Zakażenia Związane Z Opieką Zdrowotną U Pacjentów Oparzonych: OD Patogenezy DO Zintegrowanej Kontroli Zakażeń

Burn injuries remain a significant public health problem, while healthcare-associated infections (HAIs) are a major cause of morbidity and mortality among patients who survive the early phase of burn injury. This patient population is particularly susceptible due to persistent immunosuppression, loss of the skin barrier, and the need for invasive medical procedures throughout hospitalization. In the early phase of burn injury, Gram-positive pathogens predominate, including Staphylococcus aureus with various resistance phenotypes, whereas with increasing length of hospital stay, nosocomial Gram-negative pathogens, such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, account for an increasing proportion of infections. The increasing frequency of multidrug-resistant organisms (MDROs), including MDR (multidrug-resistant), XDR (extensively drug-resistant), and PDR (pandrug-resistant) strains, significantly limits available therapeutic options. An additional concern is fungal infections, mainly caused by Candida spp. and Aspergillus spp., which are associated with high mortality rates ranging from 21% to 42%. Bloodstream infections caused by MDROs are associated with 30-day mortality exceeding 50%, making them one of the most severe complications in this patient population. Available data indicate that the most effective preventive strategies are multifaceted and include hospital environmental control, contact precautions, standardized wound care and treatment, and effective HAI surveillance, including targeted surveillance and priority-directed surveillance, which can reduce HAI incidence by 47–85%. Systemic prophylactic antibiotic therapy does not reduce infection incidence, and its unjustified, uncontrolled use promotes the selection of MDRO strains. An antimicrobial stewardship program (ASP), based on local surveillance of antimicrobial resistance among HAI pathogens and systematic de-escalation, remains the recommended organizational standard in burn units. This review highlights major gaps in standardizing microbiological diagnostics and HAI control, emphasizing the need for prospective multicenter studies and an integrated approach to burn patient care.