Most Common Source of Infection in Burn Patients
The burn wound itself (Answer A) is the most common source of infection in burn patients, serving as the primary origin for most infectious complications including sepsis. 1
Evidence Supporting Burn Wound as Primary Source
Burn wound infections represent the most important and potentially serious complication in the acute period following thermal injury. 1 The evidence consistently demonstrates that:
- Most cases of sepsis in burn patients originate from infected burn wounds, making the wound the predominant source rather than other sites 2
- In a series of 175 patients with severe burns, infections (predominantly wound-related) preceded multiorgan dysfunction in 83% of patients and were the direct cause of death in 36% 1
- The burn wound disrupts the innate immune barrier, and although initially sterile after thermal injury, these wounds rapidly become colonized with microorganisms that can progress to invasive infection 1
Progression of Burn Wound Colonization
The natural history follows a predictable pattern:
- Initial colonization occurs with gram-positive bacteria from the patient's endogenous skin flora or external environment 1, 3
- Gram-negative organisms rapidly colonize within approximately one week of the burn injury 1, 3
- Burn wound infections are typically polymicrobial in nature 1
- If host defenses and therapeutic measures are inadequate, microorganisms colonize viable tissue and invasive burn wound infection occurs 1
Why Other Sources Are Less Common
While pneumonia has become increasingly recognized as a frequent infection in burn patients, the burn wound remains the most common overall source 4. The evidence shows:
- Pneumonia is now the most frequent infection occurring in burn patients, but this represents a shift from historical patterns where wound infections dominated even more completely 4
- Bronchopneumonia with gram-positive organisms is the most common form of pneumonia in modern burn care 4
- Other sources (urinary tract infections, thrombophlebitis, endocarditis) occur far less frequently than burn wound infections 1
Clinical Implications
The primacy of the burn wound as an infection source mandates specific management strategies:
- Early excision of burn eschar to remove the source of potential infection is a key component of both treatment and prevention 2, 5
- Scheduled wound surveillance and biopsy monitoring are necessary to assess microbial status and identify infections at a treatable stage 4, 5
- Accurate wound management with early excision can substantially decrease the incidence of invasive burn wound infection 1
- Source control through surgical removal of contaminated material and necrotic tissue is crucial in decreasing infective risk 1
Answer: A. Burn wound