What is the most common cause of pneumonia in burn wound patients, pneumonia or the burn wound itself?

From the Guidelines

Burn wound infection is the most common cause of infection in burn patients, not pneumonia. Burn wounds are particularly susceptible to infection because the protective barrier of the skin is compromised, exposing underlying tissues to environmental pathogens 1. The damaged tissue provides an ideal medium for bacterial growth, with common pathogens including Pseudomonas aeruginosa, Staphylococcus aureus, and various gram-negative bacteria. According to a recent study, infections among burn patients are common and are associated with high mortality rate, with infections preceding multiorgan dysfunction in 83% of patients and were considered as the direct cause of death in 36% of patients 1. While pneumonia can occur in burn patients, especially those with inhalation injuries or those requiring mechanical ventilation, it is secondary to burn wound infections in frequency. Some key points to consider in the management of burn wound infections include:

• The use of systemic antibiotic prophylaxis administered in burn patients in the first 4–14 days significantly reduced all cause mortality by nearly a half 1
• Topical antibiotic prophylaxis applied to burn wounds had no beneficial effects, and silver sulfadiazine was associated with a statistically significant increase in burn wound infection compared with dressings/skin substitute 1
• The role of an adequate source control including surgical removal of contaminated material and areas of necrosis and protection of the exposed lesion is crucial in decreasing the infective risk 1 Management of burn wound infections typically involves topical antimicrobials, along with systemic antibiotics when necessary, and regular wound cleaning, debridement of necrotic tissue, and early excision and grafting of deep burns are essential preventive measures. Infection risk increases with burn size, depth, and patient factors such as age and comorbidities, making infection control protocols critical in burn care units.

From the Research

Burn Wound Infection vs Pneumonia

• The most common cause of infection in burn patients is the burn wound itself, accounting for 60.8% of infections, followed by respiratory tract infections (22.2%) 2.
• Burn wound infections are often caused by bacteria such as Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa 2, 3.
• Pneumonia is a significant concern in burn patients, but the burn wound is the more common source of infection 2.

Comparison of Burn Wound Infection and Pneumonia

• Burn wound infections are more prevalent than pneumonia in burn patients, with 60.8% of infections originating from the burn wound 2.
• The most common pathogens involved in burn wound infections are Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa 2, 3.
• Pneumonia is a significant complication in burn patients, but the burn wound is the primary source of infection 2.

Antibiotic Sensitivity and Resistance

• The cultured bacteria from burn wound infections show high sensitivity to empirical antibiotics such as amikacin and ceftazidime 2.
• However, there is a growing concern of antibiotic resistance, particularly among Pseudomonas aeruginosa isolates 4, 5, 6.
• The choice of antibiotic therapy should be guided by the epidemiology, patient's risk factors, site of infection, and available treatment options 4.