The relationship between respiratory tract infections caused by toxin-producing bacteria in burn patients during COVID-19: pathogenesis, diagnostics and novel therapies

Abstract

The COVID-19 pandemic has significantly increased the complexity of managing burn patients, who are particularly susceptible to bacterial co-infections due to their compromised skin barriers and immune dysregulation. Toxin-producing bacteria, such as Staphylococcus aureus and Pseudomonas aeruginosa, pose severe risks by producing virulence factors that impair immune function, delay wound healing and exacerbate systemic inflammation. These challenges are amplified in the presence of SARS-CoV-2, as the viral-induced immune dysregulation and cytokine storms worsen clinical outcomes, leading to higher rates of morbidity and mortality. This review explores the interplay between viral and bacterial infections in burn patients during the COVID-19 pandemic, focusing on the role of bacterial toxins, including superantigens from S. aureus and exotoxins from P. aeruginosa in driving hyperinflammatory responses. These synergistic effects complicate treatment by increasing the likelihood of systemic complications, prolonged hospital stays and MDR infections. To address these challenges, we discuss innovative therapeutic strategies, including endotoxin adsorption therapy to reduce systemic inflammation, immunomodulatory treatments to control cytokine storms and bacteriophage therapy for targeting MDR pathogens. Advanced wound care techniques and rapid diagnostic tools, such as CRISPR-based molecular assays, are highlighted as essential for timely and effective intervention. This review underscores the urgent need for integrated approaches that combine targeted diagnostics, advanced therapeutics and robust infection control measures. These insights aim to improve outcomes for burn patients co-infected with bacterial pathogens and SARS-CoV-2, offering valuable guidance for future pandemic preparedness and burn care protocols.