Prophylactic antibiotics for simple hand lacerations: Time for a clinical trial?

Zehtabchi, Shahriar; Yadav, Kabir; Khan, Faroque A.; Singh, Savitri; Wilcoxson, R.D.; Malhotra, Shweta

doi:10.1016/j.injury.2011.05.001

Cited by 16 publications

(12 citation statements)

References 11 publications

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“…2 3 This small rate of infection makes it common practice not routinely to treat traumatic lacerations with prophylactic antibiotics. [4][5][6][7] Cost models have suggested that it is only cost effective to treat wounds at high risk when there is a greater than 5% chance of infection. 8 However, there are no clear guidelines on which wounds are 'high risk'.…”

Section: Introduction Background/importancementioning

confidence: 99%

Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared?

2013

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Objective To determine risk factors associated with infection and traumatic lacerations and to see if a relationship exists between infection and time to wound closure after injury. Methods Consecutive patients presenting with traumatic lacerations at three diverse emergency departments were prospectively enrolled and 27 variables were collected at the time of treatment. Patients were followed for 30 days to determine the development of a wound infection and desire for scar revision. Results 2663 patients completed follow-up and 69 (2.6%, 95% CI 2.0% to 3.3%) developed infection. Infected wounds were more likely to receive a worse cosmetic rating and more likely to be considered for scar revision (RR 2.6, 95% CI 1.7 to 3.9). People with diabetes (RR 2.70, 95% CI 1.1 to 6.5), lower extremity lacerations (RR 4.1, 95% CI 2.5 to 6.8), contaminated lacerations (RR 2.0, 95% CI 1.2 to 3.4) and lacerations greater than 5 cm (RR 2.9, 95% CI 1.6 to 5.2) were more likely to develop an infection. There were no differences in the infection rates for lacerations closed before 3% (95% CI 2.3% to 3.8%) or after 1.2% (95% CI 0.03% to 6.4%) 12 h. Conclusions Diabetes, wound contamination, length greater than 5 cm and location on the lower extremity are important risk factors for wound infection. Time from injury to wound closure is not as important as previously thought. Improvements in irrigation and decontamination over the past 30 years may have led to this change in outcome.

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Section: Introduction Background/importancementioning

confidence: 99%

Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared?

2013

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“…In Krankenhausambulanzen in den USA wurden 2007 116,8 Mio. einfache Weichteilverletzungen der Hand versorgt [43]. Unter gewissen Voraussetzungen drohen nach sog.…”

Section: Hintergrundunclassified

Infections following so-called minor hand injuries

Stahl

Held

Medved

et al. 2014

Trauma Berufskrankh

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“…[1] Despite the high prevalence, management of simple hand lacerations has not been standardized and the literature on infection rate, risk factors for infection, and utilizing prophylactic antibiotics to prevent infection in simple hand lacerations (hand lacerations distal to the radial carpal ligament that do not involve any special structures such as bones, tendons, vessels, or nerves) is scarce. [2] In addition, physicians' approach to management of simple hand lacerations particularly relative to administration of prophylactic antibiotics has been shown to be varied.…”

Section: Introductionmentioning

confidence: 99%

“…[2] In addition, physicians' approach to management of simple hand lacerations particularly relative to administration of prophylactic antibiotics has been shown to be varied. [1] This study was designed to identify the incidence of wound infection in ED patients with simple hand lacerations while detecting host and wound characteristics that place patients at increased risk of infection.…”

Section: Introductionmentioning

confidence: 99%

The risk of wound infection after simple hand laceration

Roodsari

Zahedi

Zehtabchi

2015

World Journal of Emergency Medicine

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BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration (SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not. METHODS:The study was performed at two urban hospitals enrolling 125 emergency department (ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defi ned as clinical infection at a follow-up visit (10-14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1-10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confi dence intervals (CI). RESULTS:In the 125 patients with SHL [median age: 28 (18, 43); range: 1-102 years old; 36% female], 44 (35%, 95% CI: 27%-44%) were given antibiotics in the ED. Wound infection was reported in 6 patients (4.8%, 95% CI: 2%-10%). Age, gender, history of diabetes and wound closure were not associated with wound infection (P>0.05). The infection rate was not signifi cantly different between patients with or without antibiotic prophylaxis [7% (3/44), 95% CI: 2%-10% vs. 4% (3/81), 95% CI: 1%-11%, P=0.66]. Patient's satisfaction with appearance of infected and non-infected wounds were signifi cantly different [7.5 (6, 8) vs. 9 (8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk of infection.

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Prophylactic antibiotics for simple hand lacerations: Time for a clinical trial?

Cited by 16 publications

References 11 publications

Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared?

Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared?

Infections following so-called minor hand injuries

The risk of wound infection after simple hand laceration

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