Most Common Fatal Infection in Burn Victims
The most common fatal infection in burn victims is pneumonia, which has become the predominant infectious cause of mortality in burn patients as improvements in wound care have reduced the incidence of invasive burn wound infections. 1
Epidemiology of Infections in Burn Patients
Infections remain the leading cause of morbidity and mortality in burn patients despite advances in burn care. The pattern of infections has evolved significantly over time:
- Historically, burn wound sepsis was the predominant fatal infection
- With advances in topical antimicrobial therapy, early excision of burn wounds, and improved wound closure techniques, the incidence of invasive burn wound infections has decreased substantially
- Pneumonia has emerged as the most common fatal infection in contemporary burn care 1
- Bronchopneumonia specifically has become the most frequent form of pneumonia in burn patients
Types of Infections in Burn Patients and Their Relative Impact
Pneumonia
- Now the most frequent infection occurring in burn patients 1
- Most commonly presents as bronchopneumonia
- Often caused by gram-positive organisms in modern burn care settings
- Associated with inhalation injury, mechanical ventilation, and immunosuppression following burn injury
Burn Wound Sepsis
- Previously the predominant cause of mortality
- Incidence has decreased significantly with:
- Early excision of eschar
- Topical antimicrobial therapy
- Improved wound closure techniques
- Still occurs in patients with extensive burns where wound closure is delayed 1
Bloodstream Infections
- Often secondary to other infection sources (pneumonia, wound infection)
- The causative organisms have changed over time in parallel with changes in wound flora
- Gram-negative bacteremia (especially Pseudomonas aeruginosa and Acinetobacter baumannii) carries a higher mortality risk than gram-positive bacteremia 2
Urinary Tract Infections
- Common but less frequently associated with fatal outcomes compared to pneumonia or septicemia
- Often related to urinary catheterization
Microbiology of Burn Infections
The microbial profile in burn patients varies by infection site and time since injury:
- Gram-positive organisms (Staphylococcus aureus and Staphylococcus epidermidis) are common early colonizers
- Gram-negative organisms, particularly Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella species emerge later and are associated with higher mortality 2, 3
- In one study, P. aeruginosa and Klebsiella species were isolated in 29% and 28% of fatal burn cases with septicemia, respectively 3
Risk Factors for Fatal Infections
- Extent of burn (total body surface area affected)
- Depth of burn
- Delayed excision of burn eschar
- Age extremes (very young or elderly)
- Inhalation injury
- Presence of indwelling devices (central lines, urinary catheters)
- Immunosuppression induced by the burn injury itself
Prevention Strategies
- Early excision of burn eschar has substantially decreased invasive burn wound infections 4
- Silver-impregnated devices (central lines, urinary catheters) may reduce device-related infections 4
- Scheduled surveillance cultures and infection control procedures help identify resistant organisms early 1
- Proper wound care including appropriate dressings and topical antimicrobials
- Avoidance of unnecessary antibiotic prophylaxis, which can promote resistance 5