title: Antimicrobial prescribing practices following publication of guidelines for the prevention of infections associated with combat-related injuries.
abstract: BACKGROUND
  Timely and limited antibiotic prophylaxis (postinjury antimicrobial therapy) targeting specific traumatic injuries is a well-recognized measure to lessen posttraumatic infection. Modern military combat injuries raise significant challenges because of complex multiple injuries and limited data derived directly from well-controlled trials to base recommendations. Expert consensus review of available evidence led to published guidance for selection and duration of antimicrobial therapy for combat-related trauma infection prevention. This analysis evaluates antibiotic-prescribing practices by military physicians in the operational theater relative to the published guidance.
  
  
  METHODS
  Trauma history and infectious disease-specific inpatient care information is captured through the Joint Theater Trauma Registry along with a supplemental infectious disease module. Injury patterns are classified based on documented International Classification of Diseases-9th Revision codes with a composite assessment of each patient's injury pattern. Antimicrobial use categorized as prophylaxis is prescribed within the first 48 hours postinjury. Adherence to published guidance is reported along with patient characteristics and injury severity to assess for potential explanations of nonadherence.
  
  
  RESULTS
  During June to November 2009, 75% of the 610 eligible trauma patients received antimicrobial prophylaxis. Adherence to the recommended antibiotic agent on the day of injury was in the range of 46% to 50% for the most common extremity injury patterns and <10% in penetrating abdominal injuries. Antibiotics were given in 39% of patients sustaining injuries that are recommendations to not receive antimicrobial prophylaxis.
  
  
  CONCLUSIONS
  This first evaluation of combat trauma-related antibiotic prophylaxis shows adherence levels comparable or superior to reported rates in civilian settings despite the austere, frequently mass casualty environment. Areas for interval surveillance and education-based strategies for improved adherence to practice guidance are identified.
authors.affiliation: General Infectious Diseases, Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-5119, USA. dtribble@usuhs.mil
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
authors.forename: Bradley
authors.initials: B
authors.lastname: Lloyd
authors.forename: Amy
authors.initials: A
authors.lastname: Weintrob
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: William
authors.initials: W
authors.lastname: Bradley
authors.forename: Susan
authors.initials: S
authors.lastname: Fraser
authors.forename: Tyler
authors.initials: T
authors.lastname: Warkentien
authors.forename: Lakisha J
authors.initials: LJ
authors.lastname: Gaskins
authors.forename: Françoise
authors.initials: F
authors.lastname: Seillier-Moiseiwitsch
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Millar
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014946:Wound Infection / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents