Prophylactic antibiotics in gunshot fractures with concomitant bowel injury to prevent fracture-related infections and other infectious complications

Abstract

Background: Standard antibiotic therapy for abdominal gunshot wounds (GSWs) with hollow viscus injury involves up to 24 h of prophylactic broad-spectrum antibiotics. However, antibiotic management strategies are poorly defined in treating gunshot wounds with bowel-to-bone trajectories. These injuries threaten fracture-related infection as missiles can carry contaminating material along their intracorporeal trajectory. This study seeks to determine whether the duration of prophylactic antibiotic therapy used in bowel-to-bone injuries is associated with fracture-related infection prevention or overall infectious sequelae.

Methods: This six-year retrospective review identified all patients experiencing abdominal GSWs with a trajectory causing bowel injury and simultaneous fracture. Patient demographics, duration of antibiotic therapy, and subsequent infectious complications were compared with nonparametric tests as indicated.

Results: 140 patients experienced GSWs with bowel-to-bone trajectory; the median duration of prophylactic antibiotic therapy was four days (IQR 2 - 5 days); two patients were diagnosed with fracture-related infection and 65 patients experienced an infectious complication during their index hospitalization. Duration of prophylactic antibiotic therapy was not associated with the development of overall infection (p = 0.31). Comparing three days of prophylactic antibiotic therapy to more than three days of therapy, no difference occurred in overall infection (p = 1.0).

Conclusion: The development of fracture-related infections in bowel-to-bone gunshot wounds is rare. The duration of prophylactic antibiotic therapy in bowel-to-bone injuries did not correlate with an increase in overall infectious complications. Notably, three days of prophylactic antibiotic therapy was not inferior compared to longer-duration therapy in the development of infectious sequelae. Thus, patients with a bowel-to-bone gunshot trajectory likely do not require extended antibiotic coverage for prevention of fracture-related infections.

Keywords: Ballistic Fracture; Bowel-to-bone trauma; Fracture-related infection; Prophylactic antibiotics.