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

Infections in Burn Patients

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

• Loss of the skin barrier function
• Immunosuppression induced by thermal injury
• Altered physiology following burn trauma
• Presence of necrotic tissue that serves as a medium for bacterial growth

Types of Infections in Burn Patients

While burn patients can develop various infections, the following are the most common types that can lead to fatal outcomes:

1. Pneumonia: Most common fatal infection in burn victims

   • Often associated with inhalation injury
   • Can be ventilator-associated in intubated patients
   • Leading cause of death in severely burned patients 1

2. Burn Wound Sepsis:

   • Occurs when bacteria invade viable tissue beneath the eschar
   • Early excision of eschar has significantly decreased its incidence 1
   • Still remains a significant cause of morbidity

3. Venous Line-Related Sepsis:

   • Associated with prolonged use of central venous catheters
   • Can be reduced with silver-impregnated devices 1

4. Urinary Tract Infections:

   • Less commonly fatal compared to other infections in burn patients
   • Often associated with indwelling catheters

Microbiology of Burn Infections

The microorganisms commonly isolated from burn patients with sepsis include:

• Gram-negative bacteria: Associated with higher mortality

  • Pseudomonas aeruginosa (22-35% of fatal cases) 3
  • Acinetobacter baumannii (35-47% of fatal cases) 3
  • Klebsiella species (28% of cases) 4

• Gram-positive bacteria: Generally associated with better outcomes

  • Staphylococcus aureus (MRSA and MSSA)
  • Staphylococcus epidermidis

Prevention and Management

Prevention:

• Early excision of burn eschar (significantly reduces invasive burn wound infection) 1
• Appropriate wound care and dressings
• Infection control practices

Antibiotic Use:

• Systemic antibiotic prophylaxis is not recommended routinely for burn patients 5
• Antibiotics should be reserved for clinical signs of infection rather than used prophylactically
• Prolonged prophylactic antibiotics may lead to selection of multidrug-resistant bacteria 5

Nutritional Support:

• Early nutritional support (within 12 hours after burn injury) is recommended 5
• Preferably via oral or enteral routes
• Adequate protein and micronutrient supplementation

Clinical Pearls and Pitfalls

Pearls:

• Early recognition and treatment of pneumonia is critical in burn patients
• Blood cultures should be obtained before starting antibiotics if infection is suspected
• Regular monitoring of burn wounds for signs of infection is essential

Pitfalls:

• Relying solely on systemic antibiotic prophylaxis without proper wound care
• Failure to recognize early signs of pneumonia in burn patients
• Delayed excision of necrotic tissue increasing risk of invasive infection
• Overlooking the importance of nutritional support in preventing infections

In conclusion, while burn wound sepsis was historically the leading cause of death in burn patients, advances in early excision of burn wounds have reduced its incidence. Currently, pneumonia represents the most common fatal infection in burn victims, particularly those with severe burns and inhalation injuries.