Most Common Fatal Infection in Burn Victims
The most common fatal infection in burn victims is burn wound sepsis (option C), which is the primary cause of death in burn patients despite advances in burn wound care. 1
Pathophysiology and Risk Factors
Burn injuries create an ideal environment for infection development due to:
- Disruption of the skin barrier function
- Impaired immune response following thermal injury
- Presence of necrotic tissue that serves as a medium for bacterial growth
- Altered physiology that increases susceptibility to invasive infections 2
Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications, with most deaths in severely burn-injured patients still occurring due to burn wound sepsis or complications from inhalation injury 3.
Common Pathogens
The microbial profile in burn wound infections varies based on time since injury:
- Early colonization: Gram-positive bacteria from the patient's endogenous skin flora
- Later colonization: Gram-negative bacteria, usually within a week of the burn injury 4
The most lethal pathogens isolated from blood and burn wounds in fatal cases include:
- Gram-negative bacteria: Acinetobacter baumannii (35.59%) and Pseudomonas aeruginosa (22.03%)
- Patients with thermal injuries are at higher risk of death when sepsis is caused by Gram-negative bacteria compared to Gram-positive bacteria 5
Comparison with Other Infectious Complications
While burn patients are also at risk for:
- Pneumonia
- Catheter-related infections
- Suppurative thrombophlebitis 3
- Urinary tract infections
Burn wound sepsis remains the most significant fatal infectious complication. When the same bacteria are found in both the blood and burn wound (especially Pseudomonas aeruginosa and Acinetobacter baumannii), the risk of death due to sepsis increases significantly 5.
Prevention and Management
Key strategies to prevent fatal burn wound infections include:
- Early excision of the eschar, which has substantially decreased the incidence of invasive burn wound infection 3
- Appropriate wound care with proper cleaning and dressings 4
- Judicious use of antimicrobial therapy
Regarding antibiotic use:
- Systemic antibiotic prophylaxis is not routinely recommended for burn patients due to the risk of selecting multidrug-resistant bacteria 4
- The evidence for systemic antibiotic prophylaxis is low, with studies showing uncertain impact on outcomes 4
- For established infections, antimicrobial therapy should be directed against both Gram-positive and Gram-negative organisms as well as anaerobes 4
Diagnostic Challenges
Diagnosis of burn sepsis relies on:
- Clinical findings
- Cultures from blood and wound sites
- Recognition of organ dysfunction attributed to the host's disordered response to infection 1
The high mortality from burn wound sepsis highlights the importance of periodic review of isolation patterns and susceptibility profiles of microorganisms infecting burn wounds, especially in resource-limited settings 6.