What is the most common fatal infection in burn victims?

Most Common Fatal Infection in Burn Victims

The most common fatal infection in burn victims is pneumonia. 1, 2, 3

Infections in Burn Patients

Burn patients are highly susceptible to infections due to several factors:

• Disruption of the skin barrier
• Immunosuppression induced by thermal injury
• Altered physiology following burn trauma
• Prolonged hospitalization and invasive procedures

Types of Infections in Burn Patients

While multiple types of infections can occur in burn patients, they can be ranked by frequency of fatal outcomes:

1. Pneumonia - Most common fatal infection in burn patients 1

   • Often associated with inhalation injury
   • Frequently caused by gram-negative organisms
   • Can develop secondary to mechanical ventilation

2. Burn wound sepsis - Second most common 1, 4

   • Occurs when bacteria invade viable tissue beneath eschar
   • Early excision of eschar has decreased incidence but remains a significant cause of mortality

3. Venous line-related sepsis - Common but less frequently fatal than pneumonia 1

   • Risk increases with prolonged catheter placement
   • Silver-impregnated devices may reduce incidence

4. Urinary tract infections - Least common cause of fatal infections in burn patients 1

   • Usually associated with indwelling catheters
   • Rarely the primary cause of death

Microbiology of Burn Infections

The most common organisms causing fatal infections in burn patients include:

• Pseudomonas aeruginosa - Associated with higher mortality (22-36% of fatal cases) 4, 2
• Acinetobacter baumannii - Found in 35-47% of fatal cases 4
• Klebsiella species - Found in 28% of fatal cases 2
• Staphylococcus aureus (including MRSA) - More common in survivors than non-survivors 4

Prevention and Management

Early recognition and appropriate management are crucial:

• Early excision of burn wounds to reduce bacterial colonization 1
• Appropriate wound care and dressings 5
• Targeted antibiotic therapy based on culture results
• Avoidance of routine antibiotic prophylaxis 5

Antibiotic Considerations

• Systemic antibiotic prophylaxis is not recommended routinely for burn patients 5
• Experts suggest avoiding systemic antibiotic prophylaxis due to risk of selecting multidrug-resistant bacteria 5
• When infection is suspected, obtain cultures before starting antibiotics and adjust therapy based on results 6

Common Pitfalls

• Delayed recognition of pneumonia symptoms in ventilated burn patients
• Overuse of prophylactic antibiotics leading to resistant organisms
• Failure to recognize the transition from colonization to invasive infection
• Inadequate source control (especially delayed excision of necrotic tissue)

Despite advances in burn care, infections remain the leading cause of death in severely burned patients, with pneumonia being the most common fatal infection, followed by burn wound sepsis, venous line-related sepsis, and urinary tract infections.