Cocchi Enrico, Montemurro Luca, Bettoni Francesco Pio, Cassalia Fortunato, D'Acunto Carmine, Stella Marcello, Melandri Davide
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy; AUSL Romagna, Neonatal and Pediatric Intensive Care Unit, Bufalini Hospital, Cesena, Italy; Division of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, NY, United States.
Residency School of Pediatrics and Neonatology, University of Ferrara, Ferrara, Italy.
Burns. 2025 Sep;51(7):107579. doi: 10.1016/j.burns.2025.107579. Epub 2025 Jun 19.
Infectious complications are a significant cause of morbidity and mortality in patients with deep burns, especially pediatric patients. While autologous split thickness skin grafting is commonly used after escharectomy to promote wound healing, its effect on reducing infection rates and the need for antibiotics in this population is not well understood.
This study aimed to evaluate the impact of skin grafting on the incidence of wound infectious complications, systemic inflammatory response syndrome (SIRS) development, and the need for antibiotic treatment, in pediatric patients.
A retrospective cohort of 123 pediatric burn patients treated at Bufalini Hospital, Cesena, Italy, between 2018 and 2024 was analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. Cox proportional hazards models were applied to assess the influence of grafting on the time to wound infectious complications, subsequent SIRS development, and need for antibiotic treatment. Sensitivity analysis using both time-insensitive logistic models and leave-one-out approach were performed to assess robustness of findings.
Skin grafting significantly reduced the risk of wound infectious complications (hazard ratio = 0.12, 95 % CI: 0.02-0.58, p < 0.01) and SIRS development (hazard ratio = 0.14, 95 % CI: 0.03-0.73, p = 0.02). A non-significant trend was also identified in the need for antibiotic treatment. Sensitivity analysis confirmed the robustness of the results.
Autologous split thickness grafting plays a critical role in preventing infectious complications in pediatric burn patients. In children with deep burns, early skin grafting may play a pivotal role as part of the treatment protocol, pending confirmation from larger multi-center studies.
感染性并发症是深度烧伤患者发病和死亡的重要原因，尤其是儿科患者。虽然在焦痂切除术后通常采用自体中厚皮片移植来促进伤口愈合，但对于该人群中其在降低感染率和抗生素使用需求方面的作用，人们了解并不充分。
本研究旨在评估皮肤移植对儿科患者伤口感染性并发症发生率、全身炎症反应综合征（SIRS）发生情况以及抗生素治疗需求的影响。
对2018年至2024年期间在意大利切塞纳市布法利尼医院接受治疗的123例儿科烧伤患者的回顾性队列进行分析。采用治疗权重的逆概率法（IPTW）来平衡协变量。应用Cox比例风险模型评估移植对伤口感染性并发症发生时间、随后SIRS发生情况以及抗生素治疗需求的影响。使用时间不敏感逻辑模型和留一法进行敏感性分析，以评估研究结果的稳健性。
皮肤移植显著降低了伤口感染性并发症的风险（风险比 = 0.12，95%可信区间：0.02 - 0.58，p < 0.01）和SIRS发生的风险（风险比 = 0.14，95%可信区间：0.03 - 0.73，p = 0.02）。在抗生素治疗需求方面也发现了不显著的趋势。敏感性分析证实了结果的稳健性。
自体中厚皮片移植在预防儿科烧伤患者感染性并发症方面起着关键作用。对于深度烧伤儿童，在大型多中心研究确认之前，早期皮肤移植作为治疗方案的一部分可能起着关键作用。
