Antibiotic resistance in bacterial infections of burn wounds: Challenges, mortality, and solutions

Abstract

Burn wounds pose a significant clinical challenge due to their vulnerability to bacterial infections, compounded by the frequent emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens. Factors such as immune dysregulation from burn injury, loss of the skin barrier, prolonged hospitalization, and invasive procedures contribute to increased susceptibility to colonization and infection by resistant bacteria, notably Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus (MRSA). This review synthesizes current evidence on the microbiological landscape of burn wound infections, highlighting high rates of MDR/XDR isolates harboring diverse resistance mechanisms, including carbapenemases and extended-spectrum beta-lactamases. These resistant pathogens significantly impair healing by prolonging inflammation and biofilm formation and severely restrict effective antibiotic options, often necessitating last-resort therapies with associated toxicity. Risk factors predictive of MDR infections include extensive burns, invasive device use, prior antibiotic exposure, and longer intensive care unit (ICU) stays. Clinical management challenges extend from infection control and wound care to antimicrobial stewardship and the integration of emerging diagnostics. Future perspectives emphasize rapid molecular diagnostics, development of novel antimicrobials and topical agents, and multidisciplinary approaches involving surgeons, infectious disease specialists, and pharmacists to optimize outcomes. Prevention strategies targeting both hospital and community settings are critical for reducing burn incidence and infection rates. In conclusion, addressing antibiotic resistance in burn wounds requires comprehensive, evidence-based interventions and continued innovation to reduce morbidity and mortality and lower healthcare costs.