Bacterial Infection in Burn Disease

Abstract

The role of infection in burn disease is a subject on which there have been wide differences and fluctuations of opinion. This is not surprising, because infection is one of the components of a complex pathology in burns, with bacteria colonising tissues already damaged and inflamed as a result of thermal injury; sepsis is superimposed on the local and general effects of this damage. In the early days of bacteriology some workers — e. g. Lustgarten (43) and Stockis (52) — recognised infection to be an important and potentially fatal complication in severely burned patients; but the subject was widely ignored for many years while clinicians, in this post-Listerian era, were pre-occupied with the problems of shock due to fluid loss and the more conjectural toxaemia attributed to products of tissue destruction. Even the bacteriological studies on burns reported by Pack (48), Aldrich (4), Cruickshank (15) and others did little to change the situation; but in the 1940’s and 1950’s, when hypovolaemic shock was brought under effective control, sepsis — in particular sepsis caused by gram-negative bacilli — became a new focus of interest in the study of burn disease; some reports placed it first among the causes of death in severely burned patients (5, 17, 35, 51).