Topic Four: Managing Infection

Wound infections are one of the most serious complications that can occur in the acute phase after a burn injury. They are the result of the disruption of the skins barrier, compromised immune system and invasive procedures. The management aim is to enhance the patient’s immune response, reduce the bioburden within the wound, optimise the wound environment and improve the healing process.

Topical antimicrobials can be used for prevention of infection in extended burns and are indicated in the presence of signs and symptoms of local infection (e.g. slough, hyper granulation tissue, dark/friable granulation tissue). Topical antimicrobials should be efficacious and not increase the risk of resistance or allergic reactions.

In the presence of spreading or systemic infection, systemic antibiotics, oral or IV are indicated. This would be based on a thorough patient and wound assessment alongside the results of a wound swab.

Common organisms in critically ill burn injured patients with bacteraemia include Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella, Escherichia coli, Enterococcus and Acinetobacter species. These infections typically require surgical debridement of the involved tissue in conjunction with systemic broad-spectrum antibiotics. (International Best Practice Guidelines, 2014; Jeschke et al., 2018)