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Burn wound infection and sepsis

Gerd G Gauglitz, MMS, MD
Shahriar Shahrokhi, MD, FRCSC, FACS
Felicia N Williams, MD
Section Editor
Marc G Jeschke, MD, PhD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Infection remains the most common cause of morbidity and mortality in burn patients. The diagnosis and management of burn wound infection remains challenging due to the many physiologic features unique to burn injury. A variety of factors increase the risk of developing burn wound infection, and individuals who sustain a severe burn have a particularly high risk for burn wound sepsis.

Any rapid change in the burn wound appearance or the clinical condition of the burn patient may herald burn wound infection or sepsis. The different categories of burn wound infection are characterized based on clinical features and depth of invasion, which is determined through cultures and histopathology of tissue obtained by burn wound biopsy. A diagnosis of burn wound infection relies on the demonstration of >105 bacteria per gram tissue (or recovery of mold or yeast by culture). Specific criteria that include the presence of microbial invasion into adjacent normal tissue, among other criteria, have been suggested by the American Burn Association (ABA) to define burn wound sepsis.

The most common organisms remain Staphylococcus and Pseudomonas; however, the epidemiology of burn wound infections has changed with time and also depends on geography. It is imperative to be aware of the flora and susceptibility of organisms in each burn unit to be able to treat burn wound infections effectively.

Depending upon the burn wound category, treatment of burn wound infection/sepsis consists of a combination of wound cleansing, debridement, topical or systemic antimicrobial therapy, and burn wound debridement or excision.

The clinical manifestations, diagnosis, and treatment of burn wound infection and sepsis are reviewed here. Sepsis related to other conditions is reviewed elsewhere. (See "Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 22, 2017.
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