Antibiotic management in combat-related wound infections

This study examines antibiotic management practices for combat-related extremity wound infections (CEWIs) among U.S. military personnel who sustained blast injuries. The analysis included 267 patients with CEWIs, half of whom had concomitant non-extremity infections. Antibiotic use varied significantly across different stages of infection management, highlighting the need for standardized guidelines to improve treatment outcomes and antimicrobial stewardship.

In the pre-diagnosis period (4–10 days before CEWI diagnosis), 36% of patients initiated a new antibiotic, with 28% receiving two or more antibiotics. During the diagnosis week, 78% of patients started a new antibiotic, with 71% receiving combinations of two or more antibiotics. The most common antibiotics used were carbapenems and vancomycin. In the post-diagnosis period (4–10 days after diagnosis), 45% of patients began a new antibiotic regimen, with 39% receiving two or more antibiotics.

The study underscores the complexity of managing CEWIs, particularly in polytrauma cases where patients often present with multiple infections. Variations in antibiotic prescribing patterns may result from differences in hospital policies, clinical presentations, and provider preferences. The findings suggest a pressing need for comprehensive clinical practice guidelines that address both prophylactic and therapeutic antibiotic use in combat-related injuries to reduce unnecessary antibiotic use and enhance patient outcomes.