Implications of leukocytosis and fever at conclusion of antibiotic therapy for intra-abdominal sepsis

Outcomes of 65 patients after operation who had exhibited a clinical response to treatment for intra-abdominal sepsis were compared based on the presence or absence of leukocytosis and fever at the conclusion of antibiotic therapy. Fifty-one patients were afebrile when antibiotics were stopped. Intra-abdominal infection developed in 7 of 21 (33%) who had a persistent leukocytosis, but no intra-abdominal infections developed after operation in 30 patients who had normal WBC counts at the end of antibiotic treatment (p less than 0.005). Nosocomial infections developed in 6 (12%) of the 51 patients, and there was no difference in the incidence between patients with or without leukocytosis. Eleven of 14 (79%) patients who were still febrile when antibiotics were discontinued developed infections after operation. Nosocomial infections occurred in three (21%) and intra-abdominal infections in eight (57%). Of the 15 patients who developed intra-abdominal infection after operation, only four responded to appropriate antibiotic treatment without requiring further surgery. The other patients required surgical management for definitive control within two months of the initial operation. In conclusion, patients at risk of developing infection after operation after exhibiting a clinical response to treatment of intra-abdominal sepsis are those who are afebrile with a persistent leukocytosis or who are still febrile when antibiotics are stopped.