Infection prevalence and patterns in self-inflicted gunshot wounds to the face

Area of Science:

• Trauma Surgery
• Infectious Diseases
• Oral and Maxillofacial Surgery

Background:

• Self-inflicted gunshot wounds (SIGSWs) to the craniomaxillofacial region are rare but severe injuries.
• High mortality rates and significant tissue damage characterize these wounds.
• Limited data exists on postinjury infection rates and microbial patterns in SIGSW patients.

Purpose of the Study:

• To determine the prevalence of postinjury infections in patients with SIGSW to the maxillofacial region.
• To identify microbial patterns associated with these infections to guide empiric antibiotic selection.

Main Methods:

• Retrospective cohort study at a Level I trauma center.
• Data collected from 17 surviving patients with SIGSW involving the maxilla or mandible (2010-2017).
• Infection defined as culture-positive within 30 days of injury.

Main Results:

• 35% (6/17) of patients developed postinjury infections, averaging 11 days post-injury.
• 88% of patients received prophylactic antibiotics, averaging 14 days.
• Infections included gram-negative (4/6), anaerobic (2/6), and polymicrobial (2/6) organisms, with notable bacteria like S. aureus, E. coli, and Bacteroides.

Conclusions:

• Craniomaxillofacial SIGSWs have a high postinjury infection rate (35%) even with prophylactic antibiotics.
• Empiric antibiotic regimens should include coverage for gram-negative and anaerobic bacteria based on observed patterns.