Sepsis in the major burn patient

Abstract Background Sepsis in the context of major burn injury presents a significant challenge to clinicians. It affects a substantial proportion of patients with major burn injury and is the leading cause of death in those that survive to hospital. Due to the complex and profound multi-system effects that thermal injury induces, mimicking the pathological changes seen in sepsis, recognising and managing the syndrome of sepsis in this population is fraught with difficulty. This review article aims to describe the pathophysiology of sepsis in burn injury, methods to diagnose it, the organisms involved and its management. Methods A comprehensive search across electronic databases was conducted. Studies were included if they provided data on the epidemiology, pathophysiology, diagnosis, or management of sepsis following major burn injury. All authors contributed to the identification of relevant studies to ensure broad capture of relevant literature. Each author contributed expertise to specific sections of this review, ensuring comprehensive coverage of various aspects of burn-related sepsis. This narrative review represents a collaborative synthesis of knowledge from specialists in burns critical care. Results Severe thermal injury predisposes an individual to sepsis due to loss of skin barrier, immune dysregulation, microbiome disruption, microbial colonisation and ecological pressures within the hospital environment. Internationally recognised definitions of sepsis, scoring systems and traditional biomarkers are of limited diagnostic utility. Instead, clinicians rely on comprehensive multi-faceted assessment of a patient’s trajectory to help identify sepsis. Multi-drug resistant organisms, fungi and moulds are of increasing concern as culprit pathogens. Effective management of burn-sepsis relies on assiduous infection prevention, prompt surgical excision of eschar and judicious antibiotic stewardship. Emerging biomarkers and novel therapies are being studied, but unlikely to be used in routine clinical practice in the near future. Conclusions Sepsis occurring after major burn injury presents the clinician with a variety of complex problems which require a detailed understanding of the complex interplay between the pathophysiology of injury and infection. Effective identification and management of sepsis rely on a holistic, multidisciplinary approach rather than any single biomarker or novel immunomodulatory therapy. However, ongoing research may open the door to future therapies to improve the outcomes for patients after such devastating injuries. Registration N/A.