Role of systemic antibiotic prophylaxis and burn dressings in preventing invasive burn infections – A systematic review

Abstract

Background: Burn dressings and systemic antibiotics are used to combat invasive burn wound infections. With emergence of antibiotic resistance and a emergence of a large variety of dressings, it becomes important to work out a strategy to use systemic antibiotics and burn dressings effectively. Materials and Methods: A systematic database search to include PubMed/Medline, EMBASE, COCHRANE, SCOPUS was performed from January 2000 to January 2021 and reviewed to define invasive burn infection, and the topical antimicrobial therapy for clinical use. For the section on antimicrobials, MESH terms used were 'Antimicrobial Prophylaxis' AND 'burn Infection' and randomised controlled trial studies were alone selected. For the section on Burn dressings, another search was carried out with search words 'Dressings' AND 'Burn Infections'. Since the Search revealed several systematic reviews, the analysis was restricted to only those studies. Results: Systemic antibiotic prophylaxis does not seem to offer advantage in preventing burn wound infection, septic episodes or mortality. Although there is some benefit in decreasing mortality in patients of inhalation burn injury who would require mechanical ventilation. It can be given pre-operatively before skin grafting as there is improved graft survival in patients getting prophylaxis. Honey and hydrogel were found to promote wound healing while honey and skin substitutes prevented infection better than conventional dressings including silver sulphadiazine. For wound cover, though the permanent method of choice is still autologous skin grafts, with the advent of cell culture technologies, cultured autografts may hold a promising future. Conclusion: Systemic antibiotic prophylaxis can be given to patients of inhalational burn injury and as a pre-operative prophylaxis but not for preventing invasive burn wound infections. The ideals strategy for preventing invasive burn infection is isolation of the patient, wound cover (surgical/artificial) and frequent wound tissue sampling.