Lauren Dehne, PharmD
PGY-2 Critical Care Pharmacy Resident
University of Cincinnati Medical Center
Cincinnati, Ohio
Disclosure information not submitted.
Madeline Foertsch, PharmD, BCCCP
Clinical Pharmacy Specialist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Chris Droege, PharmD, BCCCP, FCCM
UC Health/University of Cincinnati Medical Center
Cincinnati
Disclosure information not submitted.
Daniel Mosher, PharmD
PGY-1 Pharmacy Practice Resident
Tucson Medical Center, United States
Disclosure information not submitted.
Carolyn Philpott, PharmD, BCCCP
Clinical Pharmacy Specialist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Eric Mueller, PharmD, FCCP, FCCM
Clinical Pharmacy Specialist
University of Cincinnati Medical Center
Cincinnati, Ohio, United States
Disclosure information not submitted.
Amy Makley, MD, FACS
Associate Professor of Surgery
University of Cincinnati College of Medicine, United States
Disclosure information not submitted.
Henry Sagi, MD, FACS
Professor of Orthopaedic Trauma Surgery
University of Cincinnati College of Medicine, United States
Disclosure information not submitted.
Molly Droege, PharmD
Clinical Pharmacy Specialist
UC Health/University of Cincinnati Medical Center
Cincinnati, Ohio, United States
Disclosure information not submitted.
Title: Antibiotic Prophylaxis following Penetrating Abdominal Trauma with Associated Orthopedic Injury
Introduction:
Optimal antimicrobial prophylaxis duration following gunshot wounds (GSW) to the abdomen with associated orthopedic fracture is unknown. This study evaluated antimicrobial prophylaxis duration impact on infectious outcomes following GSW with hollow viscus injury and communicating orthopedic fracture.
Methods:
This was a single-center, retrospective, cohort study of adult patients admitted to the trauma service at an urban, academic, level-I trauma center over a 20-year period. Inclusion criteria were acute GSW with hollow viscus injury and communicating spine or pelvic fracture(s). Patients were stratified into two cohorts based on prophylactic antibiotic duration: abbreviated (AC, ≤48 hours) and extended (EC, >48 hours) courses. The primary outcome was the composite and individual incidences of osteomyelitis and meningitis up to one-year post-injury. Secondary outcomes included hospital length of stay (LOS), incidence of multidrug-resistant organisms (MDRO) and Clostridium difficile infections (CDI), and risk factor determination for osteomyelitis and meningitis.
Results:
A total of 125 patients (45 [36%] AC, 80 [64%] EC) were included. Demographics were similar between groups, except the EC group had more gastrointestinal operations (1 [IQR 1-2] vs 2 [IQR 1-2], p=0.022). Median prophylactic antibiotic duration was shorter (1 [IQR 1-2] vs 7 [IQR 5-7] days, p< 0.001) in the AC group. There were no differences in the composite (2 [4.4%] vs 4 [5%], p=0.77) and individual incidences of osteomyelitis (1 [2.2%] vs 4 [5%], p=0.78) and meningitis (1 [2.2%] vs 0 [0%], p=0.77) between groups. Median hospital LOS (7 [IQR 6-11] vs 9 [IQR 6.3-14.8] days, p=0.072), and incidence of MDRO (6 [13.3%] vs 13 [16.3%], p=0.86) and CDI (0 [0%] vs 1 [1.3%], p=0.77) were similar between groups. No independent risk factors for osteomyelitis and meningitis were identified.
Conclusions:
In the era of antimicrobial stewardship, abbreviated prophylactic antimicrobial duration following abdominal gunshot wound with concomitant hollow viscus injury and orthopedic fracture had similar patient outcomes when compared to a longer duration.