Pathogenesis

Initially, the burn wound is a sterile environment. However, colonization occurs rapidly and it is dependent on depth. Deeper burns are more likely to become colonized rapidly. Sequentially, common organisms isolated from burns include:

• 6-48 hours: Gram positive cocci eg Staphylococcus aureus
• 48 hours-1 week:
  • Gram negative organisms eg Proteus, Klebsiella
  • anaerobic organisms eg Escherichia coli

Once the burn is colonized, then invasive infection is a possible sequel that can be limited by:

• reducing the count of organisms
• minimizing the number of types of organism within the wound

The most likely sources of contamination are:

• fluids impinging on wound
• cutaneous contact with unburnt skin eg the patient touching the wound
• enteric fluids