Digestive decontamination in burn patients: A systematic review of randomized clinical trials and observational studies

• Published in: Burns 2018-02, Vol.44 (1), p.16-23
• Main Authors: Rubio-Regidor, Mercedes, Martín-Pellicer, Ana, Silvestri, Luciano, van Saene, Hendrik K.F., Lorente, José A., de la Cal, Miguel A.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial Infections - drug therapy; Bacterial Infections - mortality; Burns - complications; Burns - mortality; Cross Infection - prevention & control; Decontamination - methods; Digestive System Diseases - drug therapy; Digestive System Diseases - microbiology; Digestive System Diseases - mortality; Humans; Incidence; Observational Studies as Topic; Randomized Controlled Trials as Topic; Survival Analysis
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2017.04.001

[Display omitted] •Infections in burn patients are mainly caused by pathogenic flora previously carried in the digestive tract, oropharynx and rectum.•The impact of administration of non-absorbable enteral antibiotics or full SDD on survival and infection incidence was evaluated in 5 observational and 5 randomized clinical trials. Only 1 RCT of SDD had a low risk of bias.•The results suggest that SDD may reduce the incidence of infections and increase survival in severely burned patients. The administration of enteral antibiotics does not have any impact in the incidence of infections nor in the survival of patients.•New RCTs with low risk of bias and appropriate sample size are warranted. The objective of this systematic review is to assess the effect of selective digestive decontamination (SDD) or non-absorbable enteral antibiotics (EA) on mortality, the incidence of infection and its adverse effects in burn patients. Systematic review of randomized clinical trials (RCT) or observational studies enrolling burn patients, and comparing SDD or EA prophylaxis with placebo or no treatment. The search includes Pubmed/Medline, EMBASE, WOS, Cochrane Library (1970–2015). Bibliographic references were also reviewed, as well as communications presented at conferences (2012–2015), without language restrictions. Two reviewers inspected each reference identified by the search independently; the risk of bias was assessed with the Cochrane Collaboration method for RCT and the Newcastle Ottawa Scale for observational studies. Five RCT and 5 observational studies were identified enrolling a total of 1680 patients. The overall methodological quality of the studies was poor. The pooled effect of RCT using EA was OR: 0.62 (95% CI: 0.20–1.94). The only RCT using SDD reported OR 0.20 (95% CI: 0.09–0.81). The incidence of Enterobacteriaceae bloodstream was lower in cases treated with SDD or EA. The incidence of pneumonia was only reduced in the studies using SDD. None of the studies reported an increase in antibiotic resistance but in one RCT SDD was associated to an increase in methicillin-resistant Staphylococcus aureus infections, that was controlled with enteral vancomycin. SDD and EA have shown a beneficial effect in burn patients. Both practices are safe. Higher quality RCTs should be conducted to properly assess the efficacy and safety of SDD in this population.