Yanığa bağlı infeksiyonlarda antibiyotik kullanımı

Günümüzde, yanık nedeniyle olan ölümlerin geçmişe göre azalmasında antibiyotiklerin payı büyüktür. Ancak “geniş spektrumlu” ajanların gelişigüzel kullanılması sonucu yanık üniteleri birer virülan mikroflora alanları haline gelmişlerdir. Bir yanık ünitesinde etkili olan antibiyotik protokolü başka bir ünitede ya da aynı ünitede farklı zamanlarda etkili olamamaktadır. Bu nedenle, farklı ünitelerdeki yanık olgularında sistemik antibiyotik kullanım prensipleri değişiklik gösterebilmekte, bir ünitedeki genellemeler diğerleri için geçerli olamamaktadır. Bu yazıda, yanık olgularındaki sistemik antibiyotik kullanımı için sıkı kurallar yerine, genel anahatlardan söz edilecektir.

Antibiotic usage in burn infections

Today, antibiotics has a great role in reduction of mortality caused by burns. However, as a result of the indiscriminate use of “broad spectrum” agents, burn units became the site of virulent microflora. Application of an antibiotic usage protocol effective in one center may not be effective in another unit or at another time in the same unit. Therefore, a principle of systemic antibiotic use in burn patients for each individual unit varies and generalizations drawn from one unit may not have applicability to others. In this review, guidelines for systemic antibiotic use in burned patients will be discussed rather than rigid protocols.

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1. Alexander JW. Control of infection following burn injury, Arch Surg 1971;103(4):435-41. PMid:5094548
2. Burke JF, Quinby WC, Bondoc CC, Sheehy EM, Moreno HC. The contribution of a bacterially isolated environment to the prevention of infection in seriously burned patients, Ann Surg 1977; 186(3):377-87. http://dx.doi.org/10.1097/00000658-197709000-00016 PMid:889379 PMCid:1396349
3. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections, Clin Microbiol Rev 2006; 19(2):403-34. http://dx.doi.org/10.1128/CMR.19.2.403-434.2006 PMid:16614255 PMCid:1471990
4. Dacso CC, Luterman A, Curreri PW. Systemic antibiotic treatment in burned patients, Surg Clin North Am 1987;67(1):57-68. PMid:3101212
5. Durtschi MB, Orgain C, Counts GW, Heimbach DM. A prospective study of prophylactic penicillin in acutely burned hospitalized patients, J Trauma 1982;22(1):11-4. http://dx.doi.org/10.1097/00005373-198201000-00003
6. Ergün O, Çelik A, Ergün G, Özok G. Prophylactic antibiotic use in pediatric burn units, Eur J Pediatr Surg 2004;14(6):422-6. http://dx.doi.org/10.1055/s-2004-821065 PMid:15630646
7. Gallagher JJ, Williams-Bouyer N, Villarreal C, Heggers JP, Herndon DN. Treatment of infections in burns, “Herndon DN (ed). Total Burn Care, 3. Baskı” kitabında s.136-76, Saunders Elsevier, China (2007).
8. Lee F, Wong P, Hill F, Burgner D. Evidence behind the WHO guidelines: Hospital care for children: What is the role of prophylactic antibiotics in the management of burns, J Trop Pediatr 2009;55(2):73-7. http://dx.doi.org/10.1093/tropej/fmp017 PMid:19276147
9. Nash G, Foley FD, Goodwin MN Jr, Bruck HM, Greenwald KA, Pruitt BA Jr. Fungal burn wound infection, JAMA 1971;215(10):1664-6. http://dx.doi.org/10.1001/jama.215.10.1664
10. Pruitt BA Jr, Foley FD. The use of biopsies in burn patient care, Surgery 1973;73(6):887-97. PMid:4703490
11. Sharma RK, Parashar A. Special considerations in paediatric burn patients, Indian J Plast Surg 2010;43(Suppl):43-50. http://dx.doi.org/10.4103/0970-0358.70719 PMid:21321657 PMCid:3038395
12. Sheridan RL, Weber JM, Pasternack MS, Tompkins RG. Antibiotic prophylaxis for group A streptococcal burn wound infection is not necessary, J Trauma 2001;51(2):352-5. http://dx.doi.org/10.1097/00005373-200108000-00022
13. Wilkins TJ, Bennett JE. The selective use of systemic antibiotics in the treatment of burns, Surg Gynecol Obstet 1980;151(3):404-6. PMid:7404315