Patient selection: burn
Criteria for burn infection – one or both of the following:
(1) both of the following:
(1a) 1 or more of the following
(1a1) change in burn wound appearance
(1a2) change in burn wound character (rapid eschar separation)
(1a3) edema at wound margin
(1ad) discoloration of the eschar
(1b) 1 or more of the following
(1b1) invasion of microorganisms into adjacent viable tissue on histologic exam of burn biopsy
(1b2) organisms isolated from the blood AND no other identifiable source
(1b3) evidence of herpes simplex virus (by culture, on histology, by electron microscopy)
(2) all of the following:
(2a) 2 or more of the following
(2a1) fever (body temperature > 38°C) or hypothermia (body temperature < 36°C)
(2a2) hypotension
(2a3) oliguria (urine output < 20 mL per hour)
(2a4) hyperglycemia at previously tolerated carbohydrate intake
(2a5) mental confusion
(2b) 1 or more of the following
(2b1) invasion of microorganisms into adjacent viable tissue on histologic exam of burn biopsy
(2b2) organisms isolated from the blood AND no other identifiable source
(2b3) evidence of herpes simplex virus (by culture, on histology, by electron microscopy)
(2c) no other recognizable cause
where:
• Purulence at the burn wound site is not considered sufficient evidence by itself to make the diagnosis of a burn infection.
• PCR would be the most sensitive way of detecting herpes simplex virus (HSV). Electron microscopy is rarely used today for this purpose.
