The risk of wound infection after simple hand laceration

Abstract

BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration (SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not. METHODS:The study was performed at two urban hospitals enrolling 125 emergency department (ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defi ned as clinical infection at a follow-up visit (10-14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1-10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confi dence intervals (CI). RESULTS:In the 125 patients with SHL [median age: 28 (18, 43); range: 1-102 years old; 36% female], 44 (35%, 95% CI: 27%-44%) were given antibiotics in the ED. Wound infection was reported in 6 patients (4.8%, 95% CI: 2%-10%). Age, gender, history of diabetes and wound closure were not associated with wound infection (P>0.05). The infection rate was not signifi cantly different between patients with or without antibiotic prophylaxis [7% (3/44), 95% CI: 2%-10% vs. 4% (3/81), 95% CI: 1%-11%, P=0.66]. Patient's satisfaction with appearance of infected and non-infected wounds were signifi cantly different [7.5 (6, 8) vs. 9 (8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk of infection.

Meta-analysis of antibiotics for simple hand injuries requiring surgery

“…Six Infected wound (class IV), typical of those excluded from this analysis. This appearance is suggestive of tenosynovitis, usually treated with urgent surgical washout, antibiotics and elevation studies 14,15,17,19,20,26 gave a cephalosporin, four 16,18,22,25 penicillin (flucloxacillin or co-amoxiclav) and three 21,23,24 included any antibiotic prescribed. The trials were statistically homogeneous (P = 0⋅77, χ 2 test, I 2 = 0 per cent), but a random-effects model was used owing to the heterogeneity of regimens.…”

“…Of the 13 studies included, five 15 -17,25,26 were double-blind RCTs, five 14,18 -20,22 were prospective trials and three 21,23,24 were observational cohort studies. Among the RCTs, the risk of bias was low in two relatively recent trials 17,25 , high in two trials 15,16 , and one older trial 26 did not describe its study design in sufficient detail to assess some forms of bias.…”

“…Additional records identified through other sources n = 12 14 Aydın et al 15 Beesley et al 16 Berwald et al 17 Cassell and Ion 18 Grossman et al 19 Haughey et al 20 Platt and Page 21 Roberts and Teddy 22 Roodsari et al 23 Stone and Davidson 24 Whittaker et al 25 Worlock et al 26 Total Heterogeneity: τ 2 = 0·00; χ 2 = 8·16, 12 d.f., P = 0·77; I 2 = 0% Test for overall effect: Z = 0·69, P = 0·49 …”

Updates in emergency department laceration management

“…Recent studies have reached similar conclusions, and routine use of prophylactic systemic antibiotics is likely unnecessary and should be considered on a case by case basis. A prospective observational study of 135 ED patients with simple, uncomplicated hand lacerations found that 35% received oral antibiotics with an overall wound infection rate of 4.8%, with more infections developing in the group who received antibiotics [35]. Another study of 330 patients with traumatic wounds which were swabbed and sent for cultures found that despite the fact that 90% received prophylactic oral antibiotics, less than 10% of the wounds were found to be contaminated with potentially pathologic bacteria.…”

Comparing the effectiveness of oral versus intravenous antibiotics in the prophylaxis of wound infection in hand laceration

“…Several studies did not find a significant difference in the wound infection rate between patients who received oral and IV ABSs (12,22,23).…”