Burns are particularly susceptible to infection and wound colonization for several reasons. The disruption of the epidermal barrier combined with the denaturation of proteins and lipids provides a fertile environment for microbial growth. Furthermore, a complex cascade of biochemical events leads to a “systemic apoptotic response” and hence to immunosuppression that abrogates patient’s defense mechanisms that would fight off invading bacteria.
It is estimated that 75 percent of the mortality following thermal injuries is related directly to infections. Nosocomial infections (e.g. central venous catheter source) and emerging multi-drug-resistant strains of bacteria and fungi contribute to burn wound colonization and infections, sepsis, and associated death. The Nosocomial Infection Surveillance System from the US Centers for Disease Control and Prevention (CDC) reported that burn intensive care units (ICUs) have the highest rates of primary blood stream infection in patients with central venous catheters among all ICUs. In a series of 175 patients with severe burns, infection preceded multi-organ dysfunction in 83 percent of patients and was considered the direct cause of death in 36 percent of those who died.
Colonization of burn wounds may have major consequences including:
- Graft loss for excised and grafted burn wounds
- Increased scar formation
- Increased number of surgical interventions
- Increased nosocomial infections
- Increased length of stay
- Conversion of donor site