Survival benefit conferred by topical antimicrobial preparations in burn patients: a historical perspective.

Background: Topical antimicrobial agents have proven efficacy in preventing life-threatening invasive burn wound infection. Under wartime or mass-casualty conditions, however, there may be an inadequate supply of these agents. This study aimed to identify those patients most likely to benefit therefrom.

Methods: Logistical regression analysis of data from the U.S. Army Burn Center was performed. Mortality data for the period immediately preceding the introduction of topical mafenide acetate (MA) (1950-1963) were compared with data for the subsequent period (1964-1968). During the second period, MA was routinely applied but treatment was otherwise similar. The mortality decrement attributed to MA was determined for various ages and burn sizes.

Results: For patients of combatant age (20-50 years), MA was associated with a greater than 10% reduction in mortality for those with burns of 40-79% of the total body surface area (TBSA). Only a minimal effect on mortality was noted for those patients with burns smaller than 40% or greater than 79%.

Conclusions: When resources are limited, topical therapy (specifically, MA) is likely to confer the greatest survival benefit for combatants with burns of 40-79% TBSA.