Barclay T Stewart1, Adam Gyedu2, Pius Agbenorku2, Richcane Amankwa3, Adam L Kushner4, Nicole Gibran5. 1. Department of Surgery, University of Washington, Seattle, USA; Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: stewarb@uw.edu. 2. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana. 3. Department of Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 4. Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA. 5. UW Medicine Regional Burn Center, USA; Department of Surgery, Harborview Medical Center, Seattle, WA, USA.
Abstract
BACKGROUND: Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection. METHODS: A best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality? RESULTS: From 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses. CONCLUSION: On the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury.
BACKGROUND: Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection. METHODS: A best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality? RESULTS: From 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses. CONCLUSION: On the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury.
Authors: Omar A Khan; Joel Dunning; Amjad C Parvaiz; Riaz Agha; David Rosin; Kevin Mackway-Jones Journal: Int J Surg Date: 2011-08-09 Impact factor: 6.071
Authors: Andrew W Kiragu; Stephen J Dunlop; Njoki Mwarumba; Sanusi Gidado; Adesope Adesina; Michael Mwachiro; Daniel A Gbadero; Tina M Slusher Journal: Front Pediatr Date: 2018-06-04 Impact factor: 3.418