Systemic Perioperative Antibiotic Prophylaxis May Improve Skin Autograft Survival in Patients With Acute Burns

Abstract

Skin autograft is the most important definitive treatment for acute-deep burns. Wound infection is the most important cause of autograft loss. Prior clinical studies have not shown any significant difference in the autograft survival rate and the use of perioperative systemic antibiotics. Their study assesses the potential benefit of systemic antibiotics in this setting, especially when topical antibiotics or artificial skin products are not readily available. The authors designed a prospective, randomized study in a cohort of patients with acute burns to assess the hypothesis that the use of systemic antibiotic prophylaxis affects the rate of skin autograft survival. Enrolled patients could have more than one autograft procedure done. These patients were randomized for each surgical procedure. The outcome measurement was autograft survival rate between the two groups. From October 2001 to October 2006, 77 patients were enrolled with a mean age of 41.7 years (SD +/- 19.4) and a mean skin total burn body surface area of 21.8 (SD +/- 23). The experimental group had 44 autograft procedures with systemic antibiotics (AP) and the control group had 46 procedures without antibiotics (NP). The rate of autograft survival for the AP group was 97% and for the NP group was 87% (P < .01) There was a partial autograft loss in 10 procedures (23%) in the AP group and 23 procedures (50%) in the NP group (P < .01). Patients with acute deep burns treated with autografts may benefit from systemic perioperative antibiotics prophylaxis, as antibiotics seem to be associated with increase autograft survival rate. The risk of colonization in other parts of the body with multidrug resistant bacteria warrants further study.

Infecciones en los niños quemados: análisis epidemiológico y de los factores de riesgo

“…20,21 En el estudio llevado a cabo por Ergün y cols., 22 no se demostró que la profilaxis antibiótica sistémica fuera eficaz para prevenir la infección. Por el contrario, se relacionó con mayores tasas de infección, lo que coincide con lo observado en esta serie.…”

Prevention of Infections Associated With Combat-Related Burn Injuries

“…46 Antibiotic administration has been found to reduce the incidence of this transient bacteremia but not to affect outcomes. 47 A recently published study by Ramos et al 48 found that the use of systemic antibiotics administered perioperatively to patients undergoing grafting of deep burns was associated with improved autograft survival. However, the study had several limitations, including a small sample size, and more extensive follow-up studies will be required.…”

Towards Rational Use of Antibiotics for Suspected Secondary Infections in Buruli Ulcer Patients

“…However, there is some inconclusive evidence that in skin grafts systemic perioperative antibiotic prophylaxis contributes to the autograft survival [19]. Ramos et al found a rate of autograft survival for the group of patients with burns using two days of perioperative antibiotic prophylaxis of 97% versus 87% in the group without prophylaxis [20]. In patients with arterial and venous ulcers no differences in graft survival was observed with perioperative use of antibiotics [21].…”