What is the risk and management of infection in hematomas?

From the Guidelines

Hematomas have a significant risk of infection, particularly if they are large, located near contaminated areas, or in immunocompromised patients, with management typically involving drainage, culture, and appropriate antibiotic therapy. The risk of infection in hematomas is a critical consideration in their management, as it can lead to severe consequences, including morbidity, mortality, and a decreased quality of life. According to the provided evidence, hematoma within the pocket that complicates cardiovascular implantable electronic device (CIED) placement or invasive manipulation has been identified as a risk factor associated with device placement 1.

Signs of infected hematomas include increasing pain, redness, warmth, swelling, purulent drainage, and systemic symptoms like fever. Management of infected hematomas typically involves:

• Drainage of the infected hematoma
• Culture of the fluid to guide antibiotic therapy
• Appropriate antibiotic therapy, which may include oral antibiotics for mild infections, such as cephalexin or amoxicillin-clavulanate, or intravenous antibiotics for severe infections, such as vancomycin or piperacillin-tazobactam
• Surgical intervention to evacuate the infected collection and debride any necrotic tissue

Prevention strategies are also crucial in reducing the risk of infection in hematomas, including:

• Proper wound care
• Sterile technique during procedures
• Avoiding unnecessary trauma to the area
• Use of antibiotic prophylaxis in certain situations, such as subsequent invasive manipulation of the CIED 1
• Preoperative antiseptic preparation of the skin and compulsive attention to sterile technique during procedures 1

It is essential to note that the risk of infection in hematomas can be influenced by various factors, including the size and location of the hematoma, the presence of underlying medical conditions, and the use of immunosuppressive therapy. Therefore, a thorough assessment of the individual patient's risk factors is necessary to guide management decisions.

In terms of the frequency of infection in hematomas, the provided evidence does not specify a particular percentage or rate. However, it highlights the importance of preventing hematoma formation during CIED placement or invasive manipulation, as it can increase the risk of infection 1.

Overall, the management of hematomas requires a comprehensive approach that includes prevention, prompt recognition of infection, and appropriate treatment to minimize the risk of morbidity, mortality, and decreased quality of life.

From the Research

Risk of Infection in Hematomas

• The risk of infection in hematomas is a concern, particularly in patients with hemorrhage and those undergoing transfusions 2.
• Trauma, hemorrhage, and transfusion can impair the immune response, resulting in an increased incidence of infection 2.
• However, available data are insufficient to conclude that trauma patients experiencing hemorrhage are at elevated risk of infection and thus require more frequent redosing of antibiotic agents than the current guidelines suggest 2.

Management of Infection in Hematomas

• Antibiotic prophylaxis is a common practice in trauma centers worldwide for patients presenting with various forms of serious injury, including hemorrhage 2, 3.
• The current guidelines recommend re-dosing prophylactic antibiotic agents for every 10 units of blood products administered 2.
• However, there is no evidence available to answer the question of whether prophylactic antibiotics reduce infections and other complications in elderly patients with pretibial hematomas 4.
• In patients with hematological malignancies, antimicrobial prophylaxis is recommended to prevent infections associated with immunosuppression 5.

Factors Influencing Infection Risk in Hematomas

• Hematoma volume, location, and surface can influence the evolution of perihemorrhagic edema, which may be associated with an increased risk of infection 6.
• Peak edema is associated with worse functional outcome in intracerebral hemorrhage (ICH) volumes <30 mL, but not in ICH volumes ≥30 mL 6.
• Hematoma surface is the major parameter for edema evolution, and smaller hematomas with a higher ratio of hematoma surface to volume may be at increased risk of infection 6.