Medical Student Eastern Virginia Medical School, United States
Objectives: In the U.S. there are thousands of ballistic firearm injuries to the extremities and subsequent infections, yearly. There is a lack of consensus regarding the ideal duration of antibiotic treatment to prevent infection of these wounds. Our study investigated infection rate among ballistic extremity fracture patients based on antibiotic prophylaxis duration, wound severity (Gustilo grade), and fracture location. Our study aimed to:
1) Determine if infection rate following ballistic extremity fracture is correlated with antibiotic prophylaxis duration, wound severity, joint involvement, and/or fractured extremity location.
2) Determine the optimal and necessary duration of antibiotic prophylaxis for the prevention of infection following ballistic fractures of the extremities.
Methods: Retrospective chart review of ballistic extremity fracture patients from a single trauma center from 01/01/2010-12/31/2020.
Results: 231 of 1,611 fracture cases screened met our inclusion criteria. Infection rate was significantly higher among patients who received antibiotics for ≥48 hours (16.6%), compared to those who received antibiotics for < 48 hours (3.6%) (Chi2 = 10.57, p = 0.001). Infection rate was significantly higher among patients with Gustilo grade III wounds (18.5%), compared to Gustilo I & II wounds (5.15%) (Chi2 = 5.09, p = 0.024). When stratified by Gustilo grade, there was no difference in the rate of infection between patients who received antibiotics for ≥48 hours and those who received antibiotics for < 48 hours (Gustilo I & II Chi2 = 0.53, p = 0.82; Gustilo III Chi2 = 2.15, p = 0.14). Infection rate was not correlated with joint involvement or fractured extremity location.
Conclusion: Our results indicate that infection likelihood for extremity ballistic fractures is correlated with wound severity and not antibiotic prophylaxis duration, joint involvement, or fracture location. There was no significant difference in infection rate between ballistic extremity fracture patients who received less than 48 hours of antibiotic prophylaxis and those who received greater than 48 hours of antibiotic prophylaxis. Therefore, prophylactic antibiotic administration for greater than 48 hours for most ballistic extremity fractures is likely unwarranted.
