The Treatment of Burn Infections

One of the most dangerous things about sustaining a burn is a lack of skin barrier to protect the body against pathogens. In addition, if there is dead tissue, bacteria tend to feed off that tissue, leading to infection.   Large burns tend to negatively impact the burn victim’s immunity, making systemic infection more likely.

The best practice for treating burns includes a strict antiseptic technique, mainly using sterile gloves when handling the burned area, using facemasks in burn centers, and cleaning off as much dead tissue as possible. All equipment used in a burn center, including blood pressure cuffs, IV equipment, and dressing supplies, should be as clean or sterilized. After the patient has left the hospital, staff should come in and clean the floor, walls, ceiling, and all other surfaces.

This means that the best way to manage wound infections in patients with burns is to prevent them from occurring in the first place. Ideally, patients in a burn unit should reside in individual positive pressure rooms that keep bacteria out and have the space filtered with a reputable Hepa air filter. Cleaning and sterilizing should be scrupulous. 

When a burn happens, the bacteria in those areas of the burn that have been destroyed by heat or chemicals also die off. There are areas in the periphery of the wound or in the surrounding skin that still contain viable bacteria that can infect the burn. A single bacterium can multiply into ten billion bacteria in just one 24-hour time. The bacteria are relatively protected from injury in sebaceous glands and hair follicles in the skin’s dermis. Hence, these are the bacteria that spill out and contaminate the wound.

Burns that are deep have tissue not well supplied by blood vessels, which can carry anti-bacterial cells of the immune system so that bacteria can survive unchecked. If the bacteria are dangerous enough, they can infiltrate healthy tissue and can cause an actual “wound infection” with the possibility of systemic complications.

Burns usually have redness around them, which doesn’t necessarily mean it is infected. Even a fever doesn’t indicate infection, as the burn itself can trigger mechanisms that cause an elevation in body temperature. The redness around the burn usually indicates the presence of inflammatory molecules and cells drawn toward the burn in the healing process. This burn redness goes away by post burn days 5-6. The difference between this process and a burn infection is that the inflammatory process rarely hurts.

When bacteria are found on the surface of a burn but not in great concentrations, “burn wound colonization.” There is no invasive infection, and it is not usually painful. The doctors treat this kind of thing with local cleaning of the wound, the application of topical anti-bacterial agents, and surgery to further debride the wound. (Debriding involves physically removing dead and infected tissue). If the counts of bacteria continue to rise, they will often change the anti-microbial agent to cover for the bacteria present.

It is called a “burn infection” when the burn is colonized greatly. The healthy tissue is also infected, and the margin of redness around the burned area becomes greater. The patient usually gets a fever, and the wound is more infected. This is treated by using topical and systemic (oral or IV) antibiotics and putting on topical anti-bacterial cream or ointment.

One complication of a burn is called toxic shock syndrome. It is a severe soft tissue infection from Staphylococcus aureus that produces TSS-toxin-1. It usually occurs with minor wounds and is often found in children. The patient has severe systemic symptoms such as fever, nausea, diarrhea, vomiting, and malaise. There is often a rash associated with toxic shock syndrome. It usually occurs in burns 2-4 days old and carries the threat of shock and a mortality rate of up to 50 percent.   It needs aggressive treatment with life support and systemic antibiotics, usually against methicillin-resistant Staphylococcus aureus (MRSA), unless a different bacterium is cultured.

Another complication of burns is an invasive wound infection. No toxins or bacteria are in the blood; however, it must be treated aggressively with antibiotics and surgical removal of burned and infected tissue. The wound can change color from pink and white to become yellow, green, and black. Such infections have a bad
odor. The essential factor in clearing these wounds is to get rid of every bit of dead tissue possible through surgery.

With the emergence of bacteria resistant to many antibiotics, there has been an increase in serious burn infections that are difficult to treat.   One such bacterial type is Pseudomonas species, which causes clogging of the blood vessels around the wound, increasing dead tissue and sometimes death. When an injury is infected, it is called ecthyma gangrenous and looks like a blue to black spot in the center of the burn. Enterococcus species have also become drug-resistant.

A fungal organism called Fusarium can invade healthy tissue and turn it into necrotic (dead). It has the unfortunate problem of being amphotericin resistant.

Treatment must be as aggressive as this organism, using other anti-fungal agents, topical anti-fungal creams, and aggressively removing necrotic tissue.

Even Candida (a type of fungus) can cause burn infections. Doctors can check serum Candida antibody titers to see if the infection is developing and can save the person’s life if it is caught early.

They can also detect Candida in the urine even if the start of the infection was on the skin. A Candida infection and systemic candidiasis usually come from having an immunocompromised patient and following aggressive antibiotic use. Candida can be found just about everywhere inside the body when this happens. Death is associated with amphotericin-resistant Candida infections.

Doctors can take biopsies of any part of a burn that appears to be changing to see under the microscope whether or not there is serious infection brewing. This can allow for early and aggressive management of the burn. Increasing counts of bacteria or yeast in the wound can indicate a need for a different anti-microbial cream or ointment for the burn.

Viral infections can also contaminate wounds. Common viral infections in burn patient wounds include cytomegalovirus, herpes, and adenovirus. Cytomegalovirus can be particularly virulent and is associated with larger burns (greater than 50 percent of the total body surface area).

Patients with contaminated burns can get a bloodborne infection called sepsis. The patient will develop a fever or low body temperature, rapid heart rate, shortness of breath, high blood sugar, and low platelet counts. They have a hard time ingesting even liquid feedings, so this must be stopped until they can recover. Sometimes a particular organism is detected through cultures of the blood.

Pneumonia can come out of burn infections, and it is more common in patients who require mechanical ventilation as part of their treatment. The bacterial infection can happen because of inhalation of bacteria into the lungs or from a spread of wound bacteria to the lungs through the bloodstream. In about half the cases, the doctor can check the organisms growing in the wound for an exact match of the organism found in the lungs.
 
Other infections that can stem from burn wounds include abdominal, eye, chondritis of the ear cartilage, sinus, and urinary tract infections.

The most common bacteria to infiltrate burns include the following:

• Staphylococcus aureus
• Streptococcus species
• Enterococcus species
• Clostridium species
• Pseudomonas species

The key to managing these dangerous bacteria remains surgical excision of dead tissue, identifying the organism, and providing antibiotics by topical application and parenteral routes that can quickly get the infection under control. 

Burn injuries are painful and life-threatening. Call our experienced Sacramento Burn Injury Lawyers at (916) 921-6400 or (800) 404-5400 if you or a loved one has suffered severe burn injuries in an accident due to negligence. Our law firm offers free and friendly advice.

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Editor’s Note: This page has been updated for accuracy and relevance. [cha 5.31.22]

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