reactive protein

• PCT

Imaging

• CT

• US

Diagnosis

• Open/laparoscopic surgical repair. Use of laparoscopy in blunt trauma is highly debatable

• Resection and primary anastomosis

• Stoma (in critically ill patients and/or colorectal injuries involving all layers in the setting of multiple injuries).

+

Perioperative antibiotics. If hollow viscus injury is repaired within 12 h, antibiotics should be continued for ≤ 24 h

Treatment

Amoxicillin/clavulanate 2.2 g every 8 h +/− gentamicin 5-7 mg/Kg every 24 h

Avoid Amoxicillin/clavulanate if local Enterobacteriaceae resistances > 20%.

Piperacillin/tazobactam 6 g/0.75 g LD then 4 g/0.5 g every 6 h or 16 g/2 g by continuous infusion +/− gentamicin 5–7 mg/Kg every 24 h (in critically ill patients)

Ceftriaxone 2 g every 24 h + metronidazole 500 mg every 8 h

Cefotaxime 2 g every 8 h + metronidazole 500 mg every 8 h

or

In patients with beta-lactam allergy

A fluoroquinolone-based regimen

Ciprofloxacin 400 mg every 8/12 h + metronidazole 500 mg every 8 h

or

An aminoglycoside regimen

Amikacin 15-20 mg/kg every 24 h + metronidazole 500 mg every 8 h

or

In patients at high risk for infection with community-acquired ESBL-producing Enterobacteriaceae

One of the following antibiotics

Tigecycline 100 mg LD, then 50 mg every 12 h (carbapenem-sparing strategy)

Ertapenem 1 g every 24 h

Meropenem 1 g every 8 h (only in patients with septic shock)

Doripenem 500 mg every 8 h (only in patients with septic shock)

Imipenem/cilastatin 500 mg every 6 h (only in patients with septic shock)

In patients at high risk for infection with Enterococci including immunocompromised patients or patients with recent antibiotic exposure, consider the use of ampicillin 2 g every 6 h if patients are being treated with ertapenem/meropenem or doripenem

Antibiotic therapy