Rational selection and use of antimicrobials in burn patients

Skin is the first immune defence mechanism and function as a barrier against microorganisms . Infections are a worldwide health problem. Burn patients have a higher risk of infection, due to their complexity and fragility. In this group, infections are the leading cause of dead and morbidity. Burn patient with all is complexity constitute a major public health problem and one of the worst devastating traumas. When dealing with burn patients in the setting of infections, a challenge that is always present: the distinction between colonization vs infection and the bidirectional relation that they have.Infections in burned patients are mainly cause by bacteria, followed by fungi and then viruses. The correct treatment of burn patient’s infection is multimodal, a global approach is essential for the outcome. Burn infection care involves: assiduous washing techniques, dressings with topical antimicrobials, early wound excision, skin grafting and systemic antimicrobials.The type of infection present, is also a determinant factor for treatment choice: Burn wound infections, Infections in other locations (ex: Pneumonia, bloodstream, gastrointestinal, genitourinary) and systemic infections present as sepsis or septic shock. A systematic protocol for blood, fluids, urine samples and skin biopsies should be applied in all patients with suspicious infections, at a regularly basis. Thus, the condition can be treated in a targeted way.Multiple factors much be taken when selection the right antimicrobial: the context of the burn injury incident, the micro biotic flora of the burn unit/Hospital/country; isolation sample (blood, urine, burn wound, graft. We should always have a dynamic way of choosing the right treatment. This term dynamic has its reason. The first choice most of the times may not be the most correct one. When the agent is identified and the resistance profile results are received, our first choice should be adjusted accordingly.The only worldwide correct approach to Burn infections treatment is: The rational selection of systemic antibiotics should be based on the likely etiologic organism, local antibiogram, and systemic toxicity.