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Yang X, Li W, Liu Y, Cao N, He Y, Sun Q, Zhou S. Charged Fibrous Dressing to Promote Diabetic Chronic Wound Healing. Adv Healthc Mater 2024; 13:e2302183. [PMID: 37830231 DOI: 10.1002/adhm.202302183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/08/2023] [Indexed: 10/14/2023]
Abstract
Diabetic chronic wounds cause a significant amount of pain to patients because of their low cure rates and high recurrence rates. Traditional approaches to treating diabetic chronic wounds often involve the delivery of drugs or cytokines that regulate the microenvironment and eliminate bacterial infection in the wound area, but they are passive in controlling cell behaviors and may lead to drug resistance. Emerging drug-free wound treatments are important for convenient, effective, and safe treatment strategies. However, the current approaches cannot fully promote tissue regeneration or prevent bacterial infections. Here, the efficacy of a negatively charged fiber dressing in promoting diabetic chronic wound healing is investigated. The negatively charged fiber dressing can generate reactive oxygen species to inhibit bacterial reproduction with the assistance of ultrasound during the inflammatory phase. Furthermore, the dressing provides an electrostatic field that regulates cellular behavior during the inflammatory and proliferative phases. In particular, the dressing can promote fibroblast migration and induce macrophage polarization and neovascularization without any additional drugs. It is demonstrated that this strategy enables the healing of diabetic chronic wounds in a mouse model, achieving effective wound closure over a 12-day treatment cycle and providing a drug-free therapeutic strategy for diabetic chronic wound care.
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Affiliation(s)
- Xiaomeng Yang
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Wei Li
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Youmei Liu
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Ni Cao
- State Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Yang He
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Qiangqiang Sun
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Shaobing Zhou
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, China
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
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Teles F, Wang Y, Hajishengallis G, Hasturk H, Marchesan JT. Impact of systemic factors in shaping the periodontal microbiome. Periodontol 2000 2020; 85:126-160. [PMID: 33226693 DOI: 10.1111/prd.12356] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since 2010, next-generation sequencing platforms have laid the foundation to an exciting phase of discovery in oral microbiology as it relates to oral and systemic health and disease. Next-generation sequencing has allowed large-scale oral microbial surveys, based on informative marker genes, such as 16S ribosomal RNA, community gene inventories (metagenomics), and functional analyses (metatranscriptomics), to be undertaken. More specifically, the availability of next-generation sequencing has also paved the way for studying, in greater depth and breadth, the effect of systemic factors on the periodontal microbiome. It was natural to investigate systemic diseases, such as diabetes, in such studies, along with systemic conditions or states, , pregnancy, menopause, stress, rheumatoid arthritis, and systemic lupus erythematosus. In addition, in recent years, the relevance of systemic "variables" (ie, factors that are not necessarily diseases or conditions, but may modulate the periodontal microbiome) has been explored in detail. These include ethnicity and genetics. In the present manuscript, we describe and elaborate on the new and confirmatory findings unveiled by next-generation sequencing as it pertains to systemic factors that may shape the periodontal microbiome. We also explore the systemic and mechanistic basis for such modulation and highlight the importance of those relationships in the management and treatment of patients.
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Affiliation(s)
- Flavia Teles
- Department of Basic and Translational Sciences, Center for Innovation & Precision Dentistry, School of Dental Medicine & School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Yu Wang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Hajishengallis
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hatice Hasturk
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Julie T Marchesan
- Department of Comprehensive Oral Health, Periodontology, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Srivastava P, Sivashanmugam K. Combinatorial Drug Therapy for Controlling Pseudomonas aeruginosa and Its Association With Chronic Condition of Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2019; 19:7-20. [DOI: 10.1177/1534734619873785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus, major observations of DFU cases have reported on amputation of foot region, and microbial bioburden during DFU is a major cause that affects healing of the wound regions. Pathogenic microbes are routinely isolated from these wound regions, especially Staphylococcus, Pseudomonas, Klebsiella, and Escherichia coli have been reported, whereas higher prevalence of Pseudomonas species during chronic condition in the deeper part of the wound, when left untreated, leads to gangrene. Multiple drug-resistant Pseudomonas strains are a new threat because of their biofilm-forming ability, making it more potent and incurable. Acyl homoserine lactones (AHL) are a group of signaling molecules that can regulate biofilm growth, and Las and Rhl operon generally work in tandem to initiate biofilm formation by Pseudomonas species. These signaling molecules also initiate virulence factors that correlates upregulation of inflammatory responses, and AHL can be a therapeutic target in order to prevent the efficacy of multiple drug-resistant strains that form biofilm and also can be an alternative solution against control of multiple drug-resistant strains.
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Ganesan SM, Joshi V, Fellows M, Dabdoub SM, Nagaraja HN, O'Donnell B, Deshpande NR, Kumar PS. A tale of two risks: smoking, diabetes and the subgingival microbiome. ISME JOURNAL 2017; 11:2075-2089. [PMID: 28534880 PMCID: PMC5563960 DOI: 10.1038/ismej.2017.73] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 01/08/2023]
Abstract
Although smoking and diabetes have been established as the only two risk factors for periodontitis, their individual and synergistic impacts on the periodontal microbiome are not well studied. The present investigation analyzed 2.7 million 16S sequences from 175 non-smoking normoglycemic individuals (controls), smokers, diabetics and diabetic smokers with periodontitis as well as periodontally healthy controls, smokers and diabetics to assess subgingival bacterial biodiversity and co-occurrence patterns. The microbial signatures of periodontally healthy smokers, but not diabetics, were highly aligned with the disease-associated microbiomes of their respective cohorts. Diabetics were dominated by species belonging to Fusobacterium, Parvimonas, Peptostreptococcus, Gemella, Streptococcus, Leptotrichia, Filifactor, Veillonella, TM7 and Terrahemophilus. These microbiomes exhibited significant clustering based on HbA1c levels (pre-diabetic (<6.5%), diabetic (6.5–9.9%), diabetics >10%). Smokers with periodontitis evidenced a robust core microbiome (species identified in at least 80% of individuals) dominated by anaerobes, with inter-individual differences attributable largely to the ‘rare biosphere’. Diabetics and diabetic smokers, on the other hand, were microbially heterogeneous and enriched for facultative species. In smokers, microbial co-occurrence networks were sparse and predominantly congeneric, while robust inter-generic networks were observed in diabetics and diabetic smokers. Smoking and hyperglycemia impact the subgingival microbiome in distinct ways, and when these perturbations intersect, their synergistic effect is greater than what would be expected from the sum of each effect separately. Thus, this study underscores the importance of early intervention strategies in maintaining health-compatible microbiomes in high-risk individuals, as well as the need to personalize these interventions based on the environmental perturbation.
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Affiliation(s)
- Sukirth M Ganesan
- Division of Periodontology, College of Dentistry, The Ohio State University, Coloumbus, OH, USA
| | - Vinayak Joshi
- Maratha Mandal's NathajiRao G. Halgekar Institute of Dental Sciences and Research Center, Rajiv Gandhi University, Belgaum, India
| | - Megan Fellows
- Division of Periodontology, College of Dentistry, The Ohio State University, Coloumbus, OH, USA
| | - Shareef M Dabdoub
- Division of Periodontology, College of Dentistry, The Ohio State University, Coloumbus, OH, USA
| | | | - Benjamin O'Donnell
- Division of Endocrinology, Diabetes and Metabolism, The Wexner Medical Center, The Ohio State University, Coloumbus, OH, USA
| | - Neeta Rohit Deshpande
- Department of General Medicine, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences &Research Centre, Rajiv Gandhi University, Belgaum, India
| | - Purnima S Kumar
- Division of Periodontology, College of Dentistry, The Ohio State University, Coloumbus, OH, USA
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El Zowalaty ME, Al Thani AA, Webster TJ, El Zowalaty AE, Schweizer HP, Nasrallah GK, Marei HE, Ashour HM. Pseudomonas aeruginosa: arsenal of resistance mechanisms, decades of changing resistance profiles, and future antimicrobial therapies. Future Microbiol 2015; 10:1683-706. [PMID: 26439366 DOI: 10.2217/fmb.15.48] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Antimicrobial resistance is one of the most serious public health issues facing humans since the discovery of antimicrobial agents. The frequent, prolonged, and uncontrolled use of antimicrobial agents are major factors in the emergence of antimicrobial-resistant bacterial strains, including multidrug-resistant variants. Pseudomonas aeruginosa is a leading cause of nosocomial infections. The abundant data on the increased resistance to antipseudomonal agents support the need for global action. There is a paucity of new classes of antibiotics active against P. aeruginosa. Here, we discuss recent antibacterial resistance profiles and mechanisms of resistance by P. aeruginosa. We also review future potential methods for controlling antibiotic-resistant bacteria, such as phage therapy, nanotechnology and antipseudomonal vaccines.
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Affiliation(s)
- Mohamed E El Zowalaty
- Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA.,BioMedical Research Center, Qatar University, Doha, PO Box 2713, Qatar
| | - Asmaa A Al Thani
- BioMedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.,Department of Health Sciences, College of Arts and Sciences, Qatar University, Doha 2713, Qatar
| | - Thomas J Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA 02018, USA.,Center of Excellence for Advanced Materials Research, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed E El Zowalaty
- Department of Physiology & Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.,Interdisciplinary Toxicology Program, University of Georgia, Athens, GA 30602, USA
| | - Herbert P Schweizer
- Department of Molecular Genetics & Microbiology, College of Medicine, University of Florida, Gainesville, FL 32611, USA.,Emerging Pathogens Institute, Institute for Therapeutic Innovation, University of Florida Gainesville, FL 32611, USA
| | - Gheyath K Nasrallah
- BioMedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.,Department of Health Sciences, College of Arts and Sciences, Qatar University, Doha 2713, Qatar
| | - Hany E Marei
- BioMedical Research Center, Qatar University, Doha, PO Box 2713, Qatar
| | - Hossam M Ashour
- Department of Microbiology & Immunology, Faculty of Pharmacy, Cairo University, Egypt.,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
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Shankar EM, Vignesh R, Ellegård R, Barathan M, Chong YK, Bador MK, Rukumani DV, Sabet NS, Kamarulzaman A, Velu V, Larsson M. HIV-Mycobacterium tuberculosis co-infection: a 'danger-couple model' of disease pathogenesis. Pathog Dis 2013; 70:110-8. [PMID: 24214523 DOI: 10.1111/2049-632x.12108] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 12/11/2022] Open
Abstract
Tuberculosis (TB) and human immunodeficiency virus (HIV) infection interfere and impact the pathogenesis phenomena of each other. Owing to atypical clinical presentations and diagnostic complications, HIV/TB co-infection continues to be a menace for healthcare providers. Although the increased access to highly active antiretroviral therapy (HAART) has led to a reduction in HIV-associated opportunistic infections and mortality, the concurrent management of HIV/TB co-infection remains a challenge owing to adverse effects, complex drug interactions, overlapping toxicities and tuberculosis -associated immune reconstitution inflammatory syndrome. Several hypotheses have been put forward for the exacerbation of tuberculosis by HIV and vice versa supported by immunological studies. Discussion on the mechanisms produced by infectious cofactors with impact on disease pathology could shed light on how to design potential interventions that could decelerate disease progression. With no vaccine for HIV and lack of an effective vaccine for tuberculosis, it is essential to design strategies against HIV-TB co-infection.
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Affiliation(s)
- Esaki M Shankar
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Ramcharan A, Penders J, Smeets E, Rouflart M, Tiel FV, Bruggeman C, Baeten C, Breukink S, Tordoir J, Stobberingh E. Cross-sectional study on surveillance of surgical site infections after vascular surgery. Future Microbiol 2013; 8:1373-80. [DOI: 10.2217/fmb.13.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To determine the incidence and risk factors for surgical site infections (SSI) after vascular surgery, to evaluate the Dutch safety bundle to reduce adverse complications and to analyze causative microorganisms of SSIs. Materials & methods: The 3.5-year study was divided into two periods: the control period (before bundle implementation) and intervention period (after implementation). Postdischarge surveillance was performed until 30 days after surgery. Causative microorganisms from in-hospital wound swabs were determined. SSI rates between both periods were compared and a risk analysis was carried out by performing a logistic regression. Results: The study included 1719 operations. The in-hospital SSI rate increased significantly over time. Out of 140 SSIs, 39% were diagnosed postdischarge. Risk factors were diabetes, age >60 years and operations classified as contaminated or dirty. Pseudomonas aeruginosa susceptibility was the highest for gentamicin (97%). All Staphylococcus aureus were methicillin susceptible. Conclusion: As patient demographics are important to determine the effectiveness of infection preventive measures, (postdischarge) surveillance is important for developing SSI interventions.
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Affiliation(s)
- Amita Ramcharan
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - John Penders
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Ed Smeets
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Margriet Rouflart
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Frank van Tiel
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Cathrien Bruggeman
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Cor Baeten
- Maastricht University Medical Centre, Department of Surgery, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Stéphanie Breukink
- Maastricht University Medical Centre, Department of Surgery, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jan Tordoir
- Maastricht University Medical Centre, Department of Surgery, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ellen Stobberingh
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Arslan S, Eyi A, Özdemir F. Spoilage potentials and antimicrobial resistance of Pseudomonas spp. isolated from cheeses. J Dairy Sci 2012; 94:5851-6. [PMID: 22118075 DOI: 10.3168/jds.2011-4676] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 09/03/2011] [Indexed: 11/19/2022]
Abstract
Pseudomonas spp. are aerobic, gram-negative bacteria that are recognized as major food spoilage microorganisms. A total of 32 (22.9%) Pseudomonas spp. from 140 homemade white cheese samples collected from the open-air public bazaar were isolated and characterized. The aim of the present study was to investigate the biochemical characteristics, the production of extracellular enzymes, slime and β-lactamase, and antimicrobial susceptibility of Pseudomonas spp. isolated from cheeses. The identified isolates including Pseudomonas pseudoalcaligenes, Pseudomonas alcaligenes, Pseudomonas aeruginosa, Pseudomonas fluorescens biovar V, and P. pseudoalcaligenes ssp. citrulli were found to produce extracellular enzymes, respectively: protease and lecithinase production (100%), and lipase activity (85.7, 42.9, 100, and 100%, and nonlipolytic, respectively). The isolates did not produce slime and had no detectable β-lactamase activity. The antimicrobial susceptibility of the isolates was tested using the disk diffusion method. Pseudomonas spp. had the highest resistance to penicillin G (100%), then sulphamethoxazole/trimethoprim (28.1%). However, all Pseudomonas spp. isolates were 100% susceptible to ceftazidime, ciprofloxacin, amikacin, gentamicin, and imipenem. Multidrug-resistance patterns were not observed among these isolates. In this study, Pseudomonas spp., exhibiting spoilage features, were isolated mainly from cheeses. Isolation of this organism from processed milk highlights the need to improve the hygienic practices. All of the stages in the milk processing chain during manufacturing have to be under control to achieve the quality and safety of dairy products.
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Affiliation(s)
- S Arslan
- Abant Izzet Baysal University, Faculty of Arts and Sciences, Department of Biology, 14280 Gölköy/Bolu, Turkey.
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Singh SK, Gupta K, Tiwari S, Shahi SK, Kumar S, Kumar A, Gupta SK. Detecting aerobic bacterial diversity in patients with diabetic foot wounds using ERIC-PCR: a preliminary communication. INT J LOW EXTR WOUND 2010; 8:203-8. [PMID: 19934183 DOI: 10.1177/1534734609353080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The polymicrobial nature of diabetic foot infection is a reflection of the immune compromised state of the host.The methods of microbial identification based on colony morphology and biochemical characteristics have limitations as they may not differentiate the diverse microorganisms that infect foot wounds. The aim of the present study was to find out the bacterial diversity in diabetic foot infections at genetic level by finger printing, that is, ERIC-PCR (enterobacterial repetitive intergenic consensus -polymerase chain reaction). Nine patients with infected diabetic foot ulcers were recruited to the study. Pus and tissue samples were collected from the wound site. Aerobic bacteria were isolated employing standard microbiological culture methods and their genetic variability was analyzed using the ERIC-PCR. Sensitivity test for these isolates against commonly used antibiotics were performed using disc diffusion method. The standard microbiological culture technique yielded 38 morphotypes of bacteria and their genetic diversity was confirmed by ERIC-PCR assay. Analysis of the similarity index using NTSYSpc 2.1 software revealed 34 types of banding pattern among these isolates. Based on the similarity index these isolates were divided into 7 groups. As many as 8 types of aerobic bacterial isolates were detected from a single patient using the above technique compared with 2 on routine culture analysis. Genetically diverse isolates showed differential sensitivity pattern against commonly used antibiotics in the assay. The observed diversity at genetic level is attributed to variable sensitivity pattern of these isolates against the class of antibiotics. A molecular technique such as ERIC-PCR is a more sensitive detection method than conventional techniques, the potential of which needs to be fully understood.
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Brahmi N, Blel Y, Kouraichi N, Lahdhiri S, Thabet H, Hedhili A, Amamou M. Impact of ceftazidime restriction on gram-negative bacterial resistance in an intensive care unit. J Infect Chemother 2006; 12:190-4. [PMID: 16944257 DOI: 10.1007/s10156-006-0452-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 05/24/2006] [Indexed: 12/18/2022]
Abstract
The present study included three periods: (1) a 12-month pre-restriction and control period in 2001; (2) a 12-month restriction period with reduced ceftazidime prescribing in favor of piperacillin-tazobactam (2002); (3) and a 24 month post-restriction period (2003-2004). Note that, for results, P represents the difference between 2002 and 2001; P', the difference between 2003 and 2001; and P'', the difference between 2004 and 2001. No changes in hygiene practices were observed during these three periods. The purpose of this study was to assess the effect of reducing ceftazidime use in an intensive care unit (ICU) upon Gram-negative bacterial resistance, particularly as regards Pseudomonas aeruginosa. During the three periods of the study, patients were similar concerning age, Simplified Acute Physiology Score (SAPSII), the site of nosocomial infection, and the requirements for mechanical ventilation (75% in 2001, 76% in 2002, 74% in 2003, and 85% in 2004). The most commonly isolated pathogens were P. aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae. The use of ceftazidime decreased significantly from 12.6% in 2001 to 9% in 2002, to 3% in 2003 (P' = 0.0009), and 2.6% in 2004 (P'' = 0.0001) in favor of piperacillin-tazobactam (0% 2001 to 3.7% in 2003; P' = 0.002; and 5% in 2004; P'' = 0.0001). Simultaneously, we observed a significant decrease in isolates of P. aeruginosa resistant to piperacillin-tazobactam (P = 0.03; P' = 0.004; P'' = 0.009), and those resistant to imipenem in 2003 (P' = 0.008). We also noted a significant decrease in A. baumannii isolates resistant to ceftazidime (P' = 0.01; P'' = 0.0004) and those resistant to imipenem in both 2002 and 2004 (P = 0.03; P'' = 0.04), and a considerable decrease in isolates of Klebsiella pneumoniae producing expanded spectrum betalactamase (ESBL) in 2003 and 2004 (P' = 0.04; P'' = 6.10(-5)). In contrast, we noted an increase in penicillinase-producing isolates of K. pneumoniae, from 6% in 2001 to 16% in 2002 (p = 0.01), 20% in 2003 (P' = 0.001), and 32% in 2004 (P'' = 10(-6)). We concluded that restriction of ceftazidime use was demonstrated to be efficient in reducing antimicrobial resistance, especially to K. pneumoniae ESBL.
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Affiliation(s)
- Nozha Brahmi
- Department of Intensive Care Medicine, Centre d'Assistance Medicale Urgente (CAMU), 2 Rue Raspail, 1008 Montfleury, Tunis, Tunisia.
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