Dj. Dire et al., PROSPECTIVE EVALUATION OF TOPICAL ANTIBIOTICS FOR PREVENTING INFECTIONS IN UNCOMPLICATED SOFT-TISSUE WOUNDS REPAIRED IN THE ED, Academic emergency medicine, 2(1), 1995, pp. 4-10
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.