Use of Antibiotics for Epidermal Wounds in Emergency Room: Correct Prophylaxis and Right Choice of the Treatment

Background: antibiotic therapy and prophylaxis of epidermal wounds in emergency room are often made empirically in case of clinics due to infective complications, although there are no scientific evidences supporting their validity yet. Furthermore, resistance to many antibiotics is a constantly growing problem, especially in Lombardy, Italy. When needed, better prefer beta-lactams or macrolides for their large-spectrum activity. Methods: We identified all patients (pts) treated to our emergency room for epidermal wounds in a period between 1st and 31st july 2012. Then, we performed a retrospective, observational analysis of epidemiological, clinical and therapeutic features of those pts. <12 years old individuals were exluded. We considered at high risk of infections pts with at least one of the following comorbidities: diabetes, neoplastic disease, therapy with corticosteroids, immunodepression. Results: A total of 201 pts were evaluated, 143 males (71.1%) and 58 females (28.9%). The median age was 46,3 yrs. Among the pts 101 (50.2%) needed treatment with suture. 13 (6.5%) pts came after at least 12 hrs after the accident. 107 (53,2%) pts did not need therapy, while in 82 (40.8%) cases antibiotic prophylaxis (89% beta-lactams, 9.8% macrolides, 1.2% others) has been prescribed; 4 (2%) were adviced to start antibiotic therapy only in case of acute epidermal infection development at home; we don’t have this information about 8 pts (4%). In 185 (93.5%) pts clinical signs of acute epidermal infection were missing. 15 (7.5%) pts had an high risk of developing infections in history taking; 3 of them received antibiotic prophylaxis, 8 didn’t, 4 not known. In 143 individuals (71,1%) the history taking has been insufficient. Conclusions: Even if acute local infection is possible in wounded pts, only subjects at high risk should be closely screened and monitored to detect early infection, in order to evaluate the necessity of specific antibiotic therapy. Clinical evaluation should also include comorbilities as valvulopathy or immunosuppression.