Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-

PLoS One. 2014 Apr 21;9(4):e95042. doi: 10.1371/journal.pone.0095042. eCollection 2014.


Background: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres.

Methods: Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance.

Primary findings: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84).

Interpretation: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Burns / complications*
  • Burns / microbiology*
  • Geography
  • Gram-Negative Bacterial Infections / complications*
  • Gram-Negative Bacterial Infections / microbiology*
  • Hospitalization*
  • Humans
  • Statistics as Topic
  • Wound Infection / complications*
  • Wound Infection / microbiology*

Grants and funding

EA and EAA are funded by the Strategic Educational Pathways Scholarship Malta, co-financed by by the European Union – European Social Fund under Operational Programme II. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Individuals employed or contracted by the funders (other than the named authors) played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.