Intraosseous Antibiotic for Point-of-Care Wound Prophylaxis
Abstract
Combat wounds to the extremities are common and more severe than wounds seen in the civilian trauma population. These injuries often involve multiple tissues such as the skin, muscle, and bone. Infection is a high risk because of combat wound severity and the injury environment. Infection has been shown to decrease the chance an injured Service Member has of returning to active duty. Infection has also been attributed to limb amputation as a complication to limb salvage. Additionally, the complication of wound infection after trauma costs $1.8 billion dollars per year. Overall then, infection is a serious, expensive, and recovery-interrupting complication best avoided. This research study aims to address the FY21 PRORP ARA Focus Area by studying a simple but novel approach to protecting severe combat extremity wounds from infection which ultimately will facilitate recovery and return to duty. Extremity tourniquets are an important component of bleeding control in the combat environment. In fact, a tourniquet could be placed on oneself or by a fellow combatant very quickly following an injury. Tourniquets, however, have been shown to decrease the amount of antibiotic that gets delivered in the blood stream to tissues below the tourniquet. These are the tissues that are at risk of infection. A reliable way to deliver antibiotics to injured limbs below a potentially lifesaving tourniquet is needed. This study will use a pig model which combines prior work conducted by Dr. Rivera and colleagues at the U.S. Army Institute of Surgical Research, where she performed work on muscle loss and others contributed to our knowledge of severe wound treatment. Animals in this study will have a wound created to multiple lower extremity tissues, including bone, that are contaminated with bacteria. The typical approach to protecting wounds from infection includes IV antibiotics. Some animals will receive IV antibiotics. However, the comparison will be antibiotics given by a catheter placed directly into the bone just above the wound, called an intraosseous, or IO, catheter. An additional comparison will involve some animals having a tourniquet placed before antibiotics are given to determine whether the tourniquet hinders the IV antibiotics, which could be overcome with IO administration. Bacteria amounts, complications, and amount of antibiotic delivered to the tissue will all be measured. What makes this specific approach attractive and would allow for rapid implementation of these results among deployed personnel is that the training required for medics under Tactical Combat Casualty Care precepts already includes use of IO catheters. IO catheters are used to administer fluids for resuscitation; therefore, our deployed medics would already be readily capable of IO administration of antibiotic. The next step following this study could be a study in human patients who sustain open bone fractures. However, the use of a large animal in this study using equipment and techniques already deployed makes the results of the study very applicable even today.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2211109
Entities
People
- Jessica C. Rivera
Organizations
- LSU Health Sciences Center New Orleans
- United States Army