Stewart Laveta, Shaikh Faraz, Bradley William, Lu Dan, Blyth Dana M, Petfield Joseph L, Whitman Timothy J, Krauss Margot, Greenberg Lauren, Tribble David R
Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD.
Mil Med. 2019 Mar 1;184(Suppl 1):83-91. doi: 10.1093/milmed/usy336.
We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009-2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25-2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.
我们研究了在伊拉克和阿富汗受伤的美国军事患者（2009 - 2012年）中与战斗相关的肢体伤口感染（CEWI）的风险因素。对入住参与研究的美国医院（受伤后≤7天）且有≥1处与战斗相关的开放性肢体伤口的患者进行回顾性评估。根据最严重损伤情况（截肢、无截肢的开放性骨折或定义为非骨折/非截肢伤口的开放性软组织损伤）对人群进行分类。在1271名符合条件的患者中，分别有395名（31%）患者最严重损伤为≥1次截肢，457名（36%）有开放性骨折，419名（33%）有开放性软组织伤口。在创伤性截肢患者中，100名（47%）发生了CEWI，而开放性骨折和开放性软组织伤口患者中分别有66名（14%）和12名（3%）发生CEWI。在创伤性截肢和开放性骨折组中，对受伤后≤30天发生的CEWI进行Cox比例风险分析，截肢（风险比：1.79；95%置信区间：1.25 - 2.56）、受伤后≤24小时输血、简易爆炸装置爆炸、首次记录的休克指数≥0.80以及>4个损伤部位与CEWI风险独立相关。在CEWI诊断前至少4天存在非肢体感染与较低的CEWI风险相关，提示近期接受针对性抗菌治疗的影响。对早期临床管理的进一步评估将有助于阐明风险因素的作用。伤口分类系统为评估肢体伤口感染的风险和结局的损伤及临床因素提供了一种全面的方法。
