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 skin barrier—the body's primary defense against microorganisms—making the burn wound the predominant site for infectious complications in the acute period following injury. 1
Infections in burn patients are associated with extremely high mortality rates, with infections preceding multiorgan dysfunction in 83% of patients and considered the direct cause of death in 36% of patients. 1
Most cases of sepsis in burn patients originate from infected burn wounds, making wound management the cornerstone of infection prevention and treatment. 2
Pathophysiology of Burn Wound Infection
Burn wounds are initially sterile immediately following thermal injury but rapidly become colonized with microorganisms within hours. 1
Colonization follows a predictable pattern: Gram-positive bacteria from the patient's endogenous skin flora (particularly Staphylococcus aureus) colonize first, followed by Gram-negative bacteria within one week of injury. 1, 3
If host defenses and therapeutic measures are inadequate, microorganisms progress from surface colonization to invasive burn wound infection by invading viable tissue beneath the eschar. 1
Common Pathogens by Timeline
Early colonization (first few days):
- Staphylococcus aureus is the most common early pathogen, accounting for approximately 48.7% of infections. 4
- Staphylococcus epidermidis is also frequently isolated in the early phase. 3, 5
Later colonization (after one week):
- Pseudomonas aeruginosa (22.6% of infections) and Acinetobacter baumannii (15.7% of infections) become predominant. 3, 4
- These Gram-negative organisms are associated with significantly higher mortality rates when they cause sepsis compared to Gram-positive bacteria. 6
Clinical Implications for Management
Early excision of eschar can substantially decrease the incidence of invasive burn wound infection, underscoring that the burn wound itself is the primary target for infection prevention strategies. 1
Surgical excision of burn eschar to remove the source of potential infection is a key component of both treatment and prevention of infection. 2
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. 1, 3
Critical Diagnostic Pitfall
Blood cultures should always be obtained to detect systemic disease secondary to the burn wound, but the wound itself remains the primary source requiring direct sampling and management. 3
When the same bacteria (Pseudomonas aeruginosa or Acinetobacter baumannii) are isolated from both blood and burn wound, the risk of death from sepsis increases significantly, confirming the wound as the source of systemic infection. 6