Management of antimicrobial therapy in emergency department admissions and hospitalizations for firearm injuries: A single-center experience.

Yavuz Çekli, Elif Doğan, Şahin Kaymak, Tolga Ege, Mehmet Eryılmaz
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Abstract

Background: Firearm injuries (FI) remain a significant cause of morbidity and mortality globally. Antibiotic use, supported by guideline recommendations for preventing post-injury infections in FI cases, encounters uncertainties regarding the selection of anti-microbial agents and associated outcomes. This study aimed to investigate the relationship between Injury Severity Scores (ISS) for FI cases presented to the emergency department.

Methods: We empirically revised antimicrobial treatment protocols based on culture results and mortality rates. In the study, 164 firearm injury cases, admitted to the emergency department in 2022 and subsequently hospitalized in clinics and intensive care units (ICU), were evaluated. Cases included in the study were categorized into four groups based on ISS: mild, moderate, severe, and profound injury severity. The study compared the timing of hospital presentation following the injury, hospital length of stay, tissue or blood culture positivity, empirical treatment administered, antimicrobial revision based on culture results, need for ICU admission, mortality status, and ISS among the cases. Data were analyzed using IBM SPSS Statistics 22.0 (SPSS Inc., Chicago, IL). Variables in trauma patients were compared among various groups using Pearson Chi-Square tests. Binary logistic regression tests were performed to identify independent risk factors. A significance level of p<0.05 was considered statistically significant.

Results: The study included 164 patients, all of whom were male. The mean age was calculated as 28.9±4.51 years. The average hospital length of stay was 25.54±21.81 days. Eighty-three patients (50.6%) required intensive care. Tissue cultures were obtained from 79 patients (48%). Bacterial growth was observed in 45 of these 79 patients (57%). The appropriate empirical antibiotic treatment rate, assessed among patients who received empirical treatment followed by culture-based antibiotic sensitivity testing, was 48.9%. It was observed that empirical antibiotic regimens were appropriate in 80% of cases in the mild group and 16.7% in the profound severe group (p=0.005). Our study compared the relationship between hospitalization duration and ISS groups. It was observed that hospitalization duration was significantly shorter in the mild group compared to the other groups (p=0.003, p=0.000, p=0.000). It was also observed that the need for ICU admission was higher in groups with higher ISS, indicating a correlation between higher ISS and increased ICU requirements (p=0.000).

Conclusion: In conclusion, for cases of firearm injuries, we believe empirical antimicrobial therapy should be initiated with narrow-spectrum agents such as beta-lactam + beta-lactamase inhibitor or third-generation cephalosporin + nitroimidazole in the mild group, considering the lack of Pseudomonal activity.

急诊科收治的枪伤患者和住院患者的抗菌治疗管理:单中心经验。
背景:枪伤(FI)仍然是全球发病率和死亡率的一个重要原因。抗生素的使用得到了预防火器伤后感染指南建议的支持,但在抗微生物制剂的选择和相关结果方面存在不确定性。本研究旨在调查急诊科伤后感染病例的伤害严重程度评分(ISS)之间的关系:我们根据培养结果和死亡率对抗菌治疗方案进行了经验性修订。在这项研究中,我们对 2022 年急诊科收治的 164 例火器伤病例进行了评估,这些病例随后在诊所和重症监护室(ICU)住院治疗。研究中的病例根据ISS分为四组:轻度、中度、重度和极重度伤害。研究比较了受伤后的入院时间、住院时间、组织或血液培养阳性率、经验性治疗、根据培养结果进行的抗菌药物修订、是否需要入住重症监护室、死亡率和病例的 ISS。数据使用 IBM SPSS Statistics 22.0(SPSS Inc.)使用 Pearson Chi-Square 检验比较各组创伤患者的变量。进行二元逻辑回归测试以确定独立的风险因素。结果的显著性水平为 p:研究共纳入 164 名患者,均为男性。平均年龄为(28.9±4.51)岁。平均住院时间为(25.54±21.81)天。83名患者(50.6%)需要重症监护。79 名患者(48%)进行了组织培养。这 79 名患者中有 45 名(57%)观察到细菌生长。在接受经验性治疗后又接受了基于培养的抗生素敏感性检测的患者中,评估得出的适当经验性抗生素治疗率为 48.9%。据观察,在轻度组中,80%的病例采用了经验性抗生素治疗方案,而在极重度组中,16.7%的病例采用了经验性抗生素治疗方案(P=0.005)。我们的研究比较了住院时间与 ISS 组别之间的关系。结果发现,与其他组别相比,轻度组的住院时间明显较短(P=0.003、P=0.000、P=0.000)。还观察到,ISS较高的组别需要入住重症监护室的比例较高,这表明ISS较高与重症监护室需求增加之间存在相关性(p=0.000):总之,我们认为,对于火器伤病例,考虑到缺乏假丝酵母活性,轻度组应开始使用窄谱抗菌药,如β-内酰胺+β-内酰胺酶抑制剂或第三代头孢菌素+硝基咪唑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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