What is the most common source of infection in burn patients: burn wound, urinary tract infection (UTI), pneumonia, thrombophlebitis, or endocarditis?

From the Guidelines

The most common source of infection in burn patients is the burn wound itself (option a). Burn wounds create an ideal environment for bacterial growth due to the destruction of the skin's protective barrier, exposure of protein-rich dead tissue, and compromised blood supply which limits immune cell access. Infections among burn patients are common and are associated with high mortality rate, as seen in a series of 175 patients with severe burns, where infections preceded multiorgan dysfunction in 83% of patients and were considered as the direct cause of death in 36% of patients 1. Initially, gram-positive organisms like Staphylococcus aureus colonize the wound, but within days, gram-negative bacteria such as Pseudomonas aeruginosa often become predominant. The risk of infection increases with burn size and depth, with full-thickness burns being particularly susceptible. Some key points to consider in managing burn wound infections include:

• 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.
• Systemic antibiotic prophylaxis administered in burn patients in the first 4–14 days significantly reduced all cause mortality by nearly a half; limited perioperative prophylaxis reduced wound infections but not mortality 1.
• Topical antibiotic prophylaxis applied to burn wounds had no beneficial effects, and in some cases, such as with silver sulfadiazine, was associated with a statistically significant increase in burn wound infection and longer length of hospital stay 1. While urinary tract infections, pneumonia, thrombophlebitis, and endocarditis can occur in burn patients (especially those with indwelling catheters or on ventilators), the burn wound itself remains the primary source of infection and requires meticulous wound care, appropriate topical antimicrobials, and sometimes systemic antibiotics to manage effectively.

From the Research

Sources of Infection in Burn Patients

• The most common source of infection in burn patients is the burn wound itself, as stated in the studies 2, 3, 4.
• According to the study 4, the burn wound accounts for 60.8% of clinical sources of infection, followed by the respiratory tract (22.2%) and urinary tract (6.1%).
• The study 2 highlights that burn wounds are initially sterile but become colonized by gram-positive and gram-negative organisms, leading to infection.
• Other potential sources of sepsis in burn patients include common nosocomial infections, such as pneumonia, catheter-related infections, and suppurative thrombophlebitis, as mentioned in the study 3.

Prevalence of Burn Wound Infection

• The study 4 found that the majority of patients (85.4%) had a clinical diagnosis of infection, with the burn wound being the most common source.
• The most prevalent causes of burn wound infection were Klebsiella pneumoniae (30.2%), Staphylococcus aureus (24.3%), and Pseudomonas aeruginosa (21.0%), as reported in the study 4.
• The study 2 emphasizes that fungal wound infections pose a special challenge and cause substantial morbidity.

Prevention and Treatment of Burn Wound Infection

• The study 2 concludes that the best approach to decrease wound infections is prevention, and practices such as isolation rooms, handwashing, appropriate wound care, early excision and grafting, antibiotic stewardship, and nutritional support have been beneficial.
• The study 5 highlights the importance of topical antimicrobial agents in preventing burn wound infection, and the study 6 recommends the use of silver-containing dressings for most scenarios.
• The study 4 found that the cultured organisms in burn injury patients with wound infection showed high sensitivity and specificity to empirical antibiotics therapy.