SUMMARY OF CHANGES

1. New references have been added based on new data from the Trauma Infectious Disease Outcomes Study supporting previous recommendations to limit gram negative therapy for prophylaxis of extremity wounds.
2. The duration of antibiotics for open fractures has been curtailed to only the first 24 hours and re-dosing with subsequent irrigation and debridement.
3. Clarification had been added to describe the cohorting of patients. Long term patients (>72 hours) had been clarified to mean host nation patients; short term (<72 hours) has been clarified to mean U.S. personnel.
4. Antimicrobial stewardship recommendations have been expanded to include the recommendation for facilities responsible for trauma care to monitor adherence to antimicrobial prophylaxis regimens.
5. Reach back information has been updated to include the ADvanced VIrtual Support for OpeRational forces (AD.VI.S.OR) network and to the updated Army Infection Control email address.
6. Vancomycin dosing has been updated to reflect weight-based dosing and clindamycin dosing has been simplified.
7. A tetanus prophylaxis appendix has been added.