Efficacy and patterns of use of antimicrobial prophylaxis for gunshot wounds in a South African hospital setting: an observational study using propensity score-based analyses

Keywords: antimicrobial prophylaxis, gunshot wounds, infection

Abstract

Background: Limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in prevention of gunshot wound-related (GSW-related) infection in resource restricted areas. At Tygerberg Hospital, South Africa, it is standard care for GSW patients to receive one dose of broad-spectrum AP. For various reasons, this protocol is not consistently followed. This study aimed to assess the efficacy of AP in the reduction of in-hospital GSW-related infection and to identify opportunities for practice improvement.

Methods: All patients admitted with GSW over a three-month period were eligible for inclusion. Patients who did and did not receive AP were identified retrospectively the morning of admission; thereafter, data was collected prospectively. Data regarding circumstances of the incident, injury characteristics, type of AP and surgery was obtained. The occurrence of in-hospital GSW-related infection was recorded over 30 days or until discharge. Propensity score matching (PSM) and inverse probability weighting (IPW) methods were utilised to assess the effect of AP on the prevention of GSW-related infection.

Results: 165 consecutive patients were assessed, of which 103 received AP according to protocol within 12 hours of admission. PSM showed a reduced in-hospital GSW infection risk of 12% (95% CI, 0.2–24%, p = 0.046) with AP. IPW showed that AP reduced the risk for infection by 14% (95% CI, 3–27%, p = 0.015).

Conclusions: Providing AP to GSW patients in a civilian setting appeared to result in a modest but clinically relevant lower risk of in-hospital GSW-related infection. In this study setting, optimisation of AP for all patients with GSWs should significantly lower the burden of wound infection

Author Biographies

M C Visbeek, Leiden University Medical Center

Department of Infectious Diseases, Leiden University Medical Center, The Netherlands and Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, South Africa

J J Taljaard, Stellenbosch University

Division of Infectious Diseases, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, South Africa

M G B de Boer, Leiden University Medical Center

Department of Infectious Diseases, Leiden University Medical Center, The Netherlands

U J Cronje, Mitchell’s Plain District Hospital

Department of General Surgery, Mitchell’s Plain District Hospital, South Africa

Elmin Steyn, Stellenbosch University

Division of Surgery, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, South Africa

Published
2020-01-14
How to Cite
Visbeek, M., Taljaard, J., de Boer, M., Cronje, U., & Steyn, E. (2020). Efficacy and patterns of use of antimicrobial prophylaxis for gunshot wounds in a South African hospital setting: an observational study using propensity score-based analyses. South African Journal of Surgery, 58(01), 27-32. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3102
Section
Trauma