Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 May;38(5):934-939.
doi: 10.1016/j.ajem.2019.158358. Epub 2019 Jul 23.

Evaluation of infection rates with narrow versus broad-spectrum antibiotic regimens in civilian gunshot open-fracture injury

Jordan A Woolum  1 , Abby M Bailey  2 , Adam Dugan  3 , Rahul Agrawal  4 , Regan A Baum  2
Affiliations
Comparative Study

Evaluation of infection rates with narrow versus broad-spectrum antibiotic regimens in civilian gunshot open-fracture injury

Jordan A Woolum et al. Am J Emerg Med. 2020 May.

Abstract

Introduction: Civilian 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 methods: Patients 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.

Results: 252 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.

Conclusion: In 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.

Keywords: Antimicrobial; Fracture; Gunshot; Open; Prophylaxis.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest None to disclose.

Figures

Figure 1.
Figure 1.
Flow diagram for included subjects.
Figure 2.
Figure 2.
Antimicrobial Distribution
See this image and copyright information in PMC

References

    1. Fowler KA, et al. , Firearm injuries in the United States. Prev Med, 2015. 79: p. 5–14. - PMC - PubMed
    1. Centers for Disease Control, National Center for Injury Prevention and Control. WISQUARS fatal injuries: mortality reports. Available at: http://webappa.cdc.gov/sasweb/ncipc/mortrate.html. Accessed 14 Nov 2013.
    1. Manring MM, et al. , Treatment of war wounds: a historical review. Clin Orthop Relat Res, 2009. 467(8): p. 2168–91. - PMC - PubMed
    1. Eardley WG, et al. , Infection in conflict wounded. Philos Trans R Soc Lond B Biol Sci, 2011. 366(1562): p. 204–18. - PMC - PubMed
    1. Hoff WS, et al. , East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma, 2011. 70(3): p. 751–4. - PubMed

Publication types

MeSH terms