Department of Intensive Care Medicine, Sanatorio Dupuytren, Hospital Cosme Argerich, Buenos Aires City, Argentina.
Department of Infectious Disease, Hospital Cosme Argerich, Buenos Aires City, Argentina.
J Hosp Infect. 2017 Oct;97(2):105-114. doi: 10.1016/j.jhin.2017.06.015. Epub 2017 Jun 16.
To review studies of systemic antibiotic prophylaxis in burn patients.
Electronic databases were searched for human clinical trials performed between 1966 and 2016 that compared prophylactic systemic antibiotics with placebo or no intervention.
Nineteen trials met the selection criteria. Early postburn prophylaxis was assessed in non-severe burn patients (six trials) and severe burn patients (seven trials). Antimicrobial prophylaxis showed no effectiveness for the prevention of toxic shock syndrome or burn wound infection (Grade 1C), but could be useful in patients with severe burns and requirement for mechanical ventilation (Grade 2B). Perioperative prophylaxis was assessed in six trials. Antimicrobial prophylaxis during resection of devitalized tissue is of no benefit in most burn patients (Grade 2B); however, there is insufficient evidence to make a recommendation for patients with extensive burns. Antibiotic prophylaxis may also be effective in preventing split-thickness skin graft infections in selected procedures (Grade 2B).
The available evidence does not support the role of systemic antibiotic prophylaxis in the management of the majority of burn patients. Nevertheless, it may be useful in patients with severe burns who require mechanical ventilation, and in selected split-thickness skin grafting procedures.
综述烧伤患者全身抗生素预防用药的研究。
检索 1966 年至 2016 年间发表的比较全身预防性抗生素与安慰剂或不干预的人类临床试验。
19 项试验符合入选标准。早期烧伤预防应用于非严重烧伤患者（6 项试验）和严重烧伤患者（7 项试验）。抗生素预防用药对中毒性休克综合征或烧伤创面感染的预防没有效果（1C 级），但对需要机械通气的严重烧伤患者可能有用（2B 级）。围手术期预防用药评估了 6 项试验。在大多数烧伤患者中，对坏死组织切除时进行抗菌预防用药没有益处（2B 级）；然而，对于广泛烧伤患者，尚无足够证据推荐。在某些特定手术中，抗生素预防用药也可能有效预防切皮移植感染（2B 级）。
目前的证据不支持全身抗生素预防用药在大多数烧伤患者管理中的作用。然而，它可能对需要机械通气的严重烧伤患者以及某些特定的切皮移植手术有用。
