This article is more than 5 years old. Information may no longer be current.
Prophylactic antibiotics reduce mortality in mechanically ventilated burn patients
Click Here to Manage Email Alerts
The use of prophylactic antibiotics appeared to improve 28-day, in-hospital mortality in mechanically ventilated patients with severe burns, according to recent findings.
“However, this association was not found in patients with severe burns who did not receive mechanical ventilation,” researchers from Japan wrote.
The researchers used the Japanese diagnosis procedure combination (DPC) database to assess 2,893 severe burn patients (burn index ≥10) treated at 583 hospitals from July 2010 to March 31, 2013. They determined whether patients received mechanical ventilation within 2 days post-admission (n = 692) and established 232 propensity-matched pairs for those who received mechanical ventilation and 526 propensity-matched pairs for those who did not receive mechanical ventilation (n = 2,201).
The primary endpoint was all-cause, 28-day, in-hospital mortality. Secondary endpoints included in-hospital mortality and the use of carbapenem, piperacillin-tazobactam (PTZ), fourth-generation cephalosporins, and agents used to treat MRSA.
The overall rate of 28-day, in-hospital mortality was 15.2%, and a significant difference was observed between those who received mechanical ventilation and those who did not (42.5% vs. 6.7%).
Propensity score-adjusted logistic regression analyses showed the use of prophylactic antibiotics was significantly associated with lower 28-day, in-hospital mortality in mechanically ventilated patients (OR = 0.71; 95% CI, 0.52-0.96). These differences were observed in both the unmatched (difference, 10.2%; 95% CI, 2.7-17.7) and the propensity-matched groups (difference, 10.3% 95% CI, 1.4-19.3).
There was no difference in 28-day, in-hospital mortality in both the unmatched and propensity-matched nonmechanically ventilated groups.
In a related editorial, Péter Hankovszky, MD, of the anesthesiology and intensive therapy department at the University of Szeged, Hungary, and colleagues wrote mechanical ventilation alone may not be an adequate indicator for administering prophylactic antibiotics to burn patients. Focused individual care, such as assessing biomarkers of inflammation and organ dysfunction scores, may provide a better understanding of each patient’s needs, they said.
“Nevertheless, what we know at present should be enough to tip the scale toward refraining from antibiotic prophylaxis in the severely burned patients in general, but considering it in those requiring mechanical ventilation,” Hankovszky and colleagues wrote. – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts