The pathogenesis and diagnosis of sepsis post burn injury

Abstract

Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality. Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care, nutritional and fluid resuscitation and improved infection control practices, there are still large numbers of patients at a high risk of death. One of the most common complications of burn is sepsis, which is defined as “severe organ dysfunction attributed to host's disordered response to infection” and is the primary cause of death in burn patients. Indeed, burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome, such as a hypovolaemic state, immune and inflammatory responses and metabolic changes. Therefore, clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock. In this review, we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis. Moreover, the clinical and promising biomarkers of burn sepsis will also be summarized.

Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

“… 5 Without timely and appropriate treatment, bacterial infections in burn patients may lead to sepsis, multiple organ dysfunction syndrome, or even death. 6 A survey showed that up to 75% mortality in burn patients was due to severe burns of 40% total body surface area (TBSA) or above. 5 …”

Conductive Biomaterials as Bioactive Wound Dressing for Wound Healing and Skin Tissue Engineering

“…Wound with delayed healing more than 3 months would be referred to as chronic wound [10,228,229]. In detail, chronic wounds with impaired regenerative capacity demonstrate high levels of proinflammatory cytokines, persistent infections, and drug resistance.…”

“…Extensive tissue damage, necrotic debris, and diseases often make wounds suffer from such issues, thus leading to prolonged inflammation and delayed proliferation and remodeling. Wound with delayed healing more than 3 months would be referred to as chronic wound [ 10 , 228 , 229 ]. In detail, chronic wounds with impaired regenerative capacity demonstrate high levels of proinflammatory cytokines, persistent infections, and drug resistance.…”

“…On the other hand, wound monitoring has been developed. Diagnosis and monitoring of wounds are very imperative, especially for chronic wounds [ 6 , 228 ]. Physical examination and the parameters including wound location, size, depth, and drainage should be well recorded and further treatment needs to be adjusted depending on the healing degree.…”

Red cell distribution width/albumin ratio and 90-day mortality after burn surgery

“…Burn injury can induce multisystem stress and uncontrolled systemic inflammation, leading to mortality and morbidity [ 1 ]. Though the burn mortality rate has declined during the last 5 decades due to improved resuscitation, antibiotic therapy, surgical procedures and nutritional support [ 2 ], the mortality rate of burn patients (range 1.4–18%) remains high when compared with that of other critical care patients [ 3 ].…”