Increased Burn Patient Survival with Once-A-Day High Dose Teicoplanin and Netilmicin. An Italian Multicenter Study

Abstract

This is the final report of a large, controlled, multicenter Italian study on immuno- and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treatment of burn patients consisted of topical silver sulfadiazine, short-term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) for the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles of 5-12 days. At random, half of the patients received thymostimulin, 70 mg i.m. qd for the first month and every other day thereafter. The analysis at completion of 634 valid cases showed that when the results are stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in the first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived. There was no difference in survival of the immunotherapy group in comparison with the parallel group without thymostimulin. The short-term antimicrobial prophylaxis prevented wound infection in only 104 of 634 patients (16%) and they were at low risk (84% Roi index 1). Of the bacterial pathogens involved in septic complications Staphylococcus aureus and Pseudomonas aeruginosa were prevalent (86%): eradication was achieved in 43% of patients and clinical cure or improvement were seen with combination chemotherapy in 64% of all patients, mainly with only one treatment cycle. This value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of complier and non-complier patients was 447 of the 530 valid patients (84%). The overall mortality of the 634 evaluable patients was 13.1%, ranging from less than 2% to 68%. Burn mortality was directly proportional to the percentage of burned body surface area, to increasing age and other variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.

Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition

“…As a result, 104 patients (16%) showed no infection, though the burns of these patients were relatively minor. However, the frequency of detected bacteria which is resistant to quinolones and aminoglycosides increased following treatment administration, and the usefulness of prophylactic administration of systemic antibiotics with this protocol could not be confirmed 95 Concerning studies on minor burns, Boss et al.…”

A Study on Role of Various Types of Topical Ointment and Its Outcome Among Burn Patients : An Interesting Followup Study

“…Burn wound sepsis is the primary cause of death in early post burned period and is often characterized by massive invasive infection. 19 the ineffectiveness of systemic antibacterial therapy in combating such infection is due primarily to the avascular nature of the burn wound. In the absence of proper vascular channels and cellular host defense mechanism, 20 the systemically administered antibiotics cannot reach the site in effective concentration.…”

The wound/burn guidelines – 6: Guidelines for the management of burns

“…In a multicenter collaborative study carried out in Italy, 634 patients with extensive burns (mean age, ˜40 years; mean burned area, 35% TBSA) were treated by topical application of silver sulfadiazine and 4‐day administration of pefloxacin (a quinolone). As a result, 104 (16%) showed no infection, but the burns of all these patients were relatively minor, and bacteria resistant to quinolones and aminoglycosides increased after the administration, so the usefulness of preventive systemic administration of antibiotics by this protocol could not be confirmed Concerning studies on minor burns, Boss et al .…”

“…As a result, 104 (16%) showed no infection, but the burns of all these patients were relatively minor, and bacteria resistant to quinolones and aminoglycosides increased after the administration, so the usefulness of preventive systemic administration of antibiotics by this protocol could not be confirmed. 80 Concerning studies on minor burns, Boss et al retrospectively compared the wound infection rate between 133 who underwent systemic administration of antibiotics and 161 who did not of the 294 outpatients with burns and reported that there was no difference in the infection rate (3.8% vs 3.1%) and that, while antibiotics were administrated to a significantly higher percentage of patients in those with a burned area of 5% TBSA or more than in those with a burned area of less than 5% TBSA, the infection rate was not reduced in the first group. 81 Various reports and opinions have been presented concerning what kind of patients should receive preventive administration of antibiotics.…”