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Antimicrobial Prophylaxis with Combat-Related Open Soft-Tissue Injuries
Bradley A Lloyd1, Clinton K Murray1, Faraz Shaikh2,3
1San Antonio Military Medical Center, 3551 Roger Brooke Drive #3600, Fort Sam Houston, TX.
Military Medicine
|February 16, 2018
Summary
Expanded Gram-negative coverage (EGN) antibiotic prophylaxis for open soft-tissue injuries did not improve infectious outcomes or shorten hospital stays compared to guideline-directed therapy. This study highlights the importance of adhering to established antibiotic prophylaxis guidelines in trauma care.
Area of Science:
- Trauma Surgery
- Infectious Diseases
- Military Medicine
Background:
- Department of Defense (DoD) guidance recommends cefazolin or clindamycin for post-trauma antibiotic prophylaxis in open soft-tissue injuries.
- Expanded Gram-negative (EGN) coverage was sometimes used off-label by clinicians.
- Stewardship efforts aimed to reduce EGN use following guideline revisions in 2011/2012.
Purpose of the Study:
- To examine antibiotic utilization in military personnel with open extremity soft-tissue injuries.
- To assess the impact of EGN prophylaxis versus guideline-directed prophylaxis on infectious outcomes.
- To evaluate the effect on hospitalization duration.
Main Methods:
- Retrospective analysis of 287 military personnel with open extremity soft-tissue injuries treated from 2009-2014.
- Patients received either narrow (guideline-directed) or EGN prophylaxis.
- Infectious outcomes and hospitalization duration were compared between groups.
Main Results:
- 75 (26%) patients received EGN coverage, while 212 (74%) received narrow prophylaxis.
- EGN use decreased from 39% to 11% during the study period.
- No significant differences in skin and soft-tissue infections, other infections, or hospitalization duration were observed between groups.
Conclusions:
- Non-guideline directed EGN prophylaxis did not improve infectious outcomes in patients with open soft-tissue injuries.
- EGN prophylaxis did not lead to a shorter hospital stay compared to guideline-directed therapy.
- Adherence to established antibiotic prophylaxis guidelines is crucial in trauma care.
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