The treatment of invasive burn wound infection may include which of the following?

A. Subeschar infusion of half the daily dose of a broad-spectrum penicillin suspended in 1 liter of normal saline.

C. Specific systemic antibiotic therapy.

E. Amputation when the infection has extended to involve underlying muscle.

DISCUSSION: The Pseudomonas organisms that most commonly cause invasive bacterial burn wound infection are typically sensitive to high concentrations of broad-spectrum penicillins. When the diagnosis of invasive Pseudomonas burn wound infection has been made, one half of the daily dose of a broad-spectrum penicillin, typically piperacillin, suspended in 1 liter of normal saline, should be infused into the subeschar tissues beneath the infected wound. A number 20 spinal needle should be used for the infusion, to minimize the number of injection sites. Following a second subeschar infusion of the broad-spectrum penicillin just prior to operation, the infected tissue should be excised. The excised wounds should not be autografted but covered with a biologic dressing or a dressing soaked with an antimicrobial solution such as 5% mafenide acetate. The patient is returned to the operating room in 24 to 48 hours to examine the excised wound and assess the adequacy of the débridement. The frequency of perilymphatic and perivascular proliferation of invading Pseudomonas organisms is associated with a risk of metastatic spread to remote organs or tissues. Consequently, systemic antimicrobial therapy should be instituted based on the sensitivity patterns of the resident microbial flora and adjusted as necessary on the basis of the patient's culture and sensitivity results. Amputation is frequently necessary to control invasive burn wound infection when a phycomycotic infection on a limb has traversed the investing fascia and involves significant amounts of the subfascial tissue.