Most Common Fatal Infection in Burn Victims
The most common fatal infection in burn victims is pneumonia. 1
Pathophysiology of Infections in Burn Patients
Burn injuries create a unique environment for infections due to:
- Disruption of the skin barrier
- Immunosuppression from thermal injury
- Altered physiology and metabolism
- Prolonged hospital stays with invasive devices
Patients with significant thermal injuries experience a state of immunosuppression that predisposes them to infectious complications 2. Despite advances in burn care, infections remain the primary cause of death in burn patients 3.
Types of Infections in Burn Patients
1. Pneumonia
Pneumonia is the leading fatal infection in burn patients. This is particularly common in patients with:
- Inhalation injury
- Prolonged mechanical ventilation
- Immobility
- Impaired pulmonary clearance
2. Burn Wound Sepsis
While burn wound infections are common, modern burn care with early excision of eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis 2. However, when burn wound sepsis does occur, it carries significant mortality.
3. Venous Line-Related Sepsis
Catheter-related infections are a significant risk in burn patients due to:
- Prolonged need for vascular access
- Compromised skin integrity
- Immunosuppression
4. Urinary Tract Infections
While common, these are less frequently the primary cause of mortality compared to pneumonia.
Microbiology of Burn Infections
The most common organisms causing fatal infections in burn patients include:
- Gram-negative bacteria: Pseudomonas aeruginosa and Acinetobacter baumannii are associated with higher mortality rates 4
- Klebsiella species 5
- Gram-positive bacteria: Staphylococcus aureus (including MRSA)
A study examining autopsy reports of 334 fatal burn cases found that septicemia was the cause of death in 65% of cases, with Pseudomonas aeruginosa and Klebsiella species being the most common organisms isolated 5.
Prevention and Management
The 2020 guidelines on management of severe thermal burns recommend:
- Against routine antibiotic prophylaxis in burn patients due to risk of selecting multidrug-resistant bacteria 6
- Early excision of necrotic tissue to reduce infection risk
- Appropriate wound care management to prevent infections
- Topical antibiotics should be dedicated to infected wounds only, not used as first-line treatment 6
Key Considerations
- Early recognition of sepsis is critical and based primarily on clinical findings 1
- Patients with thermal injuries have higher mortality when sepsis is caused by Gram-negative bacteria compared to Gram-positive bacteria 4
- The same organism found in both blood and burn wound, particularly Pseudomonas aeruginosa and Acinetobacter baumannii, increases the risk of death due to sepsis 4
Conclusion
While all types of infections contribute to morbidity and mortality in burn patients, pneumonia represents the most common fatal infection in this population, followed by burn wound sepsis, venous line-related sepsis, and urinary tract infections.