title: Prevention of infections associated with combat-related extremity injuries.
abstract: During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ∼ 15% of patients with extremity injuries develop osteomyelitis, and ∼ 17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evidence-based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial therapy, debridement and irrigation, and surgical wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characterization. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA. clinton.murray@us.army.mil
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
authors.forename: Romney C
authors.initials: RC
authors.lastname: Andersen
authors.forename: Jason H
authors.initials: JH
authors.lastname: Calhoun
authors.forename: Jon C
authors.initials: JC
authors.lastname: Clasper
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Whitman
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Curry
authors.forename: Mark E
authors.initials: ME
authors.lastname: Fleming
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: James R
authors.initials: JR
authors.lastname: Ficke
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001134:Arm Injuries / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D007869:Leg Injuries / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D008887:Military Medicine; D017410:Practice Guidelines as Topic; D014857:Warfare; D014946:Wound Infection / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents