{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:27:32Z","timestamp":1786120052144,"version":"build-2736575974"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Office of the Assistant Secretary of Defense for Health Affairs","award":["HT9425-23-C-0025"],"award-info":[{"award-number":["HT9425-23-C-0025"]}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tourniquets are sometimes necessary for hemorrhage control in the setting of traumatic limb injuries but may increase the risk of ischemic complications, including infection and impaired wound healing. Antibiotics may help to reduce infection rates in combat-associated injuries; however, intravenous access is not always readily available, particularly in austere environments. This study evaluates the effect of ertapenem administered intramuscularly at the tourniquet site on infection rates in a 24-hour porcine contaminated wound model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Yorkshire pigs (n\u2009=\u200912; 33.6\u2009\u00b1\u20091.4 kg) were anesthetized. A crush laceration injury was created in the ventral forelimb and inoculated with Staphylococcus aureus (SA) and Klebsiella pneumoniae (KP). Subsequently, a tourniquet was applied for 4 hours. Pigs were randomized into a Control group (n\u2009=\u20096) receiving 1% lidocaine and an Ertapenem group (n\u2009=\u20096) receiving 1% lidocaine and Ertapenem, both administered intramuscularly at the tourniquet site. Hemodynamics and respiratory parameters were monitored continuously for 24 hours, and resuscitation was administered according to critical care guidelines. Wound cultures and histopathology were obtained at baseline, and 4 and 24 hours post-injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No animal in either group grew SA or KP in the wound at baseline. At 4 and 24 hours, deep tissue cultures from all Control animals (100%, n\u2009=\u20096) were positive for both SA and KP. In the Ertapenem group, SA was detected in deep tissue cultures in 50% of animals (n\u2009=\u20093) at 4 hours (P\u2009=\u2009.046 vs. Control) and 33% (n\u2009=\u20092) at 24 hours (P\u2009=\u2009.014 vs. Control). KP was present in 33% of Ertapenem animals (n\u2009=\u20092) at both 4 and 24 hours (P\u2009=\u2009.014 vs. Control).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ertapenem administered intramuscularly at the tourniquet site in a contaminated crush laceration with ischemia reduced the rates of SA and KP infection by 67%. Intramuscular antibiotic delivery with tourniquet placement represents a potential therapy for combat-related injuries to reduce infectious complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag243","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T11:19:09Z","timestamp":1779103149000},"page":"698-707","source":"Crossref","is-referenced-by-count":0,"title":["Intramuscular Antibiotics Modify Infectious Outcomes in Contaminated, Ischemic Limbs"],"prefix":"10.1093","volume":"191","author":[{"given":"Michaela","family":"Hall","sequence":"first","affiliation":[{"name":"174th Medical Group, 174th Attack Wing Hancock Field Air National Guard Base , Syracuse, NY 13211,","place":["United States"]},{"name":"Department of Surgery, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Walker","sequence":"additional","affiliation":[{"name":"University of Arkansas Medical Sciences , Little Rock, AR 72205,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"France","sequence":"additional","affiliation":[{"name":"TDA Research, Inc , Golden, CO 80403,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Raebiger","sequence":"additional","affiliation":[{"name":"TDA Research, Inc , Golden, CO 80403,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Srinivas","sequence":"additional","affiliation":[{"name":"TDA Research, Inc , Golden, CO 80403,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Satalin","sequence":"additional","affiliation":[{"name":"Department of Veterinary Sciences, Cornell University , Ithaca, NY 14853,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Satalin","sequence":"additional","affiliation":[{"name":"Department of Surgery, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kareeparampil","sequence":"additional","affiliation":[{"name":"Department of Surgery, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prithi","family":"Chakrapani","sequence":"additional","affiliation":[{"name":"Department of Surgery, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soma","family":"Sanyal","sequence":"additional","affiliation":[{"name":"Department of Pathology, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghe","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Surgery, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Auyon","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Medicine, SUNY Upstate Medical University , Syracuse, NY 13210,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Kollisch-Singule","sequence":"additional","affiliation":[{"name":"University of Arkansas Medical Sciences , Little Rock, AR 72205,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026080616023375500_usag243-B1","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1111\/j.1553-2712.2001.tb00190.x","article-title":"Risk factors for infection in patients with traumatic lacerations","volume":"8","author":"Hollander","year":"2001","journal-title":"Acad Emerg Med"},{"key":"2026080616023375500_usag243-B2","doi-asserted-by":"publisher","first-page":"S235","DOI":"10.1097\/TA.0b013e318227ac5f","article-title":"Prevention of infections associated with combat-related extremity injuries","volume":"71","author":"Murray","year":"2011","journal-title":"J Trauma"},{"key":"2026080616023375500_usag243-B3","doi-asserted-by":"publisher","first-page":"100","DOI":"10.55460\/QT3B-XK5B","article-title":"Tactical combat casualty care (TCCC) guidelines: 25 January 2024","volume":"24","author":"Deaton","year":"2024","journal-title":"J Spec Oper Med"},{"key":"2026080616023375500_usag243-B4","doi-asserted-by":"publisher","first-page":"S372\u2013","DOI":"10.1097\/TA.0b013e3182755662","article-title":"Military medical revolution: prehospital combat casualty care","volume":"73","author":"Blackbourne","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2026080616023375500_usag243-B5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.55460\/TDTK-RIN8","article-title":"Optimizing the use of limb tourniquets in tactical combat casualty care: TCCC guidelines change 14-02","volume":"15","author":"Shackelford","year":"2015","journal-title":"J Spec Oper Med"},{"key":"2026080616023375500_usag243-B6","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1136\/jramc-149-04-02","article-title":"Consensus statement on the early management of crush injury and prevention of crush syndrome","volume":"149","author":"Greaves","year":"2003","journal-title":"J R Army Med Corps"},{"key":"2026080616023375500_usag243-B7","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1097\/TA.0000000000002016","article-title":"Tourniquet use is not associated with limb loss following military lower extremity arterial trauma","volume":"85","author":"Kauvar","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2026080616023375500_usag243-B8","doi-asserted-by":"publisher","first-page":"S109","DOI":"10.1097\/TA.0b013e3181e4b33d","article-title":"Infectious complications of combat-related mangled extremity injuries in the British military","volume":"69","author":"Brown","year":"2010","journal-title":"J Trauma."},{"key":"2026080616023375500_usag243-B9","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1186\/s40001-024-01996-0","article-title":"Intraoperative pneumatic tourniquet application reduces soft-tissue microcirculation, but without affecting wound healing in calcaneal fractures","volume":"29","author":"Lichte","year":"2024","journal-title":"Eur J Med Res"},{"key":"2026080616023375500_usag243-B10","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1016\/j.injury.2019.09.025","article-title":"Duration of extremity tourniquet application profoundly impacts soft-tissue antibiotic exposure in a rat model of ischemia-reperfusion injury","volume":"50","author":"Mangum","year":"2019","journal-title":"Injury"},{"key":"2026080616023375500_usag243-B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7205\/milmed.172.supplement_1.1","article-title":"Tactical combat casualty care 2007: evolving concepts and battlefield experience","volume":"172","author":"Butler","year":"2007","journal-title":"Mil Med"},{"key":"2026080616023375500_usag243-B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1053\/ajem.2001.18115","article-title":"Bacterial counts in experimental, contaminated crush wounds irrigated with various concentrations of cefazolin and penicillin","volume":"19","author":"Lammers","year":"2001","journal-title":"Am J Emerg Med"},{"key":"2026080616023375500_usag243-B13","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/0735-6757(93)90106-L","article-title":"The effect of scrubbing and irrigation with normal saline, povidone iodine, and cefazolin on wound bacterial counts in a Guinea pig model","volume":"11","author":"Howell","year":"1993","journal-title":"Am J Emerg Med"},{"key":"2026080616023375500_usag243-B14","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1006\/jsre.1999.5686","article-title":"Use of cefazolin microspheres to treat localized methicillin-resistant Staphylococcus aureus infections in rats","volume":"86","author":"Fallon","year":"1999","journal-title":"J Surg Res"},{"key":"2026080616023375500_usag243-B15","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0002-9610(72)90044-x","article-title":"Effectiveness of pulsating water jet lavage in treatment of contaminated crushed wounds","volume":"124","author":"Gross","year":"1972","journal-title":"Am J Surg"},{"key":"2026080616023375500_usag243-B16","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.ajem.2007.03.030","article-title":"A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds","volume":"26","author":"Erdur","year":"2008","journal-title":"Am J Emerg Med"},{"key":"2026080616023375500_usag243-B17","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1128\/AAC.47.5.1732-1735.2003","article-title":"Pharmacokinetics of intramuscularly administered ertapenem","volume":"47","author":"Musson","year":"2003","journal-title":"Antimicrob Agents Chemother"},{"key":"2026080616023375500_usag243-B18","doi-asserted-by":"publisher","first-page":"2753","DOI":"10.1128\/JCM.00522-14","article-title":"Are quantitative bacterial wound cultures useful?","volume":"52","author":"Kallstrom","year":"2014","journal-title":"J Clin Microbiol"},{"key":"2026080616023375500_usag243-B19","first-page":"501","article-title":"Quantitative bacteriology and delayed wound closure","volume":"19","author":"Robson","year":"1968","journal-title":"Surg Forum"},{"key":"2026080616023375500_usag243-B20","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"2026080616023375500_usag243-B21","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1097\/SLA.0b013e31820752e3","article-title":"The epidemiology of vascular injury in the wars in Iraq and Afghanistan","volume":"253","author":"White","year":"2011","journal-title":"Ann Surg"},{"key":"2026080616023375500_usag243-B22","doi-asserted-by":"publisher","first-page":"e107","DOI":"10.1097\/BOT.0b013e3182703188","article-title":"The nature and incidence of musculoskeletal combat wounds in Iraq and Afghanistan (2005-2009)","volume":"27","author":"Belmont","year":"2013","journal-title":"J Orthop Trauma"},{"key":"2026080616023375500_usag243-B23","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1097\/TA.0b013e31829a0970","article-title":"The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-2011","volume":"75","author":"Schoenfeld","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2026080616023375500_usag243-B24","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1016\/j.injury.2014.02.012","article-title":"Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan","volume":"45","author":"Hoencamp","year":"2014","journal-title":"Injury"},{"key":"2026080616023375500_usag243-B25","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/BOT.0b013e31819dfa04","article-title":"Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom","volume":"23","author":"Masini","year":"2009","journal-title":"J Orthop Trauma"},{"issue":"Suppl 1","key":"2026080616023375500_usag243-B26","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.5435\/00124635-201102001-00002","article-title":"Battlefield orthopaedic injuries cause the majority of long-term disabilities","volume":"19","author":"Cross","year":"2011","journal-title":"J Am Acad Orthop Surg"},{"key":"2026080616023375500_usag243-B27","first-page":"S210","article-title":"Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society","volume":"71","author":"Hospenthal","year":"2011","journal-title":"J Trauma"},{"key":"2026080616023375500_usag243-B28","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3390\/pathogens10020148","article-title":"Interplay between ESKAPE pathogens and immunity in skin infections: an overview of the major determinants of virulence and antibiotic resistance","volume":"10","author":"Vale de Macedo","year":"2021","journal-title":"Pathogens"},{"key":"2026080616023375500_usag243-B29","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/s0735-6757(98)90225-x","article-title":"Aerobic and anaerobic microbiology of infection after trauma","volume":"16","author":"Brook","year":"1998","journal-title":"Am J Emerg Med"},{"key":"2026080616023375500_usag243-B30","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/j.1524-475X.2012.00764.x","article-title":"Understanding the host inflammatory response to wound infection: an in vivo study of Klebsiella pneumoniae in a rabbit ear wound model","volume":"20","author":"Seth","year":"2012","journal-title":"Wound Repair Regen"},{"key":"2026080616023375500_usag243-B31","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/j.ijantimicag.2006.07.018","article-title":"Bactericidal activity of ertapenem against major intra-abdominal pathogens","volume":"28","author":"Borbone","year":"2006","journal-title":"Int J Antimicrob Agents"},{"key":"2026080616023375500_usag243-B32","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1097\/00000658-197512000-00018","article-title":"Infection in war wounds: experience during the 1973 October War in Israel","volume":"182","author":"Simchen","year":"1975","journal-title":"Ann Surg"},{"key":"2026080616023375500_usag243-B33","doi-asserted-by":"publisher","first-page":"S138","DOI":"10.1097\/TA.0b013e31819d894c","article-title":"Infections in combat casualties during Operations Iraqi and Enduring Freedom","volume":"66","author":"Murray","year":"2009","journal-title":"J Trauma"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/Supplement_1\/698\/70490479\/usag243.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/Supplement_1\/698\/70490479\/usag243.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:02:41Z","timestamp":1786046561000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/191\/Supplement_1\/698\/8751816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":33,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2026,8,6]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag243","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]}}}