Infection control in severely burned patients

Abstract

In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.

Prevalence of aerobic pathogenic bacteria isolated from patients with burn infection and their antimicrobial susceptibility patterns in Al-Najaf City, Iraq- a three-year cross-sectional study.

“…Contaminated burning wards and duration of patients stay in hospital, in addition to the size of surface area of burned skin are the most important reasons to increase of persistent and multiplication of pathogenic bacteria in the burned areas 40 . There are a number of factors that influence the emergence of infection in burns patient including; prolonged hospital stays, contamination of burns wards, nature of burn injury itself, as well as intensive diagnostic and therapeutic procedures 41,42 . Some studies suggested that burn infection is the most common type of infection, while, others studies reports show it to be bacteremia and pneumonia 43,44 .…”

Burn injury outcomes in patients with pre-existing diabetic mellitus: Risk of hospital-acquired infections and inpatient mortality

“…However, diabetic patients did not have higher odds of mortality [29]. Early burn mortality is attributable to acute infections leading to sepsis, however early excision and grafting and the use of ICU protocols such as ventilator and sepsis bundles has led to the reduction of early sepsis associated burn mortality [30]. …”

Bronchoalveolar Lavage Microvesicles Protect Burn-Injured Mice from Pulmonary Infection

“…It is more prevalent in susceptible patient populations, including immunosuppressed, cystic fibrosis, and burn patients 4 . With improvements in wound care and resuscitation, pneumonia is a major cause of morbidity and mortality in the burn patient population 1,5,6 . In particular, PA is the most frequently isolated bacterial pathogen 1,7 .…”