Barajas-Nava Leticia A, López-Alcalde Jesús, Roqué i Figuls Marta, Solà Ivan, Bonfill Cosp Xavier
Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain.
Cochrane Database Syst Rev. 2013 Jun 6;2013(6):CD008738. doi: 10.1002/14651858.CD008738.pub2.
Infection of burn wounds is a serious problem because it can delay healing, increase scarring and invasive infection may result in the death of the patient. Antibiotic prophylaxis is one of several interventions that may prevent burn wound infection and protect the burned patient from invasive infections.
To assess the effects of antibiotic prophylaxis on rates of burn wound infection.
In January 2013 we searched the Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (2013); Ovid EMBASE; EBSCO CINAHL and reference lists of relevant articles. There were no restrictions with respect to language, date of publication or study setting.
All randomised controlled trials (RCTs) that evaluated the efficacy and safety of antibiotic prophylaxis for the prevention of BWI. Quasi-randomised studies were excluded.
Two review authors independently selected studies, assessed the risk of bias, and extracted relevant data. Risk ratio (RR) and mean difference (MD) were estimated for dichotomous data and continuous data, respectively. When sufficient numbers of comparable RCTs were available, trials were pooled in a meta-analysis to estimate the combined effect.
This review includes 36 RCTs (2117 participants); twenty six (72%) evaluated topical antibiotics, seven evaluated systemic antibiotics (four of these administered the antibiotic perioperatively and three administered upon hospital admission or during routine treatment), two evaluated prophylaxis with non absorbable antibiotics, and one evaluated local antibiotics administered via the airway.The 11 trials (645 participants) that evaluated topical prophylaxis with silver sulfadiazine were pooled in a meta analysis. There was a statistically significant increase in burn wound infection associated with silver sulfadiazine compared with dressings/skin substitute (OR = 1.87; 95% CI: 1.09 to 3.19, I(2) = 0%). These trials were at high, or unclear, risk of bias. Silver sulfadiazine was also associated with significantly longer length of hospital stay compared with dressings/skin substitute (MD = 2.11 days; 95% CI: 1.93 to 2.28).Systemic antibiotic prophylaxis in non-surgical patients was evaluated in three trials (119 participants) and there was no evidence of an effect on rates of burn wound infection. Systemic antibiotics (trimethoprim-sulfamethoxazole) were associated with a significant reduction in pneumonia (only one trial, 40 participants) (RR = 0.18; 95% CI: 0.05 to 0.72) but not sepsis (two trials 59 participants) (RR = 0.43; 95% CI: 0.12 to 1.61).Perioperative systemic antibiotic prophylaxis had no effect on any of the outcomes of this review.Selective decontamination of the digestive tract with non-absorbable antibiotics had no significant effect on rates of all types of infection (2 trials, 140 participants). Moreover, there was a statistically significant increase in rates of MRSA associated with use of non-absorbable antibiotics plus cefotaxime compared with placebo (RR = 2.22; 95% CI: 1.21 to 4.07).There was no evidence of a difference in mortality or rates of sepsis with local airway antibiotic prophylaxis compared with placebo (only one trial, 30 participants).
AUTHORS' CONCLUSIONS: The conclusions we are able to draw regarding the effects of prophylactic antibiotics in people with burns are limited by the volume and quality of the existing research (largely small numbers of small studies at unclear or high risk of bias for each comparison). The largest volume of evidence suggests that topical silver sulfadiazine is associated with a significant increase in rates of burn wound infection and increased length of hospital stay compared with dressings or skin substitutes; this evidence is at unclear or high risk of bias. Currently the effects of other forms of antibiotic prophylaxis on burn wound infection are unclear. One small study reported a reduction in incidence of pneumonia associated with a specific systematic antibiotic regimen.
烧伤创面感染是一个严重问题，因为它会延迟愈合、增加瘢痕形成，侵袭性感染可能导致患者死亡。抗生素预防是几种可能预防烧伤创面感染并保护烧伤患者免受侵袭性感染的干预措施之一。
评估抗生素预防对烧伤创面感染率的影响。
2013年1月，我们检索了伤口小组专业注册库；Cochrane对照试验中心注册库（CENTRAL）；Ovid MEDLINE；Ovid MEDLINE - 正在进行及其他未索引引文（2013年）；Ovid EMBASE；EBSCO CINAHL以及相关文章的参考文献列表。对语言、出版日期或研究背景没有限制。
所有评估抗生素预防预防烧伤创面感染（BWI）的疗效和安全性的随机对照试验（RCT）。排除半随机研究。
两位综述作者独立选择研究、评估偏倚风险并提取相关数据。分别对二分数据和连续数据估计风险比（RR）和均值差（MD）。当有足够数量的可比RCT时，将试验纳入荟萃分析以估计合并效应。
本综述纳入36项RCT（2117名参与者）；26项（72%）评估局部用抗生素，7项评估全身用抗生素（其中4项在围手术期给予抗生素，3项在入院时或常规治疗期间给予），2项评估用不可吸收抗生素进行预防，1项评估通过气道给予局部抗生素。将评估磺胺嘧啶银局部预防的11项试验（645名参与者）纳入荟萃分析。与敷料/皮肤替代物相比，磺胺嘧啶银与烧伤创面感染的显著增加相关（OR = 1.87；95% CI：1.09至3.19，I² = 0%）。这些试验存在高偏倚风险或偏倚风险不明确。与敷料/皮肤替代物相比，磺胺嘧啶银还与显著更长的住院时间相关（MD = 2.11天；95% CI：1.93至2.28）。三项试验（119名参与者）评估了非手术患者的全身抗生素预防，没有证据表明对烧伤创面感染率有影响。全身用抗生素（甲氧苄啶 - 磺胺甲恶唑）与肺炎的显著减少相关（仅一项试验，40名参与者）（RR = 0.18；95% CI：0.05至0.72），但与败血症无关（两项试验，59名参与者）（RR = 0.43；95% CI：0.12至1.61）。围手术期全身抗生素预防对本综述的任何结局均无影响。用不可吸收抗生素进行消化道选择性去污对所有类型感染的发生率无显著影响（2项试验，140名参与者）。此外，与安慰剂相比，使用不可吸收抗生素加头孢噻肟与耐甲氧西林金黄色葡萄球菌（MRSA）率的显著增加相关（RR = 2.22；95% CI：1.21至4.07）。与安慰剂相比，局部气道抗生素预防在死亡率或败血症发生率方面没有差异的证据（仅一项试验，30名参与者）。
我们能够就预防性抗生素对烧伤患者的影响得出的结论受到现有研究的数量和质量的限制（在很大程度上，每项比较的研究数量少且规模小，偏倚风险不明确或高）。最大量的证据表明，与敷料或皮肤替代物相比，局部用磺胺嘧啶银与烧伤创面感染率的显著增加和住院时间延长相关；该证据的偏倚风险不明确或高。目前，其他形式的抗生素预防对烧伤创面感染的影响尚不清楚。一项小型研究报告了与特定全身抗生素方案相关的肺炎发病率降低。
