title: Efficacy of point-of-injury combat antimicrobials.
abstract: BACKGROUND
  Infection is a major complication associated with combat-related injuries. One strategy to decrease infections is immediate delivery of antimicrobials at or near the point-of-injury by the casualty or the first medical responder. The 75th Ranger Regiment systematically collects data on prehospital battlefield care, including antimicrobial administration. We review infectious complications and colonization rates associated with delivery of point-of-injury antimicrobial therapy.
  
  
  METHODS
  We retrospectively reviewed casualty treatment data from the 75th Ranger Regiment prehospital trauma registry on patients injured between March 2003 and March 2010 and linked this to electronic medical record data to look for the presence of bacterial infection or colonization within 30 days of injury. Patient demographics, antimicrobial therapy, and outcomes were evaluated. Assessment of colonization included surveillance screening cultures performed for multidrug-resistant bacteria, including Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus, at US military hospitals in the combat zone, Germany, and stateside.
  
  
  RESULTS
  Of 405 total casualties, 28 (6.9%) were infected with gram-negative bacteria, primarily A. baumannii. Of those who were not returned to duty or died near the time of injury, 28 of 211 (13.3%) were infected. The only identified risk factor for infection was higher military Injury Severity Score. Prehospital administration of antimicrobials to 113 of 405 casualties (27.9%), including 8 of the 28 infected casualties, did not affect infection or colonization rates.
  
  
  CONCLUSIONS
  Although limited by population size, a significant difference in infection rates and multidrug-resistant pathogen colonization was not seen in those casualties who received single-dose broad-spectrum antimicrobials at the point-of-injury, confirming neither benefit nor harm. Overall adherence with initiating point-of-injury antimicrobials was low.
authors.affiliation: Infectious Disease Service (MCHE-MDI), San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA. Clinton.Murray@us.army.mil
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: Russ S
authors.initials: RS
authors.lastname: Kotwal
authors.forename: Frank K
authors.initials: FK
authors.lastname: Butler
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014946:Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents