title: Infection Rates and Treatment of Low-Velocity Extremity Gunshot Injuries.
abstract: OBJECTIVE
  To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Patients (N = 140) with at least 90-day follow-up for extremity-only low-energy GSW injuries from 2010-2014 were retrospectively reviewed. Treatment was recorded, including type and duration of antibiotics and details of nonoperative and operative managements.
  
  
  METHODS
  The rates of superficial and deep infections.
  
  
  RESULTS
  The overall infection rate was 15.7% (22 patients), and the deep infection rate was 3.6% (5 patients). Age, sex, and injury location were similar between the groups that did and did not receive antibiotic prophylaxis. Injury Severity Scores were higher in the group that did receive antibiotics. Regarding soft tissue-only injuries, antibiotic prophylaxis trended toward a lower rate of overall infection versus no antibiotic prophylaxis (6.1% vs. 25.9%, respectively, P = 0.07). Multiple doses of antibiotics did not reduce the rate of infection when compared with a single dose (14.6% vs. 12.5%, respectively, P = 1.00). No deep infections occurred in patients with nonoperatively treated fractures, regardless of antibiotic administration. All operatively treated fractures received antibiotic prophylaxis and demonstrated superficial and deep infection rates of 15.1% and 5.7%, respectively.
  
  
  CONCLUSIONS
  Infections after low-energy extremity GSWs are infrequent. For soft tissue injuries without fracture, a single dose of intravenous antibiotics in the emergency department was associated with a lower rate of infection compared with no antibiotics. Operatively treated low-energy GSW fractures should receive standard perioperative antibiotics.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: MetroHealth System, Case Western Reserve University, Cleveland, OH.
authors.forename: Mai P
authors.initials: MP
authors.lastname: Nguyen
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Savakus
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: OʼDonnell
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Prayson
authors.forename: Michael S
authors.initials: MS
authors.lastname: Reich
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Golob
authors.forename: Amy A
authors.initials: AA
authors.lastname: McDonald
authors.forename: John J
authors.initials: JJ
authors.lastname: Como
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D001134:Arm Injuries / Q000453:epidemiology / Q000628:therapy; D015984:Causality; D002648:Child; D015897:Comorbidity; D003646:Debridement / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014946:Wound Infection / Q000453:epidemiology* / Q000628:therapy*; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult