Prevention of Infections Associated With Combat-Related Thoracic and Abdominal Cavity Injuries

Abstract

Trauma-associated injuries of the thorax and abdomen account for the majority of combat trauma-associated deaths, and infectious complications are common in those who survive the initial injury. This review focuses on the initial surgical and medical management of torso injuries intended to diminish the occurrence of infection. The evidence for recommendations is drawn from published military and civilian data in case reports, clinical trials, meta-analyses, and previously published guidelines, in the interval since publication of the 2008 guidelines. The emphasis of these recommendations is on actions that can be taken in the forward-deployed setting within hours to days of injury. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

Characterization of wound infections among patients injured during the 2011 Libyan conflict

“…This has changed with the introduction of antibiotics and modern surgical management of wounds. This has resulted in the diminution of Gram-positive bacteria and emergence of more resistant ones particularly the aerobic and facultative anaerobic Gram-negative bacilli [3,7,8]. Our study in Libya showed that the infection rate among patients with war-associated infection was 42% with no variation according to the different regions where the injured patients came from.…”

Field Wound Care: Prophylactic Antibiotics

“…29 Postinjury infection following penetrating abdominal injury ranges from 4% to 31%. 29 Civilian and military literature has reported varying rates of infections after central nervous system injury, with a military study describing 408 patients with closed or penetrating head trauma evaluated and managed at Walter Reed Army Medical Center or National Naval Medical Center in Bethesda, MD. 30,31 There was a 9% rate of meningitis, with a rate of 26% in patients who had concomitant cerebrospinal fluid leakage from nose, ear, or wound.…”

Whatʼs new in operative trauma surgery in the last 10 years

“…Intravenous metronidazole should be added if penetrating wounds of the abdomen or esophagus are suspected [29,30]. Intravenous metronidazole should be added if penetrating wounds of the abdomen or esophagus are suspected [29,30].…”