Global pooled evidence on microbial flora, antimicrobial resistance, and infection control in burn units

Abstract

Background: Burn wound infections (BWIs) remain a major cause of morbidity, mortality, and increased healthcare costs. Their management is complicated by the dynamic microbial ecology of burn wounds and the global rise in antimicrobial resistance (AMR). A clear understanding of evolving epidemiology, microbial patterns, and infection-control outcomes is vital for improving burn-care strategies. Objectives: To synthesize global evidence on microbial distribution, resistance trends, and infection-control effectiveness in burn units, with emphasis on multidrug-resistant pathogens including Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA). Materials and Methods: This meta-analysis integrates findings from 40 peer-reviewed studies (1992–2025) involving microbiological surveillance, epidemiological assessment, molecular resistance profiling, and evaluation of infection-control practices across diverse burn centres. Trends in AMR, intervention effectiveness, and conventional versus emerging infection-prevention approaches were comparatively assessed. Results: Pooled data identified P. aeruginosa (23%), S. aureus (19%), and A. baumannii (17%) as dominant burn-wound pathogens. Substantial resistance to β-lactams and carbapenems was observed, particularly among A. baumannii and Enterobacteriaceae. Emerging findings include a rise in carbapenemase-producing strains and persistence of MDR organisms in environmental reservoirs. Bundled infection-control strategies, including stewardship and enhanced disinfection, achieved a 25–40% infection reduction in centres with high compliance. Recent evidence highlights the promise of probiotics, stem-cell therapeutics, and silver-based approaches as adjunctive preventive modalities. Conclusions: AMR-driven BWIs continue to challenge burn-care systems worldwide. Strengthened surveillance, consistent application of WHO/CDC prevention frameworks, and integration of bio-therapeutic and nanotechnology-based innovations are essential for sustainable infection control.