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Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update: Endorsed by the Infectious Diseases Society of America and the Surgical Infection Society

Hospenthal, Duane R. MD, PhD, FACP, FIDSA; Murray, Clinton K. MD, FACP, FIDSA; Andersen, Romney C. MD; Bell, R. Bryan DDS, MD, FACS; Calhoun, Jason H. MD, FACS; Cancio, Leopoldo C. MD, FACS; Cho, John M. MD, FACS, FCCP; Chung, Kevin K. MD, FACP; Clasper, Jon C. MBA, DPhil, DM, FRCSEd (Orth); Colyer, Marcus H. MD; Conger, Nicholas G. MD; Costanzo, George P. MD, MS; Crouch, Helen K. RN, MPH, CIC; Curry, Thomas K. MD, FACS; D'Avignon, Laurie C. MD; Dorlac, Warren C. MD, FACS; Dunne, James R. MD, FACS; Eastridge, Brian J. MD; Ficke, James R. MD; Fleming, Mark E. DO; Forgione, Michael A. MD, FACP; Green, Andrew D. MB, BS, FRCPath, FFPH, FFTravMed, RCPS, DTM&H; Hale, Robert G. DDS; Hayes, David K. MD, FACS; Holcomb, John B. MD, FACS; Hsu, Joseph R. MD; Kester, Kent E. MD, FACP, FIDSA; Martin, Gregory J. MD, FACP, FIDSA; Moores, Leon E. MD, FACS; Obremskey, William T. MD, MPH; Petersen, Kyle DO, FACP, FIDSA; Renz, Evan M. MD, FACS; Saffle, Jeffrey R. MD, FACS; Solomkin, Joseph S. MD, FACS, FIDSA; Sutter, Deena E. MD, FAAP; Tribble, David R. MD, DrPH, FIDSA; Wenke, Joseph C. PhD; Whitman, Timothy J. DO; Wiesen, Andrew R. MD, MPH, FACP, FACPM; Wortmann, Glenn W. MD, FACP, FIDSA

The Journal of Trauma: Injury, Infection, and Critical Care: August 2011 - Volume 71 - Issue 2 - p S210-S234
doi: 10.1097/TA.0b013e318227ac4b
Review Article

Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.

From the San Antonio Military Medical Center (D.R.H., C.K.M., H.K.C., J.R.F., D.K.H., D.E.S.), US Army Institute of Surgical Research (L.C.C., K.K.C., G.P.C., B.J.E., R.G.H, J.R.H., E.M.R., J.C.W), Fort Sam Houston, Texas; Walter Reed National Military Medical Center Bethesda (R.C.A., M.H.C., J.R.D., M.E.F., G.J.M., T.J.W., G.W.W.), Infectious Disease Clinical Research Program (D.R.T.), Bethesda, Maryland; Oregon Health & Science University (R.B.B.), Portland, Oregon; The Ohio State University (J.H.C.), Columbus, Ohio; Landstuhl Regional Medical Center (J.M.C.), Landstuhl, Germany; Royal Centre for Defence Medicine, Institute of Research and Development (J.C.C., A.D.G.), Birmingham, United Kingdom; Keesler Medical Center (N.G.C., M.A.F.), Keesler Air Force Base, Mississippi; Madigan Army Medical Center (T.K.C.), Western Regional Medical Command (A.R.W.), Fort Lewis, Washington; US Air Force Medical Support Agency (L.C.D.), Lackland Air Force Base, Texas; University of Cincinnati (W.C.D., J.S.S), Cincinnati, Ohio; University of Texas Health Science Center (J.B.H.), Houston, Texas; Walter Reed Army Institute of Research (K.E.K.), Silver Spring, Maryland; Kimbrough Ambulatory Care Center (L.E.M.), Fort Meade, Maryland; Vanderbilt University School of Medicine (W.T.O.), Nashville, Tennessee; Naval Medical Research Center (K.P.), Silver Spring, Maryland; and University of Utah (J.R.S.), Salt Lake City, Utah.

Submitted for publication April 26, 2011.

Accepted for publication June 3, 2011.

Financial support for the consensus conference and publication of the Journal of Trauma supplement was provided by the US Army Medical Command.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Air Force, Department of the Army, Department of the Navy, or Department of Defense, or the US Government. This work was prepared as part of their official duties; and, as such, there is no copyright to be transferred.

Guideline Disclaimer: It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Adherence to these guidelines is voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Address for reprints: Duane R. Hospenthal, MD, PhD, FACP, FIDSA, Infectious Disease Service (MCHE-MDI), San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234; email:

© 2011 Lippincott Williams & Wilkins, Inc.