Emerging Gram-Negative Infections in Burn Wounds

Abstract

Gram-negative infection remains a major contributor to morbidity, mortality, and cost of care. In the absence of comparative multinational epidemiological studies specific to burn patients, we sought to review literature trends in emerging Gram-negative burn wound infections within the past 60 years. Mapping trends in these organisms, although in a minority compared with the six "ESKAPE" pathogens currently being targeted by the Infectious Diseases Society of North America, would identify pathogens of increasing concern to burn physicians in the near future and develop patient profiles that may predict susceptibility to infection. Aeromonas hydrophila infection was identified as the emerging pathogen of note, constituting 76% of the identified publications. A. hydrophila constituted 96% of Aeromonas spp. isolates (mortality 10.7%). The following patient profile indicated predisposition to Aeromonas infection: mean age (mean 33.7 years, range 17 ≤ R ≤ 80, SD = 15.6); TBSA (mean 41.1%, range 8% ≤ R ≤ 80%, SD = 15.2); full-thickness skin burns (mean 27.7%, range 3% ≤ R ≤ 60%, SD = 16.6); and a male predominance (81.3%). Other pathogens included Stenotrophomonas maltophilia Vibrio spp., Chryseobacterium spp., Alcaligenes xylosoxidans, and Cedecia lapigei. Arresting the thermal injury by untreated water was the common predisposing factor. These emerging infections clearly constitute a minority of Gram-negative bacterial infections in burn patients at present. However, these are the infections most likely to pose significant clinical challenge because of the high prevalence of multidrug resistance, rapid acquisition of multidrug resistance, high mortality, and ubiquity in the natural environment. This article therefore presents a rationale for understanding and recognizing the role of these emerging infections in burn patients.

Blue Light Rescues Mice from Potentially Fatal Pseudomonas aeruginosa Burn Infection: Efficacy, Safety, and Mechanism of Action

“…Burns were incurred by applying a preheated (Ϸ95°C) brass block to the dorsal surface of each mouse for 3 s, resulting in nonlethal full-thickness third-degree burns measuring approximately 1.2 cm by 1.2 cm. Five min after incurrence of the burn, a 60-l bacterial suspension containing 3 ϫ 10 6 CFU was topically applied to the eschar of each burn.…”

“…Burn infection is one of the most important and potentially serious complications that occur in the acute period following injury (2,3,5). Over the last several decades, Gram-negative organisms have emerged as the most common etiologic agents of invasive infection by virtue of their large repertoire of virulence factors and antimicrobial resistance traits (1,6). Among Gram-negative organisms, Pseudomonas aeruginosa is one of the more feared bacterial pathogens because it is often resistant to current therapeutic modalities (5).…”

Assessment of the Effectiveness of Silver-Coated Dressing, Chlorhexidine Acetate (0.5%), Citric Acid (3%), and Silver Sulfadiazine (1%) for Topical Antibacterial Effects Against the Multi-Drug Resistant Pseudomonas Aeruginosa Infecting Full-Skin Thickness Burn Wounds on Rats

“…9 Pseudomonas aeruginosa, Staphylococus aureus, and Escherichia coli currently occupy the top ranks among factors responsible for the etiology of burn wound infections. 2,22,23 Pseudomonas aeruginosa is noted as the most common bacterial agent in burn patients in developing countries includes Turkey. 24,25 Pseudomonas strains are gram-negative bacilli, and have been recognized as the most detrimental bacterial agent in burn wounds since the 1960s.…”

“…constitute the most resistant and predominant strains. [1][2][3] Pseudomonas aeruginosa infections in hospitals mainly affect the patients in intensive care units and those having catheterization, burn, and/or chronic illnesses. 4 These species spread among patients via cross contamination in a hospital environment.…”

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

“…Pseudomonas aeruginosa é um patógeno oportunista que acomete especialmente pacientes imunocomprometidos, sob ventilação mecânica, queimados, portadores de fibrose cística e os que estão em unidades de terapia intensiva, e é um dos mais frequentes patógenos em pneumonia nosocomial (Azzopardi et al, 2011;Carvalho et al, 2008;Goossens, 2003;Høiby, 2011;Sader et al, 2001). …”