title: Protocol for a systematic review of quantitative burn wound microbiology in the management of burns patients.
abstract: BACKGROUND
  Sepsis from burn injuries can result from colonisation of burn wounds, especially in large surface area burns. Reducing bacterial infection will reduce morbidity and mortality, and mortality for severe burns can be as high as 15 %. There are various quantitative and semi-quantitative techniques to monitor bacterial load on wounds. In the UK, burn wounds are typically monitored for the presence or absence of bacteria through the collection and culture of swabs, but no absolute count is obtained. Quantitative burn wound culture provides a measure of bacterial count and is gaining increased popularity in some countries. It is however more resource intensive, and evidence for its utility appears to be inconsistent. This systematic review therefore aims to assess the evidence on the utility and reliability of different quantitative microbiology techniques in terms of diagnosing or predicting clinical outcomes.
  
  
  METHODS
  Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Bibliographic databases and ongoing trial registers will be searched and conference abstracts screened. Studies will be eligible if they are prospective studies or systematic reviews of burn patients (any age) for whom quantitative microbiology has been performed, whether it is compared to another method. Quality assessment will be based on quality assessment tools for diagnostic and prognostic studies and tailored to the review as necessary. Synthesis is likely to be primarily narrative, but meta-analysis may be considered where clinical and methodological homogeneity exists.
  
  
  CONCLUSIONS
  Given the increasing use of quantitative methods, this is a timely systematic review, which will attempt to clarify the evidence base. As far as the authors are aware, it will be the first to address this topic.
  
  
  BACKGROUND
  PROSPERO, CRD42015023903.
authors.affiliation: Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England. j_kwei@yahoo.com.|Royal North Shore Hospital and Manly District Hospital, Northern Sydney Area Network, Sydney, NSW, Australia. j_kwei@yahoo.com.|The Healing Foundation Burns Research Centre, Birmingham, England. j_kwei@yahoo.com.
authors.forename: Johnny
authors.initials: J
authors.lastname: Kwei
authors.affiliation: Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England. fenella.halstead@uhb.nhs.uk.|NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, England. fenella.halstead@uhb.nhs.uk.
authors.forename: Fenella D
authors.initials: FD
authors.lastname: Halstead
authors.affiliation: NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, England. J.dretzke@bham.ac.uk.|Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, England. J.dretzke@bham.ac.uk.
authors.forename: Janine
authors.initials: J
authors.lastname: Dretzke
authors.affiliation: Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England. beryl.oppenheim@uhb.nhs.uk.|NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, England. beryl.oppenheim@uhb.nhs.uk.
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Oppenheim
authors.affiliation: Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England. nmoiemen@aol.com.|The Healing Foundation Burns Research Centre, Birmingham, England. nmoiemen@aol.com.|Birmingham Children's Hospital, Birmingham, England. nmoiemen@aol.com.
authors.forename: Naiem S
authors.initials: NS
authors.lastname: Moiemen
mesh_terms: D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D058491:Bacterial Load; D002056:Burns / Q000382:microbiology* / Q000628:therapy*; D015169:Colony Count, Microbial; D006801:Humans; D012107:Research Design; D018805:Sepsis / Q000382:microbiology; D000078202:Systematic Reviews as Topic