Analysis of Blood Cultures from Major Burns Patients in a Tertiary Care Burn Unit in Oman

Objectives

This study aimed to review the blood stream infections of major burn patients in a tertiary care burn unit to determine the most prevalent infecting organisms in order to have a better empirical therapy protocol.

Methods

This retrospective study analysed the blood stream infection of 155 major burn (>20% Total Body Surface Area [TBSA]) patients in Khoula Hospital, Muscat, Oman between January 2014 to December 2019.

Results

The median age was 33 years and 57.42% of patients were male. The median TBSA was 38%, mortality was 25.16% and 50.9% of patients had positive blood cultures. The expired patients had higher TBSAs, Abbreviated Burns Severity Index scores and earlier first positive blood cultures. Candida was commonly grown in all the blood cultures, but the most prevalent organisms were Acinetobacter, Staphylococci, Klebsiella, Enterococcus and Pseudomonas. All Acinetobacter species are multidrug resistant. Of the 17 patients who had Kelbsiella grown in the blood culture, 8 grew multidrug-resistant Klebsiella. Only 4 patients' blood cultures grew methicillin-resistant Staphylococcus aureus. The number of blood culture samples taken ranged between 1-28 (median = 6). The first positive blood culture showed that Staphylococcus epidermidis and Acinetobacter were the most common infecting organisms.

Conclusions

Multidrug-resistant Acinetobacter was the most predominant microorganism grown from the blood cultures of major burn patients in a tertiary care burn unit. Empirical therapy should include antibiotics that are effective against this organism to reduce the mortality.

Experience of unilateral cleft lip repair using the Anatomical Subunit Technique in an Omani population over a 5 year period

Objectives: The Anatomical Subunit Technique for unilateral cleft lip repair has gained popularity worldwide. The purpose of this study is to report our experience using this technique. Methods: 114 consecutive cases of cleft lip underwent primary cleft lip repair with closed rhinoplasty by a single surgeon from 2015 to 2020. In addition to the demographic data, severity and type of the cleft lip, the surgical outcomes, including vermillion notching, were assessed by an independent senior surgeon and rate of revision surgery were collected from Al-shifa plus 3 health electronic system. Parents’ satisfaction regarding scar quality, lip and nose aesthetic appearance was collected anonymously. The documented data were evaluated using statistical analysis. Results: 82 cases satisfied the inclusion criteria. The mean age at surgery for cleft lip was 32 weeks. 35 cases (43%) were complete cleft lips and 47 cases (57%) were incomplete. 43 children (52%) were born of consanguineous marriage. Six patients (7%) needed revision surgery. The digital survey was completed by 40 subjects and showed 85% satisfaction rate with the postoperative scar, 77.5% satisfaction with the aesthetic appearance of nose. Conclusion: In our hands, the anatomical subunit technique resulted in a predictable result with high patient’s satisfaction rate as related to scar quality, nasal and lip symmetry in children with varying severity of cleft lip. Revision for vermilion excess was needed in 7 % of cases. The high percentage of consanguinity (52%) in our study highlight the need for more targeted national campaigns involving premarital counselling in the Omani population. Keywords: Cleft Lips, cheiloplasty, Oman, Surgical Technique, Millard Technique, Fisher, Consanguinity.