INCREASED BURN PATIENT SURVIVAL WITH ONCE-A-DAY HIGH-DOSE TEICOPLANINAND NETILMICIN - AN ITALIAN MULTICENTER STUDY

This is the final report of a large, controlled, multicenter Italian s tudy on immune-and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treat ment of burn patients consisted of topical silver sulfadiazine, short- term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) f or the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles o f 5-12 days. At random, half of the patients received thymostimulin, 7 0 mg i.m. qd for the first month and every other day thereafter.The an alysis at completion of 634 valid cases showed that when the results a re stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in th e first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived. There was no differenc e in survival of the immunotherapy group in comparison with the parall el group without thymostimulin. The short-term antimicrobial prophylax is prevented wound infection in only 104 of 634 patients (16%) and the y were at low risk (84% Roi index 1). Of the bacterial pathogens invol ved in septic complications Staphylococcus aureus and Pseudomonas aeru ginosa were prevalent (86%): eradication was achieved in 43% of patien ts and clinical cure or improvement were seen with combination chemoth erapy in 64% of all patients, mainly with only one treatment cycle. Th is value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of compl ier and non-complier patients was 447 of the 530 valid patients (84%). The overall mortality of the 634 evaluable patients was 13.1%, rangin g from less than 2% to 68%. Burn mortality was directly proportional t o the percentage of burned body surface area, to increasing age and ot her variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.