Infections in Burn Patients: Pathophysiology, Prevention, and Contemporary Therapeutic Strategies in the Era of Antimicrobial Resistance.

Burn injuries are associated with significant morbidity and mortality, largely driven by infectious complications. Disruption of the skin barrier, systemic inflammation, and postburn immunosuppression promote microbial colonization and progression to local and systemic infections, a challenge further exacerbated by the increasing prevalence of multidrug-resistant organisms (MDRO). Patients with extensive burns, inhalation injury, prolonged hospitalization, and invasive device use are particularly vulnerable. The microbiological profile of burn wound infections evolves dynamically, shifting from early Gram-positive predominance to Gram-negative and multidrug-resistant (MDR) pathogens, including members of the ESKAPE group, in later stages. Effective management, therefore, requires an integrated approach combining early surgical intervention, strict infection control measures, continuous microbiological surveillance, and targeted antimicrobial therapy. This narrative review synthesizes current evidence on the pathophysiology, risk factors, and microbiological dynamics of burn-associated infections, alongside contemporary prevention and treatment strategies, including topical therapies, advanced biomaterials, systemic antibiotic approaches, and antimicrobial stewardship. Emerging strategies such as nanoparticle-based systems and artificial intelligence-driven predictive models highlight a shift toward precision medicine in burn care; however, their clinical translation remains limited by insufficient validation and standardization. In conclusion, optimizing outcomes in burn-associated infections will depend on integrating evidence-based clinical practices with innovative technologies, while reinforcing antimicrobial stewardship and developing validated predictive tools to address the growing burden of antimicrobial resistance.