What is the most common source of infection in burn patients and how is it treated?

From the Guidelines

The most common source of infection in burn patients is the burn wound itself, which can become colonized with microorganisms, leading to infections that can be life-threatening if not properly managed. According to the 2024 study by 1, infections among burn patients are common and are associated with high mortality rates, with infections preceding multiorgan dysfunction in 83% of patients and being the direct cause of death in 36% of patients. The study highlights the importance of adequate source control, including surgical removal of contaminated material and areas of necrosis, and protection of the exposed lesion to decrease the infective risk.

Key factors that contribute to the high risk of infection in burn patients include:

• Compromised skin barrier
• Impaired immune function
• Ability of bacteria to form biofilms on damaged tissue
• Colonization of the burn wound with microorganisms, which can be polymicrobial and include Gram-positive and Gram-negative bacteria, as well as anaerobes

Treatment of burn wound infections typically involves a combination of topical antimicrobials and systemic antibiotics, with the goal of preventing sepsis and promoting wound healing. As noted by 1, systemic antibiotic prophylaxis administered in the first 4-14 days can significantly reduce all-cause mortality, while topical antibiotic prophylaxis has been shown to have no beneficial effects. The choice of antibiotic should be guided by wound cultures and susceptibility testing, with consideration of the potential for antibiotic resistance.

In terms of specific treatment options, the 2018 study by 1 suggests that early antibiotic treatment for 3-5 days may be recommended for fresh, deep wounds and wounds in critical bodily areas, as well as for persons at elevated risk of infection. However, the most recent and highest-quality study, 1, should be prioritized, and its findings should guide treatment decisions. Therefore, the most appropriate treatment approach for burn wound infections is a combination of adequate source control, including surgical removal of contaminated material and areas of necrosis, and protection of the exposed lesion, along with systemic antibiotic prophylaxis and topical antimicrobials as needed, with careful consideration of the potential risks and benefits of each treatment option.

From the FDA Drug Label

The burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions. Treatment with silver sulfadiazine cream, USP 1% should be continued until satisfactory healing has occurred or until the burn site is ready for grafting. The drug should not be withdrawn from the therapeutic regimen while there remains the possibility of infection except if a significant adverse reaction occurs.

The most common source of infection in burn patients is the burn wound. It is treated with silver sulfadiazine cream, USP 1% applied once to twice daily to a thickness of approximately one sixteenth of an inch, and reapplied as necessary, especially after hydrotherapy 2.

• The treatment should continue until the burn site is satisfactorily healed or ready for grafting.
• The burn area should be covered with the cream at all times to prevent infection.

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 3, 4, 5, 6.
• Other sources of infection include the respiratory tract, urinary tract, and catheter-related infections 4, 5.
• The burn wound is the most common source of infection, with a prevalence of 60.8% in one study 5.

Common Pathogens Involved in Burn Wound Infections

• The most common pathogens involved in burn wound infections are:
  • Staphylococcus aureus 3, 5
  • Klebsiella pneumoniae 5
  • Pseudomonas aeruginosa 3, 5, 7
  • Escherichia coli 3
  • Proteus spp. 3
• These pathogens can be resistant to multiple antibiotics, making treatment challenging 3, 5.

Treatment of Burn Wound Infections

• Early excision of the eschar and surgical debridement can help prevent invasive burn wound infections 4.
• Antibiotic therapy is often necessary to treat burn wound infections, with amikacin and levofloxacin being commonly prescribed empirical antibiotics 5.
• The choice of antibiotic should be guided by the results of culture and sensitivity testing 3, 5.