A retrospective analysis of bacterial colonization epidemiology in pediatric burn patients in Qatar.

BACKGROUND: Burn injuries in children are associated with a high risk of wound colonization and infection due to loss of skin integrity and prolonged hospitalization. Understanding temporal microbiological patterns is essential to guide clinical management and antimicrobial stewardship. METHODS: A retrospective cohort study was conducted at the Pediatric Intensive Care Unit (PICU) of Al-Wakrah Hospital, Qatar, between 2022 and 2025. Children aged 1 month to 14 years with burn injuries and at least one wound culture were included. Early (≤72 hours) and late (>72 hours) wound colonization patterns, antimicrobial utilization, and sepsis outcomes were analyzed using Fisher's exact test. RESULTS: A total of 199 patients were included (mean age 3 years), with scald burns accounting for 86.4% and most burns involving ≤10% total body surface area (TBSA). Early wound cultures were predominantly no growth or normal flora (68.2%). In contrast, late cultures demonstrated a significant decline in normal flora (10.5% vs 27.3%, p < 0.001) and a shift toward Gram-negative organisms, particularly Pseudomonas aeruginosa (7.2% vs 0.5%, p = 0.002), along with emergence of yeast (3.9% vs 0%, p = 0.008). Larger burns (>10% TBSA) were significantly associated with Pseudomonas aeruginosa colonization (p = 0.003). Antibiotic use among patients with negative cultures increased significantly in the late phase (56.7% vs 28.8%, p = 0.003). Sepsis occurred in 5.5% of patients and was more frequent in larger burns, although not statistically significant. CONCLUSION: Pediatric burn wound microbiology demonstrates a clear temporal shift toward Gram-negative organisms with prolonged hospitalization, particularly in larger burns. Increased antibiotic use in patients with negative cultures highlights important opportunities for antimicrobial stewardship and optimization of prescribing practices.