Prophylaxis with systemic antibiotics in patients with severe burns

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c208 (Published 15 February 2010) Cite this as: BMJ 2010;340:c208
  1. David Bracco, associate professor of anaesthesia and critical care1,
  2. Philippe Eggimann, critical care and infectious disease physician2
  1. 1Montreal Burn Unit, Montreal General Hospital, McGill University, Montreal, QC, Canada H3G 1A4
  2. 2Adult Critical Care Department and Burn Unit, Centre Hospitalier Unive rsitaire Vaudois, CH-1011 Lausanne, Switzerland
  1. david.bracco{at}mcgill.ca

    In the absence of good quality evidence, caution is advised

    In the linked systematic review and meta-analysis (doi:10.1136/bmj.c241), Avni and colleagues assess the evidence for giving antibiotic prophylaxis to patients with severe burns.1 The authors find that the quality of the evidence is poor, so robust conclusions cannot be drawn.

    Burn injuries disrupt the primary barrier between sterile tissues and the colonised external world, and they profoundly alter the subtle equilibrium of the patient’s own flora. Despite the use of dressings, burned skin becomes necrotic tissue that is constantly exposed to the environment and is an ideal medium for micro-organisms to grow. Burns severely compromise the host’s defences so that micro-organisms multiply and penetrate deeper into the tissues.

    Aggressive removal of devitalised or infected tissues in burn wounds is vital to the success of reconstructive surgery. However, it is impossible to maintain a sterile environment, and endogenous flora are progressively altered by acquisition of external organisms through contact with materials, the environment, and healthcare workers. The addition of a warm and moist environment, repeated surgery, and long term treatment with antibiotics allows resistant micro-organisms to emerge, with secondary contamination of the environment and potential spread to other patients.2 Outbreaks of meticillin resistant Staphylococcus aureus …

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