Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

Burn Wound Infections

Publisher Summary This chapter discusses antimicrobial activity and action of silver. Silver and its compounds have long been used, in one form or another, as antimicrobial agents. The silver compound of major therapeutic interest at the present time is silver sulphadiazine. Many in healthcare know that other silver compounds are still in use. It is worth stating that the treatment of ophthalmia neonatorum was revolutionized by the instillation of silver derivatives into the eyes of new-born sufferers. Several factors influence the antimicrobial activity of silver salts. Silver has a marked tendency to adsorb to surfaces and bactericidal activity is reduced in the presence of phosphates, chlorides, sulphides and hard water. Activity is increased as the temperature is raised and is pH-dependent, increasing with increasing pH. Sodium thioglycollate has been recommended as a suitable neutralizing agent for use in bactericidal testing although other SH compounds also fulfil this role. Silver, one of the native metals and second only to gold in its stability amongst the metals of antiquity, has provided several therapeutic agents which have been employed since the beginning of recorded history. These agents range from the metal itself, its salts and complexes with proteins and other macromolecules to the latest, silver sulphadiazine (AgSD).

Antimicrobial activity and action of silver

The role of silver and sulfadiazine in the mechanism of action of silver sulfadiazine on burn wound infections was investigated. Silver, but not sulfadiazine, was bound by bacteria. Sulfadiazine did not act as an antibacterial agent in low concentrations, but exhibited specific synergism in combination with subinhibitory levels of silver sulfadiazine. The efficacy of silver sulfadiazine is thought to result from its slow and steady reactions with serum and other sodium chloride-containing body fluids, which permits the slow and sustained delivery of silver ions into the wound environs. In this circumstance, a relatively minute amount of sulfadiazine appears active.

Mechanism of silver sulfadiazine action on burn wound infections.

Silver has been used for centuries. Today, silver and silver nanoparticles (AgNPs) are used in a wide range of healthcare, food industry, domiciliary applications, and are commonly found in hard surface materials and textiles. Such an extensive use raises questions about its safety, environmental toxicity and the risks associated with microbial resistance and cross-resistance. If the mechanisms of antimicrobial action of ionic silver (Ag+) have been studied, there is little understanding of AgNPs interactions with microorganisms. There have been excellent reviews on the bacterial resistance mechanisms to silver, but there is a paucity of information on resistance to AgNPs. Silver toxicity and accumulation in the environment has been studied and there is a better understanding of silver concentration and species in different environmental compartments. However, owing to the increased applications of silver and AgNPs, questions remain about the presence and consequences of AgNPs in the environment. This rev...

Silver as an antimicrobial: facts and gaps in knowledge

Compared to nonoperative treatment with silver sulfadiazine cream, early excision and grafting of 22 patients with indeterminant burns of less than 20% TBSA resulted in an average shorter hospitalization, lower cost, and less time away from work than 25 patients treated nonoperatively. While early excision and grafting resulted in increased use of blood products and operating room facilities, this did not result in increased patient morbidity. Long-term followup demonstrated no difference in need for reconstruction, incidence of blisters, incidence of loss of motion, or contour irregularities. Those patients treated nonoperatively required more late grafts for closure and demonstrated more hypertrophic scarring. Those treated by early excision demonstrated more mesh graft irregularity. We conclude that in otherwise healthy patients with dermal burns of indeterminant depth less than 20% total body surface area, early excision and grafting is the preferred form of treatment.

Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study.

Primary excision and grafting of large burns.

Alternative forms of local treatment for burns

Evaluation of phenoxetol-chlorhexidine cream as a prophylactic antibacterial agent in burns

Mortality and infection in extensively burned patients treated with silver-nitrate compresses

Assessment of red cell loss in the first two days after severe burns.

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