Topical gentamicin cream as prophylaxis against burn-wound sepsis

Abstract

Summary One hundred and thirty patients with fresh burns involving over 10 per cent of the body surface have been treated with daily prophylactic topical gentamicin cream. Pseudomonas aeruginosa colonized 30 per cent of these patients' wounds while on topical treatment and a further 20 per cent after daily applications were stopped. Over half of these patients colonized with a gentamicin-resistant Ps. aeruginosa at some time during their treatment course. No death was due to Ps. aeruginosa septicaemia. Two patients died of Candida albicans fungaemia and one died of Ps. maltophilia septicaemia following prophylactic gentamicin therapy. Compared with the preceding 5-year period in which no topical prophylactic antibacterial agent was used, a modest improvement in patient survival in burns involving less than 60 per cent of the body surface was observed, but mortality in larger burns did not decrease significantly. This slight improvement in survival must be weighed against the appearance of gentamicin-resistant Ps. aeruginosa in 25 per cent of patients who received a course of prophylactic therapy. As prophylaxis against burn-wound sepsis due to Ps. aeruginosa, gentamicin was not found to be particularly effective.