I have enjoyed the recent discussion on the appropriate and inappropriate use of antibiotics in the surgical patient and found it very helpful.
Last night we had a fairly typical case, multiple GSW abdo, arrived in OT about 4 hrs post injury, already bowel looking oedematous, operation as expeditious as possible but still long because of so many injuries, started oozing all over and needing inotropes - i.e. SIRS developing. Now contamination not massive and abdo nice and clean at closure (we had to use a Bogota bag), in OT fairly early so contamination , not established infection, so do we give a full course of antibiotics or just a big dose of prophyllaxis and wait and culture in ICU.
ON the one hand there is no infection at this stage and the dirty abdomen is rendered clean with nice surgery. On the other hand the gut is compromised and we may expect bacterial translocation to occur, finding a rich culture medium in an immunocompromised patient.
Second if you were then to find him HIV positive would you modify your approach?