Prophylactic antibiotics for burn victims: systematic review and meta-analysis
The administration of preventive systemic antibiotics has a beneficial effect in patients suffering from burns, but it is too early to systematically prescribe antibiotics to all patients burned prophylactically, with the exception of cases of perioperative antibiotic prophylaxis.
The purpose of the meta-analysis and systematic review was to assess the currently available evidence of the efficacy of the prophylactic use of systemic antibiotic therapy in patients with burns.
The review and meta-analysis included randomized and pseudo-randomized controlled clinical trials comparing the prophylactic use of antibiotics (systemic, nonabsorbable or local) with placebo or no intervention in hospitalized burn patients.
Searches were carried out in electronic databases (PubMed, Cochrane Library, LILACS, Embase), conference proceedings and bibliographic links in articles on relevant subjects. During the meta-analysis, there were no language restrictions, as well as publication restrictions by date or type. Two independent experts selected the studies to be included in the meta-analysis and assessed the quality of the studies.
The primary outcome measure was mortality for all reasons. The risk or risk ratio with a 95% confidence interval was combined using a fixed-effect model in the absence of heterogeneity in the studies.
A total of 17 studies were included in the review and meta-analysis. Studies evaluating the systemic prophylactic prescription of antibiotics within 4 to 14 days after admission to hospital have shown a statistically significant decrease in mortality for all reasons (risk ratio 0.54, confidence interval 95 % 0.34-0.87, five studies). ) The number of patients to be treated to prevent death was 8 (5 to 33), with a frequency of adverse (lethal) results in the control group of 26%. It should be noted that the perioperative use of nonabsorbable or local antibiotics did not statistically significantly affect mortality. A meta-analysis found a decrease in the incidence of pneumonia when using systemic antibiotic prophylaxis and a decrease in the frequency of wound infections when prescribing perioperative antibiotic prophylaxis. The incidence of infections caused by Staphylococcus aureus, as well as the incidence of asymptomatic colonization by Staphylococcus aureus, were lower when using antistaphylococcal antibiotics.
Three studies have shown that with the prophylactic use of antibiotics, there was a significant increase in the resistance of pathogens to antimicrobials used for prevention (risk ratio 2.84, 95% CI 1.38-5, 83), however, the overall methodological quality of these studies was poor.
Thus, according to the results of a meta-analysis, the prophylactic systemic administration of antibiotics has a beneficial effect in patients suffering from burns, however, the methodological quality of all the studies did not meet the standards. Antibiotic prophylaxis is currently not recommended for patients with severe burns (it only makes sense to perform perioperative antibiotic prophylaxis). Randomized controlled trials are needed to assess the feasibility of routine use of this method in all patients with burns.