title: Prophylactic Antibiotics May Improve Outcome in Patients With Severe Burns Requiring Mechanical Ventilation: Propensity Score Analysis of a Japanese Nationwide Database.
abstract: BACKGROUND
  The use of prophylactic antibiotics for severe burns in general settings remains controversial and is not suggested by recent guidelines owing to lack of evidence for efficacy. We examined the hypothesis that prophylactic systemic antibiotic therapy may reduce mortality in patients with severe burns.
  
  
  METHODS
  We identified 2893 severe burns patients (burn index ≥ 10) treated at 583 hospitals between July 2010 and March 2013 using the Japanese diagnosis procedure combination inpatient database. We categorized the patients according to whether they received mechanical ventilation within 2 days after admission (n = 692) or not (n = 2201). We further divided the patients into those with and without prophylactic antibiotics and generated 232 and 526 propensity score-matched pairs, respectively. We evaluated 28-day all-cause in-hospital mortality.
  
  
  RESULTS
  Among the mechanically ventilated patients, significant differences in 28-day in-hospital mortality existed between control and prophylaxis groups in both unmatched (control vs prophylaxis; 48.6% vs 38.3%; difference, 10.2%; 95% confidence interval [95% CI], 2.7 to 17.7) and propensity score-matched groups (47.0% vs 36.6%; difference, 10.3%; 95% CI, 1.4 to 19.3). Among patients without mechanical ventilation, there was no significant difference in 28-day in-hospital mortality between the 2 groups in both the unmatched (control vs prophylaxis; 7.0% vs 5.8%; difference, 1.2%; 95% CI, -1.2 to 3.5) and propensity-matched groups (5.1% vs 4.2%; difference, 0.9%; 95% CI, -1.6 to 3.5).
  
  
  CONCLUSIONS
  Prophylactic antibiotics use may result in improved 28-day in-hospital mortality in mechanically ventilated patients with severe burns but not in those who do not receive mechanical ventilation.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, the University of Tokyo Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tagami
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, the University of Tokyo.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, the University of Tokyo.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D002056:Burns / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; burns; pneumonia; prognosis; sepsis