PROSPECTIVE EVALUATION OF TOPICAL ANTIBIOTICS FOR PREVENTING INFECTIONS IN UNCOMPLICATED SOFT-TISSUE WOUNDS REPAIRED IN THE ED

Objective: To determine differences in infection rates among uncomplic ated, repaired wounds managed with: topical bacitracin zinc (BAC); neo mycin sulfate, bacitracin zinc. and polymyxin B sulfate combination (N EO): silver sulfadiazine (SIL); and petrolatum (PTR). Methods: This wa s a prospective. randomized, double-blind, placebo-controlled study co nducted at a military community hospital with an emergency medicine re sidency program. Patients were enrolled if they: presented to the ED w ithin 12 hours of injury and did not have puncture wounds, allergies t o the agents used, or a history of immunocompromise: were not receivin g antibiotics. chemotherapy, or steroids at the time of presentation; had not taken antibiotics within the preceding seven days. did not hav e an underlying fracture, and were not pregnant as determined by histo ry. Local anesthetics without epinephrine and high-pressure irrigation with normal saline were used for all the patients. Wound scrubbing, d ebridement, and polyglactin subcutaneous (SQ) suture placement were ca rried out when necessary. Interrupted simple sutures using a monofilam ent, nonabsorbable material were used for skin closure. Numbered, rand omized vials were given to all patients, with standardized instruction s to inspect, clean, and redress their wounds three times a day. The w ounds were evaluated for clinical infection at the time of follow-up. Results: Among the groups, there was no difference in patient ages; ge nder: wound location, type, length, or depth: time elapsed from injury to ED treatment: number of wounds scrubbed or necessitating debrideme nt; number of SQ and cutaneous sutures used; and rate of compliance wi th returning the used vial of dispensed topical agent. The wound infec tion rates for the treatment groups were: BAC. six of 109 (5.5%). NEO, five of 110 (4.5%); SIL, 12 of 99 (12.1%); and PTR, 19 of 108 (17.6%) (p = 0.0034). Conclusion: The use of topical antibiotics resulted in significantly lower infection rates than did the use of a petrolatum c ontrol. BAC and NEO had the lowest wound infection rates.