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Page 10 of 16 Tejiram et al. Plast Aesthet Res. 2025;12:9 https://dx.doi.org/10.20517/2347-9264.2024.109

Figure 3. (A) In the wound bed at follow-up, the entire Bacteria domain was identified as being enriched in the ABX group, while the no-
ABX group had twelve enriched taxa [P ≤ 0.05, log(LDA) ≥ 2]; (B) In the buccal swabs at follow-up, three taxa were enriched in the no-
ABX group, and eleven were enriched in the ABX group [P ≤ 0.05, log(LDA) ≥ 2]. ABX: Antibiotics; no-ABX: no antibiotics.

DISCUSSION
The pathophysiologic outcome of burn injury leads to coagulative necrosis of burned tissue, immune
deficiency, hyperinflammation, and vascular leakage. This unique environment facilitates colonization and
subsequent infection of the wound bed. Early wound excision, grafting, nutrition maintenance, and
resuscitation are clinical interventions that are considered to stem infection and speed wound closure. The
use and classification of antibiotics often increase in patients with greater TBSA burn injuries where the risk
of blood-borne infection and sepsis is higher [11,15] . Antibiotic efficacy must be weighed against the risk of
altering the resident microbiome and developing MDRO [1,15,23,41,42] . Even small doses of antibiotics risk
perturbation of the microbiome and selection for resistant organisms that can become problematic later in a
patient’s hospital course. This study provided a novel setting to examine the effect of the administration of a
short course of preoperative antibiotics in a controlled setting. Serial examination of the microbiome
following a single dose preoperative antibiotic administration is an innovative approach to assessing
microorganism changes over time. While clinical outcomes were not significantly different between groups,
samples collected from burn patients demonstrated a significantly altered microbiome following the
administration of perioperative antibiotics.