Dr Tasciana Gordon1
1Greenslopes Hospital, , Australia
Skin is a vital organ that preserves fluid homeostasis, thermoregulation, immunological, neurosensory and also metabolic functions such as vitamin D metabolism. Thermal injury causes damage to the skin integrity. This may induce a state of immunosuppression that predisposes burn patients to infection. There is also an anti-inflammatory response to burn injury with reduced production and release of monocytes and macrophages.
A literature search was conducted using a PICO format with search engines Medline, Trip database and Pubmed. Exclusion criteria were articles in a non-English language, published prior to 2010, the use of antifungals, comparison of different antibiotic regimens and the inability to obtain the full text. Key words included ‘prophylactic antibiotic’, ‘burn management’, ‘burn treatment’, ‘topical antibiotic’.
Seventeen randomised control trials (RCTs) were identified. Five RCTs reported systemic broad spectrum antibiotic prophylaxis significantly reduced all-cause in hospital mortality. (RR 0.54, 95% CI 0.34 to 0.87; NNT 8, 95% CI 5 to 33). Two RCTs reported a reduction in pneumonia. (RR 0.52, 95% CI 0.33 to 0.83). Five RCTs reported no reduction in wound infection and a further four RCTs reported no reduction in bacteraemia.
Throughout the studies there was no consensus on the type, route or duration of antibiotic provided. The depth and location of burns as well as patient demographics were also not consistently clarified. There appears to be no reduction in wound infection or bacteraemia with the use of prophylactic antibiotics. Further study needs to be conducted to reduce confounding factors and bias with improved classification of target population (burn depth) and narrowed primary outcome measures such as wound infection or sepsis. Despite this, there was an overall consensus that prophylactic antibiotics were beneficial in burn patients but the methodological quality of the evidence was poor.
Tasciana is currently working as a principal house officer in plastic and reconstructive surgery at the Greenslopes Hospital in Queensland