Antibiotic prophylaxis for preventing burn wound infection

Barajas-Nava, Leticia A.; López‐Alcalde, Jesús; Solà, Iván; Figuls, Marta Roqué i; Cosp, Xavier Bonfill

doi:10.1002/14651858.cd008738

Cited by 19 publications

(25 citation statements)

References 38 publications

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“…Of those, we excluded an additional 59 studies because they failed to meet the methodological definition of systematic review as per our inclusion criteria . Therefore, a total of 60 systematic reviews formed the basis of this study …”

Section: Resultsmentioning

confidence: 99%

Poor methodological quality and reporting standards of systematic reviews in burn care management

Wasiak

Tyack

Ware

et al. 2016

International Wound Journal

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The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.

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Section: Resultsmentioning

confidence: 99%

Poor methodological quality and reporting standards of systematic reviews in burn care management

Wasiak

Tyack

Ware

et al. 2016

International Wound Journal

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“…Despite of improvements in wound care and early mortality, wound infections by colonizing pathogens such as Staphylococcus aureus ( S. aureus ) remain as a major complication in burn patients, frequently leading to extended exposure to antibiotics and the emergence of resistant strains . As debates on how to balance the risks and benefits of antimicrobial use in the acute care of burn patients continue, existing evidence on either perioperative prophylaxis during early excision and grafting procedures or topical prophylaxis for wound infections remains inconsistent …”

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confidence: 99%

The skin microbiome of wound scars and unaffected skin in patients with moderate to severe burns in the subacute phase

Liu

Huang

Chen

et al. 2018

Wound Repair Regeneration

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Although studies on skin microbiome of acute and chronic wounds abound, evidence on newly built microbial communities of subacute wounds remains scant. To characterize the skin microbiome of recently healed (scarred) burn wounds in relation to unaffected skin surfaces, we collected weekly swabs from patients with moderate to severe burns in the 3rd postburn month for 4 weeks in 2015. We performed skin type (moist, dry, and oily)-matched comparisons within six burn patients (43 pairs of swabs) and with 13 skin-healthy, control patients (22 pairs of samples) using 16S ribosomal RNA gene sequencing results. Results of comparative microbiome analysis showed that, there were no substantial variations in the microbial abundance (all p > 0.05) or composition (all p > 0.01, adjusted for multiple comparisons) between samples obtained from wound scars and those from unaffected surfaces of burn patients. Nor did we find significant temporal dynamics in microbial richness or diversity in burn samples (all p ≥ 0.05). However, samples from burn patients harbored more Firmicutes (median: 25.6%, interquartile range [IQR]: 14.3%-52.8%) than those of control patients (14.9%, IQR: 6.7%-27.0%; p: 0.016), even after adjusting for host age, sex, and skin type-matching (p: 0.026). The number of observed bacterial operational taxonomic units at the genus level was reduced in burn patients (median: 62, IRQ: 32-85) as compared to control patients (median: 128, IQR: 112-136; age-, skin type-adjusted p < 0.01). Meanwhile, estimates of community diversity and evenness for surveyed body sites of burn patients were higher than those of control patients (all adjusted p ≤ 0.05). With a much-reduced bacterial burden and a relative overgrowth of Staphylococcus spp., the skin microbiota of burn patients remained dysbiotic in the subacute phase as compared to that of skin-normal patients.

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“…24 Similarly, sepsis, bacteremia, LOS and mortality rates were similar regardless of SAP use. 24 In addition, HIC studies demonstrated that SAP increases the incidence of antibiotic resistance and non-bacterial suprainfections. 25 As a result, routine use of SAP in HIC burn centers is no longer recommended.…”

Section: Discussionmentioning

confidence: 86%

Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)

Stewart

Gyedu

Agbenorku

et al. 2015

International Journal of Surgery

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Background Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection, Methods A best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality? Results From 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses. Conclusion On the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury.

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Antibiotic prophylaxis for preventing burn wound infection

Cited by 19 publications

References 38 publications

Poor methodological quality and reporting standards of systematic reviews in burn care management

Poor methodological quality and reporting standards of systematic reviews in burn care management

The skin microbiome of wound scars and unaffected skin in patients with moderate to severe burns in the subacute phase

Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)

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