Nguyen Mai P, Savakus Jonathan C, Simske Natasha M, Reich Michael S, Furdock Ryan, Golob Joseph F, McDonald Amy A, Como John J, Vallier Heather A
From the MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH.
Ann Surg Open. 2022 Feb 25;3(1):e136. doi: 10.1097/AS9.0000000000000136. eCollection 2022 Mar.
To prospectively determine infection rate following low-energy extremity GSWs with a single dose IV antibiotic protocol.
Previous work suggests that a single IV antibiotic dose, without formal surgical debridement, mitigates infection risk.
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).
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, = 0.01). Receipt of additional antibiotics outside of our single-dose protocol did not predict further reduction in rate of infection ( = 0.64).
A standardized protocol of single-dose IV antibiotic appears effective in minimizing infection after low-energy GSW to the extremities.
Therapeutic Level II.
前瞻性确定采用单剂量静脉注射抗生素方案治疗低能量肢体枪伤后的感染率。
先前的研究表明，单剂量静脉注射抗生素，无需进行正规手术清创，可降低感染风险。
在35个月期间，纳入了530例低能量肢体枪伤的成人患者。352例患者（66%）进行了≥30天的随访。患者接受了单剂量的第一代静脉注射头孢菌素抗生素治疗，有手术骨折的患者接受了24小时围手术期抗生素治疗。在方案组（单剂量抗生素）和非方案组（未使用抗生素或额外剂量抗生素）之间评估损伤特征、治疗、方案依从性和结果（感染情况）。
66.8%的患者遵守了单剂量方案，而33.2%的患者接受了额外抗生素或未使用抗生素。需要手术清创的深部感染率为0.8%，所有感染的综合发生率为11.1%。年龄、性别、损伤部位、多发伤、骨折情况和手术类型均不影响感染率。遵守抗生素方案与感染风险降低相关（优势比=0.39，95%置信区间0.19 - 0.83，P = 0.01）。在我们的单剂量方案之外接受额外抗生素治疗并不能预测感染率的进一步降低（P = 0.64）。
单剂量静脉注射抗生素的标准化方案似乎能有效降低低能量肢体枪伤后的感染率。
治疗性二级证据。
