외상으로 인한 상처의 치료에 있어서 선택적 항균제의 효과 및 적응증에 관한 연구

Rational Use of Antimicrobial Agents in Traumatic Simple Wounds

  • 김재은 (이화여자대학교 의학전문대학원 응급의학교실) ;
  • 서주현 (가천의과학대학교 길병원 내과) ;
  • 최윤희 (을지대학교 의과대학 응급의학교실) ;
  • 배현아 (이화여자대학교 의학전문대학원 응급의학교실) ;
  • 정진희 (이화여자대학교 의학전문대학원 응급의학교실) ;
  • 어은경 (이화여자대학교 의학전문대학원 응급의학교실) ;
  • 전영진 (이화여자대학교 의학전문대학원 응급의학교실) ;
  • 정구영 (이화여자대학교 의학전문대학원 응급의학교실)
  • Kim, Jae Eun (Department of Emergency Medicine, School of Medicine, Ewha Womans University) ;
  • Suh, Joo Hyun (Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science) ;
  • Choi, Yoon Hee (Department of Emergency Medicine, College of Medicine, Eulji University) ;
  • Bae, Hyun A (Department of Emergency Medicine, School of Medicine, Ewha Womans University) ;
  • Jung, Jin Hee (Department of Emergency Medicine, School of Medicine, Ewha Womans University) ;
  • Eo, Eun Kyung (Department of Emergency Medicine, School of Medicine, Ewha Womans University) ;
  • Cheon, Young Jin (Department of Emergency Medicine, School of Medicine, Ewha Womans University) ;
  • Jung, Koo Young (Department of Emergency Medicine, School of Medicine, Ewha Womans University)
  • 투고 : 2007.04.25
  • 심사 : 2007.06.04
  • 발행 : 2007.06.30

초록

Purpose: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. Methods: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman's University Mokdong Hospital. Structured data sheets were completed at the times of the patient's visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. Results: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). Conclusion: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate.

키워드

참고문헌

  1. Karounis H, Gouin S, Eisman H, Chalut D, Pelletier H, Williams B. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med 2004;11:730-5 https://doi.org/10.1111/j.1553-2712.2004.tb00736.x
  2. Cummings P, Del Beccaro MA. Antibiotics to prevent infection of simple wounds: A meta-analysis of Randomized studies. Am J Emerg Med 1995;13:396-400 https://doi.org/10.1016/0735-6757(95)90122-1
  3. Hollander JE, Singer AJ, Valentine S, Shofer FS. Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med 2001;8:716-20 https://doi.org/10.1111/j.1553-2712.2001.tb00190.x
  4. Beesley JR, Bowden G, Hardy RH, Reynolds TD. Prophylactic antibiotics in minor hand injuries. Injury 1975;6:366-9 https://doi.org/10.1016/0020-1383(75)90233-8
  5. Dire DJ, Hogan RE, Riggs MW. A prospective evaluation of risk factors for infections from dog-bite wounds. Acad Emerg Med 1994;1: 258-66 https://doi.org/10.1111/j.1553-2712.1994.tb02442.x
  6. Cassell OC, Ion L. Are antibiotics necessary in the surgical management of upper limb laceration? Br J Plast Surg 1997;50:523-9 https://doi.org/10.1016/S0007-1226(97)91301-1
  7. Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic laceration. N Engl J Med 1997;337:1142-8 https://doi.org/10.1056/NEJM199710163371607
  8. Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206-10 https://doi.org/10.1001/archsurg.1973.01350200078018
  9. Schneid-Kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for wound infection following cesarean deliveries. Int J Gynaecol Obstet 2005;90:10-5 https://doi.org/10.1016/j.ijgo.2005.03.020
  10. Marshall KA, Edgerton MT, Rodeheaver GT, Magee CM, Edlich RF. Quantitative microbiology: its application to hand injuries. Am J Surg 1976;131:730-3 https://doi.org/10.1016/0002-9610(76)90190-2
  11. Nylen S, Carlsson B. Time factor, infection frequency and quantitative microbiology in hand injuries: a prospective study. Scand J Plast Reconstr Surg 1980;14:185-9 https://doi.org/10.3109/02844318009106707
  12. Edlich RF, Kenney JG, Morgan RF, Nichter LS, Friedman HI, Rodeheaver GT. Antimicrobial treatment of minor soft tissue lacerations: a critical review. Emerg Med Clin North Am 1986;4:561-80
  13. Edlich RF, Rodeheaver GT, Morgan RF, Berman DE, Thacker JG. Principles of emergency wound management. Ann Emerg Med 1988;17:1284-302 https://doi.org/10.1016/S0196-0644(88)80354-8
  14. Choi YH, Jang HY, Eo EK, Cheon YJ, Jung KY. Risk factors for infection in patients with traumatic wound. J Korean Soc Emerg Med 2004;15:600-5
  15. Hollander JE, Singer AJ, Valentine S, Henry MC. Wound registry: Development and validation. Ann Emerg Med 1995;25:675-85 https://doi.org/10.1016/S0196-0644(95)70183-4
  16. Singer AJ, Quinn JV, Thode HC Jr, Hollander JE. Determinants of poor outcome after laceration and surgical incision repair. Plast reconstr Surg 2002;110:429-35 https://doi.org/10.1097/00006534-200208000-00008
  17. Duncan WC, McBride ME, Knox JM. Experimental production of infections in humans. J Invest Dermatol 1970;54:319-23 https://doi.org/10.1111/1523-1747.ep12258627
  18. Thirlby RC, Blair AJ 3rd, Thal ER. he value of prophylactic antibiotics for simple lacerations. Surg Gynecol Obstet. 1983;156:212-6
  19. Cardany CR, Rodeheaver G, Thacker J, Edgerton MT, Edlich RF. The crush injury: a high risk wound. JACEP 1976;5:965-70 https://doi.org/10.1016/S0361-1124(76)80123-2
  20. Robson MC, Duke WF, Krizek TJ. Rapid bacterial screening in the treatment of civilian wounds. J Surg Res 1973;14:426-30 https://doi.org/10.1016/0022-4804(73)90049-8
  21. Morgan WJ, Hutchison D, Johnson HM. The delayed treatment of wounds of the hand and forearm under antibiotic cover. Br J Surg 1980;67:140-1 https://doi.org/10.1002/bjs.1800670222
  22. Day TK. Controlled trial of prophylactic antibiotics in minor wounds requiring suture. Lancet 1975;2:1174-6