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

Objectives: In this study we review blood stream infections of major burns in a tertiary care burn unit to determine the most prevalent organisms in order to have a better empirical therapy protocol. Methods: This is a retrospective study where blood stream infection of major burns (>20% Total Body Surface Area) were analysed. Results:155 patients fulfilled the criteria. Median age was 33 years.  Median TBSA was 38%. 57.42% were males and 42.58% were females. Mortality was 25.16%. 50.9% of patients had positive blood culture. Expired patients had higher TBSA, Abbreviated Burns Severity Index score and earlier first positive blood culture. The most prevalent organisms grown from all blood cultures were Acinetobacter, staphylococci, Klebsiella, Enterococcus and pseudomonas. Candida is also commonly grown in blood cultures. All Acinetobacter species are always multidrug resistant. 8 of 14 patients had multidrug resistant Klebsiella.  There were only 4 patients who had Methicilin resistant Staphylococcus Aureus (MRSA) grown. The number of blood cultures samples taken ranged from 1 to 28 (median 6). First positive blood culture showed that Staphylococcus epidermidis   and Acinetobacter are the most common organisms. Conclusion: In conclusion multidrug resistant Acinetobcater has become the most predominant microorganism grown in blood cultures of major burns in our unit. Empirical therapy should include antibiotics that are effective against it to reduce the mortality. Keywords: Infection; Blood; Burn; Resistance; Antibiotics; Culture

Cutaneous drain opener burns: Report from a tertiary care burns unit

Background: Chemical burn injuries are generally industrial, but it can happen at home. Drain opener is one of the common causes of this type of burns. Drain openers are available in powder and liquid forms and contain either sodium hydroxide or sulfuric acid which causes burns when it gets in contact with the skin. This article reviews drain opener burns which presented to a tertiary care burns unit. Methods: A retrospective study of all drain opener chemical burns which presented to Khoula hospital, Muscat, Oman between 01.01.2013 and 31.12.2017. Results: There were 126 cases of drain opener burns (56% of all chemical burns). 80% of the patients were males. The mean age was 29.6 years. 18% of the patients were children. 93% of the patients had 10% or less of total body surface area (TBSA) affected. Upper limb was most commonly involved followed by lower limb and head and neck area. 37.3% of the patients had superficial dermal burns, 29.4% had mixed superficial and deep dermal burns and 33.3% had deep dermal or full thickness burns. There was no systemic poisoning in any of the cases. One of the patients required escharotomy. Two patients required ventilation. 60% of the patients had first aid given at the time of injury. Washing with tap water was the first aid given for all patients. 38% of the patients required surgery. 38% of the patients had hypertrophic scarring, 14% had hyperpigmented scars and 5% developed contracture. There were no mortalities. Conclusion: Drain openers are a common cause of domestic chemical burns in our community. These burns do not usually involve a very large area but can cause significant morbidity. The injury keeps happening despite warning signs on the bottles and the care taken by the users. More awareness needs to be created and clear warning signs must be kept on the bottles in order to reduce this type of injury. Keywords: Drain, Alkali, Acid, Burns, Chemica