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 Barajas-Nava 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 also found that systemic antibiotic prophylaxis administered in burn patients in the first 4–14 days significantly reduced all-cause mortality by nearly half.

Treatment and Prevention

Treatment of burn wound infections typically involves a combination of topical antimicrobials and systemic antibiotics. For topical treatment, dressings or skin substitutes are preferred over silver sulfadiazine due to the increased risk of burn wound infection associated with silver sulfadiazine 1. For systemic treatment, antipseudomonal antibiotics such as piperacillin-tazobactam, cefepime, or meropenem are commonly used, with therapy duration typically 10-14 days depending on clinical response.

Key Considerations

• Early identification through wound cultures is crucial for targeted therapy, as resistance patterns can vary 1.
• Prevention strategies include strict infection control measures, proper wound care, and maintaining a clean hospital environment to minimize cross-contamination between patients.
• The role of 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.
• Burn patients are particularly susceptible to infections due to their compromised skin barrier, immunosuppression from the burn injury, and the moist wound environment that promotes bacterial growth.

Infection Management

Burn wound infections are usually polymicrobial, including Gram-positive and Gram-negative bacteria, as well as anaerobes 1. Accurate management of the wound with early excision of the eschar can substantially decrease the incidence of invasive burn wound infection. Combination of surgical and antibiotic interventions may be required to manage infected burn wounds. Antibiotic therapy should be used for patients with severe burn wound infections, including those with spreading cellulitis or patients with systemic signs of 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 2, 3, 4.
• Other sources of infection include the respiratory tract and urinary tract, but the burn wound is the most prevalent source, accounting for 60.8% of infections 3.

Common Pathogens Involved in Burn Wound Infections

• The most common pathogens involved in burn wound infections are:
  • Staphylococcus aureus (24.3% - 46%) 2, 3
  • Klebsiella pneumoniae (30.2%) 3
  • Pseudomonas aeruginosa (21.0% - 7%) 2, 3, 5
  • Escherichia coli (16%) 2
  • Proteus spp. (12%) 2

Treatment and Antibiotic Susceptibility

• The treatment of burn wound infections often involves the use of empirical antibiotics, with amikacin and levofloxacin being commonly prescribed 3.
• The antibiotic susceptibility patterns of the common pathogens involved in burn wound infections vary, but many are sensitive to amikacin, gentamicin, cefotaxime, and norfloxacin 2, 3.
• Pseudomonas aeruginosa is often resistant to many antibiotics, but may be sensitive to ceftazidime 3 and has enhanced virulence in the presence of burn wound exudates 5.