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Objectives: To conduct efficacy trials of various antibiotic regimens that had been used at the Intensive Care Unit, National Institute of Burns. Subjects and methods: A retrospective study was conducted on 101 medical records of severe burn patients admitted to the Intensive Care Unit, National Institute of Burns.
Journal of military pharmaco-medicine EFFICACY OF ANTIBIOTIC REGIMENS USED IN SEVERE BURN PATIENTS Nguyen Thi Hong Tham*; Luong Quang Anh* Nguyen Nhu Lam*; Nguyen Gia Tien SUMMARY Objectives: To conduct efficacy trials of various antibiotic regimens that had been used at the Intensive Care Unit, National Institute of Burns Subjects and methods: A retrospective study was conducted on 101 medical records of severe burn patients admitted to the Intensive Care Unit, National Institute of Burns The data were analysed by calculating and comparing the outcomes among three antibiotic regimens Results: The prophylactic-antibiotic regimens succeeced in 17.56% of cases Among the antibiotic regimens, the combination between cephalosporin and fosfomycin had 19.23% of successful cases The replaced-antibiotic regimens succeeded in 50% of patients with majority of two-antibiotic regimens (68.49%) Among two-antibiotic regimens, the combination between carbapenem and other antibiotics was predominant (54.84%) Conclusions: Effectiveness of different antibiotic regimens was different for severe burn patients Further research should be conducted to clarify the indications and effects of antibiotics for severe burn patients * Keywords: Severe burn; Antibiotic regimen; Effectiveness INTRODUCTION Treatment of severe-burn patients still has encountered challenges because of complication, especially multi-organ dysfunction, sepsis [4, 5, 6] Antibiotics are currently prescribed for prevention as well as treatment of infection post burn However, two subsequence problems including inappropriate antibiotics and uneffectiveness can affect the efficacy of antibiotics The aim of this study is: To evaluate the efficacy of several antibiotic regimens using in severe-burn patients at Intensive Care Unit, National Institute of Burns SUBJECTS AND METHODS Subjects Medical records of 101 patients with severe burn treated at the Intensive Care Unit, National Institute of Burns from 01 2014 to 12 - 2014 with the following selected criteria: patients aged in the range of 16 - 65 years old, admitted within 72 hours after burn with total burned surface area (TBSA) from 20% to 70% and full thickness burn area was not more than 50% TBSA Patients who died within the first three days post burn were excluded * National Institute of Burn Corresponding author: Luong Quang Anh (luongquanganh@yahoo.com) Date received: 26/06/2017 Date accepted: 11/08/2017 188 Journal of military pharmaco-medicine Methods A retrospective study was conducted to evaluate the effect of three antibiotic regimens by the following criteria: - Prophylatic-antibiotic regimens were used if patients still had not been infected yet: the effect was evaluated by two classifications as follows: + Effective: Patients did not show the symptoms of systemic infection during hospital stay, and clinical developments were positive without changed antibiotics + Ineffective: Patients showed the symptoms of systemic infection and other infectious complications as pneumonia, urinary infection, etc Antibiotics had to change during the treatment - Therapy-antibiotic regimens were used if patients had been infected or prophylactic-antibiotic regimens were failed The effect was evaluated by two classifications as follows: + Effective: Symptoms of infection were reduced or disappeared Burn wound was healing, and functions of human body’s organs were altering to normal Culture of bacterial blood was negative + Ineffective: Symptoms of infection were not reduced or worsen, and shock sepsis was becoming a threatened factor to the patient’s life Culture of bacterial blood was negative or positive, but culture of bacteria on burn wound was positive - Replaced-antibiotic regimens were used when/if treatment antibiotic regimens failed and its effect was assessed similarly to that of treatment antibiotic regimens * Analytical data: The data were obtained, subgrouped to the subjects of study, and compared with research criteria The data were analyzed by the use of Microsoft Excel and s 0 (14.81) (100) P4 + F + Q 0 4 (Notes: A: Aminoside; C: Cephalosporin; F: Fosfomycin; P2: Peniciline& with βlactamase inhibitors; P3: Uredo cephalosporin; P4: Carbapenem; Q: Quinolone) 191 Journal of military pharmaco-medicine antibiotic Nevertheless, there were 23/27 patients used the regimens in combination of two antibiotics, in which the outcome was 13.04% successful The combination between C and F was 39.13%, and its result was 33.33% successful Four patients were used three antibiotic regimens (P4 and F and Q), but percentage of success was zero Figure 1: Percentage of prophylacticantibiotic regimens Figure 2: Percentage of therapy-antibiotic regimens In the prophylactic-antibiotic regimens, the percentage of regimens having only one antibiotic was 9.46% (7/74 patients), and the outcome was completely unsuccessful Meanwhile, 67/74 patients used two antibiotics per regimen (19.40% successful percentage) in which the combination between C and F was major ratio (64.17%) and resulted in 16.27% successfully Next, there was the combination between C and A or Q (11.94%) with 37.5% results in success Among the therapy-antibiotic regimens, there were not regimens consisting of one 192 The combination between C and F was 52 cases, in which the effective result was 19.23% (10/52 cases) The combination between C and A/Q was 13.33% (12/90 cases) in total of two antibiotic regimens, in which its effective result was 25% (3/12 cases) As a result, using prophylacticantibiotic regimens and initial therapyantibiotic regimens was similar to the practical guidelines for burn care of the French Burns Association in 2007 [7] as well as the results in an earlier study [3] In many guidelines, selection the class of broad-spectrum beta-lactam antibiotics before gathering microbiological tests was prior [7, 8] On the contrary, the effect of prophylactic- and therapy-antibiotic regimens in combination between F or Q and P3 were negative (only one case was successful in total of five cases used preventive regimens, and no successful case was found after using infective regimens) It suggested that using antibiotics in combination was very difficult to achieve the optimal effect towards prevention and, or treatment of infection in patients with severe burn Journal of military pharmaco-medicine Table 5: Relationship between burn severity and effect of antibiotic regimens Prevention Characteristics Burn surface area (%) Fullthickness burn area (%) Treatment Total Effective Effective (n, %) Ineffective (n, %) (n, %) (n, %) Ineffective (n, %) 20 - 40 (15.09) 32 (60.37) (5.66) 10 (18.88) 53 (100) 41 - 60 (12.5) 24 (60) 11 (27.5) 40 (100) > 60 (62.5) (37.5) (100) Total 13 61 24 101 - 19 12 (14.81) 51 (62.96) (2.46) 16 (19.77) 81 (100) 20 - 39 (5.88) 10 (58.82) (5.88) (29.42) 17 (100) ≥ 40 0 (100) (100) Total 13 61 24 The results in table revealed that both prophylactic and therapy antibiotic regimens were only effective in patients with burn surface area from 20% to 40% and/or full thickness burn area under 20% TBSA It seemed that the positive trend in prevention and treatment by using antibiotic regimens was inversely proportional to the increasing burn area also burn area in depth Effect of replaced-antibiotic regimens Table 6: Replaced-antibiotic regimens and effect Number of antibiotics per regimen Results Patient Effective (n, %) Ineffective (n, %) 17 (100) (47.06) (52.94) P2 C P4 Q 163 (100) 80 (49.08) 83 (50.92) 1 C + A/F/G/Q 42 (25.77) 15 (35.71) 27 (64.29) P3 + A/F/G/Q 18 (11.04) (44.44) 10 (55.56) P4 + A/F/G/Q 93 (57.06) 51 (54.84) 42 (45.16) One antibiotic Two antibiotics P2 + F 193 Journal of military pharmaco-medicine A + F/G/Q Others 1 57 (100) 31 (54.38) 26 (45.62) P4 + A + Q/G/P 10 P4 + F + G/Q/A 27 (47.36) 15 (55.55) 12 (44.45) C + F + A/G/Q 10 P3 + Q + A/G Others 4 1 Three antibiotics Four antibiotics C+F+A+Q Total 238 (Notes: G: Glycopeptide; P: Polypeptide) 23.95 0.42 7.14 antibiotic antibiotics antibiotics 68.49 antibiotics Figure 3: Percentage of replaced-antibiotic regimens In the replaced-antibiotic regimens, there were 7.14% of regimens containing only one antibiotic, and its effective percentage was 47.06% Among the regimens containing one antibiotic, C/Q were popular administrations, and brought more positive effect than that of the others The priority of the replaced-antibiotic regimens was the regimen containing two antibiotics (163/238 in total = 68.49%), in which the effective outcome was 49.08% There were many antibiotic combinations in two antibiotic regimens The combination between P4 and other antibiotics was prior (57.06%) with 54.84% in success 194 By calculating in sum of two antibiotic regimens, the effective percentage of P4 regimens was 31.29% (51/163 cases) The next widespread combination was C or P3 and other antibiotics, and the outcome was positive When comparing with the result of a recent survey [3], the two antibiotic regimens were also common among the replaced-antibiotic regimens There were 57 patients used three antibiotic regimens, and the combination between P4 plus F with other antibiotics was prior (47.36%) with its effective treatment percentage was 55.55% Journal of military pharmaco-medicine Relation between burn injuries and effects Table 7: Relation between burn injuries and effects Results (n, %) Percentage Levels of burn injuries Ineffective (2) 50 (54.95) (30) 16.67 35 7.0 (38.46) (50) 20 - 40 41 - 60 Burn area (%) > 60 Total (6.59) (20) 91 (100) 10 (100) - 19 9.1 77 (40) 19.25 12 2.40 (13.18) (50) (2.21) (10) Total 91 (100) 10 (100) Yes 16 (17.58) (80) 2.0 37.50 Depth of burn area (%) ≥ 40 (%) 3.0 (84.61) 20 - 39 Inhalation injury (1)/(2) (times) Effective (1) No Total 75 (82.42) (20) 91 (100) 10 (100) The result showed that if the patients underwent more severe burn wounds, especially with combination of inhalation injuries, the percentage of successful treatment was trending towards decrease Conversely, it was clear that the percentage of successful treatment was increasing in tendency in case of patients suffered from less serious burn states (shallow and small burn wound without inhalation injuries) 2.0 9.10 9.10 CONCLUSION Effectiveness of different antibiotic regimens was different for severe burn patients The prophylactic-antibiotic regimens succeeded in 17.56% of cases Among the therapy-antibiotic regimens, the combination between C and F was 19.23% in success, the next was the combination between C and A/Q with the effective percentage was 25% Among replaced-antibiotics regimens, the 195 Journal of military pharmaco-medicine combination of two antibiotic was common (68.49%) Both prophylactic- and therapy-antibiotic regimens were only effective in patients with burn surface area from 20% to 40% and/or full thickness burn area under 20% total body surface area The outcome of prevention and treatment by antibiotics in patients with severe burn considerably depends on the level of burn injuries (including burn area and depth of burn area, with or without inhalation injuries) REFERENCES Bộ Y tế Dược thư Quốc gia Nhà xuất Y học 2002 Bộ Y tế Hướng dẫn sử dụng kháng sinh Nhà xuất Y học 2007 196 Nguyễn Thị Thanh Minh Khảo sát tình hình kháng kháng sinh đánh giá hiệu số liệu pháp điều trị kháng sinh bệnh nhân bỏng nặng khoa hồi sức cấp cứu viện Bỏng Quốc gia Luận văn Thạc sỹ Dược học Trường Đại học Dược Hà Nội 2011 Lê Thế Trung Bỏng - kiến thức chuyên ngành Nhà xuất Y học 2003 Herndon D.N Total burn care, third edition Saunders Elsevier 2007, chapter 10, 12, 19 Ipaktchi K, Arbabi S Advance in Burn Critical Care Critical Care Medicine 2006, 34, pp.239-244 Nicholas N Advance in Burn Care Current Opinion in Critical Care 2007, 13, pp.405-410 Saleem A.K et al Effectiveness of betalactam antimicrobial drugs against gramnegative bacteria Professional Medicine Journal 2011, 18 (2), pp.300-305 ... Effectiveness of different antibiotic regimens was different for severe burn patients The prophylactic -antibiotic regimens succeeded in 17.56% of cases Among the therapy -antibiotic regimens, the combination... Four patients were used three antibiotic regimens (P4 and F and Q), but percentage of success was zero Figure 1: Percentage of prophylacticantibiotic regimens Figure 2: Percentage of therapy -antibiotic. .. the two antibiotic regimens were also common among the replaced -antibiotic regimens There were 57 patients used three antibiotic regimens, and the combination between P4 plus F with other antibiotics