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Antibiotic therapy as a risk factor for chronic residual and phantom limb pain after combat-related amputation: a
Kateryna Ksenchyna1, Oleh Ksenchyn1, Oleksandr Nazarchuk1
1National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Background:
Antibiotic (AB) therapy is standard in managing combat-related infections, particularly after traumatic limb amputations. However, prolonged or combined antibiotic regimens may contribute to neuroinflammatory processes that predispose patients to chronic post-amputation pain (ChPAP), which combines the consepts of chronic residual limb pain (RLP) and phantom limb pain (PLP).
Objective:
To investigate associations between antibiotic use (duration, type, and combination) and the development of RLP and PLP in post-amputation military patients.
Methods:
This retrospective cohort study evaluated 212 military personnel treated between 2022 and 2024 for traumatic amputations. Antibiotic regimens, pain intensity, type, and chronicity were analyzed.
Results:
Chronic RLP/PLP developed in 94 patients (44.3%). Prolonged antibiotic use (>21 days) and combined regimens (≥2 antibiotics) were) were related with increased ChPAP risk in limbs Neuropathic pain was predominant in patients exposed to fluoroquinolones or metronidazole.
Conclusion:
Extended and multi-agent antibiotic therapy was associated with ChPAP after combat-related limb amputation. Personalized antimicrobial stewardship and early pain screening are recommended in this high-risk population.
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