Burns injury in children: is antibiotic prophylaxis recommended?
Jamila Chahed1, Amine Ksia, Wieme Selmi
1Department of Pediatric Surgery, EPS Fattouma Bouguiba, Faculty of Medicine, Monastir, CP 5000, Tunisia.
Insights
Systemic antibiotics are not recommended for preventing infections in pediatric burn patients. Careful wound care is sufficient for healing, with antibiotics reserved for treating confirmed infections.
Area of Science:
- Pediatric Burn Care
- Infectious Disease Management
- Antibiotic Stewardship
Background:
- Wound infection is a common complication in pediatric burn patients.
- Current guidelines for systemic antibiotic use in this population are lacking.
- This study addresses the need for evidence-based recommendations.
Purpose of the Study:
- To evaluate the efficacy of antibiotic prophylaxis in preventing infections in pediatric burn patients.
- To compare infection rates among different antibiotic treatment groups and a control group.
- To inform clinical practice regarding antibiotic use in burn wound management.
Main Methods:
- A prospective study involving 80 pediatric burn patients.
- Patients were randomized into three groups: amoxicillin/clavulanic acid, oxacillin, or no antibiotics.
- Infection rates, types of infections, and causative bacteria were monitored.
Main Results:
- The overall infection rate was 20%, with no significant difference between antibiotic groups and the control group (P = 0.7).
- Septicemia was the most common infection (75%), followed by wound infection (25%).
- Staphylococcus aureus was the most frequently isolated bacterium.
Conclusions:
- Adequate and meticulous burn wound nursing care is sufficient for preventing complications and promoting healing.
- Systemic antibiotics should be reserved for the treatment of confirmed infections, not for prophylaxis.
- This study suggests a shift towards conservative antibiotic use in pediatric burn management.
Background:
Wound infection is the most frequent complication in burn patients. There is a lack of guidelines on the use of systemic antibiotics in children to prevent this complication.
Patients And Methods:
A prospective study is carried out on 80 patients to evaluate the role of antibiotic prophylaxis in the control of infections.
Results:
The mean age was 34 months (9 months to 8 years). There was a male predominance with sex ratio of 1.66. The mean burn surface size burn was 26.5% with total burn surface area ranging from 5% to 33%, respectively. According to American Burn Association 37% (30/80) were severe burns with second and third degree burns >10% of the total surface body area in children aged <10 years old. Scalds represented 76.2% (61/80) of the burns. Burns by hot oil were 11 cases (13.7%), while 8 cases (10%) were flame burns. The random distribution of the groups was as follow: Group A (amoxicilline + clavulanic acid) = 25 cases, Group B (oxacilline) = 20 cases and Group C (no antibiotics) = 35 cases. Total infection rate was 20% (16/80), distributed as follow: 8 cases (50%) in Group C, 5 cases (31.2%) in Group A and 3 cases in Group B (18.7%). Infection rate in each individual group was: 22.9% (8 cases/35) in Group C, 20% (5 cases/25) in Group A and 15% (3 cases/20) in Group B (P = 0.7). They were distributed as follow: Septicaemia 12 cases/16 (75%), wound infection 4 cases/16 (25%). Bacteria isolated were with a decreasing order: Staphylococcus aureus (36.3%), Pseudomonas (27.2%), Escherichia coli (18.1%), Klebsiella (9%) and Enterobacteria (9%). There is a tendency to a delayed cicatrisation (P = 0.07) in case of hot oil burns (65.18 ± 120 days) than by flame (54.33 ± 19.8 days) than by hot water (29.55 ± 26.2 days). Otherwise no toxic shock syndrome was recorded in this study.
Conclusion:
It is concluded that adequate and careful nursing of burn wounds seems to be sufficient to prevent complications and to obtain cicatrisation. Antibiotics are indicated only to treat confirmed infections.
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