[Administration of antibiotics in patients with polytrauma-based urogenital injuries-a narrative review]

Urogenital injuries occur in up to 10% of all trauma patients and are associated with increased risk of infectious complications, especially in association with polytrauma. Rational administration of antibiotics is an essential part of care, whereby evidence-based recommendations are lacking for many types of injuries.

A narrative review on the administration of antibiotics to patients with injuries to the upper and lower urinary tract as well as external genital organs taking into consideration current international guidelines, consensus documents, and review articles is presented. In addition, recommendations on antibiotic stewardship, perioperative antibiotic prophylaxis, and specific trauma-related situations are taken into account.

Routine antibiotic prophylaxis for uncomplicated, blunt urogenital injuries is not recommended. In surgically managed, penetrating, or contaminated injuries, antibiotic administration should be risk adapted and be oriented based on the injury pattern, degree of contamination, and the expected spectrum of pathogens. In addition to guideline-based perioperative antibiotic prophylaxis, aspects of antibiotic stewardship, altered pharmacokinetic aspects of patients with polytrauma and systemic inflammation, prophylaxis for gas gangrene and tetanus, and the specific requirements associated with war-related injuries are becoming increasingly important.

Administration of antibiotics in polytraumatized patients with urogenital injuries should be based on the indication and be guideline conform. Because of the limited amount of evidence, many recommendations are based on expert consensus as well as general trauma and perioperative guidelines. Prospective studies are needed to define indications, choice of antibiotics, and duration of treatment for the various injury patterns.