Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter XI: Infection
United States Department of Defense
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The primary emphasis of antibiotic treatment of wounds is early administration before an infection becomes established. During the Yom Kippur War, medical personnel were instructed to administer antibiotics routinely to all wounded. A recent review of infections following soft-tissue limb wounds in soldiers injured during the Falkland Campaign indicated that a delay in surgery and a delay in antibiotic administration were the most important factors related to the subsequent development of infection. When surgical delay was unavoidable, the delay in antibiotic administration assumed an even greater importance. That study showed a greater incidence of septic complications when debridement was delayed more than six hours, as well as an increased incidence of infectious complications when the time from wounding to antibiotic administration exceeded six hours.
An animal study of .223-caliber high-velocity projectiles in a porcine model demonstrated that bacterial proliferation could be prevented with early institution of intravenous penicillin therapy. Another study in wounded pigs suggested that the growth of mixed flora in a contaminated missile wound predisposed the wound to infection with other more pathogenic strains and impaired the ability of reversibly-injured tissue to recover. The mixed flora in that study consisted of bacterial strains usually sensitive to penicillin. Yet another study in wounded pigs demonstrated a decrease in the amount of devitalized tissue during debridement at 12 hours in penicillin-treated animals as opposed to animals not treated with penicillin.
Selection of antibiotic therapy is based upon a knowledge of likely causative organisms, examination of the Gram stain of the wound exudate, and culture and sensitivity studies of the wound. The characteristics of antibiotics useful against various organisms commonly encountered in surgical infections are described in the table at the end of this chapter (Table 7).
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