Use of antibiotics after complex open hand injury

Area of Science:

• Hand Surgery
• Infectious Diseases
• Plastic Surgery

Background:

• Bacterial contamination is a concern in hand injuries.
• Antibiotic prescribing practices vary widely in plastic surgery units.
• The efficacy of antibiotics in treating hand injuries is not well-established.

Purpose of the Study:

• To examine bacterial contamination, antibiotic prescribing patterns, and outcomes in patients with hand injuries.
• To compare antibiotic prescribing trends in plastic surgery units nationally.
• To evaluate the necessity and effectiveness of antibiotic use in open hand injuries.

Main Methods:

• Prospective study of 50 patients with hand injuries.
• Analysis of preoperative wound swabs for bacterial contamination.
• National survey of antibiotic prescribing practices in plastic surgery units.
• Correlation of antibiotic use with wound severity and patient outcomes.

Main Results:

• Preoperative swabs predominantly showed normal flora or no growth.
• 48 out of 50 patients received antibiotics with inconsistent agents, routes, and durations.
• Clinical wound infection occurred in three crush injuries.
• Antibiotic use was dictated by wound state rather than tissue damage, except in dirty wounds.
• No significant difference in antibiotic use for clean versus crushed injuries was observed.

Conclusions:

• Current antibiotic prescribing for open hand injuries lacks consistency and proven benefit.
• The state of the wound appears to be a primary driver for antibiotic prescription.
• Further research is essential to clarify the role and efficacy of antibiotics in managing open hand injuries.