Infection in the burn patient is a leading cause of morbidity and mortality and remains one of the most demanding concerns for the burn team. Initially the burn wound is colonized principally with gram-positive organisms. Within a week they usually are replaced by antibiotic-susceptible gram-negative organisms. If wound closure is delayed and the patient becomes infected, requiring treatment with broad-spectrum antibiotics, these flora maybe replaced by yeasts, fungi, and antibiotic-resistant bacteria. As burn wound size increases, bloodstream infection increases dramatically secondary to increased exposure to intravascular catheters and burn wound manipulation-induced bacteremia. Systemic antimicrobials are indicated to treat only documented infections such as pneumonia, bacteremia, wound infection, and urinary tract infection. Prophylactic antimicrobial therapy is only recommended if the burn wound must be excised or grafted in the operating room. It should be used only for coverage of the immediate perioperative period. Fifty percent or more of patients with both a major burn and an inhalation injury develop pneumonia. One of the major concerns is the worldwide emergence of antimicrobial resistance among a wide variety of nosocomial bacterial and fungal burn wound pathogens, which seriously limits the available effective treatment of burn wound infections.
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