Tiry E, Leduc A, Dumont R, Ridel P, Perrot P, Duteille F
Service des Brûlés, CHU Nantes, France.
Service de Réanimation Chirurgicale et des Brûlés, CHU Nantes, France.
Ann Burns Fire Disasters. 2018 Sep 30;31(3):209-212.
Most hospitals use protocols for surgical antibioprophylaxis (ABP). Despite SFB's 2009 recommendations promoting ABP in burn patients and stating the molecules to be used, wide variations exist within hospitals and among French hospitals, in cases of skin grafting and use of dermal substitutes. We contacted surgeons in 12 French Burn Centres (BCs) via email and questioned them about ABP in cases of skin grafting (thin and total) as well as in the use of dermal substitutes, in acute and sequelae settings. Eight BCs answered. In the acute phase, 3 BCs (37.5%) always use ABP in skin grafts, 2 (25%) use ABP on suspicion of wound infection and 3 (37.5%) never use ABP. When installing skin substitute, 5 BCs (62.5%) use ABP, one (12.5%) does so if the wound is suspected of being infected and 2 (25%) never use ABP. For sequelae, 5 BCs (62.5%) use ABP whatever the surgery, while 3 (37.5%) never use it. Infection onset after skin graft or use of dermal substitute is frequent. Our study shows wide variations in the use of ABP in these surgeries. A multi-centre evaluation of the implementation of SFB's 2009 recommendations and their role in preventing postoperative infections after skin grafting and skin substitute use, both in acute and sequelae phases, could help harmonize practices in BCs.
大多数医院都采用手术抗生素预防（ABP）方案。尽管法国烧伤学会（SFB）在2009年建议在烧伤患者中推广ABP，并说明了应使用的药物，但在医院内部以及法国各医院之间，在皮肤移植和使用真皮替代物的情况下，仍存在很大差异。我们通过电子邮件联系了12家法国烧伤中心（BCs）的外科医生，询问他们在皮肤移植（薄层和全层）以及在急性和后遗症情况下使用真皮替代物时的ABP情况。8家BCs进行了回复。在急性期，3家BCs（37.5%）在皮肤移植时始终使用ABP，2家（25%）在怀疑伤口感染时使用ABP，3家（37.5%）从不使用ABP。在安装皮肤替代物时，5家BCs（62.5%）使用ABP，1家（12.5%）在怀疑伤口感染时使用，2家（25%）从不使用ABP。对于后遗症，5家BCs（62.5%）无论进行何种手术都使用ABP，而3家（37.5%）从不使用。皮肤移植或使用真皮替代物后感染的发生很常见。我们的研究表明，在这些手术中ABP的使用存在很大差异。对SFB 2009年建议的实施情况及其在预防急性和后遗症期皮肤移植及使用皮肤替代物后术后感染中的作用进行多中心评估，可能有助于使各BCs的做法趋于一致。
