Yes, it is possible to get sepsis from a burn injury. Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. Severe burns damage the skin and underlying tissues, compromising the body’s natural protective barrier against infection. This puts burn patients at increased risk of developing sepsis due to invasion of bacteria into the bloodstream. Prompt treatment of burns and vigilance for signs of sepsis are crucial for preventing this dangerous complication.
How do burns increase sepsis risk?
Burn injuries that damage the skin provide an entry point for bacteria to enter the body and cause infection. Here’s how this occurs:
- The skin normally acts as a protective barrier against infection. But severe burns disrupt this barrier and expose underlying tissues.
- Burns also damage blood vessels, causing leakage of fluid and proteins into surrounding tissues. This fluid provides a culture medium for bacteria to grow.
- The body’s immune defenses are impaired after major burns, due to the release of immunosuppressive stress hormones. This makes it harder to fight off infection.
- Invasive procedures and devices such as IV lines further increase risk of introducing bacteria into the burn wounds.
Due to these factors, burn wounds can quickly become colonized with bacteria. Even bacteria that normally live harmlessly on the skin can provoke a dangerous infection if they penetrate beneath the skin into a burn wound.
How does an infection lead to sepsis?
When bacteria from a burn wound invade the bloodstream and spread throughout the body, this can lead to sepsis. Here is the progression:
- Bacteria enter the body through the damaged skin and multiply in the burn wound.
- The growing infection provokes an inflammatory response, causing immune cells to leak into surrounding tissues.
- Bacteria may breach the damaged blood vessels and enter the bloodstream, spreading the infection systemically.
- As the bacteria and their toxins circulate, they trigger massive inflammatory responses from immune cells throughout the body.
- The resulting cascade of inflammation leads to damage in distant organs such as the lungs, kidneys, and liver. This can quickly lead to multi-organ failure.
- If organ damage and circulatory collapse progress rapidly, the patient develops septic shock – the most dangerous manifestation of sepsis.
Sepsis can arise from infections anywhere in the body, but severe burns significantly increase this risk due to their loss of protective skin and suppression of normal immune function.
Which organisms cause burn wound sepsis?
A variety of bacteria can infect burn wounds and cause sepsis. The most common include:
- Pseudomonas aeruginosa – a virulent gram-negative bacterium commonly found in soil and water. It readily colonizes open burn wounds.
- Staphylococcus aureus – causes skin infections and can infect blood, lungs, and wounds. Methicillin-resistant S. aureus (MRSA) is a major contributor to sepsis stemming from burn wounds.
- Klebsiella, E. coli, and other gram-negative bacteria from the gut – these organisms translocate from the intestines and colonize open wounds, especially in patients with poor gut integrity after burn injury.
- Acinetobacter baumannii – a gram-negative bacterium found in soil and water. It is a growing cause of hospital-acquired burn wound infections.
These bacteria act synergistically and can combine to form dangerous drug-resistant infections in critically ill burn patients. Fungal pathogens and viruses can also opportunistically infect burn wounds and contribute to sepsis risk.
Who is at highest risk for developing burn-related sepsis?
Not all burn patients develop sepsis. Those with the following risk factors are most vulnerable:
- Total burn size greater than 30% of the body’s surface area
- Full thickness (third-degree) burns
- Burns with associated trauma such as fractures or explosion injuries
- Inhalation injury from smoke or chemicals
- Delayed wound closure or tissue healing (e.g. in patients with pre-existing illness)
- Older age or very young age
- Need for mechanical ventilation
The chances of sepsis increase dramatically with greater burn severity, as this allows more opportunity for bacteria to infiltrate through damaged skin and undergo rapid growth in fluid-filled tissues.
What are the signs and symptoms of sepsis from a burn?
Doctors monitor burn patients closely for both local and systemic signs of infection. Local signs in the wound include:
- Change in wound appearance – new discoloration, necrosis, oozing
- Unpleasant odor coming from the wound
- Worsening pain, swelling, heat around the wound
- Presence of pus or abscess
Systemic signs throughout the body such as the following may indicate sepsis:
- Fever (body temperature >38°C or 100.4°F)
- Chills, shivering
- Rapid heart rate and breathing
- Drop in blood pressure
- New onset confusion
- Decreased urine output
In severe cases, septic shock can occur and is marked by extremely low blood pressure, high fever, shortness of breath, and potential loss of consciousness. Seeking urgent medical treatment for systemic signs of infection provides the best chance of survival with sepsis.
How is sepsis diagnosed in a burn patient?
Doctors use several approaches to diagnose sepsis stemming from a burn:
- Clinical examination – assessing the wound, vital signs, and symptoms as above.
- Blood tests – blood cultures identify bacteria in the bloodstream, while tests like white blood cell count, CRP, and lactic acid help confirm inflammatory response and organ dysfunction.
- Wound cultures – swabs of the burn wounds can isolate the specific bacteria causing infection.
- Imaging – X-rays, CT scans, or ultrasound identify sources of infection and associated complications such as abscesses or pneumonia.
There is no single definitive test for sepsis – physicians make a clinical diagnosis based on evidence of infection plus systemic signs of organ dysfunction. Rapid diagnosis is key, as treatment delays of even a few hours can be life-threatening with sepsis.
How is sepsis treated in burn patients?
Prompt, aggressive treatment is crucial for sepsis survival and includes:
- IV antibiotics – broad initial coverage against common burn wound bacteria, then tailored to culture results
- IV fluids – large volumes are often needed to stabilize blood pressure and perfusion
- Vasopressors – medications to increase blood pressure in cases of septic shock
- Wound care – debridement of infected tissue, topical antibiotics, frequent dressing changes
- Treating the source – draining abscesses, pneumonia treatment, removal of infected devices
- Organ support – medications, dialysis, or ventilation to support the lungs, kidneys, and other organs damaged by sepsis
In severe cases, amputation of infected extremities or debridement of large areas of dead wound tissue may be required to remove sources of ongoing sepsis. Nutritional support and physical rehabilitation are also critical for recovering from the long-term effects.
What complications can arise from burn wound sepsis?
Some potential complications of sepsis stemming from burn injuries include:
- Septic shock and low blood pressure requiring vasopressors
- Disseminated intravascular coagulation (DIC), causing internal bleeding
- Acute respiratory distress syndrome (ARDS)
- Acute kidney injury and renal failure
- Liver damage
- Adrenal crisis
- Tissue death (gangrene) in limbs, leading to amputation
Sepsis can also worsen outcomes and recovery from the burn injury itself. It is associated with higher risk of wider, deeper tissue damage as well as long-term scarring and physical impairment.
How can sepsis be prevented in burn patients?
Several important measures can help prevent sepsis in those with major burns:
- Prompt first aid after the burn, including cooling, protecting blisters, and covering the area.
- Urgent transfer to a specialized burn care unit – delays worsen outcomes.
- Early excision of dead tissue and skin grafting to close the wound.
- Topical antimicrobial dressings containing silver sulfadiazine or mafenide.
- Frequent hand-washing by staff and visitors to avoid introducing pathogens.
- Isolation protocols for patients colonized or infected with drug-resistant organisms.
- Restrictive use of invasive devices, prompt removal when not needed.
- Early enteral feeding to maintain intestinal integrity and immunity.
Ongoing advances in burn care such as newer biological dressings, skin substitutes, and antimicrobial techniques continue to lower sepsis rates and improve survival.
Burn patients require close monitoring for sepsis
Due to massive disruption of the skin’s protective barrier, burn injury patients are at high risk of developing serious infections that can quickly lead to sepsis and septic shock. Close monitoring for both localized and systemic signs of infection, along with prompt treatment when sepsis is suspected, is crucial to prevent this life-threatening complication. Improved prevention approaches, along with advanced critical care, have reduced sepsis mortality rates in recent decades – but it remains a top concern for those with major burns.
Key Points
- Severe burns allow bacterial invasion through damaged skin, leading to wound infections.
- Bacteria may spread into the bloodstream, causing sepsis or septic shock.
- Pseudomonas, Staph aureus, Klebsiella, E. coli, and Acinetobacter commonly cause burn wound sepsis.
- Over 30% TBSA burns, full thickness injuries, and inhalation injury increase sepsis risk.
- Fever, low blood pressure, confusion are concerning systemic signs of burn sepsis.
- Rapid diagnosis, antibiotics, fluids, and wound care are crucial for treatment.
- Prevention includes prompt burn first aid, early excision, antimicrobial dressings, and restricted device use.
