Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Gulhane Training and Research Hospital, Ankara-Türkiye.
Department of General Surgery, Health Sciences University Gulhane Training and Research Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Sep;30(9):650-656. doi: 10.14744/tjtes.2024.25442.
Firearm injuries (FI) remain a significant cause of morbidity and mortality globally. Antibiotic use, supported by guideline recommendations for preventing post-injury infections in FI cases, encounters uncertainties regarding the selection of anti-microbial agents and associated outcomes. This study aimed to investigate the relationship between Injury Severity Scores (ISS) for FI cases presented to the emergency department.
We empirically revised antimicrobial treatment protocols based on culture results and mortality rates. In the study, 164 firearm injury cases, admitted to the emergency department in 2022 and subsequently hospitalized in clinics and intensive care units (ICU), were evaluated. Cases included in the study were categorized into four groups based on ISS: mild, moderate, severe, and profound injury severity. The study compared the timing of hospital presentation following the injury, hospital length of stay, tissue or blood culture positivity, empirical treatment administered, antimicrobial revision based on culture results, need for ICU admission, mortality status, and ISS among the cases. Data were analyzed using IBM SPSS Statistics 22.0 (SPSS Inc., Chicago, IL). Variables in trauma patients were compared among various groups using Pearson Chi-Square tests. Binary logistic regression tests were performed to identify independent risk factors. A significance level of p<0.05 was considered statistically significant.
The study included 164 patients, all of whom were male. The mean age was calculated as 28.9±4.51 years. The average hospital length of stay was 25.54±21.81 days. Eighty-three patients (50.6%) required intensive care. Tissue cultures were obtained from 79 patients (48%). Bacterial growth was observed in 45 of these 79 patients (57%). The appropriate empirical antibiotic treatment rate, assessed among patients who received empirical treatment followed by culture-based antibiotic sensitivity testing, was 48.9%. It was observed that empirical antibiotic regimens were appropriate in 80% of cases in the mild group and 16.7% in the profound severe group (p=0.005). Our study compared the relationship between hospitalization duration and ISS groups. It was observed that hospitalization duration was significantly shorter in the mild group compared to the other groups (p=0.003, p=0.000, p=0.000). It was also observed that the need for ICU admission was higher in groups with higher ISS, indicating a correlation between higher ISS and increased ICU requirements (p=0.000).
In conclusion, for cases of firearm injuries, we believe empirical antimicrobial therapy should be initiated with narrow-spectrum agents such as beta-lactam + beta-lactamase inhibitor or third-generation cephalosporin + nitroimidazole in the mild group, considering the lack of Pseudomonal activity.
火器伤（FI）仍然是全球发病率和死亡率的一个重要原因。预防 FI 后感染的指南建议支持抗生素的使用，但在选择抗菌药物和相关结果方面存在不确定性。本研究旨在调查急诊就诊的 FI 患者的损伤严重度评分（ISS）之间的关系。
我们根据培养结果和死亡率对经验性抗生素治疗方案进行了修订。在这项研究中，评估了 2022 年因 FI 就诊并随后在诊所和重症监护病房（ICU）住院的 164 例火器伤患者。根据 ISS 将病例分为四组：轻度、中度、重度和极重度损伤严重度。研究比较了病例受伤后就诊的时间、住院时间、组织或血液培养阳性、经验性治疗、根据培养结果修订的抗菌治疗、入住 ICU 的需要、死亡率和 ISS。使用 IBM SPSS Statistics 22.0（SPSS Inc.，芝加哥，IL）分析数据。使用 Pearson Chi-Square 检验比较创伤患者之间的变量。进行二项逻辑回归检验以确定独立的危险因素。p<0.05 被认为具有统计学意义。
研究包括 164 名男性患者，平均年龄为 28.9±4.51 岁。平均住院时间为 25.54±21.81 天。83 名患者（50.6%）需要重症监护。从 79 名患者（48%）中获得了组织培养物。在这 79 名患者中，有 45 名（57%）观察到细菌生长。在接受经验性治疗并随后进行基于培养的抗生素药敏试验的患者中，评估了适当的经验性抗生素治疗率为 48.9%。观察到轻度组的经验性抗生素方案的适当率为 80%，而极重度组为 16.7%（p=0.005）。我们的研究比较了住院时间与 ISS 组之间的关系。观察到与其他组相比，轻度组的住院时间明显缩短（p=0.003，p=0.000，p=0.000）。还观察到，ISS 较高的组需要 ICU 入院的可能性更高，表明较高的 ISS 与增加的 ICU 需求之间存在相关性（p=0.000）。
总之，对于火器伤患者，我们认为在轻度组中，应使用窄谱药物如β-内酰胺+β-内酰胺酶抑制剂或第三代头孢菌素+硝基咪唑开始经验性抗菌治疗，因为缺乏假单胞菌活性。
