What is the most common source of infection in burn patients, specifically between the burn wound, urinary tract infection (UTI), pneumonia, and thrombophlebitis?

From the Guidelines

The most common source of infection in burn patients is the burn wound itself (option A). Burn wounds create a breach in the skin's protective barrier, allowing bacteria to easily colonize the damaged tissue. The destroyed skin and underlying tissues provide an ideal environment for bacterial growth due to the presence of dead tissue (eschar) and compromised blood supply, which limits the delivery of immune cells and antibiotics to the area. Additionally, burn wounds often contain protein-rich exudates that serve as excellent culture media for microorganisms. Common pathogens include Pseudomonas aeruginosa, Staphylococcus aureus, and various gram-negative bacteria. The risk of infection increases with the size and depth of the burn, with larger burns creating more extensive barrier disruption.

Key Points

• Infections among burn patients are common and are associated with high mortality rate, with infections preceding multiorgan dysfunction in 83% of patients and being the direct cause of death in 36% of patients 1.
• Burn wound infections usually are polymicrobial, and can be immediately colonized by Gram-positive bacteria from the patient’s endogenous skin flora or the external environment, and can also be rapidly colonized by Gram-negative bacteria, usually within a week of the burn injury 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.
• While urinary tract infections, pneumonia, and thrombophlebitis can occur in burn patients, particularly those with prolonged hospitalization, the burn wound itself remains the primary and most significant source of infection in these patients.

Management

• Accurate management of the wound with early excision of the eschar can substantially decrease the incidence of invasive burn wound infection 1.
• Antibiotic prophylaxis could protect high-risk patients from infectious complications, but its use should be judicious and based on individual patient risk factors 1.

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 study 2, where 60.8% of patients had a clinical diagnosis of infection originating from the burn wound.
• Other sources of infection include the respiratory tract (22.2%) and urinary tract (6.1%), as reported in the same study 2.
• The study 3 also found that burn wound infection (BWI) is the most common reason for infection in burn patients, with 60.0% of patients experiencing BWI.

Common Pathogens

• The most prevalent causes of burn wound infection are Klebsiella pneumoniae (K pneumoniae) (30.2%), Staphylococcus aureus (S aureus) (24.3%), and Pseudomonas aeruginosa (P aeruginosa) (21.0%), as found in the study 2.
• The study 3 reported that the most frequently isolated causative organism was Staphylococcus aureus (15.7%) in patients with BWI.
• Other studies 4, 5, 6 also mention Staphylococcus and Pseudomonas spp. as common pathogens causing burn wound infection.

Answer to the Question

• Based on the evidence, the correct answer is A. Burn wound, as it is the most common source of infection in burn patients, as reported in the studies 2 and 3.