Variation in Postinjury Antibiotic Prophylaxis Patterns Over Five Years in a Combat Zone

Area of Science:

• Military Medicine
• Infectious Disease Prevention
• Clinical Practice Guidelines

Background:

• A clinical practice guideline (CPG) for preventing infections in combat casualties was established in 2008 and revised in 2011.
• Antimicrobial stewardship is crucial in deployed settings to optimize patient outcomes and combat resistance.

Purpose of the Study:

• To evaluate the utilization of antimicrobials within 48 hours of injury in combat casualties.
• To assess adherence to the 2011 clinical practice guideline (CPG) over a 5-year period.
• To analyze trends in antimicrobial regimens, types, and coverage, particularly for Gram-negative bacteria.

Main Methods:

• Retrospective analysis of antimicrobial use in 5,196 wounded military personnel from June 2009 to May 2014.
• Categorization of injuries including open fractures, skin/soft-tissue, and maxillofacial injuries.
• Comparison of antimicrobial prescribing patterns between 2009-2010 and 2013-2014, assessing adherence to the 2011 CPG.

Main Results:

• Overall CPG compliance increased, with significant improvements noted for open fractures (34% to 73%) and maxillofacial injuries (50% to 76%).
• A substantial reduction in expanded Gram-negative antimicrobial coverage was observed for open fractures (61% to 7%) and maxillofacial injuries (37% to 12%).
• Injury during 2011-2014, higher injury severity scores, and ICU admission in Germany were associated with CPG compliance and noncompliance, respectively.

Conclusions:

• There has been a demonstrable increase in adherence to infection prevention clinical practice guidelines among combat casualties.
• The study highlights a significant and positive trend in reducing the use of expanded Gram-negative antimicrobial coverage.
• Continued monitoring and adherence to CPGs are essential for optimizing antimicrobial use in military medical settings.