What is the most common cause of burn wound infection?

From the Guidelines

The most common cause of burn wound infection is typically polymicrobial, with Gram-positive bacteria such as Staphylococcus aureus and Gram-negative bacteria like Pseudomonas aeruginosa and Escherichia coli being common pathogens 1. Burn wounds are highly susceptible to infection due to the loss of the skin's barrier function and compromised local blood flow, which hinders the delivery of immune cells and antibiotics to the affected area. Key factors that contribute to the development of burn wound infections include:

• The type and severity of the burn injury
• The presence of necrotic tissue
• Inadequate wound care and management
• The patient's overall health and immune status According to the study by Sartelli et al. 1, burn wound infections can be prevented or minimized with early excision of the eschar, proper wound care, and the use of topical antimicrobials. It is essential to note that bacterial cultures can aid in the selection of an appropriate antibiotic, especially in cases of bacterial drug resistance, but altered pharmacokinetic parameters in burn patients must be considered and dosing should be adjusted accordingly to maximize antibiotic efficacy 1. Regular wound cleaning, debridement of necrotic tissue, and maintaining a moist wound environment are also crucial components of burn wound infection management. Early recognition and treatment of burn wound infections are vital to prevent sepsis and other life-threatening complications.

From the FDA Drug Label

Reduction in bacterial growth after application of topical antibacterial agents has been reported to permit spontaneous healing of deep partial-thickness burns by preventing conversion of the partial thickness to full thickness by sepsis. The most common cause of burn wound infection is bacterial growth.

• Key points:
  • Bacterial colonization can lead to sepsis
  • Sepsis can cause conversion of partial-thickness burns to full-thickness burns
  • Topical antibacterial agents can reduce bacterial growth and prevent sepsis 2

From the Research

Common Causes of Burn Wound Infections

• The most common cause of burn wound infection varies depending on the study, but some of the most frequently isolated microorganisms include:
  • Staphylococcus aureus 3
  • Pseudomonas aeruginosa 4, 5, 6
  • Staphylococcus epidermidis 3, 5
  • Escherichia coli 3, 4
  • Acinetobacter baumannii 5
• Gram-positive bacteria, such as Staphylococcus aureus and Staphylococcus epidermidis, are commonly isolated from burn wound infections 3, 5
• Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter baumannii, are also frequently isolated and are associated with a higher risk of mortality 5

Antibiotic Resistance

• Burn wound infections often exhibit antibiotic resistance, making treatment challenging 3, 4, 7
• Pseudomonas aeruginosa is particularly notorious for its antibiotic resistance, with high levels of resistance to many commonly used antibiotics 4, 7
• The use of combination therapy, extended-infusion of β-lactams, and novel antibiotics such as cefiderocol may be effective in treating Pseudomonas aeruginosa infections 7

Co-Infections

• Co-infections with multiple microorganisms, such as Staphylococcus aureus and Pseudomonas aeruginosa, can be more virulent than single infections 6
• The presence of mixed bacterial flora in burn wound infections can make treatment more challenging 5