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      The pathogenesis and diagnosis of sepsis post burn injury

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          Abstract

          Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality. Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care, nutritional and fluid resuscitation and improved infection control practices, there are still large numbers of patients at a high risk of death. One of the most common complications of burn is sepsis, which is defined as “severe organ dysfunction attributed to host's disordered response to infection” and is the primary cause of death in burn patients. Indeed, burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome, such as a hypovolaemic state, immune and inflammatory responses and metabolic changes. Therefore, clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock. In this review, we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis. Moreover, the clinical and promising biomarkers of burn sepsis will also be summarized.

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          Most cited references168

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          The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
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            Biofilms: an emergent form of bacterial life.

            Bacterial biofilms are formed by communities that are embedded in a self-produced matrix of extracellular polymeric substances (EPS). Importantly, bacteria in biofilms exhibit a set of 'emergent properties' that differ substantially from free-living bacterial cells. In this Review, we consider the fundamental role of the biofilm matrix in establishing the emergent properties of biofilms, describing how the characteristic features of biofilms - such as social cooperation, resource capture and enhanced survival of exposure to antimicrobials - all rely on the structural and functional properties of the matrix. Finally, we highlight the value of an ecological perspective in the study of the emergent properties of biofilms, which enables an appreciation of the ecological success of biofilms as habitat formers and, more generally, as a bacterial lifestyle.
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              The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.

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                Author and article information

                Journal
                Burns Trauma
                Burns Trauma
                burnst
                Burns & Trauma
                Oxford University Press
                2321-3868
                2321-3876
                January 2021
                04 February 2021
                04 February 2021
                : 9
                : tkaa047
                Affiliations
                [1 ] State Key Laboratory of Biotherapy and Cancer Center , West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine , Sichuan University, and Collaborative Innovation Center for Biotherapy, No.17 People’s South Road, Chengdu, 610041, China
                [2 ] Department of Thoracic Oncology and Department of Radiation Oncology , Cancer Center, West China Hospital, Sichuan University , No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
                [3 ] Department of Biological Sciences , Faculty of Science, National University of Singapore , 14 Science Drive 4, 117543, Singapore
                Author notes
                Correspondence. Canhua Huang, Email: hcanhua@ 123456hotmail.com ; Yih-Cherng Liou, Email: dbslyc@ 123456nus.edu.sg
                Author information
                http://orcid.org/0000-0003-2247-7750
                Article
                tkaa047
                10.1093/burnst/tkaa047
                7901709
                33654698
                9998b689-9c79-4257-9da7-426845d1dff8
                © The Author(s) 2021. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 September 2020
                : 20 October 2020
                : 27 November 2020
                Page count
                Pages: 16
                Funding
                Funded by: National Natural Science Foundation of China, DOI 10.13039/501100001809;
                Award ID: 81821002
                Award ID: 81790251
                Award ID: 81672381
                Funded by: Guangdong Basic and Applied Basic Research Foundation;
                Award ID: 2019B030302012
                Funded by: Science and Technology Department of Sichuan Province, DOI 10.13039/501100004829;
                Award ID: 2018RZ0133
                Funded by: Chengdu Science and Technology Program;
                Award ID: 2019-YF05–00715-SN
                Categories
                Review

                burn,infection,sepsis,septic shock,multiple organ dysfunction syndrome,immune dysregulation,hypermetabolism,trauma,biomaker,inflammation

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