Early Antibiotics to Mitigate Post-Traumatic Infections: A Prospective, Multicenter Study in a Prolonged Care, High-Trauma, Austere Setting
Abstract
Objectives and Rationale: Among the military population, rates of infectious complications following trauma range from 5.1% to 50%. These complications include wound infections, infections in deep bodily spaces, and blood stream infections (sepsis). Among military Service Members who become injured with major bleeding, there is an increased risk of secondary organ dysfunction. Bacterial growth sufficient for causing infection can occur as soon as 6 hours after traumatic injury; therefore, antibiotics need to be given very quickly. Early antibiotics for traumatic injuries are recommended in both civilian clinical practice guidelines and U.S. military Tactical Casualty Combat Care (TCCC) guidelines. However, knowledge gaps exist regarding which patients will benefit from antibiotics and whether antibiotics help prevent infections. Specifically, there is a need to study which types of injuries are most likely to benefit from early antibiotics and the best time of administration to decrease the number of infections. Focus Areas: This study is intended to generate advances in the U.S. military’s Strategic Goal to defeat infection by developing solutions to prevent, treat, and diagnose naturally occurring infectious disease threats and eliminate their impact on operational readiness of DOD personnel, and optimize survival and recovery from combat- related injury in current and future scenarios. It will specifically address the FY22 DMRDP BWMIR Award Focus Areas of (1) Understanding appropriate wound prophylaxis/empiric treatment strategies throughout continuum of care, regardless of injury status, through preclinical and clinical studies to inform clinical practice guidelines and (2) Optimizing prolonged care management of penetrating torso injury by developing solutions for prevention/management of deep space infections and delays in care of penetrating abdominal injury. Research and Clinical Applications: Our research will assess the effectiveness of early antibiotic administration in cases where there is a long time between injury and when the patient receives advance care. We will also look at the impact of antibiotics in patients with penetrating chest and abdominal trauma and/or hemorrhagic shock. We will assess rates of infections and death due to infections in prolonged care scenarios and with wounds at high risk of infectious complications. Our application will address several knowledge gaps relevant to prophylactic antibiotics in prolonged critical injury. Projected Timeline: This proposed study will last 4 years in total: 3 months for preparatory work; 42 months of data collection at research sites including quality checks and interim analyses; and 6 months data analysis plus dissemination. Benefit to Service Members and American Public: This study will produce a minimum of three knowledge products to inform clinical practice guideline enhancements. We will provide data to either support or challenge the hypothesis and current practice that early antibiotics decrease rates of infections in prolonged care scenarios. We will gain unique real-world data to better understand how the timing of administration of early antibiotics impacts rates of infections. We will gain data on the effectiveness of early antibiotics in casualties experiencing hemorrhagic shock. The goal of this work is to generate data to better understand how to best prevent infections in injured patients. The data from this study will provide information on the application of early antibiotics in prolonged casualty care, which will be relevant in planning for future military operations. Findings will inform future studies on the role of early antibiotics in treating hemorrhagic shock. The study will improve trauma care practices to save the lives of injured military personnel and civilians experiencing prolonged care.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310989
Entities
People
- Nee-Kofi Mould-Millman
Organizations
- United States Army
- University of Colorado Denver