Nosocomial and Healthcare Associated Infections

As nosocomial infections in burn patients are prevalent and dangerous, systemic antibiotic prophylaxis has been considered,

beside other interventions. However, this kind of therapy has been questioned due to controversy related to their effectiveness

and complications, such as drug toxicity and development of multidrug-resistance. We reviewed systemic antibiotic prophylaxis

in burn patients considering therapeutic target in different types of populations or procedures. The searching was conducted in

electronic databases during the period 1966-2016. The quality of evidence and strength of recommendation of these guidelines are

based on the GRADE system. Nineteen trials met the selection criteria. Early post-burn period prophylaxis was assessed in non

severe burn patients (6 trials), and in severe burn patients (7 trials). Antimicrobial prophylaxis showed no effectiveness for toxic

shock syndrome or burn wound infection prevention (Grade 1C) but could be useful in patients with severe burns and mechanical

ventilation requirement (Grade 2B). Moreover, perioperative prophylaxis was assessed in six trials. Beside, prophylaxis during

resection of devitalized tissue would not have indications in most burn patients (Grade 2B), but there is not enough evidence to

make a recommendation on extensive burns. Finally, it could be used for the prevention of split-thickness skin graft infections in

selected procedures (Grade 2B). We concluded that available evidence does not support the role of systemic antibiotic prophylaxis in

the management of the majority of burn patients. Nevertheless, it could be useful in patients with severe burns with requirement for

mechanical ventilation and in selected split-thickness skin grafting.