Methods: This retrospective cohort study evaluated adult civilian patients (≥18 years) treated for spinal gunshot wounds at Latin American institutions between 2014 and 2022. Demographic, clinical, and injury characteristics, treatment approaches, and infectious complications were analyzed. Results: After exclusions, 292 patients, primarily adult males (n=251, 86.0%) with a mean age of 32.6 years (standard deviation=11), were included. Most injuries affected the thoracic (n=135; 46.2%) and lumbosacral (n=95; 32.5%) spine. Infectious complications occurred in 20 patients (6.8%), including spinal infections (n=3; 1.0%), non-spinal infections (n=6; 2.1%), and wound infections (n=11; 3.8%). Most patients received prolonged antibiotic prophylaxis. The median duration of antibiotic administration was significantly increased in patients with dirty wounds (p<0.001) and high-velocity injuries (p=0.001). However, the duration of antibiotic administration did not influence spinal infection rates. Conclusions Our findings indicate a low incidence (1%) of spinal infections among patients with spinal gunshot wounds. Prolonged antibiotic use failed to reduce the risk of spinal infectious complications. Standardized guidelines for antibiotic prophylaxis in these injuries remain necessary to optimize care.