What is the most common cause of pneumonia or burn wound infection in patients with burns?

From the Guidelines

The most common cause of burn wound infection is Pseudomonas aeruginosa, with other common pathogens including Staphylococcus aureus, Klebsiella species, Acinetobacter, and various fungi like Candida species. Burn wounds create an ideal environment for bacterial colonization due to the destruction of the skin barrier and the presence of devitalized tissue. P. aeruginosa thrives in these conditions because it can tolerate a wide range of temperatures and has minimal nutritional requirements 1. Infection typically develops 5-7 days after the burn injury. Prevention involves proper wound care with topical antimicrobials, along with appropriate debridement of necrotic tissue. Systemic antibiotics are not routinely used prophylactically but are initiated when there are signs of invasive infection.

Key Points to Consider

• Early excision and grafting of deep burns significantly reduces infection risk by removing the dead tissue that serves as a bacterial reservoir 1.
• The role of an adequate source control, including surgical removal of contaminated material and areas of necrosis, is crucial in decreasing the infective risk 1.
• Antibiotic prophylaxis could protect high-risk patients from infectious complications, but its use should be carefully considered due to the risk of promoting antibiotic resistance 1.
• Topical antibiotic prophylaxis, such as silver sulfadiazine, may not be beneficial and could potentially increase the risk of burn wound infection 1.

Management Strategies

• Proper wound care and debridement of necrotic tissue are essential for preventing burn wound infections 1.
• Systemic antibiotics should be used judiciously and only when there are signs of invasive infection 1.
• Early excision and grafting of deep burns can significantly reduce the risk of infection 1.

From the Research

Burn Wound Infection vs Pneumonia

• The most common cause of infection in burn patients can be either burn wound infection or pneumonia, depending on the source and prevalent microorganisms.
• According to 2, the most common bacteria involved in burn wound infections are Staphylococcus aureus (46%), followed by Staphylococcus epidermidis (17%), Escherichia coli (16%), Proteus spp. (12%), Klebsiella pneumoniae (10%), and Pseudomonas aeruginosa (7%).
• However, 3 suggests that the most prevalent causes of burn wound infection are Klebsiella pneumoniae (30.2%), Staphylococcus aureus (24.3%), and Pseudomonas aeruginosa (21.0%).

Comparison of Burn Wound Infection and Pneumonia

• Both burn wound infection and pneumonia can be caused by similar microorganisms, such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus.
• However, the sensitivity and specificity of these microorganisms to empirical antibiotics therapy may vary, as shown in 3 and 4.
• The source of infection, whether it is burn wound or pneumonia, determines the most likely organism and its sensitivity profile, as indicated in 3.

Prevalence of Burn Wound Infection

• The incidence of clinically significant burn wound infection can be low, as reported in 4, but the morbidity due to debridement and re-grafting can be significant.
• The prevalence of burn wound infection can vary depending on the population and setting, as shown in 2, 3, and 5.
• The common pathogens in burn wound and changes in their drug sensitivity are important to monitor, as highlighted in 5 and 6.