Burn Infections
Burns are a common and devastating form of trauma. The incidence of burns worldwide severe enough to require medical attention in 2004 was nearly 11 million people, and ranked fourth in all injuries. Recent data from the USA estimate that approximately 45
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Burn Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 Epidemiology of Burn Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355 Burn Wound Excision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Pathogenesis of Burn Wound Infections . . . . . . . . . . . . . . . . . . . 357 Host Immunologic Response to Burn Injury . . . . . . . . . . . 358 The Systemic Response to Burn Injury . . . . . . . . . . . . . . 358 The Innate Immune System in Response to Burn Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359 The Adaptive Immune System in Response to Burn Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360 Inflammatory Markers in Burn Injury . . . . . . . . . . . . . . . . . . 361 Altering the Immunologic Response to Burn Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 Microbial Factors Contributing to Burn Wound Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362 Diagnosis of Burn Wound Infections . . . . . . . . . . . . . . . . . . . . . . 364 Burn Wound Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 Prevention of Infection in the Burn Patient . . . . . . . . . . . . . . . 367 Future Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Burns are a common and devastating form of trauma. Worldwide, the incidence of burns severe enough to require medical attention in 2004 was nearly 11 million people and ranked fourth in all injuries (Peck 2011). Recent data from the United States estimate that approximately 450,000 upward to 1.1 million burn injuries occur per annum based on visits to hospital emergency departments (ABA 2011; CDC 2011). Moderate to severe burn injuries requiring hospitalization account for approximately 45,000 of these cases, of which 20,000 are major burns involving 25 % of the total body surface area. Based on selected statistics for admissions to burn centers in the United States, the overall survival rate from burn injury was 94.8 % in the past decade (2000–2009), and improved survival is attributed to medical advances in fluid resuscitation, nutritional support, pulmonary care, burn wound care particularly early excision and wound closure, and infection control practices. However, although approximately 3,500–4,500 patients currently die each year as
a direct result of their burn injury, up to 10,000 patients die from burn-related infections, particularly sepsis from burn wound infection, or other sources often associated with inhalation injury (Roth and Hughes 2004; Church et al. 2006; ABA 2011; CDC 2011). This chapter reviews our current understanding of the mechanism, pathogenesis, immune response, diagnosis, management, and prevention of burn wound infections.
Burn Injury The skin is the largest organ in the human body, measuring 0
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