Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED.
OBJECTIVE
To determine differences in infection rates among uncomplicated, repaired wounds managed with: topical bacitracin zinc (BAC); neomycin sulfate, bacitracin zinc, and polymyxin B sulfate combination (NEO); silver sulfadiazine (SIL); and petrolatum (PTR).


METHODS
This was a prospective, randomized, double-blind, placebo-controlled study conducted at a military community hospital with an emergency medicine residency program. Patients were enrolled if they: presented to the ED within 12 hours of injury and did not have puncture wounds, allergies to the agents used, or a history of immunocompromise; were not receiving antibiotics, chemotherapy, or steroids at the time of presentation; had not taken antibiotics within the preceding seven days; did not have an underlying fracture; and were not pregnant as determined by history. Local anesthetics without epinephrine and high-pressure irrigation with normal saline were used for all patients. Wound scrubbing, débridement, and polyglactin subcutaneous (SQ) suture placement were carried out when necessary. Interrupted simple sutures using a monofilament, nonabsorbable material were used for skin closure. Numbered, randomized vials were given to all patients, with standardized instructions to inspect, clean, and redress their wounds three times a day. The wounds were evaluated for clinical infection at the time of follow-up.


RESULTS
Among the groups, there was no difference in patient ages; gender; wound location, type, length, or depth; time elapsed from injury to ED treatment; number of wounds scrubbed or necessitating débridement; number of SQ and cutaneous sutures used; and rate of compliance with returning the used vial of dispensed topical agent. The wound infection rates for the treatment groups were: BAC, six of 109 (5.5%); NEO, five of 110 (4.5%); SIL, 12 of 99 (12.1%); and PTR, 19 of 108 (17.6%) (p = 0.0034).


CONCLUSIONS
The use of topical antibiotics resulted in significantly lower infection rates than did the use of a petrolatum control. BAC and NEO had the lowest wound infection rates.
Dire
D J
DJ
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Coppola
M
M
Dwyer
D A
DA
Lorette
J J
JJ
Karr
J L
JL
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001414:Bacitracin / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009355:Neomycin / Q000627:therapeutic use; D009824:Ointments; D010577:Petrolatum / Q000627:therapeutic use*; D011112:Polymyxin B / Q000627:therapeutic use; D011446:Prospective Studies; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D014946:Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D009824:Ointments; D001414:Bacitracin; D010577:Petrolatum; C001816:bacitracin zinc, neomycin sulfate, polymyxin B, drug combination; D009355:Neomycin; D011112:Polymyxin B; D012837:Silver Sulfadiazine