Burn wound infections

Abstract

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

FIG. 1.

Basic skin anatomy, showing the depth of injury for first-, second-, and third-degree burns. (Adapted from reference with permission of the publisher.)

FIG. 2.

Zones of injury for superficial and deep second-degree burns. (Adapted from reference with permission of the publisher.)

FIG. 3.

Body diagram for estimation of total burned surface area (%TBSA) in adults, using the rule of nines (numbers are for anterior only and posterior only). (Adapted from reference with permission of the publisher.)

FIG. 4.

Body diagram for estimation of total burned surface area (%TBSA) in children, using the rule of nines (numbers include anterior and posterior). (Adapted from reference with permission of the publisher.)