Infection Epidemiology, Antibiotic Treatment, and Microorganism Profiles in Urban Civilian Low Energy Firearm Fractures.

BACKGROUND

Civilian fractures resulting from firearm injuries are a challenging clinical entity associated with a high risk of infection. This study aims to characterize rates, associated risk factors, and pathogen profile of infections after low-energy civilian firearm fractures.

METHODS

This study included 1,508 adults with low-velocity firearm fractures at a Level I trauma center (2018-2022). Demographic, injury, and clinical data were collected with infection status determining stratification. Outcomes of interest in the infection cohort included pathogen, timing of antibiotics, and clinical course.

RESULTS

Of 1,508 patients, 140 patients (9.3%) developed an infection. Factors significantly associated with infection included age, male gender, lower extremity fracture, vascular injury, compartment syndrome, visceral injury, retained foreign body, and operative intervention. Polymicrobial infections were found in 67 patients (68%), and the mean time from injury to positive culture was 70.8 ± 129.2 days.

CONCLUSION

Infections after firearm fractures are a challenging complication with a predominance of methicillin-resistant Staphylococcus aureus, multidrug resistant Gram-negative organisms, and rare pathogens typically seen in immunocompromised individuals. Our study emphasizes need for further study regarding efficacy of prophylactic antibiotics and suggests utility in targeted treatment for atypical organisms.

LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.