Document Type : Original Article
Authors
- Mehdi Momeni 1, 2
- Elnaz Vahidi 1, 2
- Neda Karimi Tafti 1
- Zeinab Naderpour 3
- Javad Seyedhosseini 1, 2
- Morteza Saeedi 1, 2
1 Emergency Medicine Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Prehospital and Hospital Emergency Medicine Research Center, Tehran, Iran
3 Internal Medicine Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Objective: Hand lacerations are among the most frequent causes of visiting emergency
departments (EDs). Wound infection is one of its complications. There is still an ongoing
disagreement on the administration of oral versus intravenous (IV) antibiotics (ABs). The
objective of this study is to compare the effectiveness of oral versus IV ABs in preventing
wound infection of hand lacerations.
Methods: In this double-blind, randomized clinical trial, we enrolled all patients with hand
lacerations (based on the inclusion criteria) during 6 months in the EDs of 2 tertiary referral
centers. Convenient sampling was done. Finally, in the first group, 382 patients received
oral AB (two 500 mg cephalexin capsules) and the other 382 patients in the second group
received IV AB (1 gr IV cefazolin) before wound management. Both groups were followed
and received oral cephalexin during 48 hours after suturing. Rates of wound infection and
different complications were compared between the two groups. T-test, Mann-Whitney U
test, Chi square and Fisher analysis were used.
Results: Both groups had the same age and gender distribution rate (79.8% of males with
the mean age of 30.8 years in the first group, and 83.5% of males with the mean age of 32.6
years in the second group (P = 0.19 and 0.39, respectively). In our study, wound infection
developed in 2.6% and 1.8% of patients in the first and second groups, respectively (P =
0.46).
Conclusion: Based on the results of this study, oral and IV ABs were not significantly
different in terms of preventing wound infection
Keywords
Main Subjects
2. Shah SS, Rochette LM, Smith GA. Epidemiology of pediatric hand injuries presenting to United States emergency
departments, 1990 to 2009. J Trauma Acute Care Surg.2012;72(6):1688-94. doi: 10.1097/TA.0b013e31824a4c5b.
3. Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (N Y). 2012;7(1):18-22. doi: 10.1007/s11552-011-9383-z.
4. Bowen WT, Slaven EM. Evidence-based management of acute hand injuries in the emergency department. Emerg Med Pract.2014;16(12):1-25.
5. Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the
emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196-
205. doi: 10.1016/j.annemergmed.2006.06.035.
6. Zare M, Mirshamsi MH, Modir A, Kargar S, Shiryazdi M,Hajiesmaieli MR. Comparison of the efficacy of oral and
injectable forms of prophylactic antibiotics in grade II traumatic ulcers in emergency wards of university hospitals of Yazd. J Shahid Sadoughi Univ Med Sci. 2007;15(3):9-13.[Persian].
7. Khajuria A, Geoghegan L, Solberg Y, Reissis D, Jain A, Ives M, et al. Selective non-operative management for penetrating extremity trauma: a paradigm shift in management? J Plast Reconstr Aesthet Surg. 2018;71(9):1239-44. doi: 10.1016/j.bjps.2018.05.030.
8. Whittaker JP, Nancarrow JD, Sterne GD. The role of antibiotic prophylaxis in clean incised hand injuries: a prospective
randomized placebo controlled double blind trial. J Hand Surg. 2005;30(2):162-7. doi: 10.1016/j.jhsb.2004.10.015.
9. Broder J, Jerrard D, Olshaker J, Witting M. Low risk of infection in selected human bites treated without antibiotics. Am J EmergMed 2004;22(1):10-3. doi: 10.1016/j.ajem.2003.09.004.
10. Rittner AV, Fitzpatrick K, Corfield A. Best evidence topic report. Are antibiotics indicated following human bites? Emerg Med J. 2005;22(9):654. doi: 10.1136/emj.2005.028662.
11. Murphy GR, Gardiner MD, Glass GE, Kreis IA, Jain A, Hettiaratchy S. Meta-analysis of antibiotics for simple hand
injuries requiring surgery. Br J Surg. 2016;103(5):487-92. doi:10.1002/bjs.10111.
12. National Institute for Health and Care Excellence (NICE).Surgical Site Infections: Prevention and Treatment. London:
NICE; 2008.
13. Worster B, Zawora MQ, Hsieh C. Common questions about wound care. Am Fam Physician. 2015;91(2):86-92.
14. Zehtabchi S. The role of antibiotic prophylaxis for prevention of infection in patients with simple hand lacerations.
Ann Emerg Med. 2007;49(5):682-9.e1. doi: 10.1016/j.annemergmed.2006.12.014.
15. Otterness K, A JS. Updates in emergency department laceration management. Clin Exp Emerg Med. 2019;6(2):97-105. doi:10.15441/ceem.18.018.
16. Lammers RL, Hudson DL, Seaman ME. Prediction of traumatic wound infection with a neural network-derived decision model. Am J Emerg Med. 2003;21(1):1-7. doi: 10.1053/ajem.2003.50026.
17. Berwald N, Khan F, Zehtabchi S. Antibiotic prophylaxis for ED patients with simple hand lacerations: a feasibility randomized controlled trial. Am J Emerg Med. 2014;32(7):768-71. doi:10.1016/j.ajem.2014.03.043.
18. Quinn JV, Polevoi SK, Kohn MA. Traumatic lacerations:what are the risks for infection and has the ‘golden period’
of laceration care disappeared? Emerg Med J. 2014;31(2):96-100. doi: 10.1136/emermed-2012-202143.
19. Hollander JE, Singer AJ, Valentine SM, Shofer FS. Risk factors for infection in patients with traumatic lacerations. Acad EmergMed. 2001;8(7):716-20. doi: 10.1111/j.1553-2712.2001.
tb00190.x.
20. Masmejean E. [Management and orientation of a hand laceration]. Rev Prat. 2013;63(9):1237-41.
21. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis.2014;59(2):147-59. doi: 10.1093/cid/ciu296.
22. Aydin N, Uraloğlu M, Burhanoğlu ADY, Sensöz Ö. A prospective trial on the use of antibiotics in hand surgery.
Plast Reconstr Surg. 2010;126(5):1617-23. doi: 10.1097/PRS.0b013e3181ef90cb.
23. Roodsari GS, Zahedi F, Zehtabchi S. The risk of wound infection after simple hand laceration. World J Emerg Med. 2015;6(1):44-7. doi: 10.5847/wjem.j.1920-8642.2015.01.008.
24. Al-Nammari S, Roberton B, Ferguson C. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Should a child with preseptal periorbitalcellulitis be treated with intravenous or oral antibiotics? EmergMed J. 2007;24(2):128-9. doi: 10.1136/emj.2006.045245.