An antibiotic policy for bacterial infections after thoracic and other injuries

Atherton, S. T., Wright, D. M., White, D. J., and Jones, E. S. (1977).Thorax,32, 596-600. An antibiotic policy for bacterial infections after thoracic and other injuries. Twenty-four patients suffering from thoracic and other injuries were admitted to an intensive care unit over a three-year period. The first four patients died from infection by Gram-negative bacilli with associated features of bacterial toxaemia although it was anticipated that most, if not all, of the patients would have recovered with intensive care. Antibiotics had been started when a patient showed signs of bacterial toxaemia but were ineffective. Retrospective analysis showed that, in each patient, a rapid rise in rectal temperature, white cell count, and blood sugar preceded the clinical features of bacterial toxaemia by one or two days. These observations were incorporated into an antibiotic policy for patients with similar injuries. The criteria for starting two or three wide spectrum antibiotics were as follows: (1) Gram-negative bacilli in the tracheal aspirate together with radiological evidence of consolidation or absorption collapse; (ii) two of the following three signs—a rectal temperature of 38·5°C or more, a white blood cell count of 11·0 × 10(9)/l or above, a blood glucose of 11·2 mmol/l or above; (iii) laparotomy. This policy was tested out over two years on 20 patients with thoracic and other injuries. Sixteen of the patients fulfilled the criteria for antibiotic therapy. Two of the six deaths were due to bacterial infection with toxaemia, a result which suggests that the policy was beneficial