Bacterial Infections After Burn Injuries: Impact of Multidrug Resistance

Abstract

Patients who are admitted to the hospital after sustaining a large burn injury are at high risk for developing hospital-associated infections. If patients survive the initial 72 hours after a burn injury, infections are the most common cause of death. Ventilator-associated pneumonia is the most important infection in this patient population. The risk of infections caused by multidrug-resistant bacterial pathogens increases with hospital length of stay in burn patients. In the first days of the postburn hospitalization, more susceptible, Gram-positive organisms predominate, whereas later more resistant Gram-negative organisms are found. These findings impact the choice of empiric antibiotics in critically ill burn patients. A proactive infection control approach is essential in burn units. Furthermore, a multidisciplinary approach to burn patients with a team that includes an infectious disease specialist and a pharmacist in addition to the burn surgeon is highly recommended.

Novel inducers of the expression of multidrug efflux pumps that triggerPseudomonas aeruginosatransient antibiotic resistance

“…Procaine is used as a local anesthetic agent (55) in some minor surgeries or in burn injuries, tissues that P. aeruginosa frequently colonize (56). Moreover, it has been studied for the treatment of HIV patients (phase 2 clinical trial) (57).…”

The dynamics of Klebsiella pneumoniae drug-resistant profile in a regional burn center: a retrospective study between 2009 and 2018

“…(74/1624), 9.09% (166/1827), respectively. Burn patients have skin barrier damage, long hospitalization period, ventilator and other interventional operations, which can easily lead to burn wound, bloodstream, respiratory tract and urinary tract infection [2,3,6,7,21,22]. From the sites of infection, K.pneumoniae mainly were isolated from wound secretion, bloodstream and sputum during the past 10 years, and the proportion of isolation almost being no change.…”

“…To further understand whether K.pneumoniae infection was related to the length of hospitalization, we investigated the original data and found that the isolated rate increased following with the length of hospitalization, even reached a peak in 1-3 weeks (Figure 2). This was related to the early infection of burn patients with Gram-positive bacteria, Gram-negative bacteria in the middle and late stages [3]. Because CRKP had the characteristics of low cure rate and high mortality rate, we wanted to know whether infectious site was different between CRKP and non-CRKP patients [28].…”

“…Infections are a serious medical problem in burn patients, leading more than 70% death [1,2]. The destruction of protective skin barrier is benefit for displacement of skin microorganism located in peripheral tissue of burn area [3,4]. In addition, gastrointestinal bacteria usually transfer into bloodstream, respiratory tract and burn wound, etc., because of stress injury originating in humoral and cellular immunity, which also contributes to a higher rate of infection in burn patients [5,6].…”

Bacteriophages for Chronic Wound Treatment: From Traditional to Novel Delivery Systems

“…In burn wounds, the presence of pathogens such as P. aeruginosa together with K. pneumonia, Stenotrophomonas maltophilia, and Enterobacteriaceae spp., and all multidrug-resistant (MDR) or even totally drug-resistant organisms can be deadly [18]. The leading cause of death of those burn injury patients who survive longer than 72 h is reported to be a microbial infection, causing 43% to 65% of mortality (reviewed in [44]). Infections caused by the pathogens led to sepsis, causing multi-organ failure, but other causes of mortality were reported, such as respiratory infections, cardiac arrest, and even brain death (e.g., neurological deterioration and cerebral stroke).…”