A prospective observational study of central venous catheters (CVC) was carried out in order to determine if a CVC inserted near an open burn wound increases catheter infection risk in burned patients. The study was carried out during a 12-month period (1998-1999) at the Benaim Foundation's Burn Unit in Buenos Aires (C.E.P.A.Q.). Eighty-three CVCs were inserted in 20 burned patients during the study period. Twenty-six catheters were inserted near an open wound (NOW) and 57 far from an open wound (FOW). NOW CVCs were considered when 25 cm2 surrounding the catheter's insertion site overlapped the wound. Colonization rates were 84% (22/26 CVCs) in those inserted NOW and 47% (27/57 CVCs) in FOW (P = 0.001). Colonization relative risk of NOW-CVCs was 1.79 (95% confidence interval, 1.3-2.46). Bacteremia rates were 27% (7/26 CVCs) in CVCs inserted NOW and 6% (3/57 CVCs) in FOW (P = 0.004). Bacteremic risk of NOW-CVCs was 5.12 (95% confidence interval, 1.44-18.22). Colonization rates were higher and sooner in NOW-CVCs than in FOW-CVCs. We suggest that insertion of catheters near an open burn wound should be avoided and, if inevitable, should not be left in place for period exceeding 3 days.
Skin autograft is the most important definitive treatment for acute-deep burns. Wound infection is the most important cause of autograft loss. Prior clinical studies have not shown any significant difference in the autograft survival rate and the use of perioperative systemic antibiotics. Their study assesses the potential benefit of systemic antibiotics in this setting, especially when topical antibiotics or artificial skin products are not readily available. The authors designed a prospective, randomized study in a cohort of patients with acute burns to assess the hypothesis that the use of systemic antibiotic prophylaxis affects the rate of skin autograft survival. Enrolled patients could have more than one autograft procedure done. These patients were randomized for each surgical procedure. The outcome measurement was autograft survival rate between the two groups. From October 2001 to October 2006, 77 patients were enrolled with a mean age of 41.7 years (SD +/- 19.4) and a mean skin total burn body surface area of 21.8 (SD +/- 23). The experimental group had 44 autograft procedures with systemic antibiotics (AP) and the control group had 46 procedures without antibiotics (NP). The rate of autograft survival for the AP group was 97% and for the NP group was 87% (P < .01) There was a partial autograft loss in 10 procedures (23%) in the AP group and 23 procedures (50%) in the NP group (P < .01). Patients with acute deep burns treated with autografts may benefit from systemic perioperative antibiotics prophylaxis, as antibiotics seem to be associated with increase autograft survival rate. The risk of colonization in other parts of the body with multidrug resistant bacteria warrants further study.
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 its effectiveness and complications, such as drug toxicity and development of multidrug-resistance. This review includes evidence reported during the period 1966-2016. The quality of evidence and strength of recommendation of these guidelines are based on the GRADE system. Early post-burn prophylaxis showed no effectiveness for toxic shock syndrome or burn wound infection prevention (Grade 1C) in non-severe burn patients but it could be useful for those who had severe burns and require mechanical ventilation (Grade 2B). Perioperative prophylaxis would neither have indications for wound cleaning nor for devitalized tissue debridement of most burn patients (Grade 2B), but there is not enough evidence to make a strong recommendation to those who have extensive burns. Finally, prophylaxis could be used to prevent skin graft infections in selected procedures (Grade 2B).
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