The Epidemiology of Burn Wound Infections: Then and Now

TLDR

Burn wound infections remain a serious complication of thermal injury, with evolving management practices over the past five decades that have altered their etiology, epidemiology, and prevention, yet few epidemiologic studies have examined infection rates since the shift to early excision and closure. The study seeks to determine infection rates, etiologies, epidemiology, and prevention strategies for excised and closed burn wounds, and to evaluate indications for topical antimicrobials and selective digestive tract decontamination. Historically, burn wounds were managed by exposing the wound, applying topical antimicrobials, and performing gradual debridement with immersion hydrotherapy. Transitioning to early excision, closure, and showering hydrotherapy was associated with a decline in burn wound infection rates.

Abstract

Burn wound infections are a serious complication of thermal injury. Although pneumonia is now the most important infection in patients with burns, burn wound infection remains a serious complication unique to the burn recipient. The methods for managing thermal injury have evolved during the past 50 years. This evolution has been accompanied by changes in the etiology, epidemiology, and approach to prevention of burn wound infections. In the 1950s, 1960s, and 1970s and into the mid-1980s, burn wounds were treated by the exposure method, with application of topical antimicrobials to the burn wound surface and gradual debridement with immersion hydrotherapy. As early burn wound excision and wound closure became the focal point of burn wound management, accompanied by a change from immersion hydrotherapy to showering hydrotherapy, the rate of burn wound infection appeared to decrease. Few epidemiologic studies have been done since this change in the approach to management of thermal injury. There are few data on the epidemiology of burn wound infections from the era of early excision and closure. Data are needed on infection rates for excised and closed burn wounds, the etiologies of these infections, and the epidemiology and the prevention of such infections. Additional studies are needed on the indications for topical and antimicrobial prophylaxis and selective decontamination of the digestive tract.