Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis

Autoři: Alexandra Csenkey aff001;  Gergo Jozsa aff001;  Noemi Gede aff003;  Eszter Pakai aff001;  Benedek Tinusz aff003;  Zoltan Rumbus aff001;  Anita Lukacs aff004;  Zoltan Gyongyi aff005;  Peter Hamar aff003;  Robert Sepp aff006;  Andrej A. Romanovsky aff007;  Peter Hegyi aff003;  Peter Vajda aff002;  Andras Garami aff001
Působiště autorů: Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary aff001;  Department of Paediatrics, Surgical Division, University of Pecs, Pecs, Hungary aff002;  Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary aff003;  Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary aff004;  Department of Public Health Medicine, Medical School, University of Pecs, Pecs, Hungary aff005;  Second Department of Internal Medicine and Cardiology Centre, University Szeged, Szeged, Hungary aff006;  Thermoregulation and Systemic Inflammation Laboratory (FeverLab), Trauma Research, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America aff007
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223063


In pediatric burns the use of systemic antibiotic prophylaxis is a standard procedure in some burn centers, though its beneficial effect on the infectious complications is debated. The present meta-analysis aimed at determining whether systemic antibiotic prophylaxis prevents infectious complications in pediatric patients with burn injuries. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to August 2019. We included 6 studies, in which event rates of infectious complications were reported in children with burn injuries receiving or not receiving systemic antibiotic prophylaxis. We found that the overall odds ratio (OR) of developing an infection (including local and systemic) was not different between the groups (OR = 1.35; 95% CI, 0.44, 4.18). The chances for systemic infectious complications alone were also not different between antibiotic-treated and non-treated patients (OR = 0.74; 95% CI, 0.38, 1.45). Based on the age, affected total body surface area, and country income level, we did not find any subgroup that benefited from the prophylaxis. Our findings provide quantitative evidence for the inefficacy of systemic antibiotic prophylaxis in preventing infections in pediatric burns. To validate our conclusion, multinational, randomized trials in a diverse population of children with burn injuries are warranted.

Klíčová slova:

Antibiotics – Database searching – Pediatric infections – Pediatrics – Randomized controlled trials – Antibiotic prophylaxis – Burns


1. Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, et al. Recent trends in burn epidemiology worldwide: A systematic review. Burns. 2017;43(2):249–57. doi: 10.1016/j.burns.2016.08.013 27600982.

2. Laitakari E, Koljonen V, Rintala R, Pyorala S, Gissler M. Incidence and risk factors of burn injuries among infants, Finland 1990–2010. J Pediatr Surg. 2015;50(4):608–12. doi: 10.1016/j.jpedsurg.2014.05.034 25840072.

3. Vloemans AF, Dokter J, van Baar ME, Nijhuis I, Beerthuizen GI, Nieuwenhuis MK, et al. Epidemiology of children admitted to the Dutch burn centres. Changes in referral influence admittance rates in burn centres. Burns. 2011;37(7):1161–7. doi: 10.1016/j.burns.2011.05.001 21726947.

4. Celko AM, Grivna M, Danova J, Barss P. Severe childhood burns in the Czech Republic: risk factors and prevention. Bull World Health Organ. 2009;87(5):374–81. doi: 10.2471/BLT.08.059535 19551256.

5. Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care. 2010;14(5):R188. doi: 10.1186/cc9300 20958968.

6. Peck MD. Epidemiology of burns throughout the world. Part I: distribution and risk factors. Burns. 2011;37(7):1087–100. doi: 10.1016/j.burns.2011.06.005 21802856.

7. Hyder AA, Sugerman DE, Puvanachandra P, Razzak J, El-Sayed H, Isaza A, et al. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ. 2009;87(5):345–52. doi: 10.2471/BLT.08.055798 19551252.

8. Sengoelge M, El-Khatib Z, Laflamme L. The global burden of child burn injuries in light of country level economic development and income inequality. Prev Med Rep. 2017;6:115–20. doi: 10.1016/j.pmedr.2017.02.024 28316905.

9. Park JO, Shin SD, Kim J, Song KJ, Peck MD. Association between socioeconomic status and burn injury severity. Burns. 2009;35(4):482–90. doi: 10.1016/j.burns.2008.10.007 19216029.

10. Jamshidi R, Sato TT. Initial assessment and management of thermal burn injuries in children. Pediatr Rev. 2013;34(9):395–404. doi: 10.1542/pir.34-9-395 24000343.

11. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. 2006;19(2):403–34. doi: 10.1128/CMR.19.2.403-434.2006 16614255.

12. Geyik MF, Aldemir M, Hosoglu S, Tacyildiz HI. Epidemiology of burn unit infections in children. Am J Infect Control. 2003;31(6):342–6. 14608300.

13. Williams FN, Herndon DN, Hawkins HK, Lee JO, Cox RA, Kulp GA, et al. The leading causes of death after burn injury in a single pediatric burn center. Crit Care. 2009;13(6):R183. doi: 10.1186/cc8170 19919684.

14. Rodgers GL, Mortensen J, Fisher MC, Lo A, Cresswell A, Long SS. Predictors of infectious complications after burn injuries in children. Pediatr Infect Dis J. 2000;19(10):990–5. doi: 10.1097/00006454-200010000-00010 11055602.

15. Papini RP, Wilson AP, Steer JA, McGrouther DA, Parkhouse N. Wound management in burn centres in the United Kingdom. Br J Surg. 1995;82(4):505–9. Epub 1995/04/01. doi: 10.1002/bjs.1800820423 7613896.

16. Lymperopoulos NS, Jeevan R, Godwin L, Wilkinson D, Shokrollahi K, James MI. The introduction of standard operating procedures to improve burn care in the United Kingdom. J Burn Care Res. 2015;36(5):565–73. Epub 2014/12/17. doi: 10.1097/BCR.0000000000000210 25501782.

17. Davies A, Spickett-Jones F, Brock P, Coy K, Young A. Variations in guideline use and practice relating to diagnosis and management of infection in paediatric burns services in England and Wales: A national survey. Burns. 2017;43(1):215–22. doi: 10.1016/j.burns.2016.07.032 27597639.

18. Ergun O, Celik A, Ergun G, Ozok G. Prophylactic antibiotic use in pediatric burn units. Eur J Pediatr Surg. 2004;14(6):422–6. doi: 10.1055/s-2004-821065 15630646.

19. Soleymanzadeh-Moghadam S, Azimi L, Amani L, Rastegar Lari A, Alinejad F, Rastegar Lari A. Analysis of antibiotic consumption in burn patients. GMS Hyg Infect Control. 2015;10:Doc09. Epub 2015/07/01. doi: 10.3205/dgkh000252 26124986.

20. Thorpe KE, Joski P, Johnston KJ. Antibiotic-resistant infection treatment costs have doubled since 2002, now exceeding $2 billion annually. Health Aff (Millwood). 2018;37(4):662–9. Epub 2018/03/22. doi: 10.1377/hlthaff.2017.1153 29561692.

21. Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M. Prophylactic antibiotics for burns patients: systematic review and meta-analysis. BMJ. 2010;340:c241. doi: 10.1136/bmj.c241 20156911.

22. Barajas-Nava LA, Lopez-Alcalde J, Roque i Figuls M, Sola I, Bonfill Cosp X. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev. 2013;(6):CD008738. doi: 10.1002/14651858.CD008738.pub2 23740764.

23. Committee IPG, Steering S, Advisory S. ISBI Practice Guidelines for Burn Care. Burns. 2016;42(5):953–1021. doi: 10.1016/j.burns.2016.05.013 27542292.

24. Olah E, Poto L, Hegyi P, Szabo I, Hartmann P, Solymar M, et al. Therapeutic whole-body hypothermia reduces death in severe traumatic brain injury if the cooling index is sufficiently high: meta-analyses of the effect of single cooling parameters and their integrated measure. J Neurotrauma. 2018;35(20):2407–17. Epub 2018/04/24. doi: 10.1089/neu.2018.5649 29681213.

25. Rumbus Z, Matics R, Hegyi P, Zsiboras C, Szabo I, Illes A, et al. Fever is associated with reduced, hypothermia with increased mortality in septic patients: a meta-analysis of clinical trials. PLoS One. 2017;12(1):e0170152. doi: 10.1371/journal.pone.0170152 28081244.

26. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097 19621072.

27. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. Epub 2011/10/20. doi: 10.1136/bmj.d5928 22008217.

28. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000 [August, 2019]. Available from:

29. Chahed J, Ksia A, Selmi W, Hidouri S, Sahnoun L, Krichene I, et al. Burns injury in children: is antibiotic prophylaxis recommended? Afr J Paediatr Surg. 2014;11(4):323–5. doi: 10.4103/0189-6725.143141 25323182.

30. Mulgrew S, Khoo A, Cartwright R, Reynolds N. Morbidity in pediatric burns, toxic shock syndrome, and antibiotic prophylaxis: a retrospective comparative study. Ann Plast Surg. 2014;72(1):34–7. doi: 10.1097/SAP.0b013e31829be8be 24056250.

31. Rashid A, Brown AP, Khan K. On the use of prophylactic antibiotics in prevention of toxic shock syndrome. Burns. 2005;31(8):981–5. doi: 10.1016/j.burns.2005.06.017 16288963.

32. Rosanova MT, Stamboulian D, Lede R. Infections in burned children: epidemiological analysis and risk factors. Arch Argent Pediatr. 2013;111(4):303–8. doi: 10.1590/S0325-00752013000400008 23912287.

33. Sheridan RL, Weber JM, Pasternack MS, Tompkins RG. Antibiotic prophylaxis for group A streptococcal burn wound infection is not necessary. J Trauma. 2001;51(2):352–5. doi: 10.1097/00005373-200108000-00022 11493799.

34. Krishnamoorthy V, Ramaiah R, Bhananker SM. Pediatric burn injuries. Int J Crit Illn Inj Sci. 2012;2(3):128–34. doi: 10.4103/2229-5151.100889 23181206.

35. Natterer J, de Buys Roessingh A, Reinberg O, Hohlfeld J. Targeting burn prevention in the paediatric population: a prospective study of children's burns in the Lausanne area. Swiss Med Wkly. 2009;139(37–38):535–9. doi: smw-12605 19838870.

36. Rawlins JM, Khan AA, Shenton AF, Sharpe DT. Epidemiology and outcome analysis of 208 children with burns attending an emergency department. Pediatr Emerg Care. 2007;23(5):289–93. doi: 10.1097/01.pec.0000248698.42175.2b 17505269.

37. Lee F, Wong P, Hill F, Burgner D, Taylor R. Evidence behind the WHO guidelines: hospital care for children: what is the role of prophylactic antibiotics in the management of burns? J Trop Pediatr. 2009;55(2):73–7. doi: 10.1093/tropej/fmp017 19276147.

38. Turner RM, Davey J, Clarke MJ, Thompson SG, Higgins JP. Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews. Int J Epidemiol. 2012;41(3):818–27. Epub 2012/03/31. doi: 10.1093/ije/dys041 22461129.

39. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 [August 2019]. Available from:

Článek vyšel v časopise


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…

Kurzy Doporučená témata