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Santucci C, Alexandru M, Chen X, Mellerio JE, Karagiannis SN, Jacków-Malinowska J. Unravelling drivers of cutaneous squamous cell carcinoma in recessive dystrophic epidermolysis bullosa. Hum Immunol 2024; 85:110805. [PMID: 38703415 DOI: 10.1016/j.humimm.2024.110805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
Epidermolysis bullosa (EB) is an umbrella term for a group of rare inherited skin disorders characterised by mucocutaneous fragility. Patients suffer from blisters and chronic wounds that arise spontaneously or following minor mechanical trauma, often resulting in inflammation, scarring and fibrosis due to poor healing. The recessive form of dystrophic EB (RDEB) has a particularly severe phenotype and is caused by mutations in the COL7A1 gene, encoding the collagen VII protein, which is responsible for adhering the epidermis and dermis together. One of the most feared and devastating complications of RDEB is the development of an aggressive form of cutaneous squamous cell carcinoma (cSCC), which is the main cause of mortality in this patient group. However, pathological drivers behind the development and progression of RDEB-associated cSCC (RDEB-cSCC) remain somewhat of an enigma, and the evidence to date points towards a complex process. Currently, there is no cure for RDEB-cSCC, and treatments primarily focus on prevention, symptom management and support. Therefore, there is an urgent need for a comprehensive understanding of this cancer's pathogenesis, with the aim of facilitating the discovery of drug targets. This review explores the current knowledge of RDEB-cSCC, emphasising the important role of the immune system, genetics, fibrosis, and the tumour-promoting microenvironment, all ultimately intricately interconnected.
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Affiliation(s)
- Catherine Santucci
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, UK
| | - Madalina Alexandru
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, UK
| | - Xinyi Chen
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, UK
| | - Jemima E Mellerio
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, UK; St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Sophia N Karagiannis
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, UK; Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Cancer Centre, London SE1 9RT, UK
| | - Joanna Jacków-Malinowska
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, London SE1 9RT, UK.
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Zvizdic Z, Hukic L, Ljubovic AD, Milisic E, Jonuzi A, Vranic S. Epidemiology and early bacterial colonization of minor and moderate pediatric burns: A retrospective study from a developing country. Burns 2024; 50:623-629. [PMID: 37981486 DOI: 10.1016/j.burns.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 09/03/2023] [Accepted: 10/26/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Infection is still the leading cause of morbidity and mortality among burn patients worldwide. Isolation and identification of pediatric burn wound bacterial colonizers can prevent infection and improve burn trauma treatment. In this study, we explored early microbial colonizers within the burn wounds and the susceptibility of those isolates to antibiotics among hospitalized pediatric patients with minor and moderate burns, clinically significant infections and outcomes. METHODS A retrospective analysis of pediatric patients admitted to the inpatient pediatric surgical ward and treated for minor and moderate burns from 2009 to 2018 was performed. RESULTS One hundred six patients met the inclusion criteria. The mean age was 3.6 ± three years (0.2-14.1 years). The most common type of burn was scald burns (82.1%). The mean TBSA of the hospitalized pediatric burn cases was 8.5% (IQR, 6-12%). Seventy-nine (74.5%) patients had positive wound cultures at admission, regardless of the hospital admission day. Fifty-eight (73.4%) had one bacterial growth (mono isolate), while 21 (26.6%) had mixed growth or poly isolates. Among patients with mixed growth or poly isolate, 16 had two bacteria, three had three bacteria, and one had four bacteria isolated, totaling 105 isolated microorganisms (14 different species, 70.5% Gram-positive bacteria and 29.5% Gram-negative bacteria). Twelve patients (11%) developed clinically significant infections (eleven got burn wound infection, and one had septicemia). All patients received prophylactic systemic antibiotics. Only 35.2% of the isolated bacteria from the wounds were sensitive to the prophylactic antibiotics, and only ∼17% in case of clinically significant infections. We found a statistically significant difference in the length of hospital stay between patients with initially colonized samples of burn wounds compared with patients with initial negative samples (p = 0.008). All patients in the cohort survived hospital discharge. CONCLUSION Despite common bacterial colonization of acute burn wounds, only ∼10% of the patients developed clinically significant infections, a minority of which were sensitive to prophylactic antibiotics. Our findings indicate the need to refine the antibiotic approach in pediatric patients with minor/moderate burns in our local setting.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lamija Hukic
- Public Institution Health Center of the Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amela Dedeic Ljubovic
- Department of Clinical Microbiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Kaur Sandhu S, Raut J, Kumar S, Singh M, Ahmed B, Singh J, Rana V, Rishi P, Ganesh N, Dua K, Pal Kaur I. Nanocurcumin and viable Lactobacillus plantarum based sponge dressing for skin wound healing. Int J Pharm 2023; 643:123187. [PMID: 37394156 DOI: 10.1016/j.ijpharm.2023.123187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
Curcumin loaded solid lipid nanoparticles (CSLNs) and probiotic (Lactobacillus plantarum UBLP-40; L. plantarum) were currently co-incorporated into a wound dressing. The combination with manifold anti-inflammatory, anti-infective, analgesic, and antioxidant properties of both curcumin and L. plantarum will better manage complex healing process. Recent reports indicate that polyphenolics like curcumin improve probiotic effects. Curcumin was nanoencapsulated (CSLNs) to improve its bioprofile and achieve controlled release on the wound bed. Bacteriotherapy (probiotic) is established to promote wound healing via antimicrobial activity, inhibition of pathogenic toxins, immunomodulation, and anti-inflammatory actions. Combination of CSLNs with probiotic enhanced (560%) its antimicrobial effects against planktonic cells and biofilms of skin pathogen, Staphylococcus aureus 9144. The sterile dressing was devised with selected polymers, and optimized for polymer concentration, and dressing characteristics using a central composite design. It exhibited a swelling ratio of 412 ± 36%, in vitro degradation time of 3 h, optimal water vapor transmission rate of 1516.81 ± 155.25 g/m2/day, high tensile strength, low-blood clotting index, case II transport, and controlled release of curcumin. XRD indicated strong interaction between employed polymers. FESEM revealed a porous sponge like meshwork embedded with L. plantarum and CSLNs. It degraded and released L. plantarum, which germinated in the wound bed. The sponge was stable under refrigerated conditions for up to six months. No translocation of probiotic from wound to the internal organs confirmed safety. The dressing exhibited faster wound closure and lowered bioburden in the wound area in mice. This was coupled with a decrease in TNF-α, MMP-9, and LPO levels; and an increase in VEGF, TGF-β, and antioxidant enzymes such as catalase and GSH, establishing multiple healing pathways. Results were compared with CSLNs and probiotic-alone dressings. The dressing was as effective as the silver nanoparticle-based marketed hydrogel dressing; however, the cost and risk of developing resistance would be much lower currently.
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Affiliation(s)
- Simarjot Kaur Sandhu
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Jayant Raut
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Suneel Kumar
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08844, USA
| | - Mandeep Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Bakr Ahmed
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Joga Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Vikas Rana
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Praveen Rishi
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Narayanan Ganesh
- Jawaharlal Nehru Cancer Hospital & Research Centre, Bhopal 462001, India
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, New South Wales 2007, Australia
| | - Indu Pal Kaur
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
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Cato LD, Al-Tarrah K, Moiemen N. Changes in Burn Wound Microbiology Profile Over 14 Years of an Adult Tertiary Burn Center. J Burn Care Res 2023; 44:293-301. [PMID: 34648029 PMCID: PMC10885190 DOI: 10.1093/jbcr/irab184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 11/14/2022]
Abstract
Burn wound colonization can progress to invasive infection. During 14 years of this study, the burn center was relocated to a center with improved infrastructure. This study investigates the association that infrastructure, geography, and time may have on colonization. Data were collected from October 2004 to August 2018, and relocation took place in June 2010, defining the two study periods. Admission swabs were within 48 hours. Unique isolates and resistance data were analyzed and compared statistically between the two study periods. In total, 2001 patients with 24,226 wound swabs were included. Median age was 45.4 (IQR 30.2-61.6), length of stay was 11 days (IQR 6-21), and %TBSA was 5.5 (IQR 2.5-11). Staph. aureus (33.7/100 patients) and Pseudomonas spp. (13.1/100 patients) were the most prevalent bacterial growths. After admission, the prevalence of methicillin resistant Staph. aureus, Coliform spp., and Aci. baumanni was greater in the first site, and Candida spp. colonization was higher in the second study period site. The prevalence of patients affected by multi-drug-resistant organisms was lower in the second study site (13.5/100 patients vs 16.6/100 patients; P < .05). There are differences in burn wound colonization across time, within the same region. Candida spp. growth has been shown to be increased over time and represents an added challenge. Awareness facilitates effective empirical antimicrobial therapies and protocols locally.
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Affiliation(s)
- Liam David Cato
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, UK
| | - Khaled Al-Tarrah
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, UK
| | - Naiem Moiemen
- Scar Free Foundation Birmingham Centre for Burns Research, University Hospitals Birmingham Foundation Trust, UK
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Alhusaini Q, Scheld WS, Jia Z, Das D, Afzal F, Müller M, Schönherr H. Bare Eye Detection of Bacterial Enzymes of Pseudomonas aeruginosa with Polymer Modified Nanoporous Silicon Rugate Filters. BIOSENSORS 2022; 12:1064. [PMID: 36551031 PMCID: PMC9776340 DOI: 10.3390/bios12121064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
The fabrication, characterization and application of a nanoporous Silicon Rugate Filter (pSiRF) loaded with an enzymatically degradable polymer is reported as a bare eye detection optical sensor for enzymes of pathogenic bacteria, which is devoid of any dyes. The nanopores of pSiRF were filled with poly(lactic acid) (PLA), which, upon enzymatic degradation, resulted in a change in the effective refractive index of the pSiRF film, leading to a readily discernible color change of the sensor. The shifts in the characteristic fringe patterns before and after the enzymatic reaction were analyzed quantitatively by Reflectometric Interference Spectroscopy (RIfS) to estimate the apparent kinetics and its dependence on enzyme concentration. A clear color change from green to blue was observed by the bare eye after PLA degradation by proteinase K. Moreover, the color change was further confirmed in measurements in bacterial suspensions of the pathogen Pseudomonas aeruginosa (PAO1) as well as in situ in the corresponding bacterial supernatants. This study highlights the potential of the approach in point of care bacteria detection.
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Affiliation(s)
- Qasim Alhusaini
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
| | - Walter Sebastian Scheld
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
| | - Zhiyuan Jia
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
| | - Dipankar Das
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
- Department of Chemistry, SRM Institute of Science and Technology, SRM Nagar, Potheri, Kattankulathur 603203, India
| | - Faria Afzal
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
| | - Mareike Müller
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
| | - Holger Schönherr
- Physical Chemistry I and Research Center of Micro and Nanochemistry and (Bio)Technology (Cμ), Department of Chemistry and Biology, School of Science and Technology, University of Siegen, Adolf-Reichwein-Str. 2, 57076 Siegen, Germany
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Pelizzo G, Lanfranchi G, Pantaloni M, Camporesi A, Tommasi P, Durante E, Costanzo S, Canonica CMP, Zoia E, Zuccotti G, Ruotolopalmi V, Donzelli C, Tosi GL, Calcaterra V. Epidemiological and Clinical Profile of Pediatric Burns in the COVID-19 Era: The Experience of a Reference Center. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1735. [PMID: 36421184 PMCID: PMC9688935 DOI: 10.3390/children9111735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 02/08/2024]
Abstract
Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
| | - Giulia Lanfranchi
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Marcello Pantaloni
- Plastic and Reconstructive Surgery Unit, Fatebenefratelli Sacco Hospital, 20154 Milan, Italy
| | - Anna Camporesi
- Pediatric Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Paola Tommasi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Eleonora Durante
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | | | - Elena Zoia
- Pediatric Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Ruotolopalmi
- Head Nurse Operating Room, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Claudia Donzelli
- Head Nurse Pediatric Surgery Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Giulia Lina Tosi
- Pharmacy Service Manager, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Pediatrics and Adolescentology Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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Ozhathil DK, Wolf SE. Prevention and treatment of burn wound infections: the role of topical antimicrobials. Expert Rev Anti Infect Ther 2022; 20:881-896. [PMID: 35188850 DOI: 10.1080/14787210.2022.2044795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infections related to the skin are the principal drivers of morbidity and mortality following severe burn, therefore a diverse armamentarium of topical antimicrobial agents were developed over the history of burn care. The last 30 years witnessed dramatic changes in the application of surgical intervention and utilization of topical therapies. AREAS COVERED We explore well-known topical antimicrobial products used in burn care. First, we investigate how fundamental changes in the practice of burn surgery influenced the choice of topical therapies used. Then, we examine antimicrobial creams and ointments commonly recognized due to their long record of use in burn care. Next, we dive into antimicrobial solutions commonly used as adjuncts to surgical intervention. Finally, we explore representative antimicrobial dressings, an ever-advancing roster of products opening the door to the next era in burn care. We also describe how these new agents relate to already established tools in present-day burn care. EXPERT OPINION In the current day, though the wisdom of early excision and wound closure remains valid, we continue to strive to minimize aggressive wound excision and disfiguring donor tissue collection while securing rapid wound closure. To this end, antimicrobial therapies are titrated to optimize operative outcomes and provide non-operative wound care when appropriate. Antimicrobial agents bridge the gap with the next generation of skin substitute and skin replacement therapies.
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Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas
| | - Steven E Wolf
- Division Chief, Burns, Trauma & Acute Care surgery, Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas 77555-1220
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Sharaf A, Muthayya P. Microbial profile of burn wounds managed with enzymatic debridement using bromelain-based agent, NexoBrid®. Burns 2021; 48:1618-1625. [PMID: 34973852 DOI: 10.1016/j.burns.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/20/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
The antimicrobial properties of bromelain have been previously studied. However, the effect of enzymatic debridement on bacterial colonisation in burn wounds was not described in literature. In this study, we examine whether bromelain-based enzymatic debridement using NexoBrid® gel alters the microbiological pattern of burn wounds. Bacterial emergences in burn wounds that were enzymatically debrided at Pinderfields Regional Burns Centre, between July 2016 and February 2019, were studied and compared to the bacterial profile of burn wounds that were managed either by surgical debridement or dressings only during the same period. Our results showed that the microbial profile of burn wounds treated with NexoBrid® is similar to what is widely reported in cases treated without enzymatic debridement, at all stages of wound healing. This particularly showed in the predominance of Gram-positive organisms in the first week and Gram-negative in the second week.
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Affiliation(s)
- Amal Sharaf
- Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, UK.
| | - Preetha Muthayya
- Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, UK
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Sandhu SK, Kumar S, Raut J, Singh M, Kaur S, Sharma G, Roldan TL, Trehan S, Holloway J, Wahler G, Laskin JD, Sinko PJ, Berthiaume F, Michniak-Kohn B, Rishi P, Ganesh N, Kaur IP. Systematic Development and Characterization of Novel, High Drug-Loaded, Photostable, Curcumin Solid Lipid Nanoparticle Hydrogel for Wound Healing. Antioxidants (Basel) 2021; 10:725. [PMID: 34063003 PMCID: PMC8148018 DOI: 10.3390/antiox10050725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
The study aims to develop high drug-loaded (about 15% lipid matrix) curcumin solid lipid nanoparticles (CSLNs) for wound healing. CSLNs prepared by hot, high-pressure homogenization, without using organic solvents, were optimized using the Taguchi design followed by the central composite design. The optimized CSLNs exhibited a high assay/drug content (0.6% w/w), solubility (6 × 105 times), and EE (75%) with a particle size < 200 nm (PDI-0.143). The CSLNs were safe (in vitro and in vivo), photostable, autoclavable, stable up to one year at 30 °C and under refrigeration and exhibited a controlled release (zero-order; 5 days). XRD, FTIR, and DSC confirmed solubilization and entrapment of the curcumin within the SLNs. TEM and FESEM revealed a smooth and spherical shape. The CSLNs showed a significant antimicrobial effect (MIC of 64 µg/mL for planktonic cells; 512 µg/mL for biofilm formation; and 2 mg/mL for mature biofilm) against Staphylococcus aureus 9144, while free curcumin dispersion did not exhibit any effect. This is the first report on the disruption of mature biofilms by curcumin solid lipid nanoparticles (CSLNs). The cell proliferation potential of CSLNs was also evaluated in vitro while the wound healing potential of CSLNs (incorporated in a hydrogel) was assessed in vivo. In (i) nitrogen mustard gas and (ii) a full-thickness excision wound model, CSLNs exhibited (a) significantly faster wound closure, (b) histologically and immunohistochemically better healing, (c) lower oxidative stress (LPO) and (d) inflammation (TNFα), and (e) increased angiogenesis (VEGF) and antioxidant enzymes, i.e., catalase and GSH levels. CSLNs thus offer a promising modern wound therapy especially for infected wounds, considering their effects in mature biofilm disruption.
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Affiliation(s)
- Simarjot Kaur Sandhu
- Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; (S.K.S.); (J.R.); (M.S.); (S.K.); (G.S.)
| | - Suneel Kumar
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA; (S.K.); (F.B.)
| | - Jayant Raut
- Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; (S.K.S.); (J.R.); (M.S.); (S.K.); (G.S.)
| | - Mandeep Singh
- Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; (S.K.S.); (J.R.); (M.S.); (S.K.); (G.S.)
| | - Sandeep Kaur
- Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; (S.K.S.); (J.R.); (M.S.); (S.K.); (G.S.)
| | - Garima Sharma
- Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; (S.K.S.); (J.R.); (M.S.); (S.K.); (G.S.)
| | - Tomas L. Roldan
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA; (T.L.R.); (J.H.); (P.J.S.); (B.M.-K.)
- Counter ACT Center of Excellence, Rutgers University, Piscataway, NJ 08854, USA; (G.W.); (J.D.L.)
| | - Sonia Trehan
- Center for Dermal Research (CDR), Life Sciences Building, Rutgers University, Piscataway, NJ 08854, USA;
| | - Jennifer Holloway
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA; (T.L.R.); (J.H.); (P.J.S.); (B.M.-K.)
- Counter ACT Center of Excellence, Rutgers University, Piscataway, NJ 08854, USA; (G.W.); (J.D.L.)
| | - Gabriella Wahler
- Counter ACT Center of Excellence, Rutgers University, Piscataway, NJ 08854, USA; (G.W.); (J.D.L.)
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ 08854, USA
| | - Jeffrey D. Laskin
- Counter ACT Center of Excellence, Rutgers University, Piscataway, NJ 08854, USA; (G.W.); (J.D.L.)
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ 08854, USA
| | - Patrick J. Sinko
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA; (T.L.R.); (J.H.); (P.J.S.); (B.M.-K.)
- Counter ACT Center of Excellence, Rutgers University, Piscataway, NJ 08854, USA; (G.W.); (J.D.L.)
| | - Francois Berthiaume
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA; (S.K.); (F.B.)
| | - Bozena Michniak-Kohn
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA; (T.L.R.); (J.H.); (P.J.S.); (B.M.-K.)
- Center for Dermal Research (CDR), Life Sciences Building, Rutgers University, Piscataway, NJ 08854, USA;
| | - Praveen Rishi
- Department of Microbiology, Panjab University, Chandigarh 160014, India;
| | - Narayanan Ganesh
- Jawaharlal Nehru Cancer Hospital & Research Centre, Bhopal 462001, India;
| | - Indu Pal Kaur
- Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; (S.K.S.); (J.R.); (M.S.); (S.K.); (G.S.)
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10
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Parsa P, Amirmozafari N, Nowruzi B, Bahar MA. Molecular characterization of polymorphisms among Pseudomonas aeruginosa strains isolated from burn patients' wounds. Heliyon 2020; 6:e05041. [PMID: 33376816 PMCID: PMC7758517 DOI: 10.1016/j.heliyon.2020.e05041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/30/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
Pseudomonas aeruginosa is one of the most common reasons for nosocomial infections. Given the high morbidity and mortality, as well as the cost of management, particularly in developing countries, burn injuries are considered important health concerns. Owing to the increased rate of resistance against antibiotics, this study aimed to isolate Pseudomonas aeruginosa strains from burn patient's wounds by analyzing antibiotic susceptibility and genetic profiling. In this regard, we explored the relationship between the nucleotide sequence and antibiotic susceptibility. In this cross-sectional study, 107 isolates of P. aeruginosa were collected from a major burn center in Tehran, Iran. The isolates were characterized with standard biochemical tests and examined by applying the Disk Diffusion method to find the patterns of sensitivity, and their genetic relationship was revealed by RAPD-PCR method. According to the antibiogram results, most of the isolates were resistant to 3 or more antibiotics tested and the most sensitivity was related to the Colistin antibiotic. RAPD-PCR method revealed a high polymorphism among P. aeruginosa isolates in Tehran. There was no significant association between the genotype groups and antibiotic susceptibility profiles. We evaluated the pattern of resistance to pathogenic organisms and identified multi-drug resistant organisms. Currently, Colistin antibiotic is the most suitable treatment option for burned patients. RAPD-PCR is a genotyping method with high efficiency for typing and categorizing different isolates of MDR-P. aeruginosa.
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Affiliation(s)
- Parastoo Parsa
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Nour Amirmozafari
- Microbiology Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Nowruzi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Ali Bahar
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author.
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11
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Lemoine V, Bernard C, Leman-Loubière C, Clément-Larosière B, Girardot M, Boudesocque-Delaye L, Munnier E, Imbert C. Nanovectorized Microalgal Extracts to Fight Candida albicans and Cutibacterium acnes Biofilms: Impact of Dual-Species Conditions. Antibiotics (Basel) 2020; 9:E279. [PMID: 32466354 PMCID: PMC7344943 DOI: 10.3390/antibiotics9060279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/19/2022] Open
Abstract
Biofilm-related infections are a matter of concern especially because of the poor susceptibility of microorganisms to conventional antimicrobial agents. Innovative approaches are needed. The antibiofilm activity of extracts of cyanobacteria Arthrospira platensis, rich in free fatty acids, as well as of extract-loaded copper alginate-based nanocarriers, were studied on single- and dual-species biofilms of Candida albicans and Cutibacterium acnes. Their ability to inhibit the biofilm formation and to eradicate 24 h old biofilms was investigated. Concentrations of each species were evaluated using flow cytometry. Extracts prevented the growth of C. acnes single-species biofilms (inhibition > 75% at 0.2 mg/mL) but failed to inhibit preformed biofilms. Nanovectorised extracts reduced the growth of single-species C. albicans biofilms (inhibition > 43% at 0.2 mg/mL) while free extracts were weakly or not active. Nanovectorised extracts also inhibited preformed C. albicans biofilms by 55% to 77%, whereas the corresponding free extracts were not active. In conclusion, even if the studied nanocarrier systems displayed promising activity, especially against C. albicans, their efficacy against dual-species biofilms was limited. This study highlighted that working in such polymicrobial conditions can give a more objective view of the relevance of antibiofilm strategies by taking into account interspecies interactions that can offer additional protection to microbes.
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Affiliation(s)
- Virginie Lemoine
- Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, UMR CNRS 7267, 86073 Poitiers, France; (V.L.); (C.B.); (M.G.)
| | - Clément Bernard
- Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, UMR CNRS 7267, 86073 Poitiers, France; (V.L.); (C.B.); (M.G.)
| | - Charlotte Leman-Loubière
- Laboratoire SIMBA EA 7502, Faculté de Pharmacie, Université de Tours, 31 avenue Monge, 37200 Tours, France; (C.L.-L.); (L.B.-D.)
| | | | - Marion Girardot
- Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, UMR CNRS 7267, 86073 Poitiers, France; (V.L.); (C.B.); (M.G.)
| | - Leslie Boudesocque-Delaye
- Laboratoire SIMBA EA 7502, Faculté de Pharmacie, Université de Tours, 31 avenue Monge, 37200 Tours, France; (C.L.-L.); (L.B.-D.)
| | - Emilie Munnier
- Laboratoire Nanomédicaments et Nanosondes EA 6295, Faculté de Pharmacie, Université de Tours, 31 avenue Monge, 37200 Tours, France;
| | - Christine Imbert
- Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, UMR CNRS 7267, 86073 Poitiers, France; (V.L.); (C.B.); (M.G.)
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12
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Epidermolysis Bullosa-Associated Squamous Cell Carcinoma: From Pathogenesis to Therapeutic Perspectives. Int J Mol Sci 2019; 20:ijms20225707. [PMID: 31739489 PMCID: PMC6888002 DOI: 10.3390/ijms20225707] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of inherited skin disorders determined by mutations in genes encoding for structural components of the cutaneous basement membrane zone. Disease hallmarks are skin fragility and unremitting blistering. The most disabling EB (sub)types show defective wound healing, fibrosis and inflammation at lesional skin. These features expose patients to serious disease complications, including the development of cutaneous squamous cell carcinomas (SCCs). Almost all subjects affected with the severe recessive dystrophic EB (RDEB) subtype suffer from early and extremely aggressive SCCs (RDEB-SCC), which represent the first cause of death in these patients. The genetic determinants of RDEB-SCC do not exhaustively explain its unique behavior as compared to low-risk, ultraviolet-induced SCCs in the general population. On the other hand, a growing body of evidence points to the key role of tumor microenvironment in initiation, progression and spreading of RDEB-SCC, as well as of other, less-investigated, EB-related SCCs (EB-SCCs). Here, we discuss the recent advances in understanding the complex series of molecular events (i.e., fibrotic, inflammatory, and immune processes) contributing to SCC development in EB patients, cross-compare tumor features in the different EB subtypes and report the most promising therapeutic approaches to counteract or delay EB-SCCs.
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13
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Shariati A, Asadian E, Fallah F, Azimi T, Hashemi A, Yasbolaghi Sharahi J, Taati Moghadam M. Evaluation of Nano-curcumin effects on expression levels of virulence genes and biofilm production of multidrug-resistant Pseudomonas aeruginosa isolated from burn wound infection in Tehran, Iran. Infect Drug Resist 2019; 12:2223-2235. [PMID: 31440064 PMCID: PMC6664860 DOI: 10.2147/idr.s213200] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background P. aeruginosa is considered as one of the most important pathogens, and high antibiotic resistance to P. aeruginosa has become an alarming concern. This study attempts to further improve curcumin solubility and stability by producing the involved nanoparticle and investigate the effect of this nanoparticle on those virulence genes of P. aeruginosa in pathogenicity and biofilm formation. Methods In this study, the curcumin nanoparticles were synthesized and characterized, and the antibacterial and antibiofilm effects of Nano-curcumin and curcumin were investigated by microdilution broth and microtiter plate, respectively. In addition, cytotoxic effect of Nano-curcumin on human epithelial cell lines (A549) was determined. The effects of Nano-curcumin on P. aeruginosa virulence genes, mexD, mexB, and mexT (efflux pumps), lecA (adhesion), nfxB (negative regulator of MexCD-OprJ), and rsmZ (biofilm formation) were determined using real-time quantitative PCR. Results Synthesized Nano-curcumins were soluble in water, which inhibited the growth of multidrug-resistant (MDR) P. aeruginosa at 128 µg/mL, whereas it was inhibited at 256 µg/mL for soluble curcumin in DMSO. Sub-inhibitory concentrations of Nano-curcumin reduced biofilm formation and, at 64 μg/mL, disrupted 58% of the established bacterial biofilms. In addition, curcumin nanoparticle downregulated the transcription of virulence genes except nfxB and exerted no cytotoxic effect on human epithelial cell lines (A549). Conclusions Results suggest that Nano-curcumin could be potentially used to reduce P. aeruginosa virulence and biofilm. However, in vivo studies with respect to an animal model are necessary to validate these results.
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Affiliation(s)
- Aref Shariati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Asadian
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Fallah
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Yasbolaghi Sharahi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
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14
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A 6-Year Case-Control Study of the Presentation and Clinical Sequelae for Noninflicted, Negligent, and Inflicted Pediatric Burns. J Burn Care Res 2018; 38:e101-e124. [PMID: 28009699 DOI: 10.1097/bcr.0000000000000408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflicted burns are one of the leading causes of abuse-related fatalities in children. Between 30 and 60% of children accidentally returned to abusive homes suffer reabuse. Given the high chance for abuse recurrence and the associated morbidity/mortality, it is critical that inflicted burns are promptly identified to guide appropriate medical and child welfare management. Although previous studies proposed historical and mechanistic features using noncomparative or poorly powered data, this study utilized comparative data from a 6-year period (2009-2014) at a certified burn center along with expert analysis from Child Advocacy and Protective Services (CAPS) to provide higher level evidence supporting classical findings while elucidating new features with respect to burn severity and required interventions. A retrospective chart review of 408 pediatric burns was cross-referenced with the respective CAPS consultations to construct a multidisciplinary, deidentified database. The average age was 2.9 years (0.04-17 years) with 232 (57%) males and 330 (81%) African-Americans. CAPS investigations confirmed burn etiologies: noninflicted (346 [85%]), negligent (30 [7%]), and inflicted (32 [8%]). In comparing the three etiologies, statistical significance (P < .05) was observed for numerous variables including historical inconsistency, burn age, child welfare history, burn size and depth, distribution, concomitant injury rates, number of surgical interventions, infectious complications, and hospital length of stay. In addition to reaffirming classical features of abusive burns to fortify etiologic diagnoses, this study elucidated appreciable differences in burn severity, interventional sequelae, and burn-related complications, which will help guide medical and surgical interventions for future pediatric burn patients.
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15
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Fürsatz M, Skog M, Sivlér P, Palm E, Aronsson C, Skallberg A, Greczynski G, Khalaf H, Bengtsson T, Aili D. Functionalization of bacterial cellulose wound dressings with the antimicrobial peptide ε-poly-L-Lysine. ACTA ACUST UNITED AC 2018; 13:025014. [PMID: 29047451 DOI: 10.1088/1748-605x/aa9486] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Wound dressings based on bacterial cellulose (BC) can form a soft and conformable protective layer that can stimulate wound healing while preventing bacteria from entering the wound. Bacteria already present in the wound can, however, thrive in the moist environment created by the BC dressing which can aggravate the healing process. Possibilities to render the BC antimicrobial without affecting the beneficial structural and mechanical properties of the material would hence be highly attractive. Here we present methods for functionalization of BC with ε-poly-L-Lysine (ε-PLL), a non-toxic biopolymer with broad-spectrum antimicrobial activity. Low molecular weight ε-PLL was cross-linked in pristine BC membranes and to carboxymethyl cellulose functionalized BC using carbodiimide chemistry. The functionalization of BC with ε-PLL inhibited growth of S. epidermidis on the membranes but did not affect the cytocompatibility to cultured human fibroblasts as compared to native BC. The functionalization had no significant effects on the nanofibrous structure and mechanical properties of the BC. The possibility to functionalize BC with ε-PLL is a promising, green and versatile approach to improve the performance of BC in wound care and other biomedical applications.
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Affiliation(s)
- Marian Fürsatz
- Division of Molecular Physics, Department of Physics, Chemistry and Biology, Linköping University, SE-581 83 Linköping, Sweden
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16
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Arumugam T, Dhanam S, Rameshkumar N, Krishnan M, Kayalvizhi N. Inhibition of Methicillin Resistant Staphylococcus aureus by Bacteriocin Producing Pseudomonas aeruginosa. Int J Pept Res Ther 2018. [DOI: 10.1007/s10989-018-9676-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Impaired lymphoid extracellular matrix impedes antibacterial immunity in epidermolysis bullosa. Proc Natl Acad Sci U S A 2018; 115:E705-E714. [PMID: 29305555 DOI: 10.1073/pnas.1709111115] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Genetic loss of collagen VII causes recessive dystrophic epidermolysis bullosa (RDEB), a skin fragility disorder that, unexpectedly, manifests also with elevated colonization of commensal bacteria and frequent wound infections. Here, we describe an unprecedented systemic function of collagen VII as a member of a unique innate immune-supporting multiprotein complex in spleen and lymph nodes. In this complex, collagen VII specifically binds and sequesters the innate immune activator cochlin in the lumen of lymphoid conduits. In genetic mouse models, loss of collagen VII increased bacterial colonization by diminishing levels of circulating cochlin LCCL domain. Intraperitoneal injection of collagen VII, which restored cochlin in the spleen, but not in the skin, reactivated peripheral innate immune cells via cochlin and reduced bacterial skin colonization. Systemic administration of the cochlin LCCL domain was alone sufficient to diminish bacterial supercolonization of RDEB mouse skin. Human validation demonstrated that RDEB patients displayed lower levels of systemic cochlin LCCL domain with subsequently impaired macrophage response in infected wounds. This study identifies an intrinsic innate immune dysfunction in RDEB and uncovers a unique role of the lymphoid extracellular matrix in systemic defense against bacteria.
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18
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Park HS, Pham C, Paul E, Padiglione A, Lo C, Cleland H. Early pathogenic colonisers of acute burn wounds: A retrospective review. Burns 2017; 43:1757-1765. [DOI: 10.1016/j.burns.2017.04.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
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19
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Bakkiyaraj D, Sritharadol R, Padmavathi AR, Nakpheng T, Srichana T. Anti-biofilm properties of a mupirocin spray formulation against Escherichia coli wound infections. BIOFOULING 2017; 33:591-600. [PMID: 28686044 DOI: 10.1080/08927014.2017.1337100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
Mupirocin ointment is a widely used topical drug for the treatment of bacterial skin infections. However, ointments have some limitations which motivated the development of a film forming spray of mupirocin. Mupirocin spray (2%) was formulated with Eudragit E100 as a film forming agent and tested for its antibacterial and anti-biofilm activities against Escherichia coli, a skin pathogen causing wound and surgical site infections. Treatment with mupirocin spray resulted in significant antibacterial and anti-biofilm activities (inhibition and disruption) with single spray and sub-actual dose concentrations at par with the commercial ointment concentration. The spray formulation was found to be non-toxic to fibroblast cells and greatly resisted removal from the site of application upon washing, in contrast to the ointment which was significantly removed after a single wash. This is the first study to develop and evaluate a spray formulation for mupirocin that forms a stable thin film for sustained release of the drug.
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Affiliation(s)
- Dhamodharan Bakkiyaraj
- a Nanotec-PSU Excellence Center on Drug Delivery System, Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat Yai , Thailand
| | - Rutthapol Sritharadol
- b Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat Yai , Thailand
| | - Alwar Ramanujam Padmavathi
- a Nanotec-PSU Excellence Center on Drug Delivery System, Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat Yai , Thailand
| | - Titpawan Nakpheng
- a Nanotec-PSU Excellence Center on Drug Delivery System, Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat Yai , Thailand
| | - Teerapol Srichana
- a Nanotec-PSU Excellence Center on Drug Delivery System, Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat Yai , Thailand
- b Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences , Prince of Songkla University , Hat Yai , Thailand
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20
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Satish L, Gallo PH, Johnson S, Yates CC, Kathju S. Local Probiotic Therapy with Lactobacillus plantarum Mitigates Scar Formation in Rabbits after Burn Injury and Infection. Surg Infect (Larchmt) 2016; 18:119-127. [PMID: 27788042 DOI: 10.1089/sur.2016.090] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Infection is the most common complication in burn-injured patients and is believed to contribute to the hypertrophic scarring frequently observed in such injury. Pseudomonas aeruginosa is a common pathogen in burn wound infection. We examined the effect of local probiotic therapy with Lactobacillus plantarum on the severity of the scarring following burn wounding and infection with P. aeruginosa in a rabbit model. METHODS Full-thickness burn wounds were inoculated with control vehicle or L. plantarum; wounds were then challenged with bioluminescent P. aeruginosa. The time course of the ensuing infection was monitored by quantification of the emitted light. After allowing wounds to contract to near completion, they were harvested and analyzed for markers of scar formation. RESULTS Application of L. plantarum curtailed both the severity and the length of the pseudomonal infection. Probiotic therapy significantly reduced both Type I collagen mRNA concentrations and total collagen protein accumulation in infected wounds, consistent with reduced scarring. Surprisingly, the probiotic showed a nearly equivalent effect in uninfected wounds. Masson's trichrome staining confirmed these findings histologically. CONCLUSIONS Lactobacillus plantarum shows exciting potential as a therapeutic agent to both counteract burn wound infection and to alleviate scarring even in the absence of infection.
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Affiliation(s)
- Latha Satish
- 1 McGowan Institute for Regenerative Medicine , Pittsburgh, Pennsylvania.,2 Department of Plastic and Reconstructive Surgery, University of Pittsburgh , Pittsburgh
| | - Phillip H Gallo
- 2 Department of Plastic and Reconstructive Surgery, University of Pittsburgh , Pittsburgh
| | - Sandra Johnson
- 2 Department of Plastic and Reconstructive Surgery, University of Pittsburgh , Pittsburgh
| | - Cecelia C Yates
- 1 McGowan Institute for Regenerative Medicine , Pittsburgh, Pennsylvania.,3 Department of Health Promotion and Development, School of Nursing, University of Pittsburgh , Pittsburgh.,4 Department of Pathology, School of Medicine, University of Pittsburgh , Pittsburgh
| | - Sandeep Kathju
- 1 McGowan Institute for Regenerative Medicine , Pittsburgh, Pennsylvania.,2 Department of Plastic and Reconstructive Surgery, University of Pittsburgh , Pittsburgh
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21
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Esposito S, De Simone G, Gioia R, Noviello S, Pagliara D, Campitiello N, Rubino C, Lo Pardo D, Boccia G, De Caro F, Ascione T. Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of Skin and Soft Tissue Infections (SSTIs). J Chemother 2016; 29:154-158. [PMID: 27376439 DOI: 10.1080/1120009x.2016.1205309] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thirty-two patients affected by SSTIs including DFIs were enrolled between 2013 and 2014. Superficial swab was obtained before and after cleansing with sterile saline, and after ultrasonic debridement; deep tissue biopsy was obtained from ulcer base. Samples were diluted with 1 mL of saline, serial 10-fold dilutions to 10-6 were made and 50 μL of each dilution was plated onto appropriate media. Bacteria were identified by Vitek II system. Microbial load was expressed as CFU/mL. Statistical analysis was performed by χ2. Incidence of Gram positives was higher than Gram negatives (S. aureus and P. aeruginosa being the most frequent); concordance (same bacteria isolated before and after debridement) never exceeded 60%. Ultrasonic debridement significantly reduced bacterial load or even suppressed bacterial growth. While reliability of superficial swab is poor for microbiological diagnosis of SSTIs, swabbing after ultrasonic debridement and biopsy of the ulcer base may be equally reliable.
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Affiliation(s)
- Silvano Esposito
- a Department of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Giuseppe De Simone
- a Department of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Renato Gioia
- a Department of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Silvana Noviello
- a Department of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Domenico Pagliara
- b Department of Plastic Surgery , University of Salerno , Salerno , Italy
| | - Nicola Campitiello
- b Department of Plastic Surgery , University of Salerno , Salerno , Italy
| | - Corrado Rubino
- b Department of Plastic Surgery , University of Salerno , Salerno , Italy
| | - Dante Lo Pardo
- c Hyperbaric Therapy Unit , AOU San Giovanni di Dio e Ruggi d'Aragona , Salerno , Italy
| | | | | | - Tiziana Ascione
- e Department of Infectious Diseases , Ospedale Cotugno , Naples , Italy
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22
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Fransén J, Huss FRM, Nilsson LE, Rydell U, Sjöberg F, Hanberger H. Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-2012. Burns 2016; 42:1295-303. [PMID: 27241732 DOI: 10.1016/j.burns.2016.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Patients with burn trauma are at risk for infections caused by antibiotic resistant bacteria (ABR) with subsequent increase in morbidity and mortality. As part of the Swedish strategic program against antibiotic resistance in intensive care (ICU-Strama), we have surveyed the distribution of species and ABR in isolates from patients admitted to a Swedish burn center at Linköping University Hospital from 1994 through 2012. In an international comparison Strama has been successful in reducing the antibiotic consumption among animals and humans in primary care. The aim of this study was to investigate the antibiotic consumption pressure and resistance rates in a Swedish burn unit. METHODS Microbiology data, total body surface area (TBSA), patient days, and mortality were collected from a hospital database for all patients admitted to the Burn Center at the University Hospital of Linköping from April 1994 through December 2012. RESULTS A total of 1570 patients were admitted with a mean annual admission rate of 83 patients (range: 57-152). 15,006 microbiology cultures (approximately 10 per patient) were collected during the study period and of these 4531 were positive (approximately 3 per patient). The annual mean total body surface area (TBSA) was 13.4% (range 9.5-18.5) with an annual mortality rate of 5.4% (range 1-8%). The MRSA incidence was 1.7% (15/866) which corresponds to an MRSA incidence of 0.34/1000 admission days (TAD). Corresponding figures were for Escherichia coli resistant to 3(rd) generation cephalosporins (ESBL phenotype) 8% (13/170) and 0.3/TAD, Klebsiella spp. ESBL phenotype 5% (6/134) and 0.14/TAD, carbapenem resistant Pseudomonas aeruginosa 26% (56/209) and 1.28/TAD, and carbapenem resistant Acinetobacter spp. 3% (2/64) and 0.04/TAD. CONCLUSIONS Our results show a sustained low risk for MRSA and high, although not increasing, risk for carbapenem resistant P. aeruginosa.
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Affiliation(s)
- Jian Fransén
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden.
| | - Fredrik R M Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden; Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lennart E Nilsson
- Department of Clinical and Experimental Medicine, Clinical Microbiology, Linköping University, Linköping, Sweden
| | - Ulf Rydell
- Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden
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23
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Soltan Dallal MM, Safdari R, Emadi Koochak H, Sharifi-Yazdi S, Akhoondinasab MR, Pourmand MR, Hadayatpour A, Sharifi-Yazdi MK. A comparison between occlusive and exposure dressing in the management of burn wound. Burns 2016; 42:578-82. [PMID: 26970838 DOI: 10.1016/j.burns.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 04/29/2015] [Accepted: 05/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM Two types of dressing, occlusive and exposure dressing, are commonly used in burn units. A dressing is said to be occlusive if a moist wound surface is maintained when the dressing is in place. This study was designed to compare the effectiveness of occlusive and exposure dressing in controlling burn infections. PATIENTS AND METHODS Two hundred patients with second-degree burns admitted to Mottahari Hospital, Tehran, Iran, over a period of 12 months from May 2012 to May 2013 were studied. They were divided into two groups of 100 each, to receive either occlusive or exposure dressing. During the first week of treatment, wound specimens were obtained by sterile swab and cultured in selective media. Demographics (age and gender), burn areas, cause of burn, length of hospital stay (LOS), type of infections and time to total healing were compared between the two groups. RESULTS Occlusive dressing was more susceptible to microbial contamination and infections than exposure dressing. The mean duration of treatment based on epithelialization and healing in occlusive dressing was longer than for exposure dressing. The most common isolate was Pseudomonas spp., followed by Enterobacter, Escherichia coli, Staphylococcus aureus, Acinetobacter, and Klebsiella spp. CONCLUSIONS Exposure dressing was more suitable than occlusive dressing for treating partial-thickness at our center. Pseudomonas aeruginosa was the most common organism encountered in burn infection.
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Affiliation(s)
- M M Soltan Dallal
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - R Safdari
- Health Information Management Department, School of Allied Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - H Emadi Koochak
- Zoonosis Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Infectious Diseases Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Sharifi-Yazdi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M R Akhoondinasab
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M R Pourmand
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - A Hadayatpour
- Department of Anatomical Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M K Sharifi-Yazdi
- Zoonosis Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Laboratory Sciences, School of Para Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Dokter J, Brusselaers N, Hendriks WDH, Boxma H. Bacteriological cultures on admission of the burn patient: To do or not to do, that's the question. Burns 2016; 42:421-7. [PMID: 26777453 DOI: 10.1016/j.burns.2015.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/21/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In many burn centers, routine bacteriological swabs are taken from the nose, throat, perineum, and the burn wound on admission, to check for the presence of microorganisms that require specific measures in terms of isolation or initial treatment. According to the Dutch policy of "search and destroy," for example, patients infected by multiresistant bacteria have to be strictly isolated, and patients colonized with β-hemolytic Streptococcus pyogenes must receive antibiotic therapy to prevent failed primary closure or loss of skin grafts. In this respect, the role of bacteria cultured on admission in later infectious complications is investigated. The aim of this study is to assess systematic initial bacteriological surveillance, based on an extensive Dutch data collection. MATERIALS AND METHODS A total of 3271 patients primarily admitted to the Rotterdam Burn Centre between January 1987 and August 2010 with complete bacteriological swabs from nose, throat, perineum, and the burn wounds were included. For this study, microbiological surveillance was aimed at identifying resistant microorganisms such as methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Acinetobacter, and multiresistant Pseudomonas, as well as Lancefield A β-hemolytic streptococci (HSA), in any surveillance culture. The cultures were labeled as "normal flora or non-suspicious" in the case of no growth or a typical low level of bacterial colonization in the nose, throat, and perineum and no overgrowth of one type of microorganism. Further, the blood cultures of 195 patients (6.0%) who became septic in a later phase were compared with cultures taken on admission to identify the role of the initially present microorganisms. Statistical analysis was performed using SPSS 20.0. RESULTS Almost 61% of the wound cultures are "non-suspicious" on admission. MRSA was cultured in 0.4% (14/3271) on admission; 12 out of these 14 patients (85.7%) were repatriated. Overall, 9.3% (12/129) of the repatriated patients were colonized with MRSA. Multiresistant Acinetobacter or Pseudomonas was detected in 0.3% (11/3271 and 10/3271, respectively). In total, 18 of the 129 repatriated patients (14%) had one or more resistant bacteria in cultures taken within the first 24h after admission in our burn center. On admission, S. pyogenes was found in 3.6% of patients (117/3271), predominantly in children up to 10 years of age (81/1065=7.6%). CONCLUSIONS Resistant bacteria or microorganisms that impede wound healing and cause major infections are found only in few bacteriological specimens obtained on admission of patients with burn wounds. However, the consequences in terms of isolation and therapy are of great importance, justifying the rationale of a systematic bacteriological surveillance on admission. Patients who have been hospitalized for several days in a hospital abroad and are repatriated show more colonization at admission in our burn center. The microorganisms identified are not only (multi)resistant bacteria, showing that a hospital environment can quickly become a source of contamination. These patients should receive special attention for resistant bacteria. HSA contamination is observed more frequently in younger children. Bacteria present at admission do not seem to play a predominant role in predicting later sepsis.
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Affiliation(s)
- J Dokter
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.
| | - N Brusselaers
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - W D H Hendriks
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
| | - H Boxma
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
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Perween N, Prakash SK, Siddiqui O. Multi Drug Resistant Klebsiella Isolates in Burn Patients: A Comparative Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2015; 9:DC14-6. [PMID: 26500905 DOI: 10.7860/jcdr/2015/13837.6576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Infections are the most common complications in the burn patients admitted to the hospitals leading to high morbidity and mortality. Klebsiella is one of the most frequently isolated bacteria from burn wounds. MATERIALS AND METHODS We studied antimicrobial susceptibility patterns of Klebsiella isolates from burn patients. In this cross- sectional study wound swabs from 1294 patients hospitalized in burnward were collected for bacteriological examination. Antibiotic sensitivity testing of Klebsiella isolates was done by modified Stokes disc diffusion method. RESULTS Out of 883 isolates from 1294 patients 195 were found to be Klebsiella spp. Based on the biochemical properties 153 isolates were Klebsiella pneumoniae, 37 were Klebsiella oxytoca and 5 were others species. In our study we found that 54% of the Klebsiella isolates were multidrug resistant as they were resistant to at least one antibiotic of three or more different groups of antibiotics. [Table: see text]. CONCLUSION Rate of isolation of Klebsiella as well as its resistance for commonly used antibiotics is increasing over the time.
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Affiliation(s)
- Naz Perween
- Senior Resident, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
| | - S Kirshna Prakash
- Senior Resident, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
| | - Oves Siddiqui
- Director Professor, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
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Boateng J, Catanzano O. Advanced Therapeutic Dressings for Effective Wound Healing--A Review. J Pharm Sci 2015; 104:3653-3680. [PMID: 26308473 DOI: 10.1002/jps.24610] [Citation(s) in RCA: 474] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/15/2022]
Abstract
Advanced therapeutic dressings that take active part in wound healing to achieve rapid and complete healing of chronic wounds is of current research interest. There is a desire for novel strategies to achieve expeditious wound healing because of the enormous financial burden worldwide. This paper reviews the current state of wound healing and wound management products, with emphasis on the demand for more advanced forms of wound therapy and some of the current challenges and driving forces behind this demand. The paper reviews information mainly from peer-reviewed literature and other publicly available sources such as the US FDA. A major focus is the treatment of chronic wounds including amputations, diabetic and leg ulcers, pressure sores, and surgical and traumatic wounds (e.g., accidents and burns) where patient immunity is low and the risk of infections and complications are high. The main dressings include medicated moist dressings, tissue-engineered substitutes, biomaterials-based biological dressings, biological and naturally derived dressings, medicated sutures, and various combinations of the above classes. Finally, the review briefly discusses possible prospects of advanced wound healing including some of the emerging physical approaches such as hyperbaric oxygen, negative pressure wound therapy and laser wound healing, in routine clinical care.
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Affiliation(s)
- Joshua Boateng
- Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK.
| | - Ovidio Catanzano
- Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK
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Roy DC, Tomblyn S, Burmeister DM, Wrice NL, Becerra SC, Burnett LR, Saul JM, Christy RJ. Ciprofloxacin-Loaded Keratin Hydrogels Prevent Pseudomonas aeruginosa Infection and Support Healing in a Porcine Full-Thickness Excisional Wound. Adv Wound Care (New Rochelle) 2015; 4:457-468. [PMID: 26244102 DOI: 10.1089/wound.2014.0576] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/19/2014] [Indexed: 12/19/2022] Open
Abstract
Objective: Cutaneous wound infection can lead to impaired healing, multiple surgical procedures, and increased hospitalization time. We tested the effectiveness of keratin-based hydrogels (termed "keratose") loaded with ciprofloxacin to inhibit infection and support healing when topically administered to porcine excision wounds infected with Pseudomonas aeruginosa. Approach: Using a porcine excisional wound model, 10 mm full-thickness wounds were inoculated with 106 colony-forming units of P. aeruginosa and treated on days 1 and 3 postinoculation with ciprofloxacin-loaded keratose hydrogels. Bacteria enumeration and wound healing were assessed on days 3, 7, and 11 postinjury. Results: Ciprofloxacin-loaded keratose hydrogels reduced the amount of P. aeruginosa in the wound bed by 99.9% compared with untreated wounds on days 3, 7, and 11 postinjury. Ciprofloxacin-loaded keratose hydrogels displayed decreased wound contraction and reepithelialization at day 7 postinjury. By day 11, wounds treated with ciprofloxacin-keratose hydrogels contained collagen-rich granulation tissue and myofibroblasts. Wounds treated with ciprofloxacin-loaded keratose hydrogels exhibited a transient increase in macrophages in the wound bed at day 7 postinjury that subsided by day 11. Innovation: Current therapies for wound infection include systemic antibiotics, which could lead to antibiotic resistance, and topical antimicrobial treatments, which require multiple applications and can delay healing. Here, we show that ciprofloxacin-loaded keratose hydrogels inhibit cutaneous wound infection without interfering with key aspects of the healing process including granulation tissue deposition and remodeling. Conclusions: Ciprofloxacin-loaded keratose hydrogels have the potential to serve as a point-of-injury antibiotic therapy that prevents infection and supports healing following cutaneous injury.
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Affiliation(s)
- Daniel C. Roy
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas
- KeraNetics, LLC, Winston-Salem, North Carolina
| | | | | | - Nicole L. Wrice
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Sandra C. Becerra
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | | | - Robert J. Christy
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas
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Zhang X, Guo R, Xu J, Lan Y, Jiao Y, Zhou C, Zhao Y. Poly(l-lactide)/halloysite nanotube electrospun mats as dual-drug delivery systems and their therapeutic efficacy in infected full-thickness burns. J Biomater Appl 2015; 30:512-25. [DOI: 10.1177/0885328215593837] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, poly(l-lactide) (PLLA)/halloysite nanotube (HNT) electrospun mats were prepared as a dual-drug delivery system. HNTs were used to encapsulate polymyxin B sulphate (a hydrophilic drug). Dexamethasone (a hydrophobic drug) was directly dissolved in the PLLA solution. The drug-loaded HNTs with optimised encapsulation efficiency were then mixed with the PLLA solution for subsequent electrospinning to form composite dual-drug-loaded fibre mats. The structure, morphology, degradability and mechanical properties of the electrospun composite mats were characterised in detail. The results showed that the HNTs were uniformly distributed in the composite PLLA mats. The HNTs content in the mats could change the morphology and average diameter of the electrospun fibres. The HNTs improved both the tensile strength of the PLLA electrospun mats and their degradation ratio. The drug-release kinetics of the electrospun mats were investigated using ultraviolet-visible spectrophotometry. The HNTs/PLLA ratio could be varied to adjust the release of polymyxin B sulphate and dexamethasone. The antibacterial activity in vitro of the mats was evaluated using agar diffusion and turbidimetry tests, which indicated the antibacterial efficacy of the dual-drug delivery system against Gram-positive and -negative bacteria. Healing in vivo of infected full-thickness burns and infected wounds was investigated by macroscopic observation, histological observation and immunohistochemical staining. The results indicated that the electrospun mats were capable of co-loading and co-delivering hydrophilic and hydrophobic drugs, and could potentially be used as novel antibacterial wound dressings.
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Affiliation(s)
- Xiazhi Zhang
- Department of Materials Science and Engineering, Jinan University, Guangzhou, China
| | - Rui Guo
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Jiqing Xu
- Department of Materials Science and Engineering, Jinan University, Guangzhou, China
| | - Yong Lan
- Department of Materials Science and Engineering, Jinan University, Guangzhou, China
| | - Yanpeng Jiao
- Department of Materials Science and Engineering, Jinan University, Guangzhou, China
| | - Changren Zhou
- Department of Materials Science and Engineering, Jinan University, Guangzhou, China
| | - Yaowu Zhao
- School of Medicine, Jinan University, Guangzhou, China
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Krausz AE, Adler BL, Cabral V, Navati M, Doerner J, Charafeddine RA, Chandra D, Liang H, Gunther L, Clendaniel A, Harper S, Friedman JM, Nosanchuk JD, Friedman AJ. Curcumin-encapsulated nanoparticles as innovative antimicrobial and wound healing agent. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 11:195-206. [PMID: 25240595 DOI: 10.1016/j.nano.2014.09.004] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/07/2014] [Accepted: 09/11/2014] [Indexed: 12/31/2022]
Abstract
Burn wounds are often complicated by bacterial infection, contributing to morbidity and mortality. Agents commonly used to treat burn wound infection are limited by toxicity, incomplete microbial coverage, inadequate penetration, and rising resistance. Curcumin is a naturally derived substance with innate antimicrobial and wound healing properties. Acting by multiple mechanisms, curcumin is less likely than current antibiotics to select for resistant bacteria. Curcumin's poor aqueous solubility and rapid degradation profile hinder usage; nanoparticle encapsulation overcomes this pitfall and enables extended topical delivery of curcumin. In this study, we synthesized and characterized curcumin nanoparticles (curc-np), which inhibited in vitro growth of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in dose-dependent fashion, and inhibited MRSA growth and enhanced wound healing in an in vivo murine wound model. Curc-np may represent a novel topical antimicrobial and wound healing adjuvant for infected burn wounds and other cutaneous injuries.
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Affiliation(s)
- Aimee E Krausz
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandon L Adler
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vitor Cabral
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mahantesh Navati
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Doerner
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rabab A Charafeddine
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dinesh Chandra
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hongying Liang
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leslie Gunther
- Analytical Imaging Facility, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alicea Clendaniel
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, USA
| | - Stacey Harper
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, USA; School of Chemical, Biological and Environmental Engineering, Oregon State University, Corvallis, OR, USA
| | - Joel M Friedman
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joshua D Nosanchuk
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam J Friedman
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA.
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Fekih Hassen A, Ben Khalifa S, Daiki M. Epidemiological and bacteriological profiles in children with burns. Burns 2014; 40:1040-5. [DOI: 10.1016/j.burns.2013.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/09/2013] [Accepted: 10/29/2013] [Indexed: 01/01/2023]
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31
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Sabzghabaee AM, Abedi D, Fazeli H, Javadi A, Jalali M, Maracy MR, Soltani R, Karamyafti MJ. Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian University Hospital. J Res Pharm Pract 2014; 1:30-3. [PMID: 24991585 PMCID: PMC4076853 DOI: 10.4103/2279-042x.99675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: About 73% of death cases in the first 5 days after burning are due to infection complications. The aim of this study was to identify the causing agents of infections in burn patients and the sensitivity pattern of them to the commonly used antimicrobials in an Iranian Burn center University Hospital. Methods: In this cross-sectional study, patients who were admitted to one of the Iranian Burn center University hospitals in 2009 and had nosocomial infection due to burn wound, whom received antimicrobial agents for therapeutic reasons, with a hospitalization period of more than 48 hours were enrolled. Gram stain analyses were performed to help identifying growing colonies. Differential tests for identification of pathogenic bacteria species were performed following primary tests. E-test strips of each antimicrobial were placed on the culture medium plate in order to determine the minimum inhibitory concentration Studied antimicrobials for isolated Gram-negative bacteria were meropenem, piperacillin/tazobactam, ceftriaxone, cotrimoxazole, and for Staphylococcus aureus, vancomycin, piperacillin/tazobactam, cotrimoxazole, and cephalothin. Findings: Only 16% of Pseudomonas aeruginosa species were sensitive to meropenem, and 13% were sensitive to piperacillin/tazobactam. Ten out of 29 Klebsiella species (34%) were sensitive to meropenem and piperacillin/tazobactam. All isolated strains of Staphylococcus aureus were sensitive to vancomycine while they were all resistant to cotrimoxazole. Conclusion: Pseudomona, Klebsiella and Staphylococcoci are the most common species causing burn infection in this medical center. Results showed the importance of limiting irrational use of wide-spectrum antimicrobials and recommends strict management of infections in burn injury centers.
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Affiliation(s)
- Ali Mohammad Sabzghabaee
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Daryoush Abedi
- Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Fazeli
- Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Javadi
- Department of Infectious Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Jalali
- Department of Food Science and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasool Soltani
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
OBJECTIVE Bacterial colonisation of the burn wound remains a major source of morbidity and mortality in burns patients. This study aimed to determine the presence of different micro-organisms in a UK regional burns centre and to examine the relationships between bacterial colonisation, burn size, length of hospital stay and delayed referral. METHOD A retrospective review of microbiology surveillance swab results on all adult patients admitted to a regional burns centre over a 12-month period was performed. RESULTS 139 adult patients were included in the study. Approximately 68% of patients showed evidence of burn wound colonisation at some point during their inpatient stay. The remaining 32% had negative microbiology swabs throughout their hospital stay. A total of 202 micro-organisms were isolated. Staphylococcus aureus was found to be the most common micro-organism, found in 79% of patients with positive swab results. A direct link was found between an increased incidence of bacterial colonisation and delay in referral of >24 hours, larger burn size and length of hospital stay. CONCLUSION By understanding the potential sources of bacteria and the effect of patient factors on their susceptibility to bacterial colonisation, we can form better management and treatment strategies to reduce morbidity and mortality from burns wound sepsis.
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Affiliation(s)
- M Alrawi
- Consultant Plastic Surgeon, Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - T P Crowley
- SpR Plastic Surgery, Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - S A Pape
- Consultant Plastic Surgeon, Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle, UK
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Luo G, Tan J, Peng Y, Wu J, Huang Y, Peng D, Wang X, Hu D, Xie S, Zhang G, Han C, Huang X, Jia C, Chai J, Huan J, Guo G, Zhan J, Xie W, Cen Y, Yu R, Chen H, Niu X, Wang Y, Fu J, Xue B. Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013. BURNS & TRAUMA 2014; 2:45-52. [PMID: 27602362 PMCID: PMC5012031 DOI: 10.4103/2321-3868.130182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/04/2013] [Indexed: 02/05/2023]
Abstract
Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.
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Affiliation(s)
- Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jun Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yuesheng Huang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Daizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Xu Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Guoan Zhang
- Department of Burns, Beijing Jishuitan Hospital, Forth Medical College of Peking University, Beijing, China
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Central South University, Changsha, Hunan, China
| | - Ciyu Jia
- Graduate School, Medical College of Chinese PLA, Beijing, China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, The First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Jingning Huan
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghua Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianhua Zhan
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weiguo Xie
- Department of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Cen
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huade Chen
- Department of Burns, General Hospital of Guangdong Province, Guangzhou, Guangdong, China
| | - Xihua Niu
- Department of Otolaryngology, Henan Province Hospital, Zhengzhou, Henan, China
| | - Yibing Wang
- Department of Aesthetic Plastic and Burn Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinfeng Fu
- Department of Burns, Second Affiliated Hospital of Kunmin Medical University, Yunnan, China
| | - Baosheng Xue
- Department of Burns, The First Affiliated Hospital of Chinese Medical University, Shenyang, Liaoning, China
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Mahzounieh M, Khoshnood S, Ebrahimi A, Habibian S, Yaghoubian M. Detection of Antiseptic-Resistance Genes in Pseudomonas and Acinetobacter spp. Isolated From Burn Patients. Jundishapur J Nat Pharm Prod 2014; 9:e15402. [PMID: 24872941 PMCID: PMC4036384 DOI: 10.17795/jjnpp-15402] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/25/2013] [Accepted: 02/15/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Quaternary ammonium compounds (QAC), which contain benzalkonium chloride as the most widely used agent, are employed as wound and skin antiseptics, as well as disinfectants in hospitals. The resistance mechanism to disinfectants is usually determine by genes which are related to resistance to quaternary ammonium compounds, namely, qacE, qacΔE1, qacΔE1 that are found in Gram-negative bacteria. OBJECTIVES The aim of this study was to determine the incidence of antiseptic resistance genes, qacE and qacΔE1, in clinical isolates of Pseudomonas aeruginosa and Acinetobacter bumanii. MATERIALS AND METHODS In this study, 83 clinical isolates of Pseudomonas aeruginosa, and 5 isolates of Acinetobacter baumannii from burn hospitals in Tehran and Isfahan provinces in 2010-2011, were tested by the PCR method. RESULTS Out of the 83 clinical isolates of Pseudomonas aeruginosa, 49 isolates (50%) had the qacE gene, and 76 isolates (91.5%) had the qacΔE1 gene. In addition, in 5 isolates of Acinetobacter bumanii, 2 isolates (40%) had the qacE gene, and 4 isolates (80%) had the qacΔE1 gene. CONCLUSIONS This study shows that the genes which harbored resistance to quaternary ammonium compound antiseptics are widespread among Pseudomonas aeruginosa and Acinetobacter bumanii isolates in burn patients.
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Affiliation(s)
- Mohammadreza Mahzounieh
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, IR Iran
| | - Sheida Khoshnood
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, IR Iran
| | - Azizollah Ebrahimi
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, IR Iran
| | - Saeid Habibian
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, IR Iran
| | - Maryam Yaghoubian
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, IR Iran
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Jaspers MEH, Breederveld RS, Tuinebreijer WE, Diederen BMW. The evaluation of nasal mupirocin to prevent Staphylococcus aureus burn wound colonization in routine clinical practice. Burns 2014; 40:1570-4. [PMID: 24685351 DOI: 10.1016/j.burns.2014.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/19/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Staphylococcus aureus wound colonization frequently occurs in patients with burns and can cause impaired wound healing. Nasal mupirocin application may contribute to the reduction of burn wound colonization of endogenous origin, whereas colonization by the exogenous route can be reduced by blocking cross-infection from other sources. In this study we evaluated whether the implementation of routine treatment of patients and burn center personnel using nasal mupirocin ointment reduces S. aureus burn wound colonization. METHODS We composed three study groups, consisting of a control period (Control), a mupirocin period (MUP), in which patients with burns were all receiving nasal mupirocin at admission, and a mupirocin+personnel period (MUP+P), in which we also screened the burn center personnel and decolonized S. aureus carriers by nasal mupirocin. RESULTS The patients who carried S. aureus in their nose and did not have S. aureus burn wound colonization at admission were considered as patients susceptible for the use of nasal mupirocin. In these patients, the S. aureus burn wound colonization rate was the same in all study groups. S. aureus nasal carriage was a significant independent risk factor for burn wound colonization (OR: 3.3; 95% CI: 1.4-7.6) when analyzed within the three study groups. CONCLUSION Although S. aureus carriage is a significant risk factor for developing burn wound colonization, the routine use of nasal mupirocin did not contribute to a reduction of burn wound colonization.
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Affiliation(s)
- M E H Jaspers
- Burn Center, Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
| | - R S Breederveld
- Burn Center, Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Surgery, University Medical Center Leiden, Leiden, The Netherlands
| | - W E Tuinebreijer
- Burn Center, Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - B M W Diederen
- Burn Center, Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Regional Laboratory of Public Health, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
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Raya-Cruz M, Ferullo I, Arrizabalaga-Asenjo M, Nadal-Nadal A, Díaz-Antolín MP, Garau-Colom M, Payeras-Cifre A. Infecciones de piel y partes blandas en pacientes hospitalizados: factores epidemiológicos, microbiológicos, clínicos y pronósticos. Enferm Infecc Microbiol Clin 2014; 32:152-9. [DOI: 10.1016/j.eimc.2013.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 01/22/2023]
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Chen J, Yan H, Luo G, Luo Q, Li X, Zhang J, Yuan Z, Peng D, Peng Y, Hu J, Wu J. Characteristics of burn deaths from 2003 to 2009 in a burn center: A retrospective study. BURNS & TRAUMA 2013; 1:80-6. [PMID: 27574629 PMCID: PMC4978095 DOI: 10.4103/2321-3868.118933] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mortality remains one of the most important end-point quality control parameters to evaluate a burn care system. We retrospectively reviewed the characteristics and multiple organ dysfunction syndrome (MODS) patterns of burn deaths in our center from January 2003 to December 2009. The mortality rate during this time period was 2.3%. Fifty-six patients died, including 49 males and 7 females. The mean survival time was 28.45 ± 24.60 days. The burn percentage was (76.70 ± 26.86) % total burn surface area (TBSA), with (27.74 ± 24.95) % deep-partial thickness burns and (46.88 ± 33.84) % full-thickness burns. Inhalation injury was diagnosed in 36 (64.29%) patients. Patients who had undergone an operation, particularly in the first week post-burn, had a significantly longer survival time. An average of 5.50 ± 1.35 malfunctioning organs per patient and a mean sequential organ failure assessment (SOFA) score of 13.91 ± 3.65 were observed. The most frequently malfunctioning organs were involved in the respiratory, hematologic, circulatory, and central nervous systems. Most of the organ damage occurred during the first week post-burn, followed by 4 weeks later, with relatively less organ damage observed in the third week. Among patients with a TBSA over 50%, non-survivors had larger burn sizes (particularly larger full-thickness burns) and a higher incidence of inhalation injury compared with survivors; non-survivors were also more likely to have microorganism-positive blood and sputum cultures. In conclusion, burn deaths are related to a higher burn percentage, inhalation injury, MODS, and infection. Early operation may help improve survival duration.
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Affiliation(s)
- Jian Chen
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Hong Yan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Qizhi Luo
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Xiaolu Li
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Jiaping Zhang
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Zhiqiang Yuan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Daizhi Peng
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Yizhi Peng
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Jianian Hu
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Jun Wu
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
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Lee HG, Jang J, Choi JE, Chung DC, Han JW, Woo H, Jeon W, Chun BC. Blood stream infections in patients in the burn intensive care unit. Infect Chemother 2013; 45:194-201. [PMID: 24265967 PMCID: PMC3780961 DOI: 10.3947/ic.2013.45.2.194] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/12/2013] [Accepted: 01/16/2013] [Indexed: 12/01/2022] Open
Abstract
Background The study on bacteremia helps empirically select the proper antibiotics before the results of culture test about causative pathogen. The purpose of this study is to investigate causative pathogen in bloodstream infection, changing aspects based on elapsed time after burn, relationship with other sites and resistance of important causative pathogen against antibiotics through analysis on bacteria isolated from blood culture of patients hospitalized in burn intensive care unit (BICU). Materials and Methods A retrospective study was conducted targeting patients hospitalized in BICU from January 2007 to June 2011. Changes of causative pathogen in bloodstream infection based on elapsed time after injury were analyzed. We would like to examine the relationship between bloodstream infection and infection on other body parts by comparing results of cultures in burn wound site, sputum, urine and catheter tip. Antibiotics resistance patterns of Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus species, and Klebsiella pneumoniae were studied. Results A total of 2,337 burn patients were hospitalized in BICU for 54 months. Causative pathogen was cultured in blood cultures from 397 patients (17.0%). P. aeruginosa (169, 30.1%) was the most cultured and A. baumannii (107, 19.0%) and S. aureus (81, 14.4%) were followed. It was confirmed that the relative frequency of A. baumannii tended to get lower as the period got longer after injury, but the relative frequency of K. pneumoniae got higher as the period got longer after injury. With comparison without bacteremia, P. aeruginosa bacteremia showed high probability in which the same bacteria were cultured in wound site, sputum and cathether tip, and A. baumannii bacteremia and candida bacteremia had high probability in sputum, and urine and catheter tip, respectively. 95.9% of P. aeruginosa and 95.3% of A. baumannii showed the resistance against carbapenem. 96.3% of S. aureus was methicillin resistant and 36.2% of Enterococcus species were vancomycin resistant. 75.0% of K. pneumonia were extended-spectrum beta-lactamase (ESBL)-producing bacteria. Conclusions Since the highly antibiotic resistant microorganisms were isolated from the patients hospitalized in BICU during early phase, the empirical selection of antibiotics targeting these pathogens should be considered before the results of microbiologic culture test. In addition, use of empirical antifungal agent after 1 week of injury can be considered for patients who have risk factor of fungal infection.
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Affiliation(s)
- Hun Gu Lee
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Evaluation of a nisin-eluting nanofiber scaffold to treat Staphylococcus aureus-induced skin infections in mice. Antimicrob Agents Chemother 2013; 57:3928-35. [PMID: 23733456 DOI: 10.1128/aac.00622-13] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Staphylococcus aureus is a virulent pathogen and a major causative agent of superficial and invasive skin and soft tissue infections (SSSTIs). Antibiotic resistance in S. aureus, among other bacterial pathogens, has rapidly increased, and this is placing an enormous burden on the health care sector and has serious implications for infected individuals, especially immunocompromised patients. Alternative treatments thus need to be explored to continue to successfully treat infections caused by S. aureus, including antibiotic-resistant strains of S. aureus. In this study, an antimicrobial nanofiber wound dressing was generated by electrospinning nisin (Nisaplin) into poly(ethylene oxide) and poly(d,l-lactide) (50:50) blend nanofibers. Active nisin diffused from the nanofiber wound dressings for at least 4 days in vitro, as shown by consecutive transfers onto plates seeded with strains of methicillin-resistant S. aureus (MRSA). The nisin-containing nanofiber wound dressings significantly reduced S. aureus Xen 36 bioluminescence in vivo and viable cell numbers in a murine excisional skin infection model. The bacterial burden of wounds treated with nisin-containing nanofiber wound dressings was 4.3 × 10(2) CFU/wound, whereas wounds treated with control nanofiber wound dressings had 2.2 × 10(7) CFU/wound on the last day of the trial (day 7). Furthermore, the wound dressings stimulated wound closure of excisional wounds, and no adverse effects were observed by histological analysis. Nisin-containing nanofiber wound dressings have the potential to treat S. aureus skin infections and to potentially accelerate wound healing of excisional wounds.
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Bayram Y, Parlak M, Aypak C, Bayram I. Three-year review of bacteriological profile and antibiogram of burn wound isolates in Van, Turkey. Int J Med Sci 2013; 10:19-23. [PMID: 23289001 PMCID: PMC3534873 DOI: 10.7150/ijms.4723] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/26/2012] [Indexed: 12/21/2022] Open
Abstract
The risk of infection in burns is well-known. In recent decades, the antimicrobial resistance of bacteria isolated from burn patients has increased. For this reason, a retrospective study was conducted at Van Training and Research Hospital to analyze the bacterial isolates from the wounds of patients admitted to the Burn Unit and to determine the susceptibility patterns of the commonly cultured organisms over a 3-year period, January 2009 to December 2011.A total of 250 microorganisms were isolated from burn wounds of 179 patients. Our results revealed that the most frequent isolate was Acinetobacter baumannii (23.6%), Pseudomonas aeruginosa (12%), Staphylococcus aureus (11.2%), Escherichia coli (10%) respectively. Multidrug-resistance has emerged as an important concern in our burn unit. Tigecycline, and colistin were found to be the most active drugs against Acinetobacter baumannii. Carbapenems and amikacin, were found to be the most active drugs against other gram negative bacteria. Vancomycin and linezolid were active against gram positive bacteria.Aggressive infection control measures should be applied to limit the emergence and spread of multidrug-resistant pathogens.
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Affiliation(s)
- Yasemin Bayram
- Microbiology Laboratory, Van Training And Research Hospital, Van, Turkey
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Burnouf T, Chou ML, Wu YW, Su CY, Lee LW. Antimicrobial activity of platelet (PLT)-poor plasma, PLT-rich plasma, PLT gel, and solvent/detergent-treated PLT lysate biomaterials against wound bacteria. Transfusion 2012; 53:138-46. [PMID: 22563709 DOI: 10.1111/j.1537-2995.2012.03668.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Platelet (PLT) gels exhibit antimicrobial activity useful for wound healing. The nature of the antibacterial component(s) is unknown. STUDY DESIGN AND METHODS PLT-poor plasma (PPP), PLT-rich plasma (PRP), PLT gel (PG), and solvent/detergent-treated PLT lysate (S/D-PL) from two donors were evaluated either native or after complement heat inactivation. Materials were spiked at a 10% ratio (vol/vol) with approximately 10(7-8) colony-forming units/mL with four Gram-positive and four Gram-negative bacteria of the wound flora. Bacterial count was determined by plate assays at time of spiking and after 3 and 48 hours at 31°C. Bacteria growth inhibition tests were also performed. RESULTS There was no viable Escherichia coli colony for 48 hours after spiking to the plasma and PLT materials from both donors, corresponding to greater than 7.51 to greater than 9.05 log inactivation. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus were inactivated (approx. 4.7, 7, and 2 log, respectively) 3 hours after spiking to PRP, PPP, or S/D-PL from the first donor but less (1.1, 4.6, and 0.2 log, respectively) in PG, before a regrowth at 48 hours in all materials. Similar data were obtained with the second donor. No plasma and PLT material had antimicrobial activity against Enterobacter cloacae, Bacillus cereus, Bacillus subtilis, and Staphylococcus epidermidis. Complement-inactivated samples had no antimicrobial activity. CONCLUSION Plasma complement is mostly responsible for the activity of plasma and PLT biomaterials against E. coli, P. aeruginosa, K. pneumoniae, and S. aureus. Activation of the coagulation to prepare PG may reduce antimicrobial activity. These findings may help optimize the control of wound infections by blood biomaterials.
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Affiliation(s)
- Thierry Burnouf
- College of Oral Medicine and the Department of Microbiology and Immunology, Taipei Medical University, Taipei, Taiwan
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Esposito S, Bassetti M, Borre' S, Bouza E, Dryden M, Fantoni M, Gould IM, Leoncini F, Leone S, Milkovich G, Nathwani D, Segreti J, Sganga G, Unal S, Venditti M. Diagnosis and management of skin and soft-tissue infections (SSTI): a literature review and consensus statement on behalf of the Italian Society of Infectious Diseases and International Society of Chemotherapy. J Chemother 2012; 23:251-62. [PMID: 22005055 DOI: 10.1179/joc.2011.23.5.251] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Skin and soft-tissue infections (SSTIs) are among the most common bacterial infections, posing considerable diagnostic and therapeutic challenges and resulting in significant morbidity and mortality among patients as well as increased healthcare costs. eight members of the SSTI working group of the Italian Society of infectious Diseases prepared a draft of the statements, grading the quality of each piece of evidence after a careful review of the current literature using MEDLINE database and their own clinical experience. Statements were graded for their strength and quality using a system based on the one adopted by the Infectious Diseases Society of America (IDSA). The manuscript was successively reviewed by seven members of the SSTI working group of the international Society of Chemotherapy, and ultimately re-formulated by all e xperts. the microbiological and clinical aspects together with diagnostic features were considered for uncomplicated and complicated SSTIs. Antimicrobial therapy was considered as well -both empirical and targeted to methicillin-resistant Staphylococcus aureus (MRSA) and/or other main pathogens.
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Affiliation(s)
- S Esposito
- Department Infectious Diseases, University Naples, Italy
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A Pilot Study of the Use of Biocide-Impregnated Gauze as an Adjunct to Wound Care in a Burn Population. J Burn Care Res 2012; 33:358-63. [DOI: 10.1097/bcr.0b013e31823746d2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fu Y, Xie B, Ben D, Lv K, Zhu S, Lu W, Tang H, Cheng D, Ma B, Wang G, Xiao S, Wang G, Xia Z. Pathogenic alteration in severe burn wounds. Burns 2011; 38:90-4. [PMID: 22100426 DOI: 10.1016/j.burns.2011.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 02/03/2011] [Accepted: 02/13/2011] [Indexed: 10/15/2022]
Abstract
The present study aims to define the trend of time related changes with local bacterial alteration of bacterial resistance in severe burns in our burn center during a 12-year period. Retrospective analysis of microbiological results on severely burned wounds between 1998 and 2009 was carried out. A study of 3615 microbial isolates was performed. Staphylococcus aureus was the most commonly isolated pathogen (38.2%) followed by A. baumannii (16.2%), Streptococcus viridans (11.4%), Pseudomonas aeruginosa (10.4%), coagulase-negative staphylococci (CNS, 9.2%). The species ratios of S. aureus and A. baumannii increased significantly from 1st to 8th week of hospitalization, while those of Streptococcus viridans, P. aeruginosa and coagulase-negative staphylococci decreased during the same period. Bacterial resistance rates were compared between the periods 1998-2003 and 2004-2009. Vancomycin remained as the most sensitive antibiotic in S. aureus including methicillin-resistant S. aureus (MRSA). It was very likely that the majority of infections caused by Streptococcus viridans, P. aeruginosa and coagulase-negative staphylococci occurred in the early stage of burn course and the majority of infections caused by A. baumannii occurred 4 weeks after admission. The use of different antibiotics was probably the major contributor to these trends.
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Affiliation(s)
- Yang Fu
- Burn Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
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Guggenheim M, Thurnheer T, Gmür R, Giovanoli P, Guggenheim B. Validation of the Zürich burn-biofilm model. Burns 2011; 37:1125-33. [DOI: 10.1016/j.burns.2011.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 05/30/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
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Posluszny JA, Conrad P, Halerz M, Shankar R, Gamelli RL. Surgical burn wound infections and their clinical implications. J Burn Care Res 2011; 32:324-33. [PMID: 21252689 DOI: 10.1097/bcr.0b013e31820aaffe] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Typically, burn wound infections are classified by the organisms present in the wound within the first several days after injury or later by routine surveillance cultures. With universal acceptance of early excision and grafting, classification of burn wound colonization in unexcised burn wounds is less relevant, shifting clinical significance to open burn-related surgical wound infections (SWIs). To better characterize SWIs and their clinical relevance, the authors identified the pathogens responsible for SWIs, their impact on rates of regrafting, and the relationship between SWI and nosocomial infection (NI) pathogens. Epidemiologic and clinical data for 71 adult patients with ≥ 20% TBSA burn were collected. After excision and grafting, if a grafted site had clinical characteristics of infection, a wound culture swab was obtained and the organism identified. Surveillance cultures were not obtained. SWI pathogen, anatomic location, postburn day of occurrence, and need for regrafting were compiled. A positive culture obtained from an isolated anatomic location at any time point after excision and grafting of that location was considered a distinct infection. Pathogens responsible for NIs (urinary tract infections, pneumonia, bloodstream and catheter-related bloodstream infections, pseudomembranous colitis, and donor site infections) and their postburn day were identified. The profiles of SWI pathogens and NI pathogens were then compared. Of the 71 patients included, 2 withdrew, 6 had no excision or grafting performed, and 1 had incomplete data. Of the remaining 62 patients, 24 (39%) developed an SWI. In these 24 patients, 70 distinct infections were identified, of which 46% required regrafting. Candida species (24%), Pseudomonas aeruginosa (22%), Serratia marcescens (11%), and Staphylococcus aureus (11%) comprised the majority of pathogens. Development of an SWI with the need for regrafting increased overall length of stay, area of autograft, number of operative events, and was closely associated with the number of NIs. The %TBSA burn and depth of the burn were the main risk factors for SWI with need for regrafting. The SWI pathogen was identified as an NI pathogen 56% of the time, with no temporal correlation between shared SWI and NI pathogens. SWIs are commonly found in severely burned patients and are associated with regrafting. As a result, patients with SWIs are subjected to increased operative events, autograft placement, and increased length of hospitalization. In addition, the presence of an SWI may be a risk factor for development of NIs.
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Affiliation(s)
- Joseph A Posluszny
- Loyola University Medical Center, Burn and Shock Trauma Institute, Maywood, Illinois, USA
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Thomas JG, Slone W, Linton S, Okel T, Corum L, Percival SL. In vitro antimicrobial efficacy of a silver alginate dressing on burn wound isolates. J Wound Care 2011; 20:124,126-8. [PMID: 21537295 DOI: 10.12968/jowc.2011.20.3.124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the antimicrobial effectiveness of a silver alginate dressing on opportunistic pathogens, namely meticillin-sensitive Staphylococcus aureus (MSSA) and meticillin-resistant Staphylococcus aureus (MRSA), Klebsiella spp., Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Escherichia coli, Enterobacter sakazakii, Enterobacter cloacae, Serratia marcescens, Chryseobacterium indologenes, Proteus vulgaris and Acinetobacter baumannii. METHOD In total, 40 microorganisms were isolated from patients attending three burn centres in the US and evaluated for their susceptibility to a silver alginate wound dressing, employing a corrected zone of inhibition assay, conducted on Mueller Hinton agar (MHA). RESULTS The sizes of the corrected zones of inhibition varied between and within genera. For example, all Acinetobacter baumannii strains were found to be sensitive to ionic silver at pH 7, with a mean of 2.8mm, compared with 3.5mm at pH 5.5. The silver alginate dressing also demonstrated activity on all strains of Enterobacter and Escherichia coli, with susceptibility to the silver alginate dressing enhanced at pH 5.5. For Enterococcus spp. the average corrected zone of inhibition at pH 7 was 3.6mm, versus 4.9mm at pH 5.5. All strains of Pseudomonas aeruginosa were found to be sensitive to the silver alginate dressing. The average corrected zone of inhibition was 6.9mm at pH 7, compared with 8mm at pH 5.5. For MRSA and Staphylococcus aureus, it ranged from 4.5mm to 7.5mm at pH 7. When the pH was decreased to 5.5, the corrected zone of inhibition increased. CONCLUSION This study demonstrates the activity of a silver alginate dressing on a wide range of burn isolates, including antibiotic-resistant bacteria, isolated from three different burn centres in the US. It also highlights the possible importance of pH and its potential effects on antimicrobial performance and microbial susceptibility. However, more extensive testing is required to substantiate this. CONFLICT OF INTEREST SLP is employed by Advanced Medical Solutions Ltd.
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Zhou H, Dou J, Wang J, Chen L, Wang H, Zhou W, Li Y, Zhou C. The antibacterial activity of BF-30 in vitro and in infected burned rats is through interference with cytoplasmic membrane integrity. Peptides 2011; 32:1131-8. [PMID: 21515321 DOI: 10.1016/j.peptides.2011.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/07/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
Abstract
Cathelicidin-BF (BF-30) is found in the venom of the snake Bungarus fasciatus and exhibits broad antimicrobial activity against bacteria and fungi. Nevertheless, its antibacterial activity in vivo and antibacterial mechanism is unknown. In the present study, we examined the antibacterial activity of BF-30 in vitro against drug-resistant Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, first identifying its protection against P. aeruginosa in infected burns and then delineating the antimicrobial mechanism of BF-30. The data showed that BF-30 had stronger antimicrobial activities against a broad spectrum of microorganisms than gentamicin, ampicillin or bacitracin. The killing curves of BF-30 against P. aeruginosa and S. aureus showed that CFU counts rapidly decreased by almost 2 logs within 6min, and it took just less than 2h to kill all the bacteria. In addition, we investigated whether BF-30 had antibacterial activity in a burn/acute infection rat model. Dose-response (0.75, 3, 12mg/kg/day) studies indicated that BF-30 significantly reduced the colonization of P. aeruginosa in the burn eschars, lungs and liver of burn injured rats and that it could prevent subsequent systemic infection and development of inflammation. The peptide induced chaotic membrane morphology and cell debris, as determined by electron microscopy, and caused the cytoplasmic membrane to crack, resulting in β-galactosidase leakage and EtBr accumulation. This suggests that the antimicrobial activity of BF-30 is based on cytoplasmic membrane permeability. Taken together, our data demonstrate that antibacterial activity of BF-30 has potential therapeutic value for the prevention and treatment of burn and wound infections.
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Affiliation(s)
- Huimin Zhou
- School of Life Science & Technology, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
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Jebur MS. Therapeutic efficacy of Lactobacillus acidophilus against bacterial isolates from burn wounds. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2010; 2:586-91. [PMID: 22558572 PMCID: PMC3338227 DOI: 10.4297/najms.2010.2586] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Probiotics are live microorganisms which are mainly strains of Lactobacillus spp., Bifidobacterium spp. When administered in adequate amounts, these microorganisms offer a health benefit for the host. Probiotic organisms are also available commercially in milk, sour milk, ice cream and other foods. AIMS To identify bacterial species isolated from burn wounds, and also to evaluate (In-vitro) the therapeutic efficacy of Lacto. acidophilus against these bacterial isolates. To compare this activity to other antibacterial agents which are used medically in the treatment of burn wound cases. MATERIALS AND METHODS Burn wound swabs were obtained from 50 patients who had been admitted to hospitals in Baghdad during August to November 2009. These swabs were inoculated onto enriched and differential culture media. Subcultures were performed on selective media. The necessary biochemical tests were conducted and the organisms identified using standard procedures. Susceptibility of isolated pathogens to local isolates Lacto. Acidophilus (with 1×10(8) cells/mL) and 10 commonly used burn wounds antibiotics was examined using standard susceptibility testing. RESULTS Ninety different organisms were isolated. Gram-positive cocci accounted for 16 (17.7%) and gram-negative bacilli for 74 (82.2%) bacterial isolates. Pseudomonas aeruginosa 30(33.3%) were the most commonly isolated organisms, followed by Escherichia coli, Enterobacter spp., Klebsiella spp., Proteus spp.(22.2,20,4.4,2.2%), respectively. Staphylococcus aureus isolates were performed in 8(8.8%). However, the incidence of Staphylococcus epidermidis was 2 (2.2%), while ß-haemolytic Streptococci was 4(4.4%). In susceptibility testing, Lacto. acidophilus had coverage against 90 (100%) of 74 gram-negative and 16 of gram-positive bacteria tested. The coverage of the remaining 10 antibacterial agents used was different in their activity (resistance or sensitivity), which ranged between 50-100%. CONCLUSION The results of the study concluded that lactobacillus acidophilus concentration of 1×10(8) cells/mL had a high activity to inhibit the growth in-vitro of all pathogenic gram-positive and gram-negative bacteria, which cause burn wound infections. This indicated the therapeutic efficacy of lactobacillus acidophilus bacteria.
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Chen Y, Yan L, Yuan T, Zhang Q, Fan H. Asymmetric polyurethane membrane with in situ-generated nano-TiO2 as wound dressing. J Appl Polym Sci 2010. [DOI: 10.1002/app.32813] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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