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Burn Wound Infections Follow-up

  • Author: Jairo A Fonseca, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: May 25, 2016
 

Further Outpatient Care

Patients require prolonged occupational and physical therapy support based on the site of the burn.[27]

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Further Inpatient Care

A primary goal during hospitalization is to prevent nosocomial transmission of multidrug-resistant pathogens, especially in patients with a greater percentage of total body surface area (TBSA) burn (approximately 30%) or who are known to be colonized with multidrug-resistant bacteria such as MRSA, vancomycin-resistant Enterococcus species, or gram-negative bacteria known to develop resistance (eg, Pseudomonas, Klebsiella, Acinetobacter species).[5, 10]

Hand hygiene should be aggressively implemented. Standard precautions should be used in the care of all patients with burn injuries. Patients should be managed in single rooms, if possible, with use of contact precautions. Gowns and gloves should be used when contact with infected material or open wounds is expected. Masks and caps should be implemented based on the presence of multidrug-resistant bacteria. The use of individual-patient equipment should be considered.[19]

For catheter insertion, locations distal from the wound are necessary since catheters inserted near or through burn wounds are more frequently associated with infection development and earlier bacterial contamination with higher numbers of colony-forming units than catheters inserted distant from the wound. If a central venous catheter is required, femoral insertion sites are associated with higher infection rates.[46]

Routine surveillance cultures may be used in conjunction with isolation precautions for all or those patients with multidrug-resistant bacterial colonization or previous infection. Surveillance cultures, isolation, and hand hygiene, used in conjunction with regular feedback and education and environment control measures, have been shown to control the transmission of resistant pathogens.[8]

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Transfer

Aggressive infection-control procedures should be undertaken when transferring patients between facilities because of the risk of transferring multidrug-resistant bacteria.

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Complications

Burn wound infections are often the source of bacteria responsible for other systemic infections including bloodstream infections and pneumonia. This can lead to multisystem organ failure and death.[20]

Sepsis can contribute to multisystem organ failure and death.[20]

Early wound excision is associated with bleeding complications that require transfusions. Given the evidence that increased blood transfusion is associated with higher infection rates in the general trauma population, further data is needed to evaluate the overall utility of early excision especially as the overall data supporting this technique is limited although it is considered standard of care in most burn facilities.[45]

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Prognosis

The overall prognosis depends on numerous factors, including the patient’s age, percentage of TBSA burned, comorbidities, initial management strategies, and the support necessary for long-term rehabilitative care.

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Patient Education

For patient education resources, see the First Aid and Injuries Center and the Thermal Heat or Fire) Burns article.

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Contributor Information and Disclosures
Author

Jairo A Fonseca, MD Postdoctoral Fellow, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine

Jairo A Fonseca, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Coauthor(s)

Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH Adjunct Professor of Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio

Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society for Infectious Diseases, International Society of Travel Medicine, Medical Mycological Society of the Americas, Armed Forces Infectious Diseases Society, International Society for Human and Animal Mycology, American College of Physicians, American Society for Microbiology, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Fred A Lopez, MD Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine

Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Louisiana State Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Clinton Murray, MD Program Director, Infectious Disease Fellowship, San Antonio Uniformed Services Health Education Consortium

Clinton Murray, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Association of Military Surgeons of the US, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Second-degree burns often are red, wet, and very painful. Their depth, ability to heal, and tendency to result in hypertrophic scar formation vary enormously.
 
 
 
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