Infection rates and treatment of low-velocity extremity gunshot injuries.

OBJECTIVES To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity. DESIGN Retrospective review. SETTING Level I trauma center. PATIENTS/PARTICIPANTS 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 non-operative and operative management. s MAIN OUTCOME MEASURES:: 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, gender, 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 to a single dose (14.6% vs. 12.5%, respectively, p=1.00). No deep infections occurred in patients with non-operatively 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. CONCLUSION Infections after low-energy extremity GSWs are infrequent. For soft tissue injuries without fracture, a single dose of intravenous antibiotics in the emergency room was associated with a lower rate of infection compared to no antibiotics. Operatively treated low-energy GSW fractures should receive standard perioperative antibiotics. LEVEL OF EVIDENCE Prognostic Level III.