The Burn Wound Itself is the Most Common Source of Infection
The burn wound itself is the most common source of infection in burn patients, representing the primary site from which infectious complications arise and the predominant origin of sepsis in this population. 1
Why the Burn Wound is the Primary Infection Source
The thermal injury disrupts the protective skin barrier, creating an ideal environment for microbial invasion through several mechanisms 1:
Immediate sterility followed by rapid colonization: Burn wounds are initially sterile immediately after thermal injury but become colonized within hours, first by gram-positive bacteria from the patient's own skin flora, then by gram-negative organisms within one week 1, 2
Progression from colonization to invasive infection: When host defenses and therapeutic measures are inadequate, microorganisms invade viable tissue beneath the eschar, transforming surface colonization into life-threatening invasive burn wound infection 1
Direct link to mortality: Most cases of sepsis in burn patients originate from infected burn wounds, with infections preceding multiorgan dysfunction in 83% of patients and directly causing death in 36% of cases 1, 3
Other Infection Sources (Secondary to the Burn Wound)
While the burn wound is primary, pneumonia has emerged as the most frequent secondary infection in modern burn care 4:
Pneumonia as the second most common source: Improvements in wound care have made bronchopneumonia the most common non-wound infection, typically caused by gram-positive organisms in the current era 4
Nosocomial infections: Indwelling devices (catheters, endotracheal tubes) contribute to infection risk but remain secondary to the burn wound as infection sources 2, 3
Clinical Implications for Prevention
Early excision of eschar substantially decreases the incidence of invasive burn wound infection, confirming that the burn wound itself is the primary target for infection prevention strategies 1:
Prompt surgical excision and wound closure directly address the most common infection source 1, 5
Quantitative wound cultures with tissue biopsy from the advancing margin serve as the gold standard for diagnosing burn wound infections, distinguishing surface colonization from invasive infection 1
Topical antimicrobials and appropriate wound care target the burn wound as the critical site requiring protection 2, 5