Garcia Garcia Jose Antonio, Gonzalez Chavez Alberto Manuel, Orozco Grados Jose De Jesus
Harvard T.H. Chan School of Public Health, Social and Behavioral Sciences, Boston, USA.
Hospital Español de Mexico. Mexico City, Mexico.
World J Plast Surg. 2022;11(3):3-12. doi: 10.52547/wjps.11.3.3.
Choosing adequate topical antimicrobial agents in burn patients still represents a challenge. Therefore, this systematic review was conducted to compile and evaluate current recommendations in international clinical practice guidelines (CPGs) to develop more consistent clinical guidance.
A systematic search for CPGs was conducted independently by two reviewers using PubMed, EMBASE, Google Scholar, and external citations. The quality of the selected CPGs was evaluated separately using the AGREE II instrument, and intraclass correlation coefficients were calculated. Statistical analysis was performed using R V 1.4.1 statistical software.
Eleven CPGs were included in the study. Most guidelines tend to recommend silver-containing dressings over antiseptics or antibiotics, regardless of the depth of the burn. Silver sulfadiazine is the most recommended topical antimicrobial in low-resource settings. An overall mean appraisal AGREE II score of 68.2% was obtained. The global intraclass correlation coefficient was 0.62 (95% confidence intervals 0.54-0.69), which corresponds to a substantial global concordance between both appraisers.
Great heterogeneity was found between recommendations and CPGs. The three determining factors considered to issue a recommendation were the clinical scenario, burn-wound depth, and burn severity. There is consensus among the guidelines to use topical antimicrobials as a tool to prevent infection, and most of these recommend the use of silver-containing dressings for most scenarios. However, there is currently no ideal topical antimicrobial agent that can be recommended for all clinical scenarios. The development of more consistent recommendations is warranted to standardize clinical practice.
为烧伤患者选择合适的外用抗菌剂仍然是一项挑战。因此，进行了这项系统评价，以汇总和评估国际临床实践指南（CPG）中的当前建议，从而制定更一致的临床指南。
两名评价者分别使用PubMed、EMBASE、谷歌学术和外部引文独立检索CPG。使用AGREE II工具分别评估所选CPG的质量，并计算组内相关系数。使用R V 1.4.1统计软件进行统计分析。
该研究纳入了11项CPG。大多数指南倾向于推荐含银敷料而非防腐剂或抗生素，无论烧伤深度如何。磺胺嘧啶银是资源匮乏地区最常推荐的外用抗菌剂。AGREE II总体平均评估得分为68.2%。总体组内相关系数为0.62（95%置信区间0.54 - 0.69），这表明两位评价者之间存在高度的总体一致性。
在建议和CPG之间发现了很大的异质性。被认为用于发布建议的三个决定因素是临床情况、烧伤创面深度和烧伤严重程度。各指南一致认为将外用抗菌剂作为预防感染的工具，并且大多数指南建议在大多数情况下使用含银敷料。然而，目前尚无理想的外用抗菌剂可推荐用于所有临床情况。有必要制定更一致的建议以规范临床实践。
