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Infection remains the most common cause of death in the severely burned patient. The systemic immunosuppression following burn injury allows infection to occur in any organ system, but predominantly in the lungs. In addition, the loss of the skin barrier permits microorganisms to colonize and invade the burn-injured tissue. The use of topical antimicrobial agents and early burn wound excision have significantly decreased the occurrence of invasive burn wound infection. Even so, burn wounds must be examined each day, and a biopsy should be performed of any area showing local signs indicative of infection. If histologic examination of the biopsy tissue confirms invasive infection, local and systemic interventions are required. Candida is a common colonizer of the burn wound, but rarely invasive. Aspergillus species are the most common filamentous fungi found in invasive burn wound infections. Viral infections are uncommon, but should be in the differential diagnosis of patients with cutaneous herpetic lesions and signs of systemic sepsis with no other apparent source. Pneumonia is the most common organ-specific life-threatening infection of extensively burned patients. Staphylococcus aureus was the most frequent causative organism at the United States Army Institute of Surgical Research Burn Center during 1996–1997. Other causes of infection, such as suppurative thrombophlebitis, should be in the differential diagnosis of the septic burn patient with no obvious source. Infection control procedures, including scheduled surveillance cultures, utilization of cohort nursing care, and strict enforcement of patient and staff hygiene, should be instituted at all burn centers. |
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