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Meta-Analysis
. 2013 Jun 6;2013(6):CD008738.
doi: 10.1002/14651858.CD008738.pub2.

Antibiotic prophylaxis for preventing burn wound infection

Leticia A Barajas-Nava  1 , Jesús López-Alcalde, Marta Roqué i Figuls, Ivan Solà, Xavier Bonfill Cosp
Affiliations
Meta-Analysis

Antibiotic prophylaxis for preventing burn wound infection

Leticia A Barajas-Nava et al. Cochrane Database Syst Rev. .

Abstract

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.

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Conflict of interest statement

Leticia Andrea Barajas Nava: None known. Jesús López Alcalde: None known. Ivan Solà Arnau: None known. Marta Roqué: None known. Xavier Bonfill Cosp: None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Flow diagram.
1.1
1.1. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 1 Burn wound infection.
1.2
1.2. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 2 Infections in the burned people (sepsis).
1.3
1.3. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 3 Infections in burned people (bacteraemia).
1.4
1.4. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 4 Infections in burned people (pneumonia).
1.5
1.5. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 5 Infections in burned people (urinary tract infection).
1.6
1.6. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 6 Adverse events.
1.7
1.7. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 7 Infection‐related mortality.
1.8
1.8. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 8 Antibiotic resistance (MRSA).
1.9
1.9. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 9 All‐cause mortality.
1.10
1.10. Analysis
Comparison 1 Topical antibiotic prophylaxis, Outcome 10 Length of hospital stay (LOS).
2.1
2.1. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 1 Burn wound infection.
2.2
2.2. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 2 Infections in burned people (sepsis).
2.3
2.3. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 3 Infections in burned people (bacteraemia).
2.4
2.4. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 4 Infections in burned people (pneumonia).
2.5
2.5. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 5 Infections in burned people (urinary tract infection).
2.6
2.6. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 6 Infection‐related mortality.
2.7
2.7. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 7 Antibiotic resistance (MRSA).
2.8
2.8. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 8 All‐cause mortality.
2.9
2.9. Analysis
Comparison 2 Systemic antibiotic prophylaxis (general), Outcome 9 Length of hospital stay (LOS).
3.1
3.1. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 1 Burn wound infection.
3.2
3.2. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 2 Infections in burned people (bacteraemia).
3.3
3.3. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 3 Infections in burned people (pneumonia).
3.4
3.4. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 4 Infections in burned people (urinary tract infection).
3.5
3.5. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 5 Adverse events.
3.6
3.6. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 6 All‐cause mortality.
3.7
3.7. Analysis
Comparison 3 Systemic antibiotic prophylaxis (perioperative), Outcome 7 Length of hospital stay (LOS).
4.1
4.1. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 1 Burn wound infection.
4.2
4.2. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 2 Infections in burned people (sepsis).
4.3
4.3. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 3 Infections in burned people (bacteraemia).
4.4
4.4. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 4 Infections in burned people (pneumonia).
4.5
4.5. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 5 Infections in burned people (urinary tract infection).
4.6
4.6. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 6 Adverse events.
4.7
4.7. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 7 Antibiotic resistance (MRSA).
4.8
4.8. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 8 All‐cause mortality.
4.9
4.9. Analysis
Comparison 4 Non‐absorbable antibiotic prophylaxis (selective decontamination of the digestive tract), Outcome 9 Length of hospital stay (LOS).
5.1
5.1. Analysis
Comparison 5 Local antibiotic prophylaxis (airway), Outcome 1 Infections in burned people (sepsis).
5.2
5.2. Analysis
Comparison 5 Local antibiotic prophylaxis (airway), Outcome 2 All‐cause mortality.
6.1
6.1. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 1 Burn wound infection.
6.2
6.2. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 2 Infections in burned people (sepsis).
6.3
6.3. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 3 Infections in burned people (bacteraemia).
6.4
6.4. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 4 Infections in burned people (pneumonia).
6.5
6.5. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 5 Infections in burned people (urinary tract infection).
6.6
6.6. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 6 Infection‐related mortality.
6.7
6.7. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 7 Adverse events.
6.8
6.8. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 8 Antibiotic resistance (MRSA).
6.9
6.9. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 9 All‐cause mortality.
6.10
6.10. Analysis
Comparison 6 Antibiotic prophylaxis vs control/placebo, Outcome 10 Length of hospital stay (LOS).
See this image and copyright information in PMC

Update of

References

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Ugburo 2004 {published data only}
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Varas 2005 {published data only}
    1. Varas RP, O'Keeffe T, Namias N, Pizano LR, Quintana OD, Herrero Tellachea M, et al. A prospective, randomized trial of Acticoat versus silver sulfadiazine in the treatment of partial‐thickness burns: which method is less painful?. Journal of Burn Care and Rehabilitation 2005;26(4):344‐7. - PubMed
Waffle 1988 {published data only}
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References to studies awaiting assessment

Maghsoudi 2011 {published data only}
    1. Maghsoudi H, Salehi F, Khosrowshahi MK, Baghaei M, Nasirzadeh M, Shams R. Comparison between topical honey and mafenide acetate in treatment of burn wounds. Annals of Burns and Fire Disasters 2011;24(3):132‐7. - PMC - PubMed
Panahi 2012 {published data only}
    1. Panahi Y, Beiraghdar F, Akbari H, Bekhradi H, Taghizadeh M, Sahebkar A. A herbal cream consisting of Aloe vera, Lavandulastoechas, and Pelargonium roseum as an alternative for silver sulfadiazine in burn management. Asian Biomedicine 2012;6(2):273‐8.

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