Increased burn patient survival with once-a-day high dose teicoplanin and netilmicin. An Italian multicenter study.
This is the final report of a large, controlled, multicenter Italian study on immuno- and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treatment of burn patients consisted of topical silver sulfadiazine, short-term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) for the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles of 5-12 days. At random, half of the patients received thymostimulin, 70 mg i.m. qd for the first month and every other day thereafter. The analysis at completion of 634 valid cases showed that when the results are stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in the first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived. There was no difference in survival of the immunotherapy group in comparison with the parallel group without thymostimulin. The short-term antimicrobial prophylaxis prevented wound infection in only 104 of 634 patients (16%) and they were at low risk (84% Roi index 1). Of the bacterial pathogens involved in septic complications Staphylococcus aureus and Pseudomonas aeruginosa were prevalent (86%): eradication was achieved in 43% of patients and clinical cure or improvement were seen with combination chemotherapy in 64% of all patients, mainly with only one treatment cycle. This value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of complier and non-complier patients was 447 of the 530 valid patients (84%). The overall mortality of the 634 evaluable patients was 13.1%, ranging from less than 2% to 68%. Burn mortality was directly proportional to the percentage of burned body surface area, to increasing age and other variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.
Donati
L
L
Div. Chirurgia Plastica e Centro Ustioni, Servizio di Microbiologia, Osp. Niguarda-Cà Granda, Milano, Italy.
Periti
P
P
Andreassi
A
A
Dioguardi
D
D
Gliori
A
A
Landi
G
G
Magliacani
G
G
Marinelli
L F
LF
Masellis
M
M
Barachini
P
P
Micali
G
G
Papadia
F
F
Rapisarda
V
V
Savoia
A
A
Bersieri
M
M
D'Arpa
N
N
De Bellis
A
A
Di Lonardo
A
A
Faggiano
G
G
Gianfaldoni
R
R
Magliano
E
E
Marasco
L
L
Novelli
A
A
Ranno
R
R
Zermani
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001830:Body Surface Area; D002056:Burns / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy; D007273:Injections, Intramuscular; D007558:Italy; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000008:administration & dosage / Q000627:therapeutic use*; D015366:Pefloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D013411:Sulfadiazine / Q000008:administration & dosage / Q000627:therapeutic use; D017334:Teicoplanin / Q000008:administration & dosage / Q000627:therapeutic use*; D014946:Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D005839:Gentamicins; D013411:Sulfadiazine; D015366:Pefloxacin; D009428:Netilmicin; D017334:Teicoplanin