Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X, et al.
The Cochrane database of systematic reviews. Date of publication 2013 Jun 6;volume (6):CD008738.
1. Cochrane Database Syst Rev. 2013 Jun 6;(6):CD008738. doi:
10.1002/14651858.CD008738.pub2.
Antibiotic prophylaxis for preventing burn wound infection.
Barajas-Nava LA(1), López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X.
Author information:
(1)Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant
Pau), Barcelona, Spain. leticia.barajas@cochrane.es.
BACKGROUND: Infection of burn wounds is a serious problem because it can delay
healing, increase scarring and invasive infection may result in the death of the
patient. Antibiotic prophylaxis is one of several interventions that may prevent
burn wound infection and protect the burned patient from invasive infections.
OBJECTIVES: To assess the effects of antibiotic prophylaxis on rates of burn
wound infection.
SEARCH METHODS: In January 2013 we searched the Wounds Group Specialised
Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid
MEDLINE; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (2013); Ovid
EMBASE; EBSCO CINAHL and reference lists of relevant articles. There were no
restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA: All randomised controlled trials (RCTs) that evaluated the
efficacy and safety of antibiotic prophylaxis for the prevention of BWI.
Quasi-randomised studies were excluded.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies,
assessed the risk of bias, and extracted relevant data. Risk ratio (RR) and mean
difference (MD) were estimated for dichotomous data and continuous data,
respectively. When sufficient numbers of comparable RCTs were available, trials
were pooled in a meta-analysis to estimate the combined effect.
MAIN RESULTS: This review includes 36 RCTs (2117 participants); twenty six (72%)
evaluated topical antibiotics, seven evaluated systemic antibiotics (four of
these administered the antibiotic perioperatively and three administered upon
hospital admission or during routine treatment), two evaluated prophylaxis with
non absorbable antibiotics, and one evaluated local antibiotics administered via
the airway.The 11 trials (645 participants) that evaluated topical prophylaxis
with silver sulfadiazine were pooled in a meta analysis. There was a
statistically significant increase in burn wound infection associated with silver
sulfadiazine compared with dressings/skin substitute (OR = 1.87; 95% CI: 1.09 to
3.19, I(2) = 0%). These trials were at high, or unclear, risk of bias. Silver
sulfadiazine was also associated with significantly longer length of hospital
stay compared with dressings/skin substitute (MD = 2.11 days; 95% CI: 1.93 to
2.28).Systemic antibiotic prophylaxis in non-surgical patients was evaluated in
three trials (119 participants) and there was no evidence of an effect on rates
of burn wound infection. Systemic antibiotics (trimethoprim-sulfamethoxazole)
were associated with a significant reduction in pneumonia (only one trial, 40
participants) (RR = 0.18; 95% CI: 0.05 to 0.72) but not sepsis (two trials 59
participants) (RR = 0.43; 95% CI: 0.12 to 1.61).Perioperative systemic antibiotic
prophylaxis had no effect on any of the outcomes of this review.Selective
decontamination of the digestive tract with non-absorbable antibiotics had no
significant effect on rates of all types of infection (2 trials, 140
participants). Moreover, there was a statistically significant increase in rates
of MRSA associated with use of non-absorbable antibiotics plus cefotaxime
compared with placebo (RR = 2.22; 95% CI: 1.21 to 4.07).There was no evidence of
a difference in mortality or rates of sepsis with local airway antibiotic
prophylaxis compared with placebo (only one trial, 30 participants).
AUTHORS' CONCLUSIONS: The conclusions we are able to draw regarding the effects
of prophylactic antibiotics in people with burns are limited by the volume and
quality of the existing research (largely small numbers of small studies at
unclear or high risk of bias for each comparison). The largest volume of evidence
suggests that topical silver sulfadiazine is associated with a significant
increase in rates of burn wound infection and increased length of hospital stay
compared with dressings or skin substitutes; this evidence is at unclear or high
risk of bias. Currently the effects of other forms of antibiotic prophylaxis on
burn wound infection are unclear. One small study reported a reduction in
incidence of pneumonia associated with a specific systematic antibiotic regimen.
DOI: 10.1002/14651858.CD008738.pub2
PMID: 23740764 [Indexed for MEDLINE]
