The Effect of Systemic Antibiotic Prophylaxis and Wound Irrigation on Penetrating Combat Wounds in a Return-to-Duty Population
Abstract
Background. Systemic antibiotic prophylaxis (SAP) for combat wounds is controversial. Current military practice favors its use, despite scant supporting evidence. Objective. To analyze outcomes of combat casualties returned to duty after initial wound care for penetrating trauma, comparing infection rates based on whether SAP was administered and whether wounds were irrigated. Setting: Forward operating base in Central Iraq, with units engaged in urban combat. Methods. This was a retrospective cohort study using field medical records. Wound mechanism, location, antibiotic use, and clinical course were abstracted. Subjects were excluded if injuries were isolated burns or eye trauma or if follow-up was not documented. Statistical analysis: Contingency table analysis, Fisher's exact test, and odds ratios were used. Results. Fifty-eight eligible cases were identified; five were excluded for incomplete follow-up (four) or confounding injuries (one). Of the remaining 53 cases. 43 included receipt of SAP (81 %). Wound mechanisms and anatomic locations were ons were comparable between groups. Infections developed within 48 hours in 7% of the SAP cases versus 40% without SAP ( no SAP ); odds ratio 0.11 (95% confidence interval [CI] 0.02 to 0.57); number needed to treat (NNT) 3 (95% CI 2 to 14). Forty-four subjects received wound irrigation (83%). Infections developed within 48 hours in two (4.5%) irrigated cases versus five (55%) without irrigation ( no irrigation ); odds ratio 0.04 (95% CI 0.006 to 0.24); NNT 2 (95% CI 1.4 to 4.7). Further 4 X 2 contingency table analysis yielded wound infection rates as follows: no SAP/irrigation, 17%; SAP/no irrigation, 40%; SAP/irrigation, 2.6%; no SAP/no ir- rigation, 75% (Fisher's exact p less than 0.0005).
Document Details
- Document Type
- Technical Report
- Publication Date
- Dec 01, 2009
- Accession Number
- ADA630346
Entities
People
- Joseph M. Matthews
- Robert T. Gerhardt
- Scott G. Sullivan
Organizations
- United States Army Institute of Surgical Research