Acute Crit Care.  2024 May;39(2):214-225. 10.4266/acc.2023.01571.

Microbial infections in burn patients

• Roy S
• Mukherjee P
• Kundu S
• Majumder D
• Raychaudhuri V
• Choudhury L

• KMID: 2557237
• DOI: http://doi.org/10.4266/acc.2023.01571

Abstract

Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

Keyword

burn wound infections; biofilm; epidermis; hospital; opportunistic infection

Figure

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  Figure 1. Burn wound infection microbes and their effect on a burn patient. MRSA: methicillin-resistant Staphylococcus aureus; spp.: species.

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  Figure 2. (A) Burn wounds typically contain burn wound exudates, which facilitate the initial inoculation and reversible attachment by bacterial pathogens. (B) Bacteria begin to produce extracellular matrix (ECM) and form micro-colonies during the process of irreversible attachment. (C) During the maturation stage, the biofilm grows in size and structural complexity. (D) The mature biofilm enters the dispersal stage, releasing bacterial cells from the ECM, which can then colonize new sites within the wound. Adapted from Maslova et al. NPJ Biofilms Microbiomes 2021;7:73 [3].

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