Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
Surg Infect (Larchmt). 2021 Feb;22(1):44-48. doi: 10.1089/sur.2020.346. Epub 2020 Oct 20.
Infection is a major cause of morbidity and mortality among burn patients, and it is important to understand the progression of wound colonization to wound infection to systemic sepsis. After a review of the literature we describe the clinical characteristics of burn wound colonization, infection, and sepsis, and conclude with best practices to decrease these complications. Burn wounds are initially sterile after the thermal insult but become colonized by gram-positive organisms and subsequently by gram-negative organisms. Some populations are especially susceptible to initial or subsequent colonization by drug-resistant organisms. An increase in fungal colonization has been observed because of the widespread use of topical antibiotic agents. Male gender, older age, lower extremity burn, scald burn, full-thickness burn, delay in treatment, and pre-existing diabetes place patients at increased risk of infection. These infections range from cellulitis that requires systemic antibiotic agents, to invasive burn wound infection that requires prompt treatment with antibiotic agents and excision. Fungal wound infections pose a special challenge and cause substantial morbidity. Infection that leads to systemic sepsis is difficult to define in burn patients because of the body's compensatory hypermetabolic response to the burn injury. Potential sources of sepsis include wound infections and common nosocomial infections. The American Burn Association Sepsis criteria, defined in 2007, has demonstrated poor specificity for identifying sepsis and septic shock. The best approach to decrease wound infections is prevention. Practices that have been beneficial include isolation rooms, handwashing, appropriate wound care, early excision and grafting, antibiotic stewardship, and nutritional support. A burn patient remains at a substantial risk of wound infection despite advances in care. A burn care provider must understand the natural progression of colonization to infection to sepsis, and the multidisciplinary approach to wound care to limit the morbidity and mortality from these infectious.
感染是烧伤患者发病率和死亡率的主要原因，了解创面定植、感染和全身败血症的进展非常重要。在回顾文献后，我们描述了烧伤创面定植、感染和败血症的临床特征，并得出了减少这些并发症的最佳实践。烧伤创面在热损伤后最初是无菌的，但会被革兰氏阳性菌定植，随后被革兰氏阴性菌定植。某些人群特别容易被耐药菌初始或随后定植。由于广泛使用局部抗生素，真菌定植的增加已经被观察到。男性、年龄较大、下肢烧伤、烫伤、全层烧伤、治疗延迟以及糖尿病等因素会增加感染的风险。这些感染从需要全身抗生素治疗的蜂窝织炎到需要及时用抗生素治疗和切除的侵袭性烧伤创面感染不等。真菌感染创面感染构成特殊挑战，导致大量发病率。由于烧伤损伤导致机体代偿性高代谢反应，导致感染导致全身败血症在烧伤患者中难以定义。败血症的潜在来源包括创面感染和常见医院感染。2007 年定义的美国烧伤协会败血症标准对识别败血症和感染性休克的特异性较差。减少创面感染的最佳方法是预防。已经证明有益的措施包括隔离室、洗手、适当的创面护理、早期切除和植皮、抗生素管理以及营养支持。尽管在护理方面取得了进展，但烧伤患者仍然存在严重的创面感染风险。烧伤护理提供者必须了解定植、感染到败血症的自然进展，以及多学科的创面护理方法，以限制这些感染的发病率和死亡率。
