Epidemiology, pathogen spectrum, and antimicrobial resistance of infections in burn patients stratified by total body surface area: a bicenter study with evaluation of targeted next-generation sequencing

Background Infection remains a leading cause of morbidity and mortality in burn patients, particularly in those with extensive injuries. However, comprehensive analyses integrating pathogen distribution, antimicrobial resistance, and advanced molecular diagnostics across burn severity remain limited. Methods We retrospectively analyzed 814 burn patients with infections admitted to two tertiary burn centers in southern China between 2020 and 2024, stratified by total body surface area (TBSA). Pathogen distribution, antimicrobial resistance patterns, complications, hospitalization costs, and length of stay were evaluated. In addition, 40 clinical specimens were prospectively analyzed using both conventional culture and targeted next-generation sequencing (t-NGS). Results Among 814 infected burn patients stratified by TBSA (85% resistant to cephalosporins/carbapenems. Severe burns were associated with higher complication rates (shock 70.7%, MODS 29.3%; p < 0.001), 58-day median LOS, and hospitalization costs of 554,246 CNY ( p < 0.001). In the 40-specimen pilot diagnostic comparison, t-NGS showed 77.5% positivity and culture showed 55.0% positivity ( p = 0.012), with a shorter turnaround time for t-NGS than culture (1.7 vs. 3.9 days; p < 0.001). In blood specimens, t-NGS positivity was 55.6% compared with 16.7% for conventional culture ( p = 0.039). Conclusion Burn severity is strongly associated with pathogen spectrum and antimicrobial resistance, underscoring the need for severity-stratified management strategies in burn care. In this pilot comparison, t-NGS showed a higher positivity rate than conventional culture and may serve as an adjunct diagnostic method. However, its clinical interpretation must be integrated with phenotypic data given the potential for colonization or genotypic-phenotypic discordance.