Status and Challenges of Predicting and Diagnosing Sepsis in Burn Patients

Abstract

Burns are a common form of trauma that account for more than 300,000 deaths each year worldwide. Survival rates have improved over the past decades because of improvements in nutritional and fluid support, burn wound care, and infection control practices. Death, however, remains unacceptably high. The primary cause of death has changed over the last decades from anoxic causes to now predominantly infections and sepsis. Sepsis and septic complications are not only major contributors to poor outcomes, but they further result in longer hospital stay and higher healthcare costs. Despite the importance of infections and sepsis, the diagnosis and prediction remain a major challenge. To date, no clear diagnostic criteria or predictive formula exist that can predict reliably the occurrence of sepsis and infections. This review will highlight and discuss current definitions and criteria for diagnosis as well as predictive biomarkers of sepsis in patients with burns. It will also present the diagnostic tools employed, such as procalcitonin, C-reactive protein, and cytokines. We will discuss the benefits and shortcomings of different treatment modalities in the context of sepsis prevention. Last, we identify new therapeutic strategies for sepsis prediction and present future considerations to prevent sepsis in patients with burns. Minimizing and preventing septic complications through early detection would significantly benefit patients and necessitate continued research to unravel new biomarkers and mechanisms. Subsequent studies need to take a fresh perspective and consider the implementation of patient-centered therapeutic strategies.

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.…”

A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine

“…Results on the utility of PCT levels to early detect sepsis in burned patients are controversial, probably the use of different combinations of different biomarkers could overcome their individual limitations (137,138).…”

Infections in Burns

“…More recently, the publication by Stanojcic and colleagues as well as Yan and colleagues demonstrated that the Sepsis-3 had superior sensitivity in predicting sepsis in comparison to Mann-Salinas and ABA criteria for sepsis; however, none of the aforementioned had the accuracy to be a stand-alone diagnostic tool within the burn population [ 53 , 54 ].…”