Antibiotic prophylaxis for group A streptococcal burn wound infection is not necessary

Background. Historically, group A beta-hemolytic streptococci (GAS) burn wo und infection has been a major source of morbidity and mortality in burn pa tients and has prompted the prophylactic administration of antibiotics to c hildren with burns. Wound monitoring, surveillance cultures, and early exci sion of deep wounds may have changed this. Our objective in this project wa s to determine the efficacy of routine antibiotic prophylaxis in the era of early excision and closure of deep burn wounds. Methods Two cohorts of burned children were compared: all children admitted during calendar years 1992 through 1994 (group 1) and during calendar year s 1995 through 1997 (group 2). All group I children received routine GAS an tibiotic prophylaxis. Only those group 2 children with documented positive admission or surveillance cultures for GAS were treated. Results. There were 511 children in group I and 406 children in group 2. Th ey were well matched for age (4.7 +/- 0.21 years vs. 5.3 +/- 0.26 years, p = 0.06) and burn size (11.0% +/- 0.7% vs. 12.4% +/- 0.8%,p = 0.18). GAS spe cies were recovered at admission or during hospitalization from 11 (2.6%) o f group 1 children and 18 (4.4%) of group 2 children (p = 0.05), indicating a marginally higher rate of carriage in group 2. Nevertheless, in group I there were three (0.6%) who developed GAS wound infection and in group 2 th ere were four (0.98%,p = 0.71). The incidence of GAS infection in those pat ients with positive admission cultures was three (27%) of group I and four (22%) of group 2. No child developed fulminant GAS infection. Conclusion. Routine antibiotic prophylaxis of burn wounds in children in no t effective in further reducing a low baseline incidence of GAS wound infec tion if admission screening by culture is used to identify those children w ho carry the organism and early excision of deep burns is practiced.