An evaluation of the role of systemic antibiotic prophylaxis in the control of burn wound infection at the Lagos University Teaching Hospital
Introduction
The goal of burn wound management is to reduce the onset and density of bacterial contamination, which usually occurs by the second week after injury [1], and thereby prevent invasive wound infection. This has been achieved to a large extent by the management of burn patients in specialised burn centres utilising isolation and reverse isolation techniques, early wound closure and the use of various topical anti-microbial agents [2], [3].
Burn patients are however still managed in open surgical or medical wards, along with a variety of other patients, in most parts of Africa. This is associated with a high risk of transmission of infection from patients, attending staff and fomites [4]. In order to compensate for the lack of facilities and manpower, workers in developing countries have adopted the practice of administering systemic antibiotic prophylaxis based on the local burn wound bacterial isolates so as to reduce the alarming rate of infection [5], [6], [7], [8].
Systemic antibiotic prophylaxis in the management of burns may be defined as the administration of systemic antibiotics started immediately after injury with the aim of preventing burn wound infection [9]. This is usually done before the cultures are available. The goal is to effectively saturate the oedema fluid at a time when the humoral defences are low [9], [10] and treatment is continued until the formation of healthy granulation tissue which is able to withstand invasive infection. A sequential analysis of burn wound swabs carried out at the Lagos University Teaching Hospital in 1989 by Atoyebi et al. [8] revealed that the common organisms were sensitive to co-trimoxazole, erythromycin, genticin and colistin. This study was therefore designed to find out if the use of some of these antibiotics will be effective in preventing or delaying the onset of wound colonisation and wound infection.
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Patients and method
We studied 61 patients admitted with major burns (according to the American Burn Association’s definition) from January to December 1996. Only patients with burn injury less than 24 h were included in the study. Patients were excluded from the study if they suffered from concomitant mechanical trauma or inhalation injury. Patients who were diabetic were excluded from the study. Informed consent was obtained. Any patient developing clinical evidence of septicemia was also excluded and managed
Results
There were 21 patients in group 1, 20 patients in group 2 and 20 patients in group 3. A summary of the clinical and biochemical profiles of the patients studied is shown in Table 1. There were no statistically significant differences between the groups with respect to age, percentage surface area burn, the packed cell volume; serum albumin levels, serum protein levels, and time interval of presentation post-burns. A total of 184 surface swabs were taken for culture and 46 wound biopsy specimens
Discussion
This study has once again confirmed the fact that the burn wound is usually sterile immediately after injury. However, by the end of the first week of admission, the three study groups showed over 90% colonisation rate. This is in agreement with the findings of Yemul and Sengupta [12] of a surface colonisation rate of 87% and also of 80.6% by Atoyebi et al. [8]. Indeed, Lawrence [1] has reported that 25% of swabs taken from burn wounds, which showed no growth, are usually from fresh burns. He
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Cited by (53)
Surviving Sepsis After Burn Campaign
2023, BurnsRole of systemic antibiotic prophylaxis in acute burns: A retrospective analysis from a tertiary care center
2020, BurnsCitation Excerpt :But there is no quote about the evidence on which the statement is based. A randomized control trial conducted in Nigeria found that systemic antibiotic prophylaxis had no effect in controlling burn wound infection in patients managed in surgical wards [17]. The authors also suggested that there was no significant beneficial effect on the time of occurrence and in prevention of colonization or infection of burn wounds.
Systemic antimicrobial prophylaxis in burn patients: systematic review
2017, Journal of Hospital InfectionCitation Excerpt :Eight trials were conducted in children and 10 trials were in adults; one trial included children and adults (Table I). Six of the 13 studies were performed on non-severe burn patients and seven studies were performed on severe burn patients [21–33]. Of the six studies on non-severe cases, three compared antibiotic prophylaxis with no intervention in consecutive periods; all of the studies were in paediatric burn cases [21–23].
ISBI Practice Guidelines for Burn Care
2016, BurnsRoutine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)
2015, International Journal of Surgery