The changing epidemiology of infection in burn patients

Abstract

Topical chemotherapy, prompt excision, and timely closure of the burn wound have significantly reduced the occurrence of invasive burn wound infection and its related mortality. Since wound protection is imperfect and invasive wound infection may still occur in patients with massive burns in whom wound closure is delayed, scheduled wound surveillance and biopsy monitoring are necessary to assess the microbial status of the burn wound and identify wound infections caused by resistant bacteria or non‐bacterial opportunists at a stage when therapeutic intervention can control the process. As a reflection of the systemic immunosuppressive effects of burn injury, infection remains the most common cause of morbidity and mortality even though the occurrence of wound infections has been significantly decreased. Pneumonia is the most frequent infection occurring in burn patients today but the improvements in patient management, wound care, and infection control have made bronchopneumonia the most common form of this infection and gram‐positive organisms the most common causative agents. The organisms causing bacteremia that exert a species specific effect on the mortality related to extent of burn injury and patient age have changed in concert with changes in wound flora. Infection control procedures, including scheduled surveillance cultures, utilization of cohort patient care methodology, strict enforcement of patient and staff hygiene, and patient monitoring have been effective in eliminating endemic resistant microbial strains, preventing the establishment of newly introduced resistant organisms, diagnosing infection in a timely fashion, instituting antibiotic and other necessary therapy in a prompt manner, and documenting the effectiveness of present day burn patient care and the improved survival of burn patients.

Nosocomial Infections in Iranian Pediatric Patients With Burn Injuries: A Review

“…Fungal infection was reported only in one from the reviewed articles. Mozingo et al (23) reported mold species, principally Aspergillus species, as nonbacterial pathogens (29). We conclude that lake of controlling of fungal infection by routine culture can be the cause of low fungal infection among our studied population (13).…”

“…Enterobacteriaceae species showed high level of resistance to antibiotics. In recent years, true fungi have replaced bacteria as the most com-mon microorganisms causing burn wound infection (8,29). Fungal infection was reported only in one from the reviewed articles.…”

Alternativas terapêuticas para o tratamento de infecções por Pseudomonas aeruginosa multirresistentes endêmicas no Brasil.

“…Ao mesmo tempo a lesão dos vasos sanguíneos na área afetada torna mais difícil a penetração de antibióticos e a chegada de células do sistema imune. Em 75% dos casos de óbitos de pacientes queimados, as infecções foram a grande responsável (Hammond et al, 2011;Macedo et al, 2005;Pruitt, McManus, 1992;Rempel et al, 2011).…”

“…Sendo assim, as queimaduras devem ser protegidas por agentes antimicrobianos de uso tópico para evitar a proliferação e migração dos microrganismos do tecido necrosado para as regiões sadias (Hammond et al, 2011;Pruitt, McManus, 1992 (Fiates et al, 2001;Firmida, Lopes, 2011;Rosa et al, 2008 (Nichols et al, 2008).…”

“…aeruginosa 111ER e seu diâmetro médio (d= 641,8 nm), com valores similares aos encontrados na literatura (Lincopan, Trabulsi, 2008;Ubbink, Schär-Zammaretti, 2007 (Hammond et al, 2011;Pruitt, McManus, 1992).…”