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Multiple studies published in late 2024 highlight current practices and emerging strategies for infection management for patients with burns.

Multiple studies published in late 2024—in journals including Burns and the Journal of Burn Care and Research—highlight current practices and emerging strategies for infection prevention and treatment among patients with burns.

A key goal of burn care is the prevention of wound infection. The scientific community still debates the defining characteristics of a wound infection because distinguishing infection from colonization is difficult due to a lack of definitive laboratory tests and conflicting symptoms. Colonization has microorganisms present within the wound, and infection is the encroachment of organisms into viable tissue beyond the wound. A patient with a burn wound should be closely monitored. The resulting infection could be devastating for the patient’s prognosis.

Advances in Dressings

The success of burn wound dressing is contingent on infection control, proper fit, and pain management. The application and choice of material for wound dressing should be individualized, as every burn wound is different and requires a tailored approach to treatment. Shawn Tejiram, MD, and Jeffrey W. Shupp, MD, developed a burn care overview article for the  Journal of Burn Care and Research that explored and compared current dressing strategies. Synthetic polymeric dressing is paired with hydrogels, hydrocolloids, or films to prevent infection by ceasing bacterial penetration, and this dressing traps exudates seeping from the wound.

Silver & Oxygen Advantages

An antimicrobial foam dressing impregnated with silver retains wound exudate and releases the silver over time. This combination allows the dressing to be changed less frequently, lessening the pain and discomfort of constant re-dressing. Silver ions can eliminate microbial species by clinging to DNA, proteins, and enzymes through an oxidative route. The addition of nanotechnology to this process enhances the delivery of the silver ion to the burn wound, such as using nanocrystalline products, which can slowly release the silver, lessening the silver cation burden. Lightweight silver-coated nylon fiber offers similar advantages and provides ease of use, shelf stability, and cost-effectiveness while ensuring antimicrobial coverage and fewer dressing changes.

Other metals are also being explored for their antimicrobial properties through topical means. Studies have shown that gold possesses both antimicrobial properties and healing benefits as it clings to bacterial walls and DNA. Hypochlorous acid has also been studied for its inhibition of bacterial plasma membrane proteins.

Oxygen’s contribution to infection prevention has also made it an attractive option to explore for burn wound care. Applications such as oxygen-based dressings and hyperbaric oxygen therapy continue to be studied and have shown promising results.

Resistance

As burn wound treatment protocols continue to evolve, resistance mechanisms need to be examined and considered as new avenues of therapy are developed. In their study of bacterial resistance in burn wounds published in the International Journal of Molecular Sciences, María Fernanda Fuentes-González, MD, and her colleagues found that multidrug resistance was highly prevalent among the patients they treated for burn wounds in their cohort. They further observed that the total surface area of the burn wound, as well as the number of invasive procedures performed on the patients, contributed to mortality.

A study developed by Qiang Li, MD, and colleagues published in the journal Burns corroborated the findings regarding total body surface area burned. The researchers found that as the total body surface area burned and the length of hospital stay increased, the danger of Klebsiella pneumoniae (CRKP) infection also increased. As Dr. Li and colleagues wrote in their published conclusion, “Reducing the length of hospital stay for [patients with burns] is the most important measure for lowering the risk of CRKP infection.”

As the landscape for burn wound care treatment continues to evolve, dressings and topical agents that successfully prevent bacterial infection will continue to be sought and improved so that practitioners can avoid the struggle against antibiotic resistance. Protocols that avoid invasive procedures during burn wound care and lengthen hospital stays should also be considered to optimize outcomes.

Key Takeaways

• Multiple studies published in late 2024 highlight current practices and emerging strategies for infection prevention and treatment in burn care.
• One study examines current dressing strategies, including synthetic polymeric dressing paired with hydrogels, hydrocolloids, or films to prevent infection by ceasing bacterial penetration.
• Studies assessing infections, antimicrobial therapy, and resistance found that patients undergoing treatment for burn wounds frequently exhibited multidrug resistance.
• Another determined that the risk for Klebsiella pneumoniae infection increased as the total body surface area burned and the length of hospital stay increased.