A compromised skin barrier and the severe immunosuppression caused by burn trauma predispose patients to increased risk for infection. Despite all the progress made in caring for burn patients, infections remain a major cause of mortality and morbidity. Pediatric patients are more likely to suffer from bigger total body surface area (TBSA) burns. Their less developed immune systems further predispose them to infections. Our research at Shriners Hospital for Children investigate the specific consequences of burn trauma to pediatric burn patients. Concurrently, increasing prevalence of multi-drug resistant (MDR) pathogens exacerbates the risk of poor outcome. Persistent and MDR infections are currently a major threat to burn and other trauma patients. Pseudomonas aeruginosa is the most frequently isolated pathogen from burn patients. Effective treatments for MDR or persistent infections are lacking, with no new antibiotics to address MDR near commercialization. Our work on anti-infectives that targets bacterial virulence rather than being bactericidal aim to tackle the problem with novel therapeutics.

Currently, only tools for early diagnosis of infection and sepsis are being developed, such as those based on C-reactive protein (CRP) and procalcitonin (PCT), which are not widely used in burn units and ICUs. Risks for infections in burn patients are only estimated empirically and objectively by clinical characteristics, such as TBSA and presence of inhalation injury. Statistical models using clinical characteristics are lacking. Our lab pioneered in the field of using genomic information such as transcriptomes to identify patients at increased risks for infection. We developed the first biomarker panel to measure and predict susceptibility to infection shortly after burn injury and during recovery. Over 25 failed drug trials targeting sepsis highlight our still limited understanding of the life-threatening process. We aim to better understand the immune responses to burn injury and infection, and how these differences translate to hyper-susceptibility. Our biomarker panel could be further developed to allow triaging patients based on their inherent health status and susceptibility to infection. This may greatly improve intelligent drug design and provide biomarkers necessary to evaluate drug efficacy in individuals during trials. Early prognosis and prophylaxis will reduce infection risks significantly and will improve patient outcome by providing a better basis for personalized therapy.