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Fridoni M, Kouhkheil R, Abdollhifar MA, Amini A, Ghatrehsamani M, Ghoreishi SK, Chien S, Bayat S, Bayat M. Improvement in infected wound healing in type 1 diabetic rat by the synergistic effect of photobiomodulation therapy and conditioned medium. J Cell Biochem 2018; 120:9906-9916. [PMID: 30556154 DOI: 10.1002/jcb.28273] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
We investigated the effects of photobiomodulation therapy (PBMT) and conditioned medium (CM) of human bone marrow mesenchymal stem cells (hBM-MSC) individually and/or in combination on the stereological parameters and the expression of basic fibroblast growth factor (bFGF), hypoxia-inducible factor (HIF-1α), and stromal cell-derived factor-1α (SDF-1α) in a wound model infected with methicillin-resistant Staphylococcus aureus (MRSA) in diabetic rats. CM was provided by culturing hBM-MSCs. Type 1 diabetes mellitus (T1DM) was induced in 72 rats, divided into four groups, harboring 18 rats each: group 1 served as a control group, group 2 received PBMT, group 3 received CM, and group 4 received CM + PBMT. On days 4, 7, and 15, six animals from each group were euthanized and the skin samples were separated for stereology examination and gene expression analysis by real-time polymerase chain reaction. In the CM + PBMT, CM, and PBMT groups, significant decreases were induced in the number of neutrophils (1460 ± 93, 1854 ± 138, 1719 ± 248) and macrophages (539 ± 69, 804 ± 63, 912 ± 41), and significant increases in the number of fibroblasts (1073 ± 116, 836 ± 75, 912 ± 41) and angiogenesis (15 230 ± 516, 13 318 ± 1116, 14 041 ± 867), compared with those of the control group (2690 ± 371, 1139 ± 145, 566 ± 90, 12 585 ± 1219). Interestingly, the findings of the stereological examination in the CM + PBMT group were statistically more significant than those in the other groups. In the PBMT group, in most cases, the expression of bFGF, HIF-1α, and SDF-1α, on day 4 (27.7 ± 0.14, 28.8 ± 0.52, 27.5 ± 0.54) and day 7 (26.8 ± 1.4, 29.6 ± 1.4, 28.3 ± 1.2) were more significant than those in the control (day 4, 19.3 ± 0.42, 25.5 ± 0.08, 22.6 ± 0.04; day 7, 22.3 ± 0.22, 28.3 ± 0.59, 24.3 ± 0.19) and other treatment groups. The application of PBMT + CM induced anti-inflammatory and angiogenic activities, and hastened wound healing process in a T1 DM model of MRSA infected wound.
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Affiliation(s)
- Mohammadjavad Fridoni
- Department of Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences and Price Institue Of Surgical Research, University of Louisville, Kentucky, Zanjan, Iran
| | - Reza Kouhkheil
- Department of Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences and Price Institue Of Surgical Research, University of Louisville, Kentucky, Zanjan, Iran
| | - Mohammad-Amin Abdollhifar
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Abdollah Amini
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Mahdi Ghatrehsamani
- Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Sufan Chien
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC of Louisville, Louisville, Kentucky
| | | | - Mohammad Bayat
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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Nikoloudi M, Eleftheriadou I, Tentolouris A, Kosta OA, Tentolouris N. Diabetic Foot Infections: Update on Management. Curr Infect Dis Rep 2018; 20:40. [PMID: 30069605 DOI: 10.1007/s11908-018-0645-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetic foot infections (DFIs) are common in patients with diabetes mellitus complicated by foot ulcers and can be classified in different categories based on their severity. In this report, we present the diagnosis and management of DFIs according to their classification. RECENT FINDINGS While appropriate antibiotic regiments and surgical techniques for the treatment of DFIs are well established, new technologies and techniques for example in medical imaging, wound care modalities, and supplementary therapy approaches show potentially promising results in preventing DFIs. As with every complex disease, fine tuning DFI management can be challenging as it requires careful evaluation of different parameters. It demands timely action, close collaboration of different specialties, and patient cooperation.
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Affiliation(s)
- Maria Nikoloudi
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Ioanna Eleftheriadou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Anastasios Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Ourania A Kosta
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, Greece
| | - Nikolaos Tentolouris
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, Greece.
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Saltoglu N, Ergonul O, Tulek N, Yemisen M, Kadanali A, Karagoz G, Batirel A, Ak O, Sonmezer C, Eraksoy H, Cagatay A, Surme S, Nemli SA, Demirdal T, Coskun O, Ozturk D, Ceran N, Pehlivanoglu F, Sengoz G, Aslan T, Akkoyunlu Y, Oncul O, Ay H, Mulazımoglu L, Erturk B, Yilmaz F, Yoruk G, Uzun N, Simsek F, Yildirmak T, Yaşar KK, Sonmezoglu M, Küçükardali Y, Tuna N, Karabay O, Ozgunes N, Sargın F. Influence of multidrug resistant organisms on the outcome of diabetic foot infection. Int J Infect Dis 2018; 70:10-14. [PMID: 29476898 DOI: 10.1016/j.ijid.2018.02.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. METHODS We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. RESULTS In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001). CONCLUSION Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.
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Affiliation(s)
- Nese Saltoglu
- Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
| | - Onder Ergonul
- Koc University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Necla Tulek
- Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Mucahit Yemisen
- Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Ayten Kadanali
- Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Gul Karagoz
- Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Ayse Batirel
- Kartal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Oznur Ak
- Kartal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Cagla Sonmezer
- Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Haluk Eraksoy
- Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Atahan Cagatay
- Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Serkan Surme
- Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Salih A Nemli
- İzmir Atatürk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Izmır, Turkey
| | - Tuna Demirdal
- İzmir Atatürk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Izmır, Turkey
| | - Omer Coskun
- GATA Ankara Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Derya Ozturk
- Haydarpaşa Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Nurgul Ceran
- Haydarpaşa Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Filiz Pehlivanoglu
- Haseki Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Gonul Sengoz
- Haseki Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Turan Aslan
- Bezmi Alem University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Yasemin Akkoyunlu
- Bezmi Alem University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey; Gulhane Haydarpaşa Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Oral Oncul
- Gulhane Haydarpaşa Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Hakan Ay
- Gulhane Haydarpaşa Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Lutfiye Mulazımoglu
- Marmara University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Buket Erturk
- Marmara University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Fatma Yilmaz
- Medeniyet University Medical Faculty, Goztepe Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Gulsen Yoruk
- Samatya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Nuray Uzun
- Sisli Etfal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Funda Simsek
- Okmeydanı Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Taner Yildirmak
- Okmeydanı Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Kadriye Kart Yaşar
- Haseki Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Meral Sonmezoglu
- Yeditepe Üniversity Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Yasar Küçükardali
- Yeditepe Üniversity Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Nazan Tuna
- Sakarya University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - Oguz Karabay
- Sakarya University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - Nail Ozgunes
- Medeniyet University Medical Faculty, Goztepe Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Fatma Sargın
- Medeniyet University Medical Faculty, Goztepe Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Vatan A, Saltoglu N, Yemisen M, Balkan II, Surme S, Demiray T, Mete B, Tabak F. Association between biofilm and multi/extensive drug resistance in diabetic foot infection. Int J Clin Pract 2018; 72:e13060. [PMID: 29381248 DOI: 10.1111/ijcp.13060] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI). METHODS Demographic, clinical, laboratory and outcome data of 165 patients, prospectively recorded and followed between January 2008 and December 2015 by a multidisciplinary committee, were analysed. Standard microbiological methods were adopted. Risk factors associated with biofilm were determined by univariate and multivariate analyses. RESULTS The overall rate of biofilm production among 339 wound isolates was 34%. The biofilm production rate was significantly higher in Gram-negative micro-organisms (39%) in comparison with Gram positives (21%) (P = .01). A. baumannii presented the highest biofilm production (62%), followed by P. aeruginosa (52%) and Klebsiella spp. (40%). On univariate analysis, significant factors associated with biofilm were antibiotic use within last 3 months (OR:2.94, CI: 1.5-5.75, P = .002), recurrent DFI within last 6 months (OR:2.35, CI: 1.23-4.53, P = .01), hospitalisation within last 3 months due to ipsilateral recurrent DFI (OR:2.44, CI: 1.06-5.58, P = .03), presence of amputation history (OR: 2.20, CI: 1.14-4.24, P = .01), multidrug-resistant (MDR) micro-organism (OR: 7.76, CI: 4.53-13.35, P<.001) and extensively drug-resistant (XDR) micro-organism (OR:11.33, CI:4.97-26.55, P<.001). Multivariate regression analysis revealed two variables to be significant factors associated with biofilm: MDR micro-organism (OR: 3.63, CI: 1.58-8.33, P = .002) and XDR micro-organism (OR:4.06, CI: 1.25-13.1, P = .01). CONCLUSIONS Multi/extensive drug resistance and previous recurrent DFIs were significantly associated with biofilm formation in patients with diabetic foot.
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Affiliation(s)
- Aslı Vatan
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Nese Saltoglu
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Mucahit Yemisen
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Serkan Surme
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Tayfur Demiray
- Sakarya University Medical Faculty, Microbiology, Sakarya, Turkey
| | - Birgul Mete
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Fehmi Tabak
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
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Draughn GL, Allen CL, Routh PA, Stone MR, Kirker KR, Boegli L, Schuchman RM, Linder KE, Baynes RE, James G, Melander C, Pollard A, Cavanagh J. Evaluation of a 2-aminoimidazole variant as adjuvant treatment for dermal bacterial infections. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:153-162. [PMID: 28138218 PMCID: PMC5241126 DOI: 10.2147/dddt.s111865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
2-Aminoimidazole (2-AI)-based compounds have been shown to efficiently disrupt biofilm formation, disperse existing biofilms, and resensitize numerous multidrug-resistant bacteria to antibiotics. Using Pseudomonas aeruginosa and Staphylococcus aureus, we provide initial pharmacological studies regarding the application of a 2-AI as a topical adjuvant for persistent dermal infections. In vitro assays indicated that the 2-AI H10 is nonbactericidal, resensitizes bacteria to antibiotics, does not harm the integument, and promotes wound healing. Furthermore, in vivo application of H10 on swine skin caused no gross abnormalities or immune reactions. Taken together, these results indicate that H10 represents a promising lead dermal adjuvant compound.
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Affiliation(s)
| | | | - Patricia A Routh
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Maria R Stone
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Kelly R Kirker
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - Laura Boegli
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | | | - Keith E Linder
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Ronald E Baynes
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Garth James
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - Christian Melander
- Department of Chemistry, North Carolina State University, Raleigh, NC, USA
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Development of a Novel Collagen Wound Model To Simulate the Activity and Distribution of Antimicrobials in Soft Tissue during Diabetic Foot Infection. Antimicrob Agents Chemother 2016; 60:6880-6889. [PMID: 27620475 PMCID: PMC5075099 DOI: 10.1128/aac.01064-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/20/2016] [Indexed: 01/13/2023] Open
Abstract
Diabetes has major implications for public health, with diabetic foot ulcers (DFUs) being responsible for significant morbidity and mortality. A key factor in the development of nonhealing ulcers is infection, which often leads to the development of biofilm, gangrene, and amputation. A novel approach to treating DFUs is the local release of antibiotics from calcium sulfate beads. We have developed a novel model system to study and compare the release and efficacy of antibiotics released locally, using collagen as a substrate for biofilm growth and incorporating serum to mimic the biochemical complexity of the wound environment. We found that our soft-tissue model supports the growth of a robust Pseudomonas aeruginosa biofilm, and that this was completely eradicated by the introduction of calcium sulfate beads loaded with tobramycin or gentamicin. The model also enabled us to measure the concentration of these antibiotics at different distances from the beads and in simulated wound fluid bathing the collagen matrix. We additionally found that a multidrug-resistant Staphylococcus aureus biofilm, nonsusceptible to antibiotics, nonetheless showed an almost 1-log drop in viable counts when exposed to calcium sulfate beads combined with antibiotics. Together, these data suggest that locally applied antibiotics combined with calcium sulfate provide surprising efficacy in diabetic foot infections and offer an effective alternative approach to infection management. Our study additionally establishes our new system as a biochemically and histologically relevant model that may be used to study the effectiveness of a range of therapies locally or systemically for infected DFUs.
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