What is the most common infection in burn victims?

Most Common Infection in Burn Victims

Pseudomonas aeruginosa is the most common pathogen causing infection in burn victims, with a prevalence of up to 73.9% of all burn wound infections. 1

Epidemiology and Pathophysiology

Burn wounds are particularly susceptible to infection due to:

• Loss of the skin barrier, the primary defense against microbial invasion 2
• Impaired local immune response
• Presence of devitalized tissue that serves as an excellent medium for bacterial growth

While burn wound infections are typically polymicrobial, P. aeruginosa has emerged as the predominant pathogen for several reasons:

• Ubiquitous presence in water reservoirs and hospital environments 3
• Ability to rapidly colonize burn wounds, usually within a week of injury 4
• High resistance to many antimicrobial agents

Diagnostic Approach

Accurate diagnosis of burn wound infections requires:

• Proper specimen collection:

  • Tissue biopsy of the advancing margin of the wound (preferred method) 4
  • Surface swabs are less reliable as they only reflect surface colonization rather than tissue invasion 4
  • Avoid collecting specimens from areas with topical antimicrobials 4

• Quantitative cultures:

  • Should be performed twice weekly to monitor bacterial colonization trends 4
  • Tissue biopsies should be supplemented with histopathological examination to assess microbial invasion 4

• Blood cultures:

  • Should be collected when systemic infection is suspected 4

Management Considerations

1. Surgical management:

   • Early excision of necrotic tissue (eschar) is crucial to decrease the incidence of invasive burn wound infection 4
   • Thorough debridement to remove devitalized tissue and reduce bacterial load 4

2. Antimicrobial therapy:

   • Selection should be guided by culture and susceptibility results
   • Consider local resistance patterns, particularly for P. aeruginosa
   • For empiric therapy, coverage should include both gram-positive and gram-negative organisms 4

3. Infection prevention:

   • Implement strict infection control measures to prevent nosocomial spread 3
   • Separate patients with and without P. aeruginosa infection 3
   • Decontaminate environmental reservoirs including medical equipment, sinks, and toilets 3
   • Practice proper hand hygiene 3

Clinical Impact

Infection with resistant P. aeruginosa significantly increases:

• Mortality rates
• Length of hospital stay
• Number of surgical procedures required
• Blood product usage
• Antibiotic costs 3

Common Pitfalls to Avoid

1. Relying solely on clinical signs and symptoms for diagnosis, which can be unreliable in burn patients due to their persistent hypermetabolic state 4, 2

2. Using surface swabs alone rather than tissue biopsies for definitive diagnosis 4

3. Requesting "culture of everything that grows" rather than focusing on clinically relevant pathogens 4

4. Delayed excision of necrotic tissue, which increases risk of invasive infection 5

5. Prolonged prophylactic antibiotic use, which can lead to development of resistant organisms 2

Early recognition and appropriate management of P. aeruginosa infections in burn patients are essential for improving outcomes and reducing the significant morbidity and mortality associated with these infections.