Infection control and antimicrobial stewardship in the ICU: Preventing ARDS among burn patients

Abstract

Acute respiratory distress syndrome (ARDS) represents a severe and often fatal complication in patients with extensive burn injuries admitted to intensive care units (ICUs). The pathophysiological continuum linking burn-related immune dysregulation, infection, and sepsis is recognized as a major driver of pulmonary inflammation and alveolar damage. This narrative review synthesizes current evidence on infection control and antimicrobial stewardship (AMS) as integrated strategies to prevent infection-driven lung injury and reduce the burden of acute lung injury in burn ICUs. Burn patients are uniquely predisposed to healthcare-associated infections and multidrug-resistant (MDR) organisms due to disrupted skin barriers, invasive procedures, and prolonged antimicrobial exposure. Studies have reported that structured infection prevention programs including hand hygiene, wound care standardization, and device-care bundles significantly decrease sepsis incidence and improve clinical outcomes. Complementary AMS initiatives focusing on appropriate antibiotic selection, dosing optimization, and de-escalation have been associated with reduced antimicrobial pressure and improved microbial ecology. Integration of these approaches within a unified clinical governance framework has been shown to enhance infection prevention efficiency and limit ARDS-related complications. The effectiveness of such integration depends on multidisciplinary engagement involving intensivists, infectious disease specialists, pharmacists, and nursing staff. Technological advances, including microbiological surveillance, artificial intelligence driven prediction models, and microbiome-based monitoring, are increasingly being incorporated to strengthen early infection detection and optimize stewardship interventions in burn care.