Volume 11, Issue 3 (2022)                   WJPS 2022, 11(3): 3-12 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Garcia J A G, Chavez A M G, Grados J D J O. Topical Antimicrobial Agents for the Prevention of Burn-Wound Infection. What Do International Guidelines Recommend? A Systematic Review. WJPS 2022; 11 (3) :3-12
URL: http://wjps.ir/article-1-988-en.html
1- Harvard T.H. Chan School of Public Health, Social and Behavioral Sciences, Boston, U.S.A.
2- Hospital Español de Mexico. Mexico City, Mexico.
3- Hospital Angeles Queretaro. Queretaro, Mexico.
Abstract:   (1321 Views)
Background:  Choosing adequate topical antimicrobial agents in burn patients still represents a challenge. Therefore, this systematic review was conducted to compile and evaluate current recommendations in international clinical practice guidelines (CPGs) to develop more consistent clinical guidance.
Methods:  A systematic search for CPGs was conducted independently by two reviewers using PubMed, EMBASE, Google Scholar, and external citations. The quality of the selected CPGs was evaluated separately using the AGREE II instrument, and intraclass correlation coefficients were calculated. Statistical analysis was performed using R V 1.4.1 statistical software.
Results: Eleven CPGs were included in the study. Most guidelines tend to recommend silver-containing dressings over antiseptics or antibiotics, regardless of the depth of the burn. Silver sulfadiazine is the most recommended topical antimicrobial in low-resource settings. An overall mean appraisal AGREE II score of 68.2% was obtained. The global intraclass correlation coefficient was 0.62 (95% confidence intervals 0.54-0.69), which corresponds to a substantial global concordance between both appraisers.
Conclusions:  Great heterogeneity was found between recommendations and CPGs. The three determining factors considered to issue a recommendation were the clinical scenario, burn-wound depth, and burn severity. There is consensus among the guidelines to use topical antimicrobials as a tool to prevent infection, and most of these recommend the use of silver-containing dressings for most scenarios. However, there is currently no ideal topical antimicrobial agent that can be recommended for all clinical scenarios. The development of more consistent recommendations is warranted to standardize clinical practice.
Keywords: Burn, Infection, Prevention, Antimicrobials, Topical
Supplementary file
Full-Text [PDF 530 kb]   (1148 Downloads)    
Type of Study: Review Article | Subject: Special
ePublished: 2022/12/12

1. American Burn Association. National Burn Repository: 2019 Update, Report of data from 2009-2018. 2019
2. Greenhalgh DG, Saffle JR, Holmes JH 4th, Gamelli RL, Palmieri TL, Horton JW, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res 2007;28(6):776-90. doi: 10.1097/BCR.0b013e3181599bc9 [DOI:10.1097/BCR.0b013e3181599bc9]
3. Corcione S, Pensa A, Castiglione A, Lupia T, Bortolaso B, Romeo MR, et al. Epidemiology, prevalence and risk factors for infections in burn patients: results from a regional burn centre's analysis. J Chemother 2021;33(1):62-6. doi: 10.1080/1120009X.2020.1780776 [DOI:10.1080/1120009X.2020.1780776]
4. Rowan MP, Cancio LC, Elster EA, Burmeister DM, Rose LF, Natesan S, et al. Burn wound healing and treatment: review and advancements. Crit Care 2015;19(1):243. doi: 10.1186/s13054-015-0961-2 [DOI:10.1186/s13054-015-0961-2]
5. Norbury W, Herndon DN, Tanksley J, Jeschke MG, Finnerty CC. Infection in burns. Surg Infect (Larchmt) 2016;17(2):250-5. doi: 10.1089/sur.2013.134 [DOI:10.1089/sur.2013.134]
6. Mir MA, Khurram MF, Khan AH. What should be the antibiotic prescription protocol for burn patients admitted in the department of burns, plastic and reconstructive surgery: Antibiotic prescription protocol for burn patients. Int Wound J 2017;14(1):194-7. doi: 10.1111/iwj.12588 [DOI:10.1111/iwj.12588]
7. Cambiaso-Daniel J, Boukovalas S, Bitz GH, Branski LK, Herndon DN, Culnan DM. Topical antimicrobials in burn care: Part 1-topical antiseptics. Ann Plast Surg 2018; doi: 10.1097/SAP.0000000000001297 [DOI:10.1097/SAP.0000000000001297]
8. Merchant N, Smith K, Jeschke MG. An ounce of prevention saves tons of lives: Infection in burns. Surg Infect (Larchmt) 2015;16(4):380-7. doi: 10.1089/sur.2013.135 [DOI:10.1089/sur.2013.135]
9. Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers 2020;6(1):11. doi: 10.1038/s41572-020-0145-5 [DOI:10.1038/s41572-020-0145-5]
10. Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T. Antiseptics for burns. Cochrane Database of Systematic Reviews 2017. [DOI:10.1002/14651858.CD011821.pub2]
11. Foster K. Clinical guidelines in the management of burn injury: a review and recommendations from the organization and delivery of burn care committee. J Burn Care Res 2014;35(4):271-83. doi: 10.1097/BCR.0000000000000088 [DOI:10.1097/BCR.0000000000000088]
12. Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database of Systematic Reviews 2013 Jun 6; [DOI:10.1002/14651858.CD008738.pub2]
13. Heyneman A, Hoeksema H, Vandekerckhove D, Pirayesh A, Monstrey S. The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review. Burns 2016;42(7):1377-86. doi: 10.1016/j.burns.2016.03.029 [DOI:10.1016/j.burns.2016.03.029]
14. Lloyd ECO, Rodgers BC, Michener M, Williams MS. Outpatient burns: prevention and care. Am Fam Physician 2012;85(1):25-32.
15. Wang Y, Beekman J, Hew J, Jackson S, Issler-Fisher AC, Parungao R. Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Advanced Drug Delivery Reviews 2018. [DOI:10.1016/j.addr.2017.09.018]
16. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010;182(18):E839-42. doi: 10.1503/cmaj.090449 [DOI:10.1503/cmaj.090449]
17. Publications. Ministry of Health NZ. [cited 2022 Sep 15]. Available from: https://www.health.govt.nz/publications?f%5B0%5D=im_field_publication_type%3A26
18. CPG infobase: Clinical practice guidelines. CMA Joule. [cited 2022 Sep 15]. Available from: https://joulecma.ca/cpg/homepage
19. Evidence search service closure information | NICE. [cited 2022 Sep 15]; Available from: https://www.evidence.nhs.uk
20. Gov.au. [cited 2022 Sep 15]. Available from: https://www.clinicalguidelines.gov.au
21. Guidelines international network. Z Evid Fortbild Qual Gesundhwes [Internet]. 2008 [cited 2022 Sep 15];102(2):119-20. Available from: https://guidelines.ebmportal.com [DOI:10.1016/j.zefq.2008.02.021]
22. American Burn Association. Journal of Burn Care and Research [Internet]. Practice Guidelines Collection. 2021 [cited 2021 Jul 24]. Available from: https://academic.oup.com/jbcr/pages/practice_guidelines_collection
23. Asia pacific burn association Apburn.org [cited 2022 Sep 15]. Available from: https://www.apburn.org
24. DGV. Verbrennungsmedizin.de [cited 2022 Sep 15]. Available from: https://verbrennungsmedizin.de
25. British Burn Association. Britishburnassociation.org [cited 2022 Sep 15]. Available from: https://www.britishburnassociation.org
26. American Burn Association. American Burn Association 2017 [cited 2022 Sep 15]. Available from: https://ameriburn.org
27. European Burns Association (EBA). European Burns Association (EBA) 2016 [cited 2022 Sep 15]. Available from: https://www.euroburn.org
28. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021;10(1):89. doi: 10.1186/s13643-021-01626-4 [DOI:10.1186/s13643-021-01626-4]
29. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15(2):155-63. doi: 10.1016/j.jcm.2016.02.012 [DOI:10.1016/j.jcm.2016.02.012]
30. NSW Statewide Burn Injury Service. Clinical Guidelines: Burn Patient Management. Agency for Clinical Innovation 2019.
31. Médecins Sans Frontières. Clinical Guidelines: Diagnosis and Treatment Manual. Chapter 10: Medical and Minor surgical procedures, Burns 2021.
32. Jeschke M, McCallum C, Baron D, Godleski M, Knighton J, Shahrokhi S. Best practice recommendations for the prevention and management of burns. In: Foundations of Best Practice for Skin and Wound Management. 2018.
33. Deutsche Gesellschaft für Verbrennungsmedizin (DGV). Behandlung thermischer Verletzungen des Erwachsenen. 2021.
34. Yastı AÇ, Şenel E, Saydam M, Özok G, Çoruh A, Yorgancı K. Guideline and treatment algorithm for burn injuries. Ulus Travma Acil Cerrahi Derg 2015;21(2):79-89. doi: 10.5505/tjtes.2015.88261 [DOI:10.5505/tjtes.2015.88261]
35. Allorto N, Atieh B, Bolgiani A, Chatterjee P, Cioffi W, Dziewulski P, et al. ISBI practice guidelines for burn care, part 2. Burns 2018;44(7):1617-706. doi: 10.1016/j.burns.2018.09.012 [DOI:10.1016/j.burns.2018.09.012]
36. Vaittinada Ayar P, Benyamina M. Prise en charge du patient brûlé en préhospitalier. Première partie : cas général et inhalation de fumées. Annals of burns and fire disasters 2019 Mar 31;32(1):22-9. Available from: https://pubmed.ncbi.nlm.nih.gov/31285730
37. ISBI Practice Guidelines Committee, Ahuja RB, Gibran N, Greenhalgh D, Jeng J, Mackie D, et al. ISBI practice guidelines for burn care. Burns 2016;42(5):953-1021. doi: 10.1016/j.burns.2016.05.013 [DOI:10.1016/j.burns.2016.05.013]
38. European Burns Association. European Practice Guidelines for Burn Care: Minimum Level of Burn Care Provision in Europe
39. Cancio LC, Barillo DJ, Kearns RD, Holmes JH IV, Conlon KM, Matherly AF, et al. Guidelines for burn care under austere conditions: Surgical and nonsurgical wound management. J Burn Care Res 2017;38(4):203-14. doi: 10.1097/bcr.0000000000000368 [DOI:10.1097/BCR.0000000000000368]
40. Yoshino Y, Hashimoto A, Ikegami R, Irisawa R, Kanoh H, Sakurai E, et al. Wound, pressure ulcer and burn guidelines - 6: Guidelines for the management of burns, second edition. J Dermatol 2020;47(11):1207-35. doi: 10.1111/1346-8138.15335 [DOI:10.1111/1346-8138.15335]
41. Grammatikopoulou MG, Theodoridis X, Gkiouras K, Stamouli E-M, Mavrantoni M-E, Dardavessis T, et al. AGREEing on guidelines for nutrition management of adult severe burn patients. JPEN J Parenter Enteral Nutr 2019;43(4):490-6. doi: 10.1002/jpen.1452 [DOI:10.1002/jpen.1452]
42. Gamst-Jensen H, Vedel PN, Lindberg-Larsen VO, Egerod I. Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines. Burns 2014;40(8):1463-9. doi: 10.1016/j.burns.2014.08.020 [DOI:10.1016/j.burns.2014.08.020]
43. Kis E, Szegesdi I, Dobos E, Nagy E, Boda K, Kemény L, et al. Quality assessment of clinical practice guidelines for adaptation in burn injury. Burns 2010;36(5):606-15. doi: 10.1016/j.burns.2009.08.017 [DOI:10.1016/j.burns.2009.08.017]
44. Marx DE, Barillo DJ. Silver in medicine: the basic science. Burns 2014;40 Suppl 1:S9-18. doi: 10.1016/j.burns.2014.09.010 [DOI:10.1016/j.burns.2014.09.010]
45. Patel PP, Vasquez SA, Granick MS, Rhee ST. Topical antimicrobials in pediatric burn wound management. J Craniofac Surg 2008;19(4):913-22. doi: 10.1097/SCS.0b013e318175b516 [DOI:10.1097/SCS.0b013e318175b516]
46. D'Abbondanza JA, Shahrokhi S. Burn infection and burn sepsis. Surg Infect (Larchmt). 2021;22(1):58-64. doi: 10.1089/sur.2020.102 [DOI:10.1089/sur.2020.102]
47. Corcione S, Pensa A, Castiglione A, Lupia T, Bortolaso B, Romeo MR, et al. Epidemiology, prevalence and risk factors for infections in burn patients: results from a regional burn centre's analysis. J Chemother 2021;33(1):62-6. doi: 10.1080/1120009X.2020.1780776 [DOI:10.1080/1120009X.2020.1780776]
48. Javanmardi, F., Emami, A., Pirbonyeh, N., Rajaee, M., Hatam, G., & Keshavarzi, A. Study of multidrug resistance in prevalent gram-negative bacteria in burn patients in Iran: A systematic review and meta-analysis. Journal of Global Antimicrobial Resistance 2019, 19, 64-72. doi: 10.1016/j.jgar.2019.04.017 [DOI:10.1016/j.jgar.2019.04.017]
49. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ 2010;182(10):E472-8. doi: 10.1503/cmaj.091716 [DOI:10.1503/cmaj.091716]

Add your comments about this article : Your username or Email:

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | World Journal of Plastic Surgery

Designed & Developed by : Yektaweb