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1. Introduction to Skin and Burns Skin as a Barrier Largest organ, covering 2 m² and weighing 4 kg (Dermatology and Restorative Medicine, 2023) Acts as a microbial barrier and protects the body from infections (Philpot, 1988) Impact of Burns Burns damage skin structure, impair elasticity, and increase infection vulnerability (Hernandez Garcia & Gonzalez Vazquez, 2024) One of the leading causes of morbidity and mortality in burn patients due to bacterial infections ( Sultanova et al., 2023)

2. Common Pathogens in Burn Infections Microbial Threats Common opportunistic pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, etc. ( Zurnadzh’yants et al., 2024) Staphylococcus aureus: Gram-positive, coagulase-positive, associated with biofilm formation and antibiotic resistance (Gherardi, 2023) Pseudomonas aeruginosa: Gram-negative, biofilm-forming, highly resistant, complicates recovery (Jubair & Alkhudhairy , 2024) Risk in Burn Patients Increased infection risk and delayed healing, especially in immunocompromised individuals

3. The Study's Relevance and Research in Erbil Study Overview Focuses on the prevalence and antibiotic resistance of Pseudomonas aeruginosa and Staphylococcus aureus in burn patients in Erbil, Iraq Research Importance Helps identify bacterial strains and antibiotic resistance profiles Crucial for improving infection control practices and treatment protocols in burn units

4. Findings and Implications Impact of Antibiotic Resistance Rising resistance to common antibiotics, affecting treatment efficacy Essential data for adjusting clinical practices and selecting effective antibiotics Future Directions Potential for future studies on molecular mechanisms of resistance, alternative treatments (bacteriophage therapy), and region-specific epidemiology Technological Tool Used VITEK system for rapid bacterial identification and antibiotic susceptibility testing

5. Research Design and Study Area Research Design : Cross-sectional study to assess the prevalence and antibiotic susceptibility of Pseudomonas aeruginosa and Staphylococcus aureus . Study Area : Conducted at Erbil Community Emergency Hospital, Erbil, Kurdistan, Iraq. Samples processed at the microbiology lab of Cihan University, Erbil.

6. Study Population and Methods Study Population : Includes all ages and sexes with burns of varying degrees confirmed by physicians. Inclusion Criteria : All patients with burn wounds, regardless of age or sex. Hospitalized burn patients. Exclusion Criteria : Patients under antibiotic therapy or those who recently passed away.

7. Sample Collection : 45 burn wound swabs collected between 1st Dec 2024 - 15th Jan 2025. Samples transferred to transport media and analyzed in Cihan University's microbiology lab. Materials Used : Petri dishes, Agar media (MacConkey, Mannitol Salt, Cetrimide), Oxidase test strips, and Vitek 2 device for antibiotic testing.

8. Biochemical Tests and Antibiotic Susceptibility Testing Biochemical Tests : Catalase and Oxidase tests used for bacterial identification. Gram staining for Pseudomonas aeruginosa and Staphylococcus aureus . Antibiotic Susceptibility Testing (AST) : Kirby-Bauer disc diffusion method on Mueller Hinton Agar. Antibiotic discs: Ciprofloxacin, Imipenem, Tetracycline, Azithromycin, Ceftazidime, Gentamicin. VITEK 2 System : Automated microbial identification and antibiotic susceptibility testing system.

9. Burn Wound Bacterial Sample Collection & Prevalence Study Location : Emergency Hospital, Erbil, Kurdistan, Iraq Total Samples : 45 burn wound samples collected Bacterial Growth : Pseudomonas aeruginosa : 8 samples (18%) Staphylococcus aureus : 13 samples (29%) Prevalence Chart : Staphylococcus aureus : 29% Pseudomonas aeruginosa : 18%

10. Bacterial Growth & Colony Identification Staphylococcus aureus : Mannitol Salt Agar : Yellow colonies, pH change from red to yellow Pseudomonas aeruginosa : MacConkey Agar : Colorless colonies Cetrimide Agar : Green colonies (due to pyocyanin production) Figure References : Figure 4.1 : Staphylococcus aureus colonies Figure 4.2 : Pseudomonas aeruginosa colonies

11. Catalase & Oxidase Test Results Title: Biochemical Test Results (Catalase & Oxidase) Catalase Test : Staphylococcus aureus : 29% Catalase positive Pseudomonas aeruginosa : 18% Catalase positive Oxidase Test : Pseudomonas aeruginosa : All samples positive Staphylococcus aureus : Negative results Charts : Chart 4.2 : Catalase test for both bacteria Chart 4.4 : Oxidase test results for Pseudomonas aeruginosa

12. Antibiotic Sensitivity & Resistance Patterns Staphylococcus aureus : Sensitive to : Ciprofloxacin, Azithromycin (60%) Resistant to : Ceftazidime (80%) Pseudomonas aeruginosa : Highly resistant to all tested antibiotics (e.g., Ciprofloxacin, Imipenem, Ceftazidime) Clinical Implications : MRSA Risk : Methicillin-resistant Staphylococcus aureus (MRSA) due to β- lactam resistance Treatment Recommendations : Use of Vancomycin & Teicoplanin for MRSA Avoid β- lactam antibiotics Consider combination therapy or alternative treatments

13. Prevalence and Antibiotic Resistance of Staphylococcus aureus & Pseudomonas aeruginosa in Burn Patients in Erbil, Iraq Objective: To analyze the prevalence and antibiotic resistance of S. aureus and P. aeruginosa in burn patients. Location: Erbil City, Iraq Key Findings: S. aureus : 29% prevalence P. aeruginosa : 18% prevalence Dominance of S. aureus aligns with global trends.

14. Resistance Profile of Staphylococcus aureus Isolates High Resistance: 100% resistance to Ceftazidime 38% resistance to Imipenem Resistance to Gentamicin (54%) and Azithromycin (46%) Susceptibility: Vancomycin and Teicoplanin remain effective Concerns: Emergence of Methicillin-resistant S. aureus (MRSA) Potential for evolving Carbapenem resistance

15. Resistance Profile of Pseudomonas aeruginosa Isolates High Resistance: 75% resistance to Ciprofloxacin and Imipenem 100% resistance to Gentamicin 87.5% resistance to Ceftazidime Concerns: Multidrug-resistant (MDR) phenotype 87.5% Colistin resistance (last-resort antibiotic) Molecular Resistance Mechanisms: Efflux pumps, β- lactamases, membrane permeability barriers

16. Clinical Implications & Infection Control Measures Empirical Therapy Adjustments: S. aureus: Use Vancomycin or Teicoplanin for suspected MRSA P. aeruginosa: Combination therapy (e.g., Colistin + Fosfomycin ) Infection Control: Strict disinfection protocols Enhanced surveillance of high-touch surfaces Decolonization strategies for MRSA carriers (e.g., Nasal Mupirocin ) Future Directions: Multi- center studies, molecular characterization of resistance mechanisms Exploration of alternative treatments (e.g., Bacteriophage therapy )

17. Introduction to Infection Challenges in Burn Patients Context : Pseudomonas aeruginosa & Staphylococcus aureus infections are major threats to burn patients in Erbil, Iraq. Skin as a Barrier : The skin is crucial for protection, thermoregulation, and immune defense. Burn Injuries : Disrupt the skin's protective function, increasing infection risk. Pathogens : P. aeruginosa & S. aureus are prominent causes of morbidity and mortality in burn units.

18. Characteristics of Key Pathogens Staphylococcus aureus : Gram-positive, biofilm formation. Antimicrobial resistance (e.g., MRSA). Leads to sepsis and refractory infections. Pseudomonas aeruginosa : Gram-negative, intrinsic antibiotic resistance. Diverse virulence factors (pigments, biofilm formation, motility). A major cause of nosocomial infections.

19. Local Significance in Erbil, Iraq Limited Data : There is a lack of data on infection rates and antibiotic resistance in Erbil. Prevalence & Susceptibility : Study aims to determine the prevalence and antibiotic resistance of these pathogens in burn patients. Impact : Understanding the local epidemiology aids infection control and antibiotic treatment strategies.

20. Objectives : Investigate P. aeruginosa and S. aureus prevalence in burn patients. Assess antibiotic susceptibility profiles using disk diffusion and Vitek machine. Impact on Burn Care : Data will inform infection control practices, guide antibiotic therapy, and improve patient outcomes in burn units. Broader Contribution : Enhances global efforts to combat antibiotic resistance and improve burn care.

21. Combating Pseudomonas aeruginosa & Staphylococcus aureus Infections in Burn Patients in Erbil City, Iraq Focus on multi-faceted approach for managing burn infections. Highlight the need for advanced research and clinical strategies. Importance of tackling antimicrobial resistance in burn care.

22. Research Priorities & Goals Epidemiological Studies: Prioritize detailed molecular characterization of isolates. Track local resistance patterns and outbreaks. Biofilm Formation & Virulence Factors: Investigate novel therapeutic targets for treatment. Antimicrobial Stewardship: Implement evidence-based infection control practices. Utilize rapid diagnostic testing for precise antibiotic use.

23. Education & Alternative Therapies Healthcare Professional Education: Focus on infection prevention, antibiotic resistance, and burn wound management. Exploration of Alternative Therapies: Consider phage therapy and immunomodulatory agents as potential treatments.

24. Study Limitations & Challenges Study Limitations: Limited sample size and time constraints. Lack of resources like Cetrimide Agar and Coagulase reagent. Financial constraints limited testing (e.g., Vitek test).