Use of selective decontamination of the digestive tract in burn patients: A European survey

Infectious complications are a major cause of morbidity and mortality in burn patients. Selective decontamination of the digestive tract (SDD) is a prophylactic antimicrobial strategy aimed at suppressing potential pathogenic microorganisms in the gut microbiome. This study aimed to assess the values and preferences for the use of SDD in burn centres across Europe and to evaluate clinicians' interest in further research on its efficacy.

We circulated a survey on the values and preferences for the use of SDD between March and October 2024, targeting surgeons, anaesthesiologists, and intensivists at European burn centres. The survey comprised 13 questions focusing on SDD usage criteria, regimens, and willingness to participate in a multicentre randomised clinical trial. Data were analysed and presented descriptively.

We invited 45 burn centres to participate; 22 responded (49 % response rate). Among these, 27 % (6/22) reported routine use of SDD, primarily for patients with extensive burns or those requiring intensive care. Most centres using SDD (5/6) administered a combination of enteral and intravenous antibiotics and/or antifungals, while one centre (1/6) relied on enteral antimicrobials alone. The most common regimen included intravenous cefotaxime combined with enteral polymyxin E, tobramycin, and amphotericin B or nystatin. Notably, 82 % (18/22) of respondents expressed interest in participating in a multicentre randomised clinical trial on SDD in burn patients.

A minority of European burn centres routinely used SDD, while the majority did not. Among those that used SDD, treatment regimens were largely aligned with practices commonly used in ICU patients. Notably, there was significant interest among European burn centres in participating in future clinical trials comparing SDD versus no SDD in burn patients.