Perioperative Antibiotic Prophylaxis in Burn Patients: Protocol for a Systematic Review

BACKGROUND: Burn injuries are associated with substantial morbidity and mortality worldwide, with infections representing a major complication. The desirable and undesirable effects of perioperative antibiotic prophylaxis in burn patients are unresolved. METHODS/DESIGN: We will conduct a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing the desirable and undesirable effects of systemic antibiotic prophylaxis in burn patients undergoing surgery, compared with placebo or no prophylaxis/standard of care. The primary outcome will be the number of patients with one or more bloodstream infections. Secondary outcomes include 30-day and 90-day mortality, the number of patients with one or more skin and soft tissue infections, ventilator-associated pneumonias, clostridium difficile infections, antimicrobial-resistant bacteria, serious adverse events, days alive without organ support (renal replacement therapy, mechanical ventilation, vasopressor), ICU- and hospital-free days. We will search the following databases: CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science, and CINAHL. The review will follow the recommendations provided by the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. DISCUSSION: The outlined systematic review and meta-analysis will evaluate the desirable and undesirable effects of perioperative antibiotic prophylaxis on patient-important outcomes and may inform clinical practice and future research in this area. TRIAL REGISTRATION: ClinicalTrials.gov identifier: CRD420261378296.