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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Reviewed
Bacterial contamination of a war wound is certain. The wounds are contaminated at the time of injury and secondary contamination may occur at any time during the course of treatment. Clostridium species are commonly introduced at the time of injury. Hemolytic Staphylococci and Streptococci may also be introduced at the time of wounding or by later contamination with such organisms in the hospital. Animal studies have shown heavy growth of Gram-positive cocci and Clostridium species in experimental missile wounds after delayed debridement. Gram-negative bacilli are typically encountered later and are often hospital acquired. Patients with abdominal injuries are also at risk of developing Gram-negative infection, particularly those with an injury to a hollow viscus. Many of these bacteria produce toxins and enzymes to facilitate their spread through tissues within wounds. Coagulase, fibrinolysin, proteinase, collagenase, and hyaluronidase favor the development and spread of wound infection.
The results of cultures taken from wound walls after debridement in animal studies indicate that, even though the degree of contamination or colonization can be significantly reduced by prompt debridement, the wound is not sterilized. Persistance of wound following mechanical cleansing and removal of damaged tissue justifies the use of prophylactic antibiotics.
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