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. 2022 Feb 25;3(1):e136.
doi: 10.1097/AS9.0000000000000136. eCollection 2022 Mar.

Single dose IV Antibiotic for Low-Energy Extremity Gunshot Wounds: A Prospective Protocol

Mai P Nguyen  1 , Jonathan C Savakus  1 , Natasha M Simske  1 , Michael S Reich  1 , Ryan Furdock  1 , Joseph F Golob Jr  1 , Amy A McDonald  1 , John J Como  1 , Heather A Vallier  1
Affiliations

Single dose IV Antibiotic for Low-Energy Extremity Gunshot Wounds: A Prospective Protocol

Mai P Nguyen et al. Ann Surg Open. .

Abstract

Objective: To prospectively determine infection rate following low-energy extremity GSWs with a single dose IV antibiotic protocol.

Summary background data: Previous work suggests that a single IV antibiotic dose, without formal surgical debridement, mitigates infection risk.

Methods: Over 35 months 530 adults with low-energy GSWs to the extremities were included. Three hundred fifty-two patients (66%) had ≥30 days follow-up. Patients were administered a single dose of first-generation IV cephalosporin antibiotics, and those with operative fractures received 24-hour perioperative antibiotics. Injury characteristics, treatment, protocol adherence, and outcomes (infection) were assessed between the protocol group (single-dose antibiotics) and the non-protocol group (no antibiotics or extra doses of antibiotics).

Results: Compliance with the single-dose protocol occurred in 66.8%, while 33.2% received additional antibiotics or no antibiotics. The deep infection rate requiring surgical debridement was 0.8%, while the combined rate of all infections was 11.1%. Age, sex, injury location, multiple injuries, fracture presence, and type of surgery did not affect infection rate. Adherence to the antibiotic protocol was associated with a reduction in infection risk (odds ratio = 0.39, 95% confidence interval 0.19-0.83, P = 0.01). Receipt of additional antibiotics outside of our single-dose protocol did not predict further reduction in rate of infection (P = 0.64).

Conclusions: A standardized protocol of single-dose IV antibiotic appears effective in minimizing infection after low-energy GSW to the extremities.

Level of evidence: Therapeutic Level II.

Keywords: GSW; antibiotics; gunshot wound; infection.

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Figures

FIGURE 1.
FIGURE 1.
Flowchart depicting inclusion/exclusion process.
See this image and copyright information in PMC

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