Plastic Surgery Unit Research Articles

Department Versus Division: An In-Depth Analysis of Units of Plastic Surgery and Other Surgical Specialties at Their Institutions.

An increasing number of plastic and reconstructive surgery (PRS) units have transitioned from divisions to departments in recent years. This study aimed to identify quantifiable differences that may reflect challenges and benefits associated with each type of unit. We conducted a cross-sectional analysis of publicly-available data on characteristics of academic medical institutions housing PRS units, faculty size of surgical units within these institutions, and academic environments of PRS units themselves. Univariate analysis compared PRS divisions versus departments. Matched-paired testing compared PRS units versus other intra-institutional surgical departments. Compared to PRS divisions (n = 64), departments (n = 22) are at institutions with more surgical departments overall (P = 0.0071), particularly departments that are traditionally divisions within the department of surgery (ie urology). Compared to PRS divisions, PRS departments have faculty size that more closely resembles other intra-institutional surgical departments, especially for full-time surgical faculty and faculty in areas of clinical overlap with other departments like hand surgery. Plastic and reconstructive surgery departments differ from PRS divisions by certain academic measures, including offering more clinical fellowships (P = 0.005), running more basic science laboratories (P = 0.033), supporting more nonclinical research faculty (P = 0.0417), and training residents who produce more publications during residency (P = 0.002). Institutions with PRS divisions may be less favorable environments for surgical divisions to become departments, but other recently-transitioned divisions could provide blueprints for PRS to follow suit. Bolstering full-time surgical faculty numbers and faculty in areas of clinical overlap could be useful for PRS divisions seeking departmental status. Transitioning to department may yield objective academic benefits for PRS units.

Evolution of Indian Units as International Training Centres—the Experience of Plastic Surgery Unit of Ganga Hospital

Evolution of Indian Units as International Training Centres—the Experience of Plastic Surgery Unit of Ganga Hospital

FREQUENCY OF BACTEREMIA IN BURN PATIENTS IN RELATION TO THROMBOCYTOPENIA

Burn patients are obviously at high risk for infections due to the immune compromising effects of burn injury. E.coli is an important life-threatening pathogen in burn units [1]. The aim of this study was to determine bacteremia in the surgical and plastic surgery units of Guru Gobind Singh Medical College and Hospital, Faridkot.25 burn patients were chosen at random study staph aureus (6) was the dominant organism followed by E. Coli (4) in blood culture,. Eight (32%) of the total patients died and 68% survived.
 Keywords: Burn, Bacteremia, Thrombocytopenia

The Impact of a Multidisciplinary Approach Protocol and Integrated Guidelines for Antibiotic Prophylaxis in Plastic Surgery Procedures.

BACKGROUNDSurgical antibiotic prophylaxis has been widely used for prevention of surgical site infections (SSI’s). World Health Organization (WHO) global guidelines strongly recommend the administration of pre-operative prophylactic antibiotic, depending on the type of surgery, to reduce SSI’s. However, within Gulf Cooperation Council (GCC) countries, antibiotic resistance has been rising due to unregulated prescribing practice. We aimed to assess adherence to local/international guidelines in the plastic surgery unit of Salmaniya Medical Complex.METHODSThis study was a retrospective review of adults’ undergoing plastic surgery between the dates of 1st of January 2019 to 30th of April 2019. Recommendations and guidelines were provided by South Australian Guidelines for Surgical Antimicrobial Prophylaxis, NHS Greater-Glasgow Foundation Trust. Salmaniya Medical Complex Guidelines were also taken into consideration. This was followed by an implementation of standardized guidelines and a re-assessment period for another four months.RESULTSThere were 106 patients who met the inclusion/exclusion criteria throughout the primary cohort. With respect to choice and dose of antibiotics, only 21 (19.8%) of the procedures were adherent to global/local guidelines. Similarly, only 11.5% of those cases have met the recommended timing for pre-operative antibiotic administration. After the implementation period, adherence to guidelines regarding choice and time of antibiotic administration has increased to 36.8% and 32.6% respectively. SSI decreased from 1.8% to 0.08%.CONCLUSIONPractice in SMC in plastic surgery pre-operative antibiotic prophylaxis shows poor compliance to both local and international guidelines in terms of choice, dose, and time of administration. We were able to significantly improve adherence to international/local practice in both areas by implementing an integrated protocol in liaison with the medical staff involved in the plastic surgery unit and operating theatres.

Efficacy of the Free-Style, Perforator-Plus Flaps in the Reconstruction of the Soft Tissue Defects at the Lower Leg and Ankle Regions

ABSTRACTBackground: Reconstruction of the lower leg and ankle soft tissue defects is not that the convenient task, due to the unique anatomy and its variation. Aim of Study: Evaluation efficacy of the Free-Style, Perforator-Plus flap concepts in the reconstruction of the soft tissue defects at lower two-thirds leg, tendo-Achilles and ankle regions.Method: A Prospective (Case Series) Study, was carried on 20 consecutive patients, which performed at the Plastic and Reconstructive Surgery Unit, of General Surgery Department, of Benha University Hospitals, and Department of Plastic and Reconstructive Surgery at Nasser Institute for Research and Treatment in the period from June 2020 to June 2021. Results: 20, consecutive, exclusively males, patients, aged from 3 to 57 years old (Mean 28 ± 12 SD years), had a “Free-Style, Perforator-Plus Flap” reconstructive surgery, to cover defects presented at lower Leg two-thirds (75% of cases), Tendo-Achilles (10%) and Ankle (15%) regions. Flap complications were encountered in 4 cases (20%): 2 cases (10%) had distal congestion, the other 2 cases had distal ischemia, which one of them developed full-thickness distal loss. The final recipient outcome “Defect Coverage” was achieved in all cases (100%). Conclusion: The Free-Style, Perforator-Plus Flap is reliable with relative efficiency, versatile, and has a modest rate of failure and need for secondary surgery. It capable to reconstruct small to relatively large, complex defects (exposed bone or hardware and chronic osteomyelitis) in the distal Leg two-thirds, Tendo-Achilles, and Ankle regions.

Training the Trainers in Microsurgery: A Success Story from Vietnam's Hanoi National Hospital of Odonto-stomatology.

Background:Microsurgery is a highly specialized skill that requires advanced training. This is a recount of the 12-year development of Hanoi National Hospital of Odonto-Stomatology (NHOS) from a basic plastic surgery unit to a high-volume, subspecialized reconstructive center.Methods:We present a 12-year retrospective account of the development of NHOS with a brief summary of microsurgical reconstructive outcomes.Results:From 2008 to 2020, NHOS has performed 665 microsurgical flaps for reconstruction of various maxillomandibular defects. In the pioneering stage (2008-2011), without surgical microscopes, all five free flaps failed. After acquiring a microscope and mentoring from Hanoi's 108 Military Hospital, mandibular bone defect reconstruction with free fibula flaps had 85% success rate. In the growth stage (2012-2015), reconstruction advanced toward more complex defects requiring soft tissue, with a 98.7% success rate. The maturation stage (2016-2020) focused on refinement of reconstructive service to provide subspecialized care for malignant head and neck cancer patients with help from Taiwan's E-Da Hospital and Operation Smile's charity program. The charity mission trips were structured to facilitate good quality teaching rather than hit a quantitative goal of the number of surgeries done. And with a success rate of 99.4%, we have begun further education of the plastic surgery community in Vietnam.Conclusions:Our rapid 12-year maturation into a high-volume, subspecialized microsurgical center is the embodiment of the generous efforts of many international friends who invested their time and expertise. And we highly recommend charity mission trips to adopt the “training the trainers” concept to maximize lasting, local impact.

ADDING MONSPEXY STEP TO ABDOMINOPLASTY, DOES THIS BENEFIT IN MANAGEMENT OF URINARY STRESS INCONTINENCE IN FEMALES WITH REDUNDANT ABDOMEN AND MONS PUBIS? Ayman M. Abdelmofeed MD1, Ola Seif MD1 , Mohamed T. Younes MD1, Shabieb A.Abdelbaki MD2. 1 Department of General Surgery, plastic surgery unit Benha University, Egypt 2 Department of urology, Benha University, Egypt Corresponding author, Ayman M. Abdelmofeed

ADDING MONSPEXY STEP TO ABDOMINOPLASTY, DOES THIS BENEFIT IN MANAGEMENT OF URINARY STRESS INCONTINENCE IN FEMALES WITH REDUNDANT ABDOMEN AND MONS PUBIS? Ayman M. Abdelmofeed MD1, Ola Seif MD1 , Mohamed T. Younes MD1, Shabieb A.Abdelbaki MD2. 1 Department of General Surgery, plastic surgery unit Benha University, Egypt 2 Department of urology, Benha University, Egypt Corresponding author, Ayman M. Abdelmofeed

387 Plastic Surgery Workload During The COVID-19 Pandemic

IntroductionCOVID-19 has been a formidable opponent to every aspect of the NHS. A comparative study examined referral workload at a regional Plastic Surgery Unit, Major Trauma Centre & Burns Facility during the initial stages of the lockdown period. Lessons learnt can then help prepare for the future.MethodFrom initial lockdown (24/03/2020), all Plastic Surgery referrals were documented for 28 days. This data was compared to the same period in 2019. Demographics, diagnosis, mechanism of injury and time to presentation and surgery were noted.ResultsA total of 525 patients were managed, with a 48% reduction in referrals during lockdown. Hand trauma referrals reduced by 16% but increases in deliberate self-harm (100%), DIY injury (75%), lower limb trauma (250%) and burns (64%) were seen. Fewer work and school related injuries were managed in keeping with lockdown rules. Notably, access to surgical management did not alter.ConclusionsThe COVID-19 pandemic significantly affected the workload of our service. Social behaviours and psychological impact were common contributing factors. As Plastic Surgeons this should be acknowledged and consideration of optimising mental health services and health education should be prioritised for the future.

Outcome of Local Flaps in Mid and Lower Face Reconstruction

Background: Different reconstructive approaches have been introduced over last decades for management of facial defects. Local flaps, whenever possible, may be an ideal solution for some defects. The aim of our study is evaluation of the outcomes of different local flaps in reconstruction of mid and lower facial defects.Patients and methods: This study was a prospective, non-randomized and uncontrolled trial recruiting twenty patients admitted between December 2017 to June 2018 at plastic surgery unit, Zagazig University Hospitals complaining of facial defects post trauma and tumors excision and trauma to mid- and lower face regions due to multiple etiologies. Twenty patients were admitted to plastic surgery unit complaining of facial skin tumors and post-traumatic mid and lower facial defect.Results: The mean and standard deviation of age was 51 years ± 20.68 with minimum 9 years and maximum 77 years. In our study, there were 11 males (55%) and 9 females (45%). the relationship between patient satisfaction and outcome, there was statistically significant difference toward having good outcome and good verbal response (p = 0.006). There was statistically significant deviation of outcome to be good or very good rather than poor or accepted despite presence of complication (p=0.002). In order to examine the relationship between patient satisfaction and defect area there was no statistically significant difference both variables (p = 0.085). Conclusion: Meticulous selection of facial flap for every lesion is mandatory for gaining not only better results aesthetically but to protect patient's self-image, self-esteem and prevention of associated depression.

P37: THE IMPACT OF TEMPORAL ARTERY BIOPSY AT A UK TERTIARY PLASTIC SURGERY UNIT

Abstract Introduction Guidelines recommend temporal artery biopsy (TAB) for patients suspected of having giant cell arteritis (GCA). We evaluated the impact of TAB on the diagnosis and management of patients with suspected GCA at a tertiary plastic surgery unit. Method A retrospective review of all TAB procedures performed at our centre over 7 years was performed. One hundred and one patients were included in the study. Patients were classified into 3 diagnostic groups: confirmed (positive TAB), presumed (negative TAB with high clinical suspicion) and unlikely (negative TAB with low clinical suspicion). The clinical presentation and management for each group were compared. Result The average American College of Rheumatology (ACR) score was 3.07. The number of patients with an ACR score of ≥3 before TAB was 72 (71.3%) and remained the same after TAB. The number of patients who remained on steroid therapy was lower in the group with an unlikely diagnosis of GCA compared to the group with a confirmed diagnosis (p<0.05). Conversely, there was no significant difference in steroid therapy between those with a presumed and confirmed diagnosis (p>0.05). Conclusion This study found a significant difference in steroid treatment between those with confirmed GCA and those where the diagnosis was unlikely showing that TAB may support decisions regarding steroid therapy. However, TAB was inappropriately requested for patients whose pre-TAB ACR score was ≥3 as this score is sufficient for the diagnosis of GCA. Therefore, the use of TAB should be limited to cases of diagnostic uncertainty. Take-home message while temporal artery biopsy has a role to play in the diagnosis of GCA, its use should be limited to cases of diagnostic uncertainty and not requested for every patient with a suspicion of Giant Cell Arteritis.

Peri-areolar double-pedicle technique in the treatment of iatrogenic gynecomastia.

Objectives:To describe the surgical approach to the treatment of iatrogenic gynecomastia via peri-areolar incision.Methods:In this study, we describe our experience in the surgical management of iatrogenic hormonal gynecomastia with our technique described for idiopathic gynecomastia. We treated 70 patients with gynecomastia at a plastic surgery unit between 2000 and 2016. Ten of these patients had a painful hypertrophic mammary gland with grade III gynecomastia secondary to hormone therapy after prostate cancer.Results:The presence of a very discreet scar around the areola often has very interesting aesthetic results. Areolar tissue sensation was completely preserved in 40% of patients. No short-term complications were observed; in follow-up, only one case of keloid scars was noted on a patient with dark skin, and only one case of areolar necrosis on a patient with critical breast ptosis.Conclusion:This technique is feasible. It restores almost normal anatomy structure with minimal scarring and preserves good regional neurovascular supply, with only 60% altered areolar sensation.

Clinical concern for necrotising fasciitis: a review of referrals to plastic surgery units at two tertiary centres.

To evaluate the impact of clinical suspicion on the diagnosis of necrotising fasciitis (NF) in two inpatient plastic surgery units. A multicentre retrospective audit of all referrals of adult patients to the inpatient plastic surgery units of two Melbourne metropolitan tertiary centres from 1 February 2018 to 31 December 2018. A total of 53 patients (37 male, 16 female) were referred to evaluate for NF. There were 20 patients (37.04%) who underwent operative debridement. Of those, 15 were pre-operatively suspected of having NF and there were seven confirmed cases of NF (13.21%). Laboratory risk indicator for NF (LRINEC) score ≥ 6 had a statistically significant association with a diagnosis of NF (P= 0.03) and with operative debridement (P= 0.04). The incidence of NF in the cohort where the referrer had clinical concern for NF was 13.21% (P< 0.001) and when the referrer and the plastic surgeon suspected NF was 46.67% (P< 0.001). The number of patients needed to be referred for one case of NF to be diagnosed was 7.58. Clinical suspicion of NF is essential for diagnosis and clinicians who suspect NF should not hesitate to refer to the appropriate surgical unit. Prompt review is required of patients in whom NF is clinically suspected as these patients have a 13.21% incidence of NF. The laboratory risk indicator for NF score is not sufficiently specific nor sensitive to exclude or to diagnose NF as a stand-alone diagnostic tool but may have a role as an adjunct.

The Propeller Myocutaneous Flap of the Upper Eyelid: Anatomical Study and its Clinical Implication.

The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region. The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2. The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result. Patients were followed up at 3-6-12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible. The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region.

Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center.

Background Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time. Methods This is a retrospective review done in a tertiary care teaching institute from January 2005 to June 2018 and the data of 72 patients who had DSWI out of 4,214 patients who underwent median sternotomy for coronary artery bypass grafting (CABG) was collected with respect to the duration between CABG and presentation of DSWI as well as time of referral to a plastic surgery unit. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality. Results The early group had 33 patients, while the late group had 39 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant ( p = 0.002). The average duration from the presentation of DSWI to definitive surgery was found to be 16.58 days in the early group and 89.36 days in the late group. The rest of the variables that were compared in both the groups did not have significant differences. Conclusion There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs. Early referral of post-CABG DSWIs to Plastic surgeons by the cardiothoracic surgeons is highly recommended.

Vaginal Colposuspension Using the Uphold Lite Mesh System versus Transvaginal Hysterectomy with Uterosacral Ligament Suspension for Treatment of Apical Prolapse: A Comparative Study

To compare clinical and anatomic outcomes as well as patient satisfaction in women undergoing vaginal colposuspension using the Uphold Lite system (Boston Scientific Corporation, Marlborough, MA) and transvaginal hysterectomy with uterosacral ligament suspension (VUSLS) for the treatment of apical prolapse. Retrospective cohort study. Female pelvic medicine and reconstructive surgery unit at a university-affiliated tertiary medical center. Women with apical prolapse who underwent either vaginal colposuspension using the Uphold Lite system (uterine-preserving as well as after previous hysterectomy) or VUSLS from 2010 to 2019. Excluded were women with 1 month or less of follow-up. None. A total of 164 women were included in the study: 112 women underwent VUSLS, and 52 underwent colposuspension using the Uphold Lite mesh system. Age, body mass index, maximal birth weight, comorbidity rates, and pelvic organ prolapse severity were similar between the groups. The clinical cure rate was similarly high in both groups, with 91.1% in the women who underwent VUSLS and 88.5% in those in the Uphold Lite group (p = .60). No differences were noted between the groups with regard to anatomic cure rate or composite outcome success rate (73.9% vs 76.0%, p = .77 and 70.3% vs 74.0%, p = .63, in the VUSLS and Uphold Lite groups, respectively). An advantage was noted in the VUSLS group with regard to patient satisfaction with 98.1% of the women stating that their condition was very much better (Patient Global Impression of Improvement questionnaire: A) or much better (Patient Global Impression of Improvement questionnaire: B) compared with 83.9% of the women in the Uphold Lite group (p = .023). In an attempt to assess the association between different variables and the composite outcome, a multivariate analysis was performed in which increased body mass index, menopausal status, and increased preoperative genital hiatus were found to decrease composite outcome success. Vaginal colposuspension using the Uphold Lite system and VUSLS for the treatment of apical prolapse have comparable results with high clinical success rates.

Effects of COVID-19 lockdown measures on emergency plastic and reconstructive surgery presentations.

BackgroundIn Australia, the COVID‐19 pandemic has caused severe social disruptions, including restrictions to the movement of people. Healthcare centres around the world have seen changes in the nature of injuries acquired during the COVID‐19 pandemic; we therefore hypothesize that social isolation measures have changed the pattern of plastic and reconstructive surgery presentations.MethodsA prospective cohort study was designed comparing patient presentations during the enforced COVID‐19 lockdown to two previous periods. All emergency referrals requiring operative intervention by the plastic and reconstructive surgery unit of our institution were included. Patient demographics, place and mechanism of injury, drug and alcohol involvement, delays to presentation, length of admission and complication rates were collected.ResultsDemographics and complication rates were similar across all groups. A 31.8% reduction in total number of emergency cases was seen during the lockdown period. Increase in do‐it‐yourself injuries (P = 0.001), bicycle injuries (P = 0.001) and injuries acquired via substance abuse (P = 0.041) was observed. Head and neck injuries, mostly due to animal bites and falls, were also more prevalent compared to the same period the previous year (P = 0.007). As expected, over 80% of plastic surgery operations during the COVID‐19 period were due to injuries acquired at home, a significant increase compared to previous periods.ConclusionDespite changes in the pattern of presentations requiring plastic and reconstructive emergency surgery, traumatic injuries continued to occur during the pandemic. Thus, planning will be essential to ensure resource allocation for emergency procedures is sustained as second and third waves of COVID‐19 cases emerge worldwide.

A historical analysis of surgery performed between 1941 and 1942 at the Bangour Maxillofacial and Plastic Surgery Unit, Scotland

In 1939, Bangour Emergency Medical Services Hospital was built as an annexe to Edinburgh War Hospital. The Maxillofacial and Plastic Surgery Unit opened in 1941, one of the several set-ups built with the support of Sir Harold Gillies, to ensure a service with specialist skills throughout Great Britain. The unit was led by Alexander Burns Wallace, who had to rapidly adapt the service to reflect the patterns of injury reflected by the more modern warfare practiced in the Second World War, while also incorporating techniques that were, at the time, revolutionary. Although much has been written about other units, Bangour's activity revealed through its case histories' highlights that plastic surgery was developing in parallel throughout Britain. The influence of Sir Harold Gillies was clear, and his input to support the fledgling service serves as an important aspect of the newly developing specialty of plastic surgery: collaboration and sharing of knowledge. This paper analyses the work of the Maxillofacial and Plastic Surgery Unit at Bangour General Hospital in Scotland between 1941 and 1942 and demonstrates its historical significance, as well as its relevance to current practice. Ninety-two case notes from the unit recently became accessible. These were analysed and four were selected for review in this study. These cases were selected as they were well-documented with photographs and good examples of the work performed at the unit in order to highlight the innovative, creative and complicated work carried out at the Unit.

Free Flap Monitoring, Salvage, and Failure Timing: A Systematic Review.

Microsurgical free tissue transfer has become a reliable technique with success rates around 99% and around 5% requiring exploration for vascular compromise. Protocols for flap monitoring between plastic surgery units vary. We aimed to elucidate the time period when monitoring is crucial for flap salvage. A systematic search of literature was performed in PubMed, Cochrane Library, Medline, and Scopus databases from 1966 to July 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying 3,844 studies with mention of free flap and monitoring or timing or salvage or compromise. Studies were screened for relevance according to predetermined inclusion criteria. Data was extracted from included studies relating to flap type, monitoring, timing and reason for failure, and success of salvage intervention. A total of 109 studies featuring 44,031 free flaps were included. A total of 2,549 (5.8%) flaps required return to theater for compromise; 926 (2.1%) were lost and 1,654 (3.7%) were salvaged. In the first 24 hours postoperatively 93.8% of explored flaps are successfully salvaged, by day 2: 83.33%, day 3: 12.1%, and beyond day 4: none were successful. Of the 355 flaps where the cause of failure was reported, 59.5% was venous, 27.9% was arterial, 2.3% was a combination of both, and 10.2% was hematoma or infection. The proportion of flap failures at various recipient sites was highest in the trunk/viscera (7%, 95% confidence interval [CI] 0.00, 0.36), followed by limbs (5%, 95% CI 0.02, 0.08), head and neck (3%, 95% CI 0.02, 0.04), and breast (<1%; 95% CI 0.00, 0.02). Close flap monitoring is of most value in the first 48 hours postoperatively, facilitating rapid detection of vascular compromise, early salvage, and better outcomes. The location of the flap has implications on its success and certain recipient sites may need particular attention to improve chances of success.

Detection of Pathogenic Microorganisms from Burn Patients Admitted in Tertiary Medical College Hospital and Their Antimicrobial Patterns

Object: To isolate and identify the microorganisms from the burn patients admitted to the National Institute of Burn and Plastic Surgery Unit in Tertiary Medical College Hospital, Bangladesh. A total number of fifty wound surface swab samples of first and second-degree burn patients were collected and the microbial analysis as well as the study of antibacterial susceptibility was conducted. The study showed the bacterial isolates were found. 45 (90%) of wound swab were positive among 50 and only 5 samples (10%) were negative in bacterial growth, which presented invasive burn wound infection from both sex age groups marked 12 - 60 years. The total viable count TVC-11651 CFU/plate was found and the highest amount in the second-degree burn patients. The results showed that Pseudomonas aeruginosa was common in all positive samples 6636 CFU/plate (57%) followed by Staphylococcus aureus 4070 CFU/plate (35%), Klebsiella spp. 450 CFU/plate (5%), Proteus spp. 243 CFU/plate (2%), and E. coli 162 CFU/plate (1%). Most of the pathogens were found to be drug-resistant while several isolates were noted to be multi-drug resistant. The growth of multidrug-resistant organisms should be considered as a serious risk factor in a burn unit. Aggressive infection control measures should be applied to limit the emergence and spread of multidrug-resistant pathogens.

Prevalence of Multidrug Resistant (MDR) &amp;lt;i&amp;gt;Proteus&amp;lt;/i&amp;gt; spp. in Burn Wound Infection of a Tertiary Care Hospital, Rajshahi

Background: Multidrug resistant (MDR) bacteria are an emerging public health issue in all over the world especially in developing countries like Bangladesh. Objective: This study was aimed to determine the prevalence of MDR Proteus species in burn wound infected patients admitted in Burn and Plastic Surgery Unit, Rajshahi Medical College Hospital (RMCH). Methodology: This cross sectional study was conducted at Microbiology Department of Rajshahi Medical College, Rajshahi, Bangladesh. A total of 212 wound swabs were collected and processed as per standard protocol from January to December 2016 for a period of one year. The isolation and identification of Proteus species was done by conventional microbiological process and antimicrobial susceptibility was performed by Modified Kirby-Bauer disk diffusion method. The Proteus species was further classified into MDR on the basis of standardised international criteria. Result: Among the 196 isolates from 212 wound swabs, Proteus spp. was the 2nd most frequent isolated organism (23.47%) following Pseudomonas aeruginosa (34.18%). Two species of Proteus were identified; Proteus mirabilis (65.22%) and Proteus vulgaris (34.78%). More than 75.0% Proteus spp. showed resistance to ciprofloxacin and ceftriaxone where meropenem was the highest sensitive drug (>93%). MDR Proteus spp. were 63.04% among which Proteus mirabilis and Proteus vulgaris were 60% & 68.75% MDR respectively. Conclusion: This study culminates the high prevalence of MDR Proteus spp. in Burn Unit of RMCH and decreased sensitivity to commonly used antibiotics. Therefore a greater emphasis on prevention of MDR bacterial colonization and antibiotic stewardship are imperative.