Terror in Paris: Incidence and risk factors for infections related to high-energy ammunition injuries

• DOI: 10.1016/j.accpm.2021.100908
• Publication Date: 2021-06-24T13:38:51Z
• Authors: Ron Birnbaum; Rudy Bitton; Romain Pirracchio; Anne-Laure Féral-...; Anne-Laure Constant; Clément Dubost; Benjamin Chousterman; Thomas Lescot; Brice Lortat-Jacob; Anatole Harrois; Paer-Selim Abback; Anissa Belbachir; Emmanuel Basto; Yves Castier; Philippe Laitselart; Pierre Carli; Frédéric Lapostolle; Jean Pierre Tourtier; Matthieu Langlois; Mathieu Raux; Roman Mounier
• Keywords: Univariate analysis

We aimed to assess the incidence and the risk factors for secondary wound infections associated to high-energy ammunition injuries (HEAI) in the cohort of civilian casualties from the 2015 terrorist attacks in Paris.This retrospective multi-centric study included casualties presenting at least one HEAI who underwent surgery during the first 48 h following hospital admission. HEAI-associated infection was defined as a wound infection occurring within the initial 30 days following trauma. Risk factors were assessed using univariate and multivariate analysis.Among the 200 included victims, the rate of infected wounds was 11.5%. The median time between admission and the surgical revision for secondary wound infection was 11 days [IQR 9-20]. No patient died from an infectious cause. Infections were polymicrobial in 44% of the cases. The major risk factors for secondary wound infection were ISS (p < 0.001), SAPS II (p < 0.001), MGAP (p < 0.001), haemorrhagic shock (p = 0.003), use of vasopressors (p < 0.001), blood transfusion (p < 0.001), abdominal penetrating trauma (p = 0.003), open fracture (p = 0.01), vascular injury (p = 0.001), duration of surgery (p = 0.009), presence of surgical material (p = 0.01). In the multivariate analysis, the SAPS II score (OR 1.07 [1.014-1.182], p = 0.019) and the duration of surgery (OR 1.005 [1.000-1.012], p = 0.041) were the only risk factors identified.We report an 11.5% rate of secondary wound infection following high-energy ammunition injuries. Risk factors were an immediately severe condition and a prolonged surgery.