title: Adherence to published antimicrobial prophylaxis guidelines for wounded service members in the ongoing conflicts in Southwest Asia.
abstract: In 2008, a clinical practice guideline (CPG) was developed for the prevention of infections among military personnel with combat-related injuries. Our analysis expands on a prior 6-month evaluation and assesses CPG adherence with respect to antimicrobial prophylaxis for U.S. combat casualties medically evacuated to Landstuhl Regional Medical Center over a 1-year period (June 2009 through May 2010), with an eventual goal of continuously monitoring CPG adherence and measuring outcomes as a function of compliance. We classified adherence to the CPG as receipt of recommended antimicrobials within 48 hours of injury. A total of 1106 military personnel eligible for CPG assessment were identified and 74% received antimicrobial prophylaxis. Overall, CPG compliance within 48 hours of injury was 75%. Lack of antimicrobial prophylaxis contributed 2 to 22% to noncompliance varying by injury category, whereas receipt of antibiotics other than preferred was 11 to 30%. For extremity injuries, antimicrobial prophylaxis adherence was 60 to 83%, whereas it was 80% for closed injuries and 68% for penetrating abdominal injuries. Overall, the results of our analysis suggest an ongoing need to improve adherence, monitor CPG compliance, and assess effectiveness.
authors.affiliation: Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Lloyd
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.affiliation: Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hinkle
authors.affiliation: Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Fortuna
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive #3600, Fort Sam Houston, TX 78234.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: William
authors.initials: W
authors.lastname: Bradley
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Millar
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Faraz
authors.initials: F
authors.lastname: Shaikh
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Kristen
authors.initials: K
authors.lastname: Vanderzant
authors.affiliation: Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Stacie
authors.initials: S
authors.lastname: Gregg
authors.affiliation: Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Gina
authors.initials: G
authors.lastname: Lloyd
authors.affiliation: Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: Stevens
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: M Leigh
authors.initials: ML
authors.lastname: Carson
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Deepak
authors.initials: D
authors.lastname: Aggarwal
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
mesh_terms: D055826:Afghan Campaign 2001-; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006772:Hospitals, Military / Q000639:trends; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents