Ministry of Health ‫وزارة الصحة‬

Specialized Medical center ‫أمانة المراكز الطبية المتخصصة‬

Mansoura International Hospital ‫مستشفى المنصورة الدولي‬

Non-invasive burn wound infection

Presents when there are clinical features of infection without
systemic signs & bacterial count>10 ^5 bacteria per grm of
tissue obtained from burn wound.
*Subcategories of noninvasive infection :
-Burn wound cellulitis (when clinical features of infection
extend to healthy uninjured skin).
-Burn related surgical site infection.
-Burn wound impetigo (loss of epithelium).
Invasive burn infection
Presents when there are clinical features of infection associated
with systemic signs.

M.O Suspected:
1-Gm+ve such as (streptococcus & staphylococcus species).
2-Gm-ve such as (pseudomonas aeruginosa, acinetobacter
baumani, E.coli, klebsiella, Enterobacter cloacae).
3-More resistant bacteria: such as MRSA, VRE (vancomycin
resistant enterococcus) , MDR , Pseudomonas.
4-Yeast &fungi such as Candida Species.

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 Ministry of Health ‫وزارة الصحة‬
Specialized Medical center ‫أمانة المراكز الطبية المتخصصة‬
Mansoura International Hospital ‫مستشفى المنصورة الدولي‬

Clinical features:

Physical:
1-Fever
2-rapid change in wound appearance (purulent drainage, erythema,
tenderness, increased pain.
3-Edema, dicoloration of margin of burn.
4-Hemorrhagic discoloration of subeschar tissue.
5-separation of discoloration of burn eschar.
6-presence of green pigment (pyocyanin) in sbcutaneous fat
(indication of Pseudomonas infection).
7-presence of intial erythematous and later black necrotic noddular.
Lesion in adjacent un burn skin.
Systemic signs :
1-Temp> 39 C or <36.5
2-progressive tachycardia (adult >90bpm, children >2SD above
normal)
3-progressive tachypnea (adult >30 bpm, child >2SD above normal)
4-refractory hypotension.
Lab findings :
-Glucose: FBG >110 mg/dl in absence of preexisting DM
(hypermetabolic response to sever burn).
-White blood count: leucocytes >12,000 cells/microl in adults, >2SD
above normal in children) or lecocytopenia <4000).
-platelet count <100,000 in adults, <2SD below normal level in child.)
-procalcitonin measures in patient with sever burn useful for
monitoring effectiveness of antibiotic therapy.

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 Ministry of Health ‫وزارة الصحة‬
Specialized Medical center ‫أمانة المراكز الطبية المتخصصة‬
Mansoura International Hospital ‫مستشفى المنصورة الدولي‬

Management plan:
Initial management:
1- Cleansing with skin disinfectants or mild soap and water.
2-Debridement to remove loose, devitalized & necrotic tissue
(e.g. blisters & foreign materials).
3-Topical antimicrobials such as {silver sulfadiazine SSD 1%, SSD
plus cerium, Bacitracin oint, combination AB oint
(Bacitracin + neomycin + polymyxin B), mupirocin oint 2%,
Mafenide 8.5% cream, chlorhexidine, povidone iodine}.
4-Dressing with non-adherent films or fine mesh gauze in combination
with topical AB is commonly used to cover burn wound.
**Purpose of dressing a- Adsorb drainage.
b- Protection & isolation from environment.
c- Decrease wound pain.
Systemic ABS :
Time of admission Antibiotic
First 48 hrs -No need for antimicrobials.
*Unasyn (1.5 gm/6hr) or
st
After 1 48 hrs *Cefatrixone 2gm/24hr)
*cefepime (2gm/12hr) or
After 5 days
*ceftazidime(1gm/8hr) or
*Amikacin(5-7.5 mg/kg/dose every 8 hrs)
More resistant
*Vancomycin(15-20 mg/kg/dose every 6-8hrs)
bacteria,MRSA
Vancomycin(15-20 mg/kg/dose every 8-12 hrs)
+
Sepsis
*( Piperacillin /tazobactam)4.5 gm/8hrs) or
(Imipenem/cilastatin 500mg/6hrs).

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 Ministry of Health ‫وزارة الصحة‬
Specialized Medical center ‫أمانة المراكز الطبية المتخصصة‬
Mansoura International Hospital ‫مستشفى المنصورة الدولي‬

Risk factors for MRSA:

Usually 2ry to:
- Broad spectrum antibiotics.
-Inadequate host response.
-Therapeutic measures.

Duration:
Mainly 14 days except for Amikacin 7days maximum & Levofloxacin
5 days .

Follow up :
*1st wound culture withdrawn in day 5.
*Then culture repated after 14 days to assure NO microbial growth
after using the suitable AB .
*monitor for AB efficacy and patient response.
*follow up using other lab parameters (CBC, S.CR ..).

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 Ministry of Health ‫وزارة الصحة‬
Specialized Medical center ‫أمانة المراكز الطبية المتخصصة‬
Mansoura International Hospital ‫مستشفى المنصورة الدولي‬

References :
1-Edgar DW,Homer L, philipsM.et al.The influence of advancing age on quality of
life and rate of recovery after treatment for burn. Burns 2013;39:1067(UPToDate).
2-Hussain A,Dunn K.Burn related mortality in greater Manchester:11-year review
of regional coronial department data. Burns 2015;41:225(UPToDate).
3-Satahoo SS,Parikh PP, Naranjo D,et al.Are burn patients really at risk for
thrombotic events? J Burn care Res 2015;36:100(UPToDate).
4-de Almedia Silva KC,Calomino MA, Deutch G et al.Molecular characterization of
Multi drug resistant(MDR) Pseudomonas Aeruginosa isolated in burn center.Burns
2017;43:137(UPToDate).
5-Fransen J,Huss FR, Nilsson LE, et al .Survelliance of antibiotic susceptibility in
Swedish Burn Center .Burns 2016;42:1295(UPToDate).
6-Erik D schraga,MD Emergent Management of thermal burns-plastic surgery-
burns Sep 08,2017 (Medscape).
7-Management of burn injuries –recent developments in resuscitation ,infection
control and outcomes research (PubMed).
8-infectious complications :prevention and strategies for their control
- burn wound infection(PubMed) .
9-Fairbairn NG,Rndolph MA, Redmond RW . The clinical applications of human
amnion in plastic surgery.JPlast Reconstr Aesthet surg 2014.(Medscape).
10-Alan D Burns ,MD,FACS, Arlen D Meyers MD,MBA, Facial burns Aug
02,2017(Medscape).

Reviewing date :
June 20, 2022

‫مدير المستشفى‬ ‫رئيس القسم‬ ‫مديرة الصيادلة‬ ‫رئيس الصيدله اإلكلينيكية‬ ‫صيدلي اكلينيكي‬
.‫ ايمان ابراهيم عنان‬-1
‫ حنان عبد الحكيم محمد‬-2
‫ نهى حسن محمود حسانين‬-3