What are the complications of thermal burns with superadded infection?

From the Guidelines

Thermal burns with superadded infection require prompt treatment with topical antimicrobials, systemic antibiotics for severe infections, and proper wound care, as recommended by the most recent study 1.

Key Considerations

• Infection in burn wounds is serious as it can delay healing, deepen the burn injury, and potentially lead to sepsis.
• The compromised skin barrier and protein-rich exudate create an ideal environment for bacterial growth, particularly Pseudomonas aeruginosa, Staphylococcus aureus, and various gram-negative organisms.
• Regular wound assessment for signs of infection (increased pain, redness beyond wound margins, purulent discharge, foul odor) is essential.

Topical Treatment

• Silver sulfadiazine 1% cream applied once or twice daily is effective against many pathogens, but its use should be limited to infected wounds only, as it may be associated with prolonged healing if used for a long time on superficial burns 1.

Systemic Treatment

• Empiric therapy with piperacillin-tazobactam 4.5g IV every 6 hours or meropenem 1g IV every 8 hours is recommended until culture results guide targeted therapy.

Wound Care

• Gentle cleansing with normal saline, debridement of necrotic tissue, and appropriate dressings changed daily or as needed are crucial.
• Burn wound care should be performed in a clean environment and will mostly require deep analgesia or general anaesthesia.

Additional Considerations

• Nutritional support and tetanus prophylaxis should also be considered as part of comprehensive management.
• Severe or extensive infections may require surgical intervention including excision of infected tissue.
• 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.

From the FDA Drug Label

Fungal proliferation in and below the eschar may occur. However, the incidence of clinically reported fungal superinfection is low. 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 use of silver sulfadiazine may help prevent sepsis and superinfection in thermal burns by reducing bacterial growth. However, there is a potential risk of fungal proliferation. Key points to consider:

• Fungal superinfection is relatively rare
• Bacterial growth reduction can aid in healing and prevent conversion to full-thickness burns
• Silver sulfadiazine may be beneficial in preventing superadded infection in thermal burns 2 2

From the Research

Thermal Burns and Infection

• Thermal burns are a significant cause of morbidity and mortality worldwide, with infections being the primary source of morbidity and mortality in burn patients 3
• The goal of prophylactic topical antimicrobial therapy is to control microbial colonisation and prevent burn wound infection 3
• Topical antimicrobial therapy remains the single most important component of wound care in hospitalised burn patients 3

Treatment of Thermal Burns and Infection

• Silver sulfadiazine is the most frequently used topical prophylactic agent, due to its relatively low cost, ease of application, and good activity against most burn pathogens 3
• Mafenide acetate has superior eschar-penetrating characteristics, making it the agent of choice for early treatment of burn wound sepsis, but its use must be limited due to systemic toxicity associated with prolonged or extensive use 3
• Other agents, such as nitrofurazone or chlorhexidine preparations, may be useful in isolated clinical situations 3
• Early excision and grafting of the burn wound has decreased the importance of topical antimicrobial care, but it is still a crucial component of burn wound care 4

Current Status and Future Directions

• The development of effective topical antimicrobial agents for wound care was a major advance in the care of burn patients, but many gaps in our ability to treat complicated burn wounds remain 4
• Research on optimal topical treatment continues, particularly for patients with impaired wound healing, advanced age, or medical comorbidities, and for those in austere or remote locations 4
• Fungal infection is an unusual but daunting challenge in burn wound care, and further research is needed to address this issue 4