Prevention of Infections Associated With Combat-Related Extremity Injuries

Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA.
The Journal of trauma (Impact Factor: 2.96). 08/2011; 71(2 Suppl 2):S235-57. DOI: 10.1097/TA.0b013e318227ac5f
Source: PubMed


During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ∼ 15% of patients with extremity injuries develop osteomyelitis, and ∼ 17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evidence-based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial therapy, debridement and irrigation, and surgical wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characterization. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

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    • "The use of antimicrobial agents active against MRSA and MSSA could have a major impact on the care of casualties on the battlefield or those injured during natural disasters or humanitarian relief operations. Due to the high rate of infections associated with combat-related injuries, a standard practice is to initiate antimicrobial therapy at the time of injury [32-34]. Oral moxifloxacin is currently the recommended field antimicrobial for the US military unless there is an intraabdominal injury, for which ertapenem is recommended [33]. "
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