1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Deplazes BC, Hofmaenner DA, Scheier TC, Epprecht J, Mayer M, Schweizer TA, Buehler PK, Frey PM, Brugger SD. Enzymatic debridement with bromelain and development of bacteremia in burn injuries: A retrospective cohort study. Burns 2024; 50:405-412. [PMID: 38182450 DOI: 10.1016/j.burns.2023.12.005] [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: 07/25/2023] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Debridement is crucial for effective wound management in patients with severe burn injuries, and bromelain, a proteolytic enzyme from pineapple stems, has emerged as a promising alternative for surgery. However, potential links of bromelain use to fever and sepsis have raised some concerns. Given the uncertainty as to whether this was caused by infection or other inflammatory sources, we aimed to investigate if the use of topical bromelain was associated with bacteremia. METHODS This single-centre retrospective cohort study included critically ill adult patients with severe burn injuries hospitalised at the Burn Center of the University Hospital Zurich between January 2017 and December 2021. Data were collected from two in-hospital electronic medical records databases. Our primary outcome, the association between topical bromelain treatment and the development of bacteremia, was investigated using a competing risk regression model, taking into account the competing risk of death. As a secondary outcome, the relationship between bromelain treatment and overall ICU mortality was examined using a Cox proportional hazards model. RESULTS The study included 269 patients with a median age of 50 years and median burnt total body surface area of 19%. A first bacteremia occurred in 61 patients (23%) after a median time of 6 days. Bromelain treatment was given to 83 (31%) of patients, with 22 (27%) of these developing bacteremia. In the fully adjusted competing risk regression model, no evidence for an association between bromelain treatment and bacteremia was found (SHR 0.79, 95%CI 0.42-1.48, p = 0.47). During hospital stay, 40 (15%) of patients died. There was no significant difference in mortality between patients treated with bromelain and those who were not (HR 0.55, 95%CI 0.26-1.20, p = 0.14). Among the five multidrug-resistant (MDR) pathogens identified, three were found in patients with bromelain treatment. CONCLUSION Our study did not confirm an association between topical bromelain and bacteremia in patients with severe burn injuries. This finding can inform evidence-based practices by addressing concerns about potential risks of bromelain use, contributing to the development of more effective and safe burn wound management strategies.
Collapse
Affiliation(s)
- Barla C Deplazes
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jana Epprecht
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michelle Mayer
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tiziano A Schweizer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Intensive Care Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Pascal M Frey
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Moon AY, Bailey EJ, Polanco JA, Kurata WE, Pierce LM. Antibacterial Efficacy of a Chitosan-Based Hydrogel Modified With Epsilon-Poly-l-Lysine Against Pseudomonas aeruginosa in a Murine-Infected Burn Wound Model. Mil Med 2023; 188:52-60. [PMID: 37948238 DOI: 10.1093/milmed/usad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Because antibiotic resistance is increasing worldwide and the leading cause of death in burn patients is an infection, an urgent need exists for nonantibiotic approaches to eliminate multidrug-resistant bacteria from burns to prevent their systemic dissemination and sepsis. We previously demonstrated the significant antibiofilm activity of a chitosan (CS) hydrogel containing the antimicrobial peptide epsilon-poly-l-lysine (EPL) against multidrug-resistant Pseudomonas aeruginosa using ex vivo porcine skin. In this study, we evaluated the in vivo antibacterial efficacy of a CS/EPL hydrogel against P. aeruginosa in a murine burn wound infection model. MATERIALS AND METHODS Full-thickness burns were created on the dorsum using a heated brass rod and were inoculated with bioluminescent, biofilm-forming P. aeruginosa (Xen41). Mice were treated with CS/EPL, CS, or no hydrogel applied topically 2 or 24 hours after inoculation to assess the ability to prevent or eradicate existing biofilms, respectively. Dressing changes occurred daily for 3 days, and in vivo bioluminescence imaging was performed to detect and quantitate bacterial growth. Blood samples were cultured to determine systemic infection. In vitro antibacterial activity and cytotoxicity against human primary dermal fibroblasts, keratinocytes, and mesenchymal stem cells were also assessed. RESULTS CS/EPL treatment initiated at early or delayed time points showed a significant reduction in bioluminescence imaging signal compared to CS on days 2 and 3 of treatment. Mice administered CS/EPL had fewer bloodstream infections, lower weight loss, and greater activity than the untreated and CS groups. CS/EPL reduced bacterial burden by two orders of magnitude in vitro and exhibited low cytotoxicity against human cells. CONCLUSION A topical hydrogel delivering the antimicrobial peptide EPL demonstrates in vivo efficacy to reduce but not eradicate established P. aeruginosa biofilms in infected burn wounds. This biocompatible hydrogel shows promise as an antimicrobial barrier dressing for the sustained protection of burn wounds from external bacterial contamination.
Collapse
Affiliation(s)
- Andrea Y Moon
- Department of General Surgery, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Emily J Bailey
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Jonilee A Polanco
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Wendy E Kurata
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Lisa M Pierce
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| |
Collapse
|
4
|
Abstract
Infections are the leading cause of mortality in burn patients who survive their initial resuscitation. Burn injury leads to immunosuppression and a dysregulated inflammatory response which can have a prolonged impact. Early surgical excision along with support of the multidisciplinary burn team has improved mortality in burn patients. The authors review diagnostic and therapeutic challenges as well as strategies for management of burn related infections.
Collapse
|
5
|
Francisco P, Neves Amaral M, Neves A, Ferreira-Gonçalves T, Viana AS, Catarino J, Faísca P, Simões S, Perdigão J, Charmier AJ, Gaspar MM, Reis CP. Pluronic® F127 Hydrogel Containing Silver Nanoparticles in Skin Burn Regeneration: An Experimental Approach from Fundamental to Translational Research. Gels 2023; 9:gels9030200. [PMID: 36975649 PMCID: PMC10048756 DOI: 10.3390/gels9030200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Presently, skin burns are considered one of the main public health problems and lack therapeutic options. In recent years, silver nanoparticles (AgNPs) have been widely studied, playing an increasingly important role in wound healing due to their antibacterial activity. This work is focused on the production and characterization of AgNPs loaded in a Pluronic® F127 hydrogel, as well as assessing its antimicrobial and wound-healing potential. Pluronic® F127 has been extensively explored for therapeutic applications mainly due to its appealing properties. The developed AgNPs had an average size of 48.04 ± 14.87 nm (when prepared by method C) and a negative surface charge. Macroscopically, the AgNPs solution presented a translucent yellow coloration with a characteristic absorption peak at 407 nm. Microscopically, the AgNPs presented a multiform morphology with small sizes (~50 nm). Skin permeation studies revealed that no AgNPs permeated the skin after 24 h. AgNPs further demonstrated antimicrobial activity against different bacterial species predominant in burns. A chemical burn model was developed to perform preliminary in vivo assays and the results showed that the performance of the developed AgNPs loaded in hydrogel, with smaller silver dose, was comparable with a commercial silver cream using higher doses. In conclusion, hydrogel-loaded AgNPs is potentially an important resource in the treatment of skin burns due to their proven efficacy by topical administration.
Collapse
Affiliation(s)
- Pedro Francisco
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Mariana Neves Amaral
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
- Instituto de Biofísica e Engenharia Biomédica (IBEB), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - Afonso Neves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Tânia Ferreira-Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
- Instituto de Biofísica e Engenharia Biomédica (IBEB), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - Ana S. Viana
- Centro de Química Estrutural, Institute of Molecular Sciences, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal
| | - José Catarino
- Faculdade de Medicina Veterinária, Universidade Lusoófona de Humanidades e Tecnologias, 1749-024 Lisbon, Portugal
| | - Pedro Faísca
- Faculdade de Medicina Veterinária, Universidade Lusoófona de Humanidades e Tecnologias, 1749-024 Lisbon, Portugal
- CBIOS—Research Center for Biosciences & Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisbon, Portugal
| | - Sandra Simões
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - João Perdigão
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Adília J. Charmier
- DREAMS, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisbon, Portugal
| | - M. Manuela Gaspar
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Catarina Pinto Reis
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
- Instituto de Biofísica e Engenharia Biomédica (IBEB), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
- Correspondence: ; Tel.: +351-217-946-429 (ext. 14244)
| |
Collapse
|
6
|
Herrera KM, Lopes GF, Oliveira ME, Sousa JF, Lima WG, Silva FK, Brito JC, Gomes AJPS, Viana GH, Soares AC, Ferreira JM. A 3-alkylpyridine-bearing alkaloid exhibits potent antimicrobial activity against methicillin-resistant Staphylococcus aureus (MRSA) with no detectable resistance. Microbiol Res 2022; 261:127073. [DOI: 10.1016/j.micres.2022.127073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/25/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
|
7
|
Lu P, Holden D, Padiglione A, Cleland H. Perioperative antibiotic prophylaxis in Australian burns patients. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Perioperative antibiotic prophylaxis is perceived to reduce intraoperative bacteraemia and prevent surgical site infections, however, the evidence for its use in burns surgery is limited. Excessive use of perioperative antibiotics has become a growing concern. The authors aimed to audit the prescribing practices of perioperative antibiotic prophylaxis at the Victorian Adult Burns Service and determine whether the duration of antibiotic prophylaxis influenced the risk of postoperative wound infection, bacte-raemia and antibiotic resistance.
Methods: This retrospective chart review included all acute adult burns patients who had an operation between November 2018 and November 2019. Basic demographic data, burn specific data and data on perioperative antibiotic use were collected. The outcome measures were wound infection, bacteraemia, other infections and presence of resistant organisms.
Results: Results demonstrated that almost all patients (98.6%) received perioperative antibiotic prophylax-is. In comparison, there was no significant difference between the rate of postoperative wound infection, bacteraemia or antibiotic resistance between patients receiving a short or long course of antibiotics.
Conclusion: The results of our study demonstrate variable use of perioperative antibiotic prophylaxis with-in one burns unit. There were many cases of unsubstantiated use of long courses of antibiotics without apparent benefit for clinical outcomes of wound infection or bacteraemia. With the growing concern over antibiotic overuse and development of resistance, there is an increasing need for development of clear guidelines for antibiotic use in burns surgery.
Collapse
|
8
|
Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
|
9
|
Dawson KA, Mickelson MA, Blong AE, L Walton RA. Management of severe burn injuries with novel treatment techniques including maggot debridement and applications of acellular fish skin grafts and autologous skin cell suspension in a dog. J Am Vet Med Assoc 2022; 260:428-435. [PMID: 34843435 DOI: 10.2460/javma.20.10.0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital's intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal's total body surface area.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Ramalingam R, Dhand C, Mayandi V, Leung CM, Ezhilarasu H, Karuppannan SK, Prasannan P, Ong ST, Sunderasan N, Kaliappan I, Kamruddin M, Barathi VA, Verma NK, Ramakrishna S, Lakshminarayanan R, Arunachalam KD. Core-Shell Structured Antimicrobial Nanofiber Dressings Containing Herbal Extract and Antibiotics Combination for the Prevention of Biofilms and Promotion of Cutaneous Wound Healing. ACS APPLIED MATERIALS & INTERFACES 2021; 13:24356-24369. [PMID: 34024104 DOI: 10.1021/acsami.0c20642] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Burn wounds are susceptible to microbial invasion from both resident and exogenous bacteria, which becomes a critical public health issue and causes substantial economic burden. There is a perceived demand to produce new antimicrobial wound dressings that hinder bacterial colonization while accelerating the healing process and hence would provide an improved standard of care for patients. Since ancient times, herbal extracts from medicinally important plants have extensively been used for treating burn injuries. This work reports the utility of electrospun nanofibers containing plant extracts and antibiotics combination as a multifunctional scaffold for treating second-degree burns. First, we determined the various components of plant extracts from Gymnema sylvestre by two different processing methods and their synergism with minocycline antibiotics. Then, we prepared core-shell nanofibrous dressings with poly-ε-caprolactone/gelatin laden with minocycline hydrochloride as a shell and gelatin infused with G. sylvestre extracts (ultrasound-assisted extracts and cold macerated extracts) as the core using coaxial electrospinning. The electrospun nanofibers displayed a smooth, continuous, and bead-free morphology with adequate wettability. The presence of extract components in the core-shell nanofibers resulted in enhanced mechanical properties when compared to pristine mats. The core-shell structures resulted in sustained release of the bioactive components when compared to nanofiber blends. Core-shell nanofiber mats containing plant extracts and antibiotic combinations displayed potent antimicrobial and antibiofilm properties while promoting the spread and proliferation of skin cells when compared to pristine mats. In a porcine model of cutaneous second-degree burns, we showed that wounds treated with the antimicrobial dressing improved re-epithelialization and collagen organization in comparison to untreated wounds.
Collapse
Affiliation(s)
- Raghavendra Ramalingam
- Center for Environmental Nuclear Research, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu 603203, India
- Department of Physics and Nanotechnology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu 603203, India
- Center for Nanofibers and Nanotechnology, Department of Mechanical Engineering, Faculty of Engineering, 2 Engineering Drive 3, National University of Singapore, 117576, Singapore
| | - Chetna Dhand
- Ocular Infections & Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856, Singapore
- Industrial Waste Utilization, Nano and Biomaterials, CSIR-Advanced Materials and Processes Research Institute (CSIR-AMPRI), Bhopal, Madhya Pradesh 462026, India
| | - Venkatesh Mayandi
- Ocular Infections & Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856, Singapore
- School of Biological Sciences, Nanyang Technological University Singapore, 60 Nanyang Drive, Singapore 637551, Singapore
| | - Chak Ming Leung
- Department of Biomedical Engineering, National University of Singapore, 117581, Singapore
- NUS Graduate School for Integrative Sciences & Engineering, National University of Singapore, 117456, Singapore
| | - Hariharan Ezhilarasu
- Center for Nanofibers and Nanotechnology, Department of Mechanical Engineering, Faculty of Engineering, 2 Engineering Drive 3, National University of Singapore, 117576, Singapore
| | - Sathish Kumar Karuppannan
- Center for Environmental Nuclear Research, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu 603203, India
| | - Praseetha Prasannan
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Seow Theng Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Nandhini Sunderasan
- Interdiscipilinary Institute of Indian System of Medicine, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu (Dt), Tamil Nadu 603203, India
| | - Ilango Kaliappan
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu (Dt), Tamil Nadu 603203, India
| | - Mohammed Kamruddin
- Materials Physics Division, Material Science Group, Indira Gandhi Centre for Atomic Research, Kalpakkam, Tamilnadu 603102, India
| | - Veluchamy Amutha Barathi
- Ocular Infections & Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228, Singapore
| | - Navin Kumar Verma
- Ocular Infections & Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
- Skin Research Institute of Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Seeram Ramakrishna
- Center for Nanofibers and Nanotechnology, Department of Mechanical Engineering, Faculty of Engineering, 2 Engineering Drive 3, National University of Singapore, 117576, Singapore
| | - Rajamani Lakshminarayanan
- Ocular Infections & Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857, Singapore
- Department of Pharmacy, National University of Singapore, 18 Science Drive, 117543, Singapore
| | - Kantha Deivi Arunachalam
- Center for Environmental Nuclear Research, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu 603203, India
| |
Collapse
|
12
|
Interplay between ESKAPE Pathogens and Immunity in Skin Infections: An Overview of the Major Determinants of Virulence and Antibiotic Resistance. Pathogens 2021; 10:pathogens10020148. [PMID: 33540588 PMCID: PMC7912840 DOI: 10.3390/pathogens10020148] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
The skin is the largest organ in the human body, acting as a physical and immunological barrier against pathogenic microorganisms. The cutaneous lesions constitute a gateway for microbial contamination that can lead to chronic wounds and other invasive infections. Chronic wounds are considered as serious public health problems due the related social, psychological and economic consequences. The group of bacteria known as ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter sp.) are among the most prevalent bacteria in cutaneous infections. These pathogens have a high level of incidence in hospital environments and several strains present phenotypes of multidrug resistance. In this review, we discuss some important aspects of skin immunology and the involvement of ESKAPE in wound infections. First, we introduce some fundamental aspects of skin physiology and immunology related to cutaneous infections. Following this, the major virulence factors involved in colonization and tissue damage are highlighted, as well as the most frequently detected antimicrobial resistance genes. ESKAPE pathogens express several virulence determinants that overcome the skin's physical and immunological barriers, enabling them to cause severe wound infections. The high ability these bacteria to acquire resistance is alarming, particularly in the hospital settings where immunocompromised individuals are exposed to these pathogens. Knowledge about the virulence and resistance markers of these species is important in order to develop new strategies to detect and treat their associated infections.
Collapse
|
13
|
Steele A, Stacey HJ, de Soir S, Jones JD. The Safety and Efficacy of Phage Therapy for Superficial Bacterial Infections: A Systematic Review. Antibiotics (Basel) 2020; 9:E754. [PMID: 33138253 PMCID: PMC7692203 DOI: 10.3390/antibiotics9110754] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022] Open
Abstract
Superficial bacterial infections, such as dermatological, burn wound and chronic wound/ulcer infections, place great human and financial burdens on health systems globally and are often complicated by antibiotic resistance. Bacteriophage (phage) therapy is a promising alternative antimicrobial strategy with a 100-year history of successful application. Here, we report a systematic review of the safety and efficacy of phage therapy for the treatment of superficial bacterial infections. Three electronic databases were systematically searched for articles that reported primary data about human phage therapy for dermatological, burn wound or chronic wound/ulcer infections secondary to commonly causative bacteria. Two authors independently assessed study eligibility and performed data extraction. Of the 27 eligible reports, eight contained data on burn wound infection (n = 156), 12 on chronic wound/ulcer infection (n = 327) and 10 on dermatological infections (n = 1096). Cautionary pooled efficacy estimates from the studies that clearly reported efficacy data showed clinical resolution or improvement in 77.5% (n = 111) of burn wound infections, 86.1% (n = 310) of chronic wound/ulcer infections and 94.14% (n = 734) of dermatological infections. Over half of the reports that commented on safety (n = 8/15), all published in or after 2002, did not express safety concerns. Seven early reports (1929-1987), described adverse effects consistent with the administration of raw phage lysate and co-administered bacterial debris or broth. This review strongly suggests that the use of purified phage to treat superficial bacterial infections can be highly effective and, by various routes of administration, is safe and without adverse effects.
Collapse
Affiliation(s)
- Angharad Steele
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK;
| | - Helen J. Stacey
- Edinburgh Medical School, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK;
| | - Steven de Soir
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Rue Bruyn, 1120 Brussels, Belgium;
- Cellular & Molecular Pharmacology, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), avenue E. Mounier 73, 1200 Brussels, Belgium
| | - Joshua D. Jones
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK;
| |
Collapse
|
14
|
De Maesschalck V, Gutiérrez D, Paeshuyse J, Lavigne R, Briers Y. Advanced engineering of third-generation lysins and formulation strategies for clinical applications. Crit Rev Microbiol 2020; 46:548-564. [PMID: 32886565 DOI: 10.1080/1040841x.2020.1809346] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the possible solutions for the current antibiotic resistance crisis may be found in (often bacteriophage-derived) peptidoglycan hydrolases. The first clinical trials of these natural enzymes, coined here as first-generation lysins, are currently ongoing. Moving beyond natural endolysins with protein engineering established the second generation of lysins. In second-generation lysins, the focus lies on improving antibacterial and biochemical properties such as antimicrobial activity and stability, as well as expanding their activities towards Gram-negative pathogens. However, solutions to particular key challenges regarding clinical applications are only beginning to emerge in the third generation of lysins, in which protein and biochemical engineering efforts focus on improving properties relevant under clinical conditions. In addition, increasingly advanced formulation strategies are developed to increase the bioavailability, antibacterial activity, and half-life, and to reduce pro-inflammatory responses. This review focuses on third-generation and advanced formulation strategies that are developed to treat infections, ranging from topical to systemic applications. Together, these efforts may fully unlock the potential of lysin therapy and will propel it as a true antibiotic alternative or supplement.
Collapse
Affiliation(s)
- Vincent De Maesschalck
- Department of Biosystems, KU Leuven, Leuven, Belgium.,Department of Biotechnology, Ghent University, Gent, Belgium
| | - Diana Gutiérrez
- Department of Biotechnology, Ghent University, Gent, Belgium
| | - Jan Paeshuyse
- Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Rob Lavigne
- Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Yves Briers
- Department of Biotechnology, Ghent University, Gent, Belgium
| |
Collapse
|
15
|
Mayandi V, Wen Choong AC, Dhand C, Lim FP, Aung TT, Sriram H, Dwivedi N, Periayah MH, Sridhar S, Fazil MHUT, Goh ETL, Orive G, W Beuerman R, Barkham TMS, Loh XJ, Liang ZX, Barathi VA, Ramakrishna S, Chong SJ, Verma NK, Lakshminarayanan R. Multifunctional Antimicrobial Nanofiber Dressings Containing ε-Polylysine for the Eradication of Bacterial Bioburden and Promotion of Wound Healing in Critically Colonized Wounds. ACS APPLIED MATERIALS & INTERFACES 2020; 12:15989-16005. [PMID: 32172559 DOI: 10.1021/acsami.9b21683] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bacterial colonization of acute and chronic wounds is often associated with delayed wound healing and prolonged hospitalization. The rise of multi-drug resistant bacteria and the poor biocompatibility of topical antimicrobials warrant safe and effective antimicrobials. Antimicrobial agents that target microbial membranes without interfering with the mammalian cell proliferation and migration hold great promise in the treatment of traumatic wounds. This article reports the utility of superhydrophilic electrospun gelatin nanofiber dressings (NFDs) containing a broad-spectrum antimicrobial polymer, ε-polylysine (εPL), crosslinked by polydopamine (pDA) for treating second-degree burns. In a porcine model of partial thickness burns, NFDs promoted wound closure and reduced hypertrophic scarring compared to untreated burns. Analysis of NFDs in contact with the burns indicated that the dressings trap early colonizers and elicit bactericidal activity, thus creating a sterile wound bed for fibroblasts migration and re-epithelialization. In support of these observations, in porcine models of Pseudomonas aeruginosa and Staphylococcus aureus colonized partial thickness burns, NFDs decreased bacterial bioburden and promoted wound closure and re-epithelialization. NFDs displayed superior clinical outcome than standard-of-care silver dressings. The excellent biocompatibility and antimicrobial efficacy of the newly developed dressings in pre-clinical models demonstrate its potential for clinical use to manage infected wounds without compromising tissue regeneration.
Collapse
Affiliation(s)
- Venkatesh Mayandi
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- School of Biological Sciences, Nanyang Technological University Singapore, 60 Nanyang Drive, 637551 Singapore
| | - Alvin Chua Wen Choong
- Department of Plastic Reconstructive & Aesthetic Surgery, Singapore General Hospital, 20 College Road, 169856 Singapore
- Skin Bank Unit, Singapore General Hospital, 169608 Singapore
| | - Chetna Dhand
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
| | - Fui Ping Lim
- Alice Lee Centre for Nursing Studies, National University of Singapore, 117597 Singapore
| | - Thet Tun Aung
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Department of Microbiology and Immunology, National University of Singapore, 119077 Singapore
| | - Harini Sriram
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Neeraj Dwivedi
- Department of Electrical and Computer Engineering, National University of Singapore, 117583 Singapore
| | - Mercy Halleluyah Periayah
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Sreepathy Sridhar
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Mobashar Hussain Urf Turabe Fazil
- Lee Kong Chian School of Medicine, Clinical Sciences Building, Nanyang Technological University Singapore, 11 Mandalay Road, 308232 Singapore
| | - Eunice Tze Leng Goh
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz 01006, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria 01006, Spain
| | - Roger W Beuerman
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
| | | | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 138634 Singapore
| | - Zhao-Xun Liang
- School of Biological Sciences, Nanyang Technological University Singapore, 60 Nanyang Drive, 637551 Singapore
| | - Veluchamy Amutha Barathi
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
| | - Seeram Ramakrishna
- Center for Nanofibers & Nanotechnology, National University of Singapore, 119077 Singapore
| | - Si Jack Chong
- Department of Plastic Reconstructive & Aesthetic Surgery, Singapore General Hospital, 20 College Road, 169856 Singapore
- Skin Bank Unit, Singapore General Hospital, 169608 Singapore
| | - Navin Kumar Verma
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Lee Kong Chian School of Medicine, Clinical Sciences Building, Nanyang Technological University Singapore, 11 Mandalay Road, 308232 Singapore
- Skin Research Institute of Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232 Singapore
| | - Rajamani Lakshminarayanan
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
- Department of Pharmacy, National University of Singapore, 18 Science Drive, 117543 Singapore
| |
Collapse
|
16
|
Microbiology and clinical characteristics of industrial oil burns. Burns 2019; 46:711-717. [PMID: 31761453 DOI: 10.1016/j.burns.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/14/2019] [Accepted: 10/02/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Infections complicating burns generally transition from Gram-positive to Gram-negatives over the first couple weeks, but this depends on multiple factors. The microbiology of infections complicating crude oil (CO) and hydraulic fracturing (FRAC) burns is unknown. METHODS We performed a retrospective study of patients with industrial thermal burns hospitalized >2 days with ≥1 day in the ICU between 4/2011-11/2016. Burns were oil-related (ORB; CO or FRAC) or non-oil related (NORB). Epidemiology and microbiology during the first 15 hospital days was compared. RESULTS 149 patients were included, with 11 FRAC and 24 CO. CO burns were more severely burned than those with FRAC and NORB (p<0.05). Mortality was 17% and 18% for CO and FRAC burns compared to 3% in NORB (p<0.01). More cultures were obtained from ORB than NORB (p<0.05). ORB were associated with Stenotrophomonas maltophilia and FRAC associated with Serratia marcescens and Candida glabrata. Patients with FRAC, CO and NORB had a median of 13, 3.5, and 4 days to first positive culture respectively (p=0.03). CONCLUSION ORB were associated with more severe burns and unique microbiology. FRAC burns had longer to initial positive culture, potentially suggesting our current methodology is inadequate to diagnose infections associated with FRAC.
Collapse
|
17
|
Bekeschus S, Seebauer C, Wende K, Schmidt A. Physical plasma and leukocytes - immune or reactive? Biol Chem 2019; 400:63-75. [PMID: 30030959 DOI: 10.1515/hsz-2018-0224] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022]
Abstract
Leukocytes are professionals in recognizing and removing pathogenic or unwanted material. They are present in virtually all tissues, and highly motile to enter or leave specific sites throughout the body. Less than a decade ago, physical plasmas entered the field of medicine to deliver their delicate mix of reactive species and other physical agents for mainly dermatological or oncological therapy. Plasma treatment thus affects leukocytes via direct or indirect means: immune cells are either present in tissues during treatment, or infiltrate or exfiltrate plasma-treated areas. The immune system is crucial for human health and resolution of many types of diseases. It is therefore vital to study the response of leukocytes after plasma treatment in vitro and in vivo. This review gathers together the major themes in the plasma treatment of innate and adaptive immune cells, and puts these into the context of wound healing and oncology, the two major topics in plasma medicine.
Collapse
Affiliation(s)
- Sander Bekeschus
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), ZIK plasmatis, Felix-Hausdorff-Str. 2, D-17489 Greifswald, Germany
| | - Christian Seebauer
- Greifswald University Medical Center, Department of Oral and Maxillofacial Surgery/Plastic Surgery, Ferdinand-Sauerbruch-Str. DZ 7, D-17475 Greifswald, Germany
| | - Kristian Wende
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), ZIK plasmatis, Felix-Hausdorff-Str. 2, D-17489 Greifswald, Germany
| | - Anke Schmidt
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), ZIK plasmatis, Felix-Hausdorff-Str. 2, D-17489 Greifswald, Germany
| |
Collapse
|
18
|
Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial. Burns 2019; 45:1401-1409. [PMID: 31230798 DOI: 10.1016/j.burns.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm®, Mölnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex® Ag, Mölnlycke Health Care, Gothenburg, Sweden). METHODS We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. RESULTS The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). CONCLUSIONS We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group.
Collapse
|
19
|
Kalligeros M, Shehadeh F, Karageorgos SA, Zacharioudakis IM, Mylonakis E. MRSA colonization and acquisition in the burn unit: A systematic review and meta-analysis. Burns 2019; 45:1528-1536. [PMID: 31202530 DOI: 10.1016/j.burns.2019.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most commonly encountered bacteria in the burn unit. In order to investigate the magnitude of this challenge, we assessed the prevalence of MRSA colonization on admission and the incidence of MRSA acquisition within burn units. METHODS We searched PubMed and EMBASE for studies reporting MRSA colonization among patients admitted in burn units. RESULTS We identified 16 articles that fulfilled our inclusion criteria and found an overall pooled prevalence of MRSA colonization upon the first 72 h of admission (colonization on admission) to the burn unit of 4.1% (95% CI: 2.7%-5.7%). MRSA acquisition in studies without a decolonization protocol was 21.2% (95% CI: 13.2%-30.5%) with a statistically significant downward trend over the years. Studies that implemented a decolonization protocol yielded a MRSA acquisition incidence rate of 4.5% (95% CI: 0.9%-10.6%). MRSA acquisition was higher among patients that have had inhalation injury (OR 3.96, 95% CI: 2.51-6.23), flame burns (OR 1.85, 95% CI: 1.25-2.73), or ICU admission (OR 3.12, 95% CI: 2.18-4.47). CONCLUSION Our study yielded that among burn victims, MRSA colonization prevalence on admission is not negligible and the risk of becoming MRSA colonized during hospitalization is higher when no decolonization protocols are implemented. Flame burns, admission to ICU, and inhalation injury were found to be associated with MRSA acquisition.
Collapse
Affiliation(s)
- Markos Kalligeros
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Spyridon A Karageorgos
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| |
Collapse
|
20
|
Harish V, Li Z, Maitz PKM. The optimal timing of outpatient Biobrane™ application for superficial and mid dermal partial thickness burns: Evidence for the '12-hour rule'. Burns 2018; 45:936-941. [PMID: 30553529 DOI: 10.1016/j.burns.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Biobrane™ is a skin substitute used for the definitive management of partial thickness burns. No studies have examined the optimal timing of Biobrane™ application in this setting. The purpose of this study was to determine whether there was a clinically significant difference in applying Biobrane to a superficial and mid dermal partial thickness burn within 12h after burn. METHODS From August 2016-February 2017, 29 consecutive superficial and mid dermal partial thickness burn injuries were prospectively treated with Biobrane™ within 12h of the injury. This 'early Biobrane™' cohort was compared to a historical cohort of 148 patients who were treated with Biobrane™ for superficial and mid dermal burns after 12h after injury during 2015 to 2016. Multivariate regression analysis was used to determine the difference in time to re-epithelialisation and number of outpatient visits between the two cohorts. RESULTS In the 'early Biobrane™' group, the mean TBSA was 3.5±2.7%. and the mean time to Biobrane™ application was 7.1±2.7h after burn injury. The mean time to re-epithelialisation in this group was 9.1±3.0 days, and no patients underwent skin grafting. In the 'delayed Biobrane™' group, the mean TBSA was 2.6±2.8% and the mean time to Biobrane™ application was 35.1±21.4h. The mean time to re-epithelialisation was 14.8±8.7 days, with 3 patients undergoing skin grafting. Regression analysis demonstrated a statistically significant 63% reduction in time to re-epithelialisation (95% CI=0.23-0.60; P<0.0001) with early Biobrane™ application. CONCLUSION Patients treated with application of Biobrane™ within 12h of superficial and mid dermal partial thickness burns have a statistically significant reduction in healing time when compared to patients treated with standard Biobrane™ practice.
Collapse
Affiliation(s)
- Varun Harish
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.
| | - Zhe Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
21
|
Chan CH, Yang SF, Yeh HW, Yeh YT, Wang YH, Teng YH, Yeh CB. Risk of pneumonia in patients with burn injury: a population-based cohort study. Clin Epidemiol 2018; 10:1083-1091. [PMID: 30214313 PMCID: PMC6121749 DOI: 10.2147/clep.s172980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Burns are the main cause of accidental injury, and pneumonia is a common respiratory disease in humans. Aim The purpose of this study was to investigate the relationship between burn injury and pneumonia. Patients and methods A nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. We identified and enrolled 2,893 subjects with burn injury, who were individually matched to 2,893 subjects in the comparison group by using the propensity score. Furthermore, we used a self-controlled case-series design to estimate the temporal association between burn injury and pneumonia. Results Exposure to burn injury revealed a higher risk of pneumonia than that to non-burn injury within 1 year. The Cox proportional hazards model revealed that, compared with the non-burn injury, burn injury yielded a 2.39-fold (95% CI=1.44-3.96) increase in risk of pneumonia. The exposure period of burn injury within 30 days showed 2.76-fold increase in risk of pneumonia (95% CI=1.44-3.96) compared with that in the baseline period. Conclusion Burn injury was associated with a significant increased risk of pneumonia, especially occurring within 30 days.
Collapse
Affiliation(s)
- Chi-Ho Chan
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Ying-Tung Yeh
- Graduate School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
| |
Collapse
|
22
|
Beele H, Smet S, Van Damme N, Beeckman D. Incontinence-Associated Dermatitis: Pathogenesis, Contributing Factors, Prevention and Management Options. Drugs Aging 2017; 35:1-10. [DOI: 10.1007/s40266-017-0507-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|