Infection in Burns - An Overview

Introduction:

Burns are common injuries to the skin that can occur as a result of thermal, chemical, electrical, or radiation exposure. Infection is a very common burn complication that can impact the recovery process and overall outcome significantly. Infection in burns occurs when the skin's protective barrier is damaged, allowing bacteria to enter and multiply in the wound. Infection risk is highest during the first few days after the burn injury, as the skin's immune system is weakened.

In addition to the loss of the skin's protection function, burns can also cause reduced or diminished blood flow to the affected area, damaging or delaying the immune response, and making it more difficult for the body to fight infection. Burn injuries can compromise the body's immune system, thus making it difficult for the body to fight off an infection. The immune system can also weaken due to any pre-existing medical conditions, the extent of the burn, and the severity of the burn injury. Three primary classifications of burns are:

• First Degree Burns - Superficial burns that affect only the outer layer of skin called the epidermis. They cause mild pain.

• Second Degree Burns - Injuries on the outer layer of the skin as well as the underlying layer of skin (dermis). They cause moderate to severe pain.

• Third Degree Burns - Injuries on all the layers of the skin. Pain is very severe in this type of burn.

Infections in burns are a major cause of morbidity and mortality in burn victims. This article elaborates on the incidence and types of infections in burns, the signs and symptoms of burn infections, and the diagnosis, treatment, and prevention of infection in burns.

What Are the Types of Infections in Burns?

1. Bacterial Infections: Bacterial infections are very common after a burn injury. Bacteria cause production of toxins that can damage the tissue, cause delayed wound healing, and thereby increase the risk of scarring. The commonly involved bacteria are Staphylococcus aureus, Enterococci, and Pseudomonas aeruginosa. Pseudomonas aeruginosa is known to produce a pigment called pyocyanin, which can cause tissue damage and delay wound healing.

2. Fungal Infections: Fungal infections occur when there is prolonged use of antibiotics or when the patient has a weakened immune system. Fungal infections are very difficult to diagnose and treat, leading to significant morbidity and mortality rate.

3. Viral Infections: Viral infections in burns are less common, generally affecting the patient who has a weakened immune system. Herpes simplex virus and Varicella-zoster virus are the most common viral infections seen in burns.

What Are the Symptoms of Infection in Burn Injuries?

• Redness.

• The warmth from the wound surface.

• Swelling.

• Increased tenderness.

• Discharge from the wound.

• Fever.

• Chills.

• Nausea and vomiting.

How to Diagnose the Infection in Burns?

A complete physical examination can help in the diagnosis. The following laboratory tests can be used to diagnose infection in burns:

• Blood cultures.

• Wound cultures.

• Biopsy of infected tissue.

Imaging techniques such as X-rays or MRIs (magnetic resonance imaging) may also be used to evaluate the extent and depth of the infection.

What Is the Treatment for Burn Infection?

Treatment of infection in burns typically involves:

• Identifying the Causative Organism: A sample of the wound is collected and sent to the laboratory for culture and sensitivity testing. This helps in identifying the causative organism and determining the most appropriate antibiotic.

• Application of Topical Or Systemic Antibiotics: Applying topical or systemic antibiotics can help to kill or reduce the bacterial load till the immune system takes the charge. The antibiotics are selected depending on the type and severity of the infection and the results of culture and sensitivity testing. In more severe cases, hospitalization may be necessary for the administration of intravenous (IV) antibiotics, appropriate wound care, and monitoring of the patient.

• Wound Care: Along with antibiotics, wound care is an important element of the treatment of burn infection. The wound should be cleaned and debrided to remove any dead tissue or foreign material that may help bacteria to grow. Dressings must be changed regularly to maintain a moist environment that promotes healing and prevents bacterial growth.

• Surgical Interventions: Surgicalinterventions are rarely required but may be necessary in some cases to remove infected tissue (excessive scar tissue) or to repair damaged skin. Skin grafting may be necessary in cases of extensive tissue damage or scarring.

• Supportive Care: Supportive care is an essential regimen in the treatment of infection in burns which includes fluids and electrolytes management (balancing the levels in the body), pain control, and nutritional support.

How to Prevent Infection In Burns?

Prevention of infection in burns is critical and includes:

1. Wound Cleaning: The wound should be thoroughly cleaned to remove any debris, dirt, or other contaminants. This is usually done by washing the wound with soap and water or a sterile saline solution.

2. Wound Dressings: Appropriate dressings should be used to protect the wound from further contamination and to promote healing. Different types of dressings such as hydrocolloids, foams, and alginate dressings can be used based on the type and severity of the burn.

3. Maintain Proper Hygiene: Burn patients should practice good hygiene such as washing their hands frequently, keeping the wound clean and dry, and avoiding touching the wound or any medical equipment with dirty hands.

4. Immunizations: Immunizations can help prevent infections caused by specific pathogens. Burn patients who receive appropriate immunizations such as tetanus toxoid and pneumococcal vaccine respond properly to treatment to avoid infections.

5. Wound Monitoring: It is also important to monitor the wound for signs of infection and to seek medical attention promptly if symptoms occur.

It is important to note that to manage the burn infections, a multidisciplinary approach is essential, which includes a burn specialist, an infectious disease specialist, and a wound care specialist. Also, a thorough understanding of the mechanism of wounds and its principles is very crucial in the prevention of infection of wounds.

Conclusion:

Infections in burns are of serious concern, and therefore they need to be closely monitored. Early detection and prompt treatment of bacterial infections are crucial steps in the management of burn patients. Treatment of bacterial infections in burn patients can be challenging, as burn wounds are more susceptible to infection due to their compromised immune status and the presence of dead tissue that can provide a breeding ground for bacteria. With all the preventive measures and accurate treatment, the chances of getting an infection in burn patients can be minimized, as can the chances of early recovery and a reduced impact on their overall health.