Prophylaxis and treatment of infections associated with penetrating traumatic injury

Accidents or violence can result in penetrating trauma in the adult population. Contaminated penetrating foreign bodies introduced at the time of wounding cause infection, especially high velocity projectiles, which result in cavitation. Surgical debridement reduces potential infection; however, perioperative antibiotics are usually indicated owing to studies demonstrating high rates of sepsis in the pre-antibiotic era. Trauma-associated pathogens include Gram-positive, Gram-negative and anaerobic pathogens. Antibiotic resistance is increasing, and several recent panels have sought to develop guidelines for perioperative prevention and empiric treatment of infection to limit usage and reduce selective pressure for resistance. We review infections of the CNS, thorax, abdomen and extremities following penetrating trauma injury, as well as the data supporting a reasonable antimicrobial approach.