Antibiotic Prophylaxis in Patients Undergoing Burn Wound Excision

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Eleclive excision of burn wound eschar is frequently associated with transient bacteremias that may predispose to episodes of surgically induced sepsis. The need for parenteral administration of prophylactic antibiotics, often used in nonseptic burn patients undergoing early elective burn wound excision, was therefore evaluated. Sixty patients with 4% to 90% total body surface area (TBSA) burn undergoing elective burn wound excision [full- thickness eschareetomies and deep partial-thickness tangential excisions] were stratified on the basis of percent TBSB and divided into treated and untreated groups. Blood cultures were obtained preoperatively, intraoperatively, and postoperatively for temperature elevations greater than 38.5C. A positive intraoperative blood culture associated with a subsequent postoperative septic course was not identified in any patient with a burn of less than 60% TBSA, during either the initial or subsequent surgical procedures. These data show that antibiotic prophylaxis for early elective wound excision in nonseptic burn patients with less than 60% TBSB may be an unnecessary expense.

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