Antimicrobial Prophylaxis with Combat-Related Open Soft-Tissue Injuries

Lloyd, Bradley A.; Murray, Clinton K.; Shaikh, Faraz; Carson, M. Leigh; Blyth, Dana M; Schnaubelt, Elizabeth; Whitman, Timothy J.; Tribble, David R.

doi:10.1093/milmed/usx125

Cited by 22 publications

(8 citation statements)

References 15 publications

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“…Lloyd et al, in 2018 [ 37 ], considered the effect of antibiotic prophylaxis in combat-related open soft tissues wounds in a retrospective study based on 287 patients. The study compared infectious outcomes in narrow prophylaxis regimens (as indicated by Department of Defense guidelines) and expanded gram negative coverage.…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence

Cicuttin

Sartelli

Scozzafava³

et al. 2022

Antibiotics

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Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.

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Section: Resultsmentioning

confidence: 99%

Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence

Cicuttin

Sartelli

Scozzafava³

et al. 2022

Antibiotics

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show abstract

“…Broad spectrum AP in open skin and soft tissue combat-related injuries is necessary and beneficial to decrease infection rates and length of hospital stay. 126,127 Data on skin and soft tissue injuries reported a synergistic effect of extensive wound irrigation and AP in decreasing the incidence of infection in moderately and severely contaminated skin and soft tissue injuries. 128 The reported different rates of infections in different management strategies include 17% in irrigation/no AP, 40% in AP/no irrigation, and 75% in no AP/no irrigation group ( p < 0.0005).…”

Section: Thoracic Traumamentioning

confidence: 99%

“…The need for AP, often suggested and used by physicians, needs to be assessed. Broad spectrum AP in open skin and soft tissue combat-related injuries is necessary and beneficial to decrease infection rates and length of hospital stay 126,127 . Data on skin and soft tissue injuries reported a synergistic effect of extensive wound irrigation and AP in decreasing the incidence of infection in moderately and severely contaminated skin and soft tissue injuries 128 .…”

Section: Definitionsmentioning

confidence: 99%

Antibiotic prophylaxis in trauma: Global Alliance for Infection in Surgery, Surgical Infection Society Europe, World Surgical Infection Society, American Association for the Surgery of Trauma, and World Society of Emergency Surgery guidelines

Coccolini,

Sartelli,

Sawyer

et al. 2023

J Trauma Acute Care Surg

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Trauma is a complex disease, and the use of antibiotic prophylaxis (AP) in trauma patients is common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. Antibiotic stewardship is of paramount importance in fighting resistance spread. Definitive rules or precise indications about antibiotic prophylaxis in trauma remain unclear. The present manuscript describes the indications of antibiotic prophylaxis in traumatic lesions to the head, brain, torso, maxillo-facial, extremities, skin, and soft tissues endorsed by the Global Alliance for Infection in Surgery (GAIS), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), World Society of Emergency Surgery (WSES).

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“…The rule of thumb here is to administer antibiotics as soon as possible. In case of any delay, they can be administered up to 3 hours after injury but not later than 6 hours after injury (2,(33)(34)(35).…”

Section: Medication Prophylaxis and Antibiotic Treatmentsmentioning

confidence: 99%

Prevention of Combat-Related Infections: A Review of the Literature

Darvishi,

Hejripoor,

Hosseini Shokouh

et al. 2023

Ann Mil Health Sci Res

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Context: Combat-related injuries remain prevalent on the battlefield despite advances in personal protective armor. Infections following these injuries pose a significant concern. Evidence Acquisition: We used a combination of keywords, including "combat" OR "military", "wound" OR "injury", "infection," and "prevention", to identify relevant articles from major databases, including PubMed/MEDLINE, Web of Science, and Scopus. Results: Infection risk correlates with the extent and location of the injury. Severe open fractures and penetrating abdominal injuries carry a higher risk of infection than abrasions, blunt traumas, burns, or closed injuries, which are often infection-free. Combat-related infections can manifest early or late, with late-onset infections having a greater likelihood of multidrug resistance. Penetrating abdominal injuries are particularly susceptible to infection due to rapid bacterial colonization in the wounded area and the potential presence of drug-resistant gut microbiota pathogens. Aggressive surgical debridement, along with thorough irrigation and appropriate dressing, proves effective in infection prevention. The timely administration of prophylactic antibiotics is of utmost importance, with continued antibiotic prophylaxis in cases of delayed evacuation. Conclusions: This review provides a concise summary of current literature on combat-related injury management, emphasizing infection prevention and control strategies.

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Antimicrobial Prophylaxis with Combat-Related Open Soft-Tissue Injuries

Abstract: Use of non-guideline directed EGN-based post-trauma antibiotic prophylaxis does not improve infectious outcomes nor does it shorten hospital stay.

Cited by 22 publications

References 15 publications

Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence

Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence

Antibiotic prophylaxis in trauma: Global Alliance for Infection in Surgery, Surgical Infection Society Europe, World Surgical Infection Society, American Association for the Surgery of Trauma, and World Society of Emergency Surgery guidelines

Prevention of Combat-Related Infections: A Review of the Literature

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