Abstract | April 5, 2022

ACUTE AND CHRONIC INFECTIOUS COMPLICATIONS FOLLOWING GUNSHOT INJURIES: A CASE COMPARISON

Presenting Author: Yichi Zhang, BS, Medical Student, 3rd Year, Department of Medicine, Division of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA

Coauthors: Madison Bangert, MD, Fellow, Division of Infectious Diseases,Tulane University School of Medicine, New Orleans, LA; Magnus Chun, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Travis Mattingly, MD, Fellow, Division of Infectious Diseases,Tulane University School of Medicine, New Orleans, LA; Crystal Zheng, MD, Faculty, Division of Infectious Diseases,Tulane University School of Medicine, New Orleans, LA.

Learning Objectives

  1. Describe acute and chronic infectious sequelae of gunshot wounds

Gunshot wounds(GSW) can precipitate a variety of acute or chronic infectious complications across different organ systems, and can involve a wide range of organisms. However, current evidence and guidelines on this topic are lacking. Here, we present two young patients with drastically different clinical courses of post-GSW infections to highlight the need for further research in this overlooked intersection of trauma and infectious disease.

A 20-year-old African American(AA) man was admitted after GSWs to bilateral lower extremities resulted in open fractures of the right tibia and left fibula and retainment of bullet fragments. He reported crawling through a ditch shortly after getting shot. CT angiogram of the legs showed suspicion for vascular injury. He subsequently underwent orthopedic surgery for irrigation, debridement, and placement of an intramedullary nail. On hospital day three, purulence was noted at the wound site. Subsequent deep tissue cultures showed polymicrobial infection. Broad coverage antibiotics was initiated, with added levofloxacin to treat Stenotrophomonas. Subsequently, the patient made good recovery progress and was discharged on hospital day sixteen.

A 25-year-old AA man was admitted due to paraplegia secondary to GSWs to the right ankle and the thoracic spine. Imaging showed fractures of two thoracic vertebrae and left hemopneumothorax. The patient subsequently underwent thoracentesis, urinary catherization, and extensive physical rehabilitation. On hospital day twenty, he had no major complaints but was found to have a superficial sacral pressure wound and was discharged. The patient followed with wound care but returned to the ED one-year later. He was found to have a stage IV sacral ulcer with purulent drainage. CT pelvis also showed right ischial osteomyelitis due to coagulase-negative Staphylococcus. The patient was initially started on a regimen of IV vancomycin, cefepime, and metronidazole but developed C.Difficile-positive diarrhea. Oral vancomycin was started, and the patient was discharged to a long-term acute care facility.

Future research is needed to help refine risk stratification in patients with post-GSW infection. The establishment of new evidence-based guidelines in this area can help clinicians better prepare for the wide spectrum of acute or chronic complications that may arise in the post-GSW clinical course.

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