Most Common Source of Infection in Burn Patients
The burn wound itself is the most common source of infection in burn patients, representing the predominant site for infectious complications following thermal injury. 1
Primary Source: The Burn Wound
The burn wound is explicitly identified as the most important and potentially serious source of infection in the acute period following thermal injury. 1 This occurs because:
Thermal injury disrupts the skin barrier, eliminating the body's primary defense against microorganism invasion and creating an ideal environment for bacterial colonization and subsequent infection. 1, 2
Most cases of sepsis in burn patients originate from infected burn wounds, making the wound the critical target for infection prevention and treatment strategies. 3
Infections precede multiorgan dysfunction in 83% of burn patients and are considered the direct cause of death in 36% of cases, underscoring the clinical significance of burn wound infections. 1
Pathophysiology of Burn Wound Infection
The progression from sterile wound to invasive infection follows a predictable pattern:
Burn wounds are initially sterile immediately after thermal injury but rapidly become colonized with microorganisms within hours. 1
Early colonization (first few days) is predominantly by Gram-positive bacteria, particularly Staphylococcus aureus and Staphylococcus epidermidis, originating from the patient's endogenous skin flora. 4, 1
Later colonization (within one week) shifts to Gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii. 4, 1
If host defenses and therapeutic measures are inadequate, microorganisms invade viable tissue, progressing from surface colonization to invasive burn wound infection. 1
Supporting Evidence from Clinical Studies
Research consistently confirms the burn wound as the primary infection source:
In a Lebanese burn center study, 55% of patients contracted at least one infection during hospitalization, with Staphylococcus aureus (48.7%) being the predominant pathogen, followed by Pseudomonas aeruginosa (22.6%) and Acinetobacter baumannii (15.7%). 5
Burn wound infections are often polymicrobial, involving both Gram-positive and Gram-negative organisms simultaneously. 4
Patients with the same bacteria isolated from both blood and burn wound have significantly worse outcomes, particularly when Pseudomonas aeruginosa or Acinetobacter baumannii are involved. 6
Clinical Implications for Management
Understanding the burn wound as the primary infection source directly informs treatment priorities:
Early excision of eschar can substantially decrease the incidence of invasive burn wound infection, making surgical source control the most definitive treatment approach. 1, 3
Total body surface area burned remains one of the most important risk factors for infectious complications, with mortality risks increasing significantly when burn size exceeds 40%. 3
Quantitative wound cultures with tissue biopsy from the advancing margin are the gold standard for diagnosing burn wound infections, as surface colonization must be distinguished from invasive infection. 7, 4
Common Pitfalls to Avoid
Do not rely on clinical signs alone for diagnosis, as burn wound infections are challenging to diagnose without microbiological confirmation due to the persistent inflammatory response from the open wound. 4, 2
Do not confuse colonization with infection—all burn wounds become colonized, but only invasive infection requires aggressive antimicrobial therapy beyond topical agents. 1
Do not overlook the importance of thorough wound cleansing and removal of topical antimicrobials before obtaining cultures, as these can significantly affect culture results and lead to misdiagnosis. 4