Burns

Injuries due to burns rank among the most serious forms of trauma, resulting in anatomic, physiologic, endocrine, and immunologic stresses, especially when burns involve greater than 20% of the total body surface area (TBSA). Predicted mortality related to burn injuries can be estimated based on the sum of age and percentage TBSA burned (Baux score), although inhalational injury is also an important factor. After initial resuscitation, infectious complications cause 75% of deaths in burn patients with pneumonia, cellulitis, and urinary tract infections being the most common causes. Prolonged hospitalizations, multiple surgical interventions, and indwelling lines and devices make nosocomial infections and associated resistance a major challenge for burn patients. The microbiology of these infections has shifted to gram-negative organisms, especially as length of stay increases. Also unique to burn patients is the threat of fungal wound infections, which have been associated with increased mortality. Because of the hypermetabolic state of burn patients, guidelines for diagnosing sepsis in this unique population were created, but research is ongoing to attempt to refine these criteria. The importance of surgical intervention cannot be overemphasized in the prevention (through early excision and grafting) and treatment of burn wound infections. Because of the unique challenges of burn care and prolonged hospitalizations, infection prevention and antimicrobial stewardship also have a vital role in the burn intensive care unit.