Management and prevention of drug resistant infections in burn patients

ABSTRACT

Introduction: Despite modern advances, the primary cause of death after burns remains infection and sepsis. A key factor in determining outcomes is colonization with multi-drug resistant (MDR) organisms. Infections secondary to MDR organisms are challenging due to lack of adequate antibiotic treatment, subsequently prolonging hospital stay and increasing risk of adverse outcomes.

Areas covered: This review highlights the most frequent organisms colonizing burn wounds as well as the most common MDR bacterial infections. Additionally, we discuss different treatment modalities and MDR infection prevention strategies as their appropriate management would minimize morbidity and mortality in this population. We conducted a search for articles on PubMed, Web of Science, Embase, Cochrane, Scopus and UpToDate with applied search strategies including a combination of: “burns, ‘thermal injury,’ ‘infections,’ ‘sepsis,’ ‘drug resistance,’ and ‘antimicrobials.’

Expert opinion: Management and prevention of MDR infections in burns is an ongoing challenge. We highlight the importance of preventative over therapeutic strategies, which are easy to implement and cost-effective. Additionally, targeted, limited use of antimicrobials can be beneficial in burn patients. A promising future area of investigation within this field is post-trauma microbiome profiling. Currently, the best treatment strategy for MDR in burn patients is prevention.

KEYWORDS:

• Antimicrobials
• burns
• drug resistance
• infection
• prevention

Article highlights

• Principal cause of burn patient mortality is infection and sepsis.

• Burn wounds are predominately colonized by Staphylococcus and Streptococcus species early on admission and P. aeruginosa later.

• Best preventative approach consists of early debridement and coverage with antimicrobial-coated dressings. Prophylactic antimicrobials depending on phase of admission and common pathogens at the particular burn unit is also beneficial.

• ASPs are key to MDR infection management. They provide knowledge of common endemic organism(s) and resistance patterns, allowing appropriate selection of empiric agents.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by grants from the Canadian Institutes of Health Research (#123336), the Canada Foundation for Innovation Leader’s Opportunity Fund (#25407) and National Institutes of Health (2R01GM087285-05A1).