Evaluation of infection rates with narrow versus broad-spectrum antibiotic regimens in civilian gunshot open-fracture injury |
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| Institution: | 1. Department of Pharmacy, West Virginia University, Morgantown, WV, United States;2. Department of Pharmacy, University of Kentucky, Lexington, KY, United States;3. Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States;4. Department of Business Intelligence, University of Kentucky HealthCare Information Technology, Lexington, KY, United States;1. Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon;2. Emergency Medical Services and Pre-hospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon;1. Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, United States of America;2. Department of Emergency Medicine and The Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States of America;3. Department of Emergency Medicine, University of California, Davis, United States of America;4. Department of Emergency Medicine, University of California, San Francisco, United States of America;1. Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-8180, Japan;2. Department of Emergency and Critical Care Center, Kochi Health Sciences Center, 2125-1, Ike, Kochi-city 781-8555, Japan;1. Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan;2. Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan;3. Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei City, Taiwan;4. Department of Neurosurgery, Shuang Ho Hospital, New-Taipei City, Taiwan;1. Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza Camden, NJ 08103, United States of America;2. Departments of Emergency Medicine and Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States of America;3. Department of Emergency Medicine, University of California San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143-0749, United States of America;4. Department of Medicine, Sutter Eden Medical Center, 20103 Lake Chabot Road Castro Valley, CA 94546, United States of America;5. Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States of America |
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| Abstract: | IntroductionCivilian gunshot open-fracture injuries portray a significant health burden to patients. Use of antibiotics is endorsed by guideline recommendations for the prevention of post-traumatic infections, however, antimicrobial selection and their associated outcomes remains unclear. Therefore, we sought to compare infectious and other clinical outcomes between three antimicrobial cohorts in patients with gunshot-related fractures requiring operative intervention.Materials and methodsPatients were identified by retrospectively querying the University of Kentucky Trauma Registry for gunshot wound victims. A narrow regimen, an expanded gram-negative regimen, and a regimen containing a fluoroquinolone antimicrobial were identified for comparison. The primary outcome was a composite of infections at or before 14 days of hospitalization. Secondary endpoints included hospital length of stay, incidence of multidrug resistant bacteria and methicillin-resistant Staphylococcus aureus colonization, number of drug-related adverse events, number of Clostridium difficile infections, and 30-day mortality.Results252 patients were selected for inclusion: 126 in the narrow regimen, 49 in the expanded gram-negative regimen, and 77 in the fluoroquinolone-based regimen. There were no statistical differences in the primary endpoint of early infectious outcomes between groups (p = 0.1797). The expanded gram-negative regimen was associated with increased hospital length of stay, and increased incidence of multi-drug resistant bacteria and methicillin-resistant Staphylococcus aureus colonization. There were no statistically significant differences in any of the remaining secondary endpoints.ConclusionIn this study evaluating civilian gunshot trauma, broad spectrum antibiotic coverage was not associated with improvements in post-traumatic infections. A randomized trial is needed to confirm these results. |
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