Prevention of infections associated with combat-related extremity injuries

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 h...

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Published inThe journal of trauma Vol. 71; no. 2 Suppl 2; p. S235
Main Authors Murray, Clinton K, Obremskey, William T, Hsu, Joseph R, Andersen, Romney C, Calhoun, Jason H, Clasper, Jon C, Whitman, Timothy J, Curry, Thomas K, Fleming, Mark E, Wenke, Joseph C, Ficke, James R
Format Journal Article
LanguageEnglish
Published United States 01.08.2011
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Abstract 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.
AbstractList 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.
Author Wenke, Joseph C
Whitman, Timothy J
Obremskey, William T
Ficke, James R
Murray, Clinton K
Hsu, Joseph R
Calhoun, Jason H
Andersen, Romney C
Curry, Thomas K
Fleming, Mark E
Clasper, Jon C
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  surname: Murray
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  organization: Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA. clinton.murray@us.army.mil
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ContentType Journal Article
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Chung, Kevin K
Dunne, James R
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Conger, Nicholas G
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Snippet During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ∼ 15% of...
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StartPage S235
SubjectTerms Anti-Bacterial Agents - therapeutic use
Arm Injuries - complications
Arm Injuries - microbiology
Arm Injuries - therapy
Humans
Leg Injuries - complications
Leg Injuries - microbiology
Leg Injuries - therapy
Military Medicine
Practice Guidelines as Topic
Warfare
Wound Infection - etiology
Wound Infection - prevention & control
Title Prevention of infections associated with combat-related extremity injuries
URI https://www.ncbi.nlm.nih.gov/pubmed/21814090
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