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 Five-Year Period.

Objectives: This study aimed to report the authors' experience with the anatomical subunit technique for unilateral cleft lip repair, which has gained popularity worldwide. Methods: From July 2015 to April 2020, 114 consecutive cases of cleft lip underwent primary cleft lip repair with closed rhinoplasty by a single surgeon. The demographic data, severity and type of the cleft lip, surgical outcomes, including vermillion notching, were assessed by an independent senior surgeon. The rate of revision surgery was collected from the Al-Shifa® - 3Plus healthcare information system (Ministry of Health, Oman). Parents' satisfaction regarding scar quality and lip and nose appearance was collected and all data were statistically analysed. Results: A total of 82 cases satisfied the inclusion criteria. The mean age at surgery for cleft lip was 32 weeks. Among these, 35 cases (43%) were complete cleft lips and 47 cases (57%) were incomplete. Additionally, 43 children (52%) were born of consanguineous marriage. Six patients (7%) needed revision surgery. The digital survey was completed by 40 subjects (response rate: 48.8%) which showed 85% satisfaction rate with the postoperative scar and 77.5% satisfaction with the aesthetic appearance of the nose. Conclusion: The anatomical subunit technique resulted in a predictable outcome indicating a high rate of patient satisfaction with scar quality and nasal and lip symmetry in children with varying severity of cleft lip. The high percentage of consanguinity (52%) in this study highlights the need for more targeted national campaigns involving premarital counselling in the Omani population.