Single dose IV Antibiotic for Low-Energy Extremity Gunshot Wounds: A Prospective Protocol

• Published in: Annals of surgery open 2022-03, Vol.3 (1), p.e136-e136
• Main Authors: 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.
• Format: Article
• Language: English
• ISSN: 2691-3593; 2691-3593
• DOI: 10.1097/AS9.0000000000000136

ObjectiveTo prospectively determine infection rate following low-energy extremity GSWs with a single dose IV antibiotic protocol. Summary Background DataPrevious work suggests that a single IV antibiotic dose, without formal surgical debridement, mitigates infection risk. MethodsOver 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). ResultsCompliance 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, P = 0.01). Receipt of additional antibiotics outside of our single-dose protocol did not predict further reduction in rate of infection (P = 0.64). ConclusionsA standardized protocol of single-dose IV antibiotic appears effective in minimizing infection after low-energy GSW to the extremities. Level of EvidenceTherapeutic Level II.