Changing flora in burn and trauma units: historical perspective--experience in the United States.

Changes in patient management, increased survival rates, and widespread use of antimicrobials have altered the flora that are found to colonize the wounds of patients with burns and trauma-related injuries. Enterococci have emerged as a prominent cause of wound infection and are capable of producing significant morbidity. Staphylococcus aureus, although it remains a common colonizer, has developed resistance to several antimicrobial agents. Recent reports suggest that the incidence of Pseudomonas infections is decreasing, whereas multiple antimicrobial resistance has emerged in a number of other gram-negative organisms that were not heretofore considered major pathogens. Candida organisms appear to be the prominent pathogens among opportunistic yeasts and fungi, and Bacteroides and Clostridium species appear to be the most common causes of infection by anaerobes. Patterns of viral infection in patients with burns and trauma-related injuries have not been investigated in detail. Overall, it appears that rates of infection and associated mortality have decreased in some patient populations; progress in this regard can be attributed to improvements in antimicrobial therapy, would management, and nutrition.