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Study of antibiotic prophylaxis during burn wound debridement in children
G L Rodgers1, M C Fisher, A Lo
1Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA 19134-1095, USA.
Insights
Antibiotic prophylaxis with cefazolin is not necessary for children with less than 35% total body surface area burns. Cefazolin was also ineffective in preventing burn wound infections in children with larger burns.
Area of Science:
- Pediatric Surgery
- Infectious Disease
- Wound Care
Background:
- Antibiotic prophylaxis is commonly used in burn care.
- The necessity and effectiveness of prophylactic antibiotics in pediatric burn patients undergoing debridement and grafting require further investigation.
Purpose of the Study:
- To assess the need and effectiveness of antibiotic prophylaxis at the time of burn wound debridement and grafting in pediatric patients.
Main Methods:
- A randomized, prospective, partially blinded study involving 23 children.
- Patients were stratified by total body surface area (TBSA) burn size (<35% TBSA or ≥35% TBSA).
- Interventions included cefazolin, placebo, or targeted antibiotics based on surveillance cultures; blood and tissue cultures, and histologic examination were performed.
Main Results:
- For burns <35% TBSA, infections occurred in both cefazolin (2/?) and placebo (1/?) groups; quantitative cultures and histology did not predict infection.
- For burns ≥35% TBSA, all patients receiving cefazolin developed burn wound infections (3/3), while one patient receiving targeted antibiotics did not.
- Quantitative tissue cultures showed >10(5) CFU/g in all severe burn cases, but histology was positive in only one.
Conclusions:
- Cefazolin prophylaxis was not necessary for pediatric patients with <35% TBSA burns.
- Cefazolin prophylaxis was ineffective in preventing burn wound infections in pediatric patients with ≥35% TBSA burns.
Abstract:
Twenty-three children completed a randomized, prospective, partially blinded study performed to assess the need and effectiveness of antibiotic prophylaxis at the time of burn wound debridement and grafting. Patients with a total body surface area (TBSA) burn less than 35% were randomized to receive cefazolin or placebo. Patients with burns of 35% or more TBSA were randomized to receive cefazolin or targeted antibiotics based on surveillance cultures. Blood cultures were obtained at commencement, immediately after, and 24 hours after surgical debridement. Quantitative cultures and histologic examination of biopsied burn wounds were performed. Burn wound infection occurred in three patients with burns of less than 35% TBSA, two in the cefazolin group and one in the placebo group. Quantitative tissue cultures and histologic examination did not predict either infection. During the four procedures in three patients with 35% or more TBSA, three were randomized to receive cefazolin, and one targeted antibiotics. All receiving cefazolin developed burn wound infection. Quantitative tissue culture was more than 10(5) colony-forming units per gram in all, whereas histologic examination was positive in one. In our patients with less than 35% burn, cefazolin was not necessary, and in those with 35% or more burn, it was not effective.