Microbiome in the setting of burn patients: implications for infections and clinical outcomes

Abstract

Burn damage can lead to a state of immune dysregulation that facilitates the development of infections in patients. The most deleterious impact of this dysfunction is the loss of the skin’s natural protective barrier. Furthermore, the risk of infection is exacerbated by protracted hospitalization, urinary catheters, endotracheal intubation, inhalation injury, arterial lines and central venous access, among other mainstays of burn care. Currently, infections comprise the leading cause of mortality after major burn injuries, which highlights the improvements observed over the last 50 years in the care provided to burn victims. The need to implement the empirical selection of antibiotic therapy to treat multidrug-resistant bacteria may concomitantly lead to an overall pervasiveness of difficult-to-treat pathogens in burn centres, as well as the propagation of antimicrobial resistance and the ultimate dysregulation of a healthy microbiome. While preliminary studies are examining the variability and evolution of human and mice microbiota, both during the early and late phase burn injury, one must consider that abnormal microbiome conditions could influence the systemic inflammatory response. A better understanding of the changes in the post-burn microbiome might be useful to interpret the provenance and subsequent development of infections, as well as to come up with inferences on the prognosis of burn patients. This review aims to summarise the current findings describing the microbiological changes in different organs and systems of burn patients and how these alterations affect the risks of infections, complications, and, ultimately, healing.

Innate Immune System Response to Burn Damage—Focus on Cytokine Alteration

“…(both 2%). Commensals such as Staphylococcus epidermidis and Propionibacterium acnes present in the burn wound maintain homeostasis, reduce the secretion of proinflammatory cytokines [ 80 ] and negatively affect wound healing [ 81 ].…”

The role and therapeutic potential of gut microbiome in severe burn

“…Current studies have demonstrated that probiotic supplementation and FMT may be the most beneficial options for treating patients with severe burn ( Corcione et al., 2020 ). However, with advances in microbiome research, we have every reason to expect more accurate and comprehensive multispecies microbial therapies or dietary interventions that target specific individuals or microorganisms.…”

Gut Microbial Changes and their Contribution to Post-Burn Pathology

“…Probiotics utilize the specific administration of a few beneficial bacterial species to bolster commensal populations and promote healthy gut functions. Although many preliminary studies have been limited to mouse models, several indicate that FMT and probiotics are promising therapeutic options for severe burn patients (226). A recent study by Kuethe et al utilized a mouse model of severe burn injury in which intestinal permeability and bacterial dysbiosis are evident at 6 days post-burn.…”