Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;50(9):107200.
doi: 10.1016/j.burns.2024.07.004. Epub 2024 Jul 8.

Epidemiology and timing of infectious complications from battlefield-related burn injuries

Matthew R Geringer  1 , Laveta Stewart  2 , Faraz Shaikh  2 , M Leigh Carson  2 , Dan Lu  2 , Leopoldo C Cancio  3 , Jennifer M Gurney  4 , David R Tribble  5 , John L Kiley  6
Affiliations

Epidemiology and timing of infectious complications from battlefield-related burn injuries

Matthew R Geringer et al. Burns. 2024 Dec.

Abstract

Background: Infections are the most frequent complication and cause of mortality in burn patients. We describe the epidemiology and outcomes of infections among deployed U.S. military personnel with burns.

Methods: Military personnel who sustained a burn injury in Iraq or Afghanistan (2009-2014) and were admitted to the Burn Center at U.S. Army Institute of Surgical Research at Brooke Army Medical Center were included in the analysis.

Results: The study population included 144 patients who were primarily young (median 24 years) males (99 %) with combat-related burns (62 %) sustained via a blast (57 %), resulting in a median total body surface area burned (TBSA) of 6 % (IQR 3-14 %). Twenty-six (18 %) patients developed infections, with pneumonia being the predominant initial infection (= 16), followed by skin and soft-tissue infections (SSTI, = 6), bloodstream infections (BSI, = 3), and intra-abdominal infections (IAI, = 1). Initial infections were diagnosed at a median of 4 days (IQR 3-5) post-injury for pneumonia, 7 days (IQR 4-12) for SSTIs, 7 days (IQR 6-7) for BSI, and 17 days for IAI. Patients with infections were more severely injured with greater TBSA (median 31 % vs 5 %), more inhalation injury (38 % vs 12 %), and longer time to definitive surgical management (median of 34 days vs 9) compared to those who did not develop infections (p < 0.001). Among patients with inhalation injury, a higher proportion developed pneumonia (42 %) compared to those without inhalation injury (5 %; p < 0.001). Five patients developed an invasive fungal infection. Gram-negative bacilli were most frequently recovered, with 32 % of Gram-negative isolates being multidrug-resistant. Four patients died, of whom all had ≥ 4 infections.

Conclusions: Military personnel with burn injuries who developed infections were more severely injured with greater TBSA and inhalation injury. Improved understanding of risk factors for burn-related infections in combat casualties is critical for effective management.

Keywords: Burn infections; Burns; Invasive fungal infections; Military; Multidrug-resistant infections; Wound infections.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts to disclose. All authors approved the final version for submission.

References

    1. Kelly EJ, Oliver MA, Carney BC, Shupp JW. Infection and burn injury. Eur Burn J 2022;3:165–79. 10.3390/ebj3010014. - DOI - PMC - PubMed
    1. Lachiewicz AM, Hauck CG, Weber DJ, Cairns BA, van Duin D. Bacterial infections after burn injuries: impact of multidrug resistance. Clin Infect Dis 2017;65:2130–6. 10.1093/cid/cix682. - DOI - PMC - PubMed
    1. Blyth DM, Murray CK. Burns. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases 8th Edition. Volume 2, edn. Edited by Bennett JE, Dolin R, Blaser MJ: Elsevier Health Sciences; 2015: 3757–64.e3.
    1. Żwierełło W, Piorun K, Skórka-Majewicz M, Maruszewska A, Antoniewski J, Gutowska I. Burns: classification, pathophysiology, and treatment: a review. Int J Mol Sci 2023;24:3749. 10.3390/ijms24043749. - DOI - PMC - PubMed
    1. Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers 2020;6:11. 10.1038/s41572-020-0145-5. - DOI - PMC - PubMed

Publication types

MeSH terms