Kahler Dylan, DeWitte Natalie, Thompson Megan, Rehman Saqib, Anderson Jeffrey
Department of General Surgery, Temple University Hospital, Philadelphia, PA, USA.
Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Injury. 2025 Jun;56(6):112304. doi: 10.1016/j.injury.2025.112304. Epub 2025 Apr 8.
Standard antibiotic therapy for abdominal gunshot wounds (GSWs) with hollow viscus injury involves up to 24 h of prophylactic broad-spectrum antibiotics. However, antibiotic management strategies are poorly defined in treating gunshot wounds with bowel-to-bone trajectories. These injuries threaten fracture-related infection as missiles can carry contaminating material along their intracorporeal trajectory. This study seeks to determine whether the duration of prophylactic antibiotic therapy used in bowel-to-bone injuries is associated with fracture-related infection prevention or overall infectious sequelae.
This six-year retrospective review identified all patients experiencing abdominal GSWs with a trajectory causing bowel injury and simultaneous fracture. Patient demographics, duration of antibiotic therapy, and subsequent infectious complications were compared with nonparametric tests as indicated.
140 patients experienced GSWs with bowel-to-bone trajectory; the median duration of prophylactic antibiotic therapy was four days (IQR 2 - 5 days); two patients were diagnosed with fracture-related infection and 65 patients experienced an infectious complication during their index hospitalization. Duration of prophylactic antibiotic therapy was not associated with the development of overall infection (p = 0.31). Comparing three days of prophylactic antibiotic therapy to more than three days of therapy, no difference occurred in overall infection (p = 1.0).
The development of fracture-related infections in bowel-to-bone gunshot wounds is rare. The duration of prophylactic antibiotic therapy in bowel-to-bone injuries did not correlate with an increase in overall infectious complications. Notably, three days of prophylactic antibiotic therapy was not inferior compared to longer-duration therapy in the development of infectious sequelae. Thus, patients with a bowel-to-bone gunshot trajectory likely do not require extended antibiotic coverage for prevention of fracture-related infections.
腹部枪伤合并中空脏器损伤的标准抗生素治疗包括长达24小时的预防性广谱抗生素治疗。然而，在治疗伴有肠至骨弹道的枪伤时，抗生素管理策略尚不明确。这些损伤会引发与骨折相关的感染风险，因为子弹在体内弹道中可能携带污染物质。本研究旨在确定用于肠至骨损伤的预防性抗生素治疗持续时间是否与预防骨折相关感染或总体感染后遗症有关。
这项为期六年的回顾性研究确定了所有经历腹部枪伤且弹道导致肠损伤并同时伴有骨折的患者。根据需要，使用非参数检验比较患者的人口统计学数据、抗生素治疗持续时间和随后的感染并发症。
140例患者经历了肠至骨弹道的枪伤；预防性抗生素治疗的中位持续时间为4天（四分位间距2 - 5天）；2例患者被诊断为与骨折相关的感染，65例患者在首次住院期间出现感染并发症。预防性抗生素治疗持续时间与总体感染的发生无关（p = 0.31）。将三天的预防性抗生素治疗与超过三天的治疗进行比较，总体感染无差异（p = 1.0）。
肠至骨枪伤中与骨折相关感染的发生很少见。肠至骨损伤中预防性抗生素治疗的持续时间与总体感染并发症的增加无关。值得注意的是，在感染后遗症的发生方面，三天的预防性抗生素治疗并不比更长疗程的治疗效果差。因此，伴有肠至骨枪伤弹道的患者可能不需要延长抗生素覆盖时间来预防与骨折相关的感染。
