Survival Benefit Conferred by Topical Antimicrobial Preparations in Burn Patients: A Historical Perspective

Abstract

When resources are limited, topical therapy (specifically, MA) is likely to confer the greatest survival benefit for combatants with burns of 40-79% TBSA.

Burn Wound Infections

“…A recent study conducted by the U.S. Army Burn Center compared the levels of mortality of adult patients according to age and burn size before (1950 to 1963) and after (1964 to 1968) the introduction of mafenide acetate topical antibiotic therapy (62). Use of mafenide acetate was associated with a greater than 10% reduction in mortality for those with burns of 40 to 79% TBSA, but its use had only a minimal effect on mortality in patients with smaller or much larger burn injuries.…”

Activity of topical antimicrobial agents against multidrug-resistant bacteria recovered from burn patients

“…Inhibits nucleotide synthesis [8] Bacteriostatic against gramnegative organisms including P. aeruginosa and gram-positive organisms [13,39] 11.1% cream, 5% solution Rapidly penetrates full thickness eschar making it effective in heavily colonized wounds and established burn wound infection [3,5,33] 11.1% concentration is painful when applied to the superficial partial-thickness burns with intact free nerve endings [3,40] Can dry into a tenacious gum (neoeschar) that attaches to the wound requiring hydrotherapy to remove [41] 5% aqueous solution is less painful and does not leave a residue [42] Absorbed systemically with highest blood levels of mafenide and its metabolite (pcarboxybenzenesulfonamide) in 2nd-4th hour resulting in urinary alkalinization from carbonic anhydrase inhibition [43] Possible metabolic acidosis, especially in patients with pulmonary dysfunction such as atelectasis or pneumonia that limits respiratory compensation [14,40,44] Electrolyte disturbances [45] 7% incidence of hypersensitivity, usually a rash [5] Rapid absorption from the tissue requires twice daily application to keep levels high enough for bacterial inhibition [33] No resistance reported to P. aeruginosa [6] Some resistance described to Providencia [5] Mortality benefit in prevention of burn wound sepsis described in animal models [13] Reduction in mortality and the rate of invasive burn wound infections in patients from before the introduction of mafenide to after, particularly in patients with 40-79% TBSA in one study [5] and between 20 and 59% TBSA in another study [14,15] Found to be the most effective topical agent against A. baumannii [18] Poor correlation between broth microdilution and agar well diffusion [23] b u r n s 3 6 ( 2 0 1 0 ) 1 1 7 2 -1 1 8 4…”

“…Though the rate of burn wound infections has decreased, burn wound sepsis remains a substantial source of infection in this population [4]. Improvements in burn wound care, such as early excision and grafting, have resulted in decreased mortality [5]. Early excision and grafting is the standard of care at specialized burn centers in the United States.…”

“…Topicals such as honey have been in use since antiquity, and others for decades [4][5][6][7][8][9][10][11]. There are both animal studies and clinical studies that provide data about the morbidity and mortality benefits associated with use of various topical antimicrobial agents in the prevention and treatment of burn wound infections [5,[12][13][14][15][16][17]. Another benefit of topical agents is that they can be delivered directly to the site of colonization or infection and can be used for both the prophylaxis and treatment of burn wound infections [18].…”

Revisión sistemática:¿Cuál es el agentetópico más eficaz en la prevención de infecciones en el paciente quemado?

“…Debido a su corta semivida debe aplicarse cada 12 h. 1,9 Bacitracina: Es un antibiótico polipeptídico, de uso local, en una base de petróleo. Es eficaz frente a cocos y bacilos grampositivos.…”