Abstract
Traumatic wounds represent a significant proportion of emergency department (ED) admissions, and inappropriate use of prophylactic antibiotics remains a global concern. This study evaluated adherence to Rosen’s Emergency Medicine and Mandell’s Principles and Practice of Infectious Diseases guidelines in prescribing antibiotics and tetanus immunoglobulin for patients with traumatic wounds. This retrospective cross-sectional audit was conducted among patients with traumatic wounds presenting to Shahid Beheshti Hospital in Babol, Iran, from 2019–2020. Patients receiving antibiotics for other indications or with incomplete medical records were excluded. Data regarding wound characteristics, prophylactic anti-biotic therapy, and tetanus management were collected from patient records. Concordance between actual clinical practice and reference guidelines was analyzed using Cohen’s kappa statistics. Of 130 eligible patients, 90 were included in the final analysis. Antibiotics were prescribed for 59% of patients—most commonly cefazolin alone or combined with gentamicin. Adherence to Rosen’s guidelines was good (κ = 0.80, p < 0.001), while adherence to Mandell’s guidelines was moderate (κ = 0.45, p < 0.001). Compliance was higher for clean wounds, wounds <12 hours old, and patients without comorbidities. Tetanus prophylaxis was appropriate in nearly all cases, with 98.9% of patients fully vaccinated. More explicit and context-specific protocols, such as Rosen’s Emergency Medicine, improve guideline adherence in ED wound management. Implementing clear institutional protocols can enhance antibiotic stewardship and optimize care.