Prevention of combat-related infections: Antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities

Mérens, Audrey; Rapp, C.; Delaune, D.; Danis, J.; Berger, Franck; Michel, R.

doi:10.1016/j.tmaid.2014.04.013

Cited by 36 publications

(30 citation statements)

References 91 publications

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“…There is consensus on the need for early antibiotic prophylaxis to prevent bacterial growth in the highly contaminated tissues that result from cases of trauma-related infections in battlefield casualties 50. However, there are little data in the literature regarding the role of topical antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Blast injury of the ear by massive explosion: a review of 41 cases

et al. 2017

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Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.

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Section: Discussionmentioning

confidence: 99%

Blast injury of the ear by massive explosion: a review of 41 cases

et al. 2017

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“…This reflected the disagreement on the need for EGN coverage between the Joint Trauma System trauma team members and mirrored the controversy in the civilian trauma literature regarding the use of EGN post-trauma antibiotic prophylaxis in the management of Type III open fractures. 1,4,5,24–27 The 2011 CPG 12 (and follow-on internal 2012 Joint Trauma System guidance 13 ) standardized recommendations for Joint Trauma System trauma providers with the goal of reducing practice variability in the fast-moving and austere environment, which complicates combat trauma care.…”

Section: Discussionmentioning

confidence: 99%

Early infectious outcomes after addition of fluoroquinolone or aminoglycoside to posttrauma antibiotic prophylaxis in combat-related open fracture injuries

et al. 2017

J Trauma Acute Care Surg

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Background We examined combat-related open extremity fracture infections as a function of whether post-trauma antimicrobial prophylaxis included expanded Gram-negative (EGN) coverage. Methods Military personnel with open extremity fractures sustained in Iraq and Afghanistan (2009–2014) who transferred to participating hospitals in the United States were assessed. The analysis was restricted to patients with a U.S. hospitalization period of ≥7 days. Prophylaxis was classified as narrow (e.g., IV cefazolin, clindamycin, or amoxicillin-clavulanate) or EGN, if the prophylactic regimen included fluoroquinolones and/or aminoglycosides. Results The study population included 1044 patients, of which 585 (56%) and 459 (44%) received narrow and EGN coverage, respectively (p<0.001). Skin and soft-tissue infections (SSTIs) were more common among patients who received narrow prophylaxis compared to EGN coverage (28% versus 22%; p=0.029), while osteomyelitis rates were comparable between regimens (8%). Similar findings were noted when endpoints were measured at two and four weeks post-injury. There was no significant difference related to length of hospitalization between narrow and EGN regimens (median: 34 and 32 days, respectively) or operation room visits (median: 5 and 4). A higher proportion of EGN coverage patients had Gram-negative organisms isolated that were not susceptible to fluoroquinolones and/or aminoglycosides (49% versus 40%; p<0.001). In a Cox proportional model, narrow prophylaxis was independently associated with an increased risk of extremity SSTIs (Hazard Ratio: 1.41; 95% confidence interval: 1.09–1.83). Discussion Despite seeing a small benefit with EGN coverage related to a reduction of SSTIs, it does not decrease the risk of osteomyelitis and there appears to be a cost of increased antibiotic resistance associated with use. Overall, our findings support the current post-combat trauma antibiotic prophylaxis guidelines, which recommend use of cefazolin or clindamycin with open fractures. Level of Evidence Prognostic/Epidemiological Level I

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“…Debritman, yabancı cisimlerin uzaklaştırılması 4. Yaralanma sonrası antibiyotik verilmesidir (11) . Günümüz savaş alanlarında, savaş yarası enfeksiyonlarına neden olan mikroorganizmalar geç kontaminasyona bağlı olarak Gram negatif bakterilerdir.…”

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“…Bu mikroorganizmalar sıklıkla antibiyotiklere dirençli veya çok ilaç dirençli olup, sağlık hizmetinde aksaklıklara bağlı yayılma eğilimdedir. Bu yayılımı önle-mede ön plana çıkan noktalar ise (11) : 1. Antimikrobiyal profilaksi 2.…”

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Infections in Combat / Terrorist Injuries And Rational Antibiotic Use

Artuk¹

2017

Okmeydani Medical Journal

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ÖZ GİRİŞSavaş ve terör olayları, insanlar tarafından ortaya çıkarılan, toplumun normal yaşantısını engelleyen, baş etmesini sağlayacak destek sistemlerini yok eden durumlardır. Savaşlar ve terörist saldırılar, oldukça fazla insanın yaşamını tehlikeye attığı gibi sağlık kuruluşlarına hasar vermekte, hasta naklini, ileri bakım kabiliyetini, personelinin iletişimini olumsuz etkilemektedir. Savaşın/terörün yıkıcı sonuçları, yalnızca meydana geldiği bölgeyi değil, çok uzaklarda yaşa-yan insanları da olumsuz etkilemektedir. Mağdurların biyolojik, psikolojik ve sosyal sağlığı önemli ölçüde bozulmakta, dünya genelinde morbidite ve mortalite artmakta ve konu uluslararası bir halk sağlığı sorunu olarak karşımıza çıkmaktadır (1) .Özellikle günümüzde meydana gelen savaş yaralanmaları, kompleks multipl yaralanmalar olması nedeniyle komplikasyon görülme olasılığı yüksektir. En önemli komplikasyonlarından biri yara yeri enfeksiyonları olup, yüzyıllardır süre gelen sorun olmaya de-

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Prevention of combat-related infections: Antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities

Cited by 36 publications

References 91 publications

Blast injury of the ear by massive explosion: a review of 41 cases

Blast injury of the ear by massive explosion: a review of 41 cases

Early infectious outcomes after addition of fluoroquinolone or aminoglycoside to posttrauma antibiotic prophylaxis in combat-related open fracture injuries

Infections in Combat / Terrorist Injuries And Rational Antibiotic Use

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