Infection in burn patients

Q: Which organism is most likely to occur in burn patients? - select one

A) Pseudomonas aeruginosa 

B) Staphylococcus aureus

Answer: A

P. aeruginosa is the most commonly isolated organism from burn patients and is an independent predictor of mortality. It tends to occur most commonly after the first week of hospitalization. The mortality rates in patients with and without bаϲteremia are around 77 and 49 percent, respectively. 

Colonization of the burn eschar site with P. aeruginosa is manifested as discoloration of the burn eschar, bleeding in the subcutaneous tissue, and degeneration of the granulation tissue. Healthy adjacent tissue may rapidly develop edema, hemorrhage, and necrosis, with new nodular lesions and eschars forming by centrifugal spread. Systemic signs and symptoms of sepsis occur.

Diagnosing P. aeruginosa infection in burn patients requires quantitative cultures from a biopsy of the burn skin and adjacent unburned tissue. A colony count of 105 organisms per gram of tissue in the setting of consistent clinical findings indicates a burn ԝoսnd infection rather than simple colonization. PCR is now commonly used for early de-escalation of antibiotics.

Antimicrobial resistance is high. Treatment needs aggressive surgical debridement of necrotic tissue and infected eschar and systemic antimicrobial therapy, usually a combination of two antibiotics, because of the high load of organisms and the likelihood of resistant organisms. Prevention is essential with cleaning, debridement, dressing, and topical antimicrobials. 

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References:

1. Estahbanati HK, Kashani PP, Ghanaatpisheh F. Frequency of Pseudomonas aeruginosa serotypes in burn wound infections and their resistance to antibiotics. Burns 2002; 28:340.

2. Lachiewicz AM, Hauck CG, Weber DJ, et al. Bacterial Infections After Burn Injuries: Impact of Multidrug Resistance. Clin Infect Dis 2017; 65:2130.

3. Weaver AJ, Brandenburg KS, Sanjar F, et al. Clinical Utility of PNA-FISH for Burn Wound Diagnostics: A Noninvasive, Culture-Independent Technique for Rapid Identification of Pathogenic Organisms in Burn Wounds. J Burn Care Res 2019; 40:464.

4. Ibrahim D, Jabbour JF, Kanj SS. Current choices of antibiotic treatment for Pseudomonas aeruginosa infections. Curr Opin Infect Dis 2020; 33:464.