{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T13:19:07Z","timestamp":1777987147314,"version":"3.51.4"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Infection is a nearly universal complication among patients with major burns, yet guidance on early empiric antibiotic therapy remains limited. Broad-spectrum antibiotics are commonly initiated in the early phase of care but carry risks of antimicrobial resistance and drug toxicities. This single-center, retrospective study evaluated the microbiological profiles and antibiotic prescribing patterns associated with first positive cultures (FPCs) in patients with major burn injuries admitted to Canada\u2019s highest-volume adult burn center between January 1, 2018 and May 1, 2023. A total of 114 patients with \u2265 20% total body surface area burns were included. Among 145 FPCs, the most commonly cultured sites were respiratory (55%) and wound (30%). The most frequently identified organisms were methicillin-sensitive Staphylococcus aureus (19%), Haemophilus influenzae (15%), Enterobacter cloacae complex (8%), Escherichia coli (7%), methicillin-resistant S aureus (MRSA) (7%), and Pseudomonas aeruginosa (6%). Notably, only 3% of patients who screened negative for MRSA on admission developed MRSA-positive cultures. Antibiotic therapy was initiated in 99% of patients with FPCs, most commonly with piperacillin-tazobactam (41%), vancomycin (16%), and cefazolin (14%). Dual therapy, typically piperacillin-tazobactam plus vancomycin, was used in 13% of cases. Sensitivity data demonstrated that meropenem (90%) and the combination of ciprofloxacin with cefazolin (83%) covered the highest proportion of isolates. While piperacillin-tazobactam remains effective for early empiric use, our findings indicate that targeted alternatives\u2014such as reserving meropenem for select cases or using ciprofloxacin plus cefazolin in appropriate patients\u2014could provide comparable coverage while adhering to antimicrobial stewardship principles. A negative MRSA screening swab on admission demonstrated a high negative predictive value (~97%), supporting the withholding of vancomycin in screen-negative patients. This study supports evidence-based antibiotic use in patients with burn injuries and underscores the need for local, data-driven stewardship.<\/jats:p>","DOI":"10.1093\/jbcr\/iraf229","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T12:53:19Z","timestamp":1766062399000},"page":"780-787","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating First Positive Cultures in Burns: Rethinking Broad-Spectrum Antibiotic Choices"],"prefix":"10.1093","volume":"47","author":[{"given":"Pouriya","family":"Sadeghighazichaki","sequence":"first","affiliation":[{"name":"Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario M4N 3M5 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan D","family":"Rogers","sequence":"additional","affiliation":[{"name":"Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario M4N 3M5 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