Skin Grafting as a Preventive Strategy Against Infections in Children With Deep Burns

Background Infectious complications are a significant cause of morbidity and mortality in deep burn patients, especially pediatric ones. While autologous split thickness skin grafting is commonly used after escharectomy to promote wound healing, its effect on reducing infection rates and the need for antibiotics in this population is not well understood. Objective This study aimed to evaluate the impact of skin grafting on the incidence of wound infectious complications, systemic inflammatory response syndrome (SIRS) development, and the need for antibiotic treatment, in pediatric patients. Methods A retrospective cohort of 123 pediatric burn patients treated at Bufalini Hospital, Cesena, Italy, between 2018 and 2024 was analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. Cox proportional hazards models were applied to assess the influence of grafting on the time to wound infectious complications, subseqeunt SIRS development, and need for antibiotic treatment. Sensitivity analysis using both time-insensitive logistic models and leave-one-out approach were performed to assess robustness of findings. Results Skin grafting significantly reduced the risk of wound infectious complications (Hazard Ratio = 0.12, 95% CI: 0.02 - 0.58, p < 0.01) and SIRS development (Hazard Ratio = 0.14, 95% CI: 0.03 - 0.73, p = 0.02). A non-significant trend was also identified for the need of antibiotic treatment. Sensitivity analysis confirmed the robustness of the results. Conclusion Autologous split thickness grafting plays a critical role in preventing infectious complications in pediatric burn patients. In children with deep burns, early skin grafting may play a pivotal role as part of the treatment protocol, pending confirmation from larger multi-center studies.