Antibiotic Prophylaxis in Small (≤20% TBSA) Burn Excisions Does Not Affect Patient Outcomes

Antibiotic prophylaxis does not significantly affect outcomes in patients with small burns [≤20% total body surface area (TBSA)], a new study finds. 

Researchers from Johns Hopkins University School of Medicine recently conducted a retroactive review of 76 patients admitted to the institution’s burn center during an 18-month period. Included patients presented with a 20% or less TBSA burn and at least 1 burn excision in the operating room. The study found “no significant difference in postoperative infection, graft loss, or 30-day readmission in two similar patient cohorts who received or did not receive prophylactic perioperative antibiotics for acute excision of small (≤20% TBSA) burns.”

Every year, there are nearly 500,000 burn injuries in the United States requiring medical treatment. Increasing survival rates over recent decades can be attributed to improved care protocols, but infection is still a major cause of morbidity and mortality among burn patients and can lead to complications, including graft loss, longer hospital stays, and increased rates of readmission. There is currently mixed evidence on the use of perioperative prophylactic antibiotics, resulting in difficult decision-making processes for clinicians.

“Perioperative antibiotics are often used in cutaneous surgery for extensive burn injuries, during which the large surface area of the surgical site and altered physiology puts the patient at high risk of local and systemic infection,” notes the study’s author. “However, no standardized data exist for prophylactic use of antibiotics in small burns, a scenario in which these risks are reduced.”

In this study, researchers reviewed charts from 336 patients who had been admitted to the burn center between January 2020 and July 2021. After excluding all patients with more than 20% TBSA burns, those who did not undergo burn excision, and those who presented with a preoperative infection, 76 patients made up the final cohort. Of this group, 29 patients were administered prophylactic perioperative antibiotics, while 47 were not. The data showed no statistical differences in the patients’ age, body mass index, TBSA, percent third-degree burn, or comorbidities between groups who did or did not receive prophylactic antibiotics perioperatively.

Researchers examined three primary outcomes: graft loss, infection, and 30-day readmission. The study showed no statistically significant difference in any of these outcomes among the two groups. As a result, the author noted that potential reduction in the risk of infection should be weighed against antibiotic stewardship practices to maintain effective therapies for multidrug-resistant organisms, to which burn patients are particularly susceptible.

Reviewing the lack of statistical difference in outcomes for patients who did or did not receive antibiotics prophylactically, the author of the study concludes by noting the potential for further studies to be done in this area, writing, “Although the power of the study is low, we feel that the results provide adequate justification for a practice-altering prospective trial to further characterize the use or nonuse of antibiotic prophylaxis in small burns.”

-Kirra Fedyszyn, Associate Digital Editor

Reference: 
Puthumana JS, Khan IF, Tiongco RFP, et al. Is Antibiotic Prophylaxis Necessary in Small (≤20% TBSA) Burn Excisions? A Retrospective Study. Plast Reconstr Surg Glob Open. 2022;10(6):e4388. Published 2022 Jun 21. doi:10.1097/GOX.0000000000004388