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Phan S, Feng CH, Huang R, Lee ZX, Moua Y, Phung OJ, Lenhard JR. Relative Abundance and Detection of Pseudomonas aeruginosa from Chronic Wound Infections Globally. Microorganisms 2023; 11:1210. [PMID: 37317184 DOI: 10.3390/microorganisms11051210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 06/16/2023] Open
Abstract
Pseudomonas aeruginosa is a difficult-to-treat pathogen that is frequently involved with chronic wound infections. Here, we conducted a literature search of world-wide studies published between 2005 and 2022 that described the microbiological profiles of chronic wound infections. For each continent, a hierarchy of pathogens was created to define the organisms that were most frequently isolated in each region. Except for South America, P. aeruginosa was the second most common organism in each major continent, with Staphylococcus aureus being the most abundant pathogen overall. When individual countries were evaluated, P. aeruginosa was the most frequently isolated organism in several Southeast Asia nations including India and Malaysia. P. aeruginosa was less commonly isolated from diabetic foot infections in North America, Europe, and Africa in comparison to other types of chronic wound infections. Additionally, the Levine wound swab technique may be a quick and painless way to isolate P. aeruginosa from wound infections, but the isolation of P. aeruginosa does not seem to be an informative predictor of the patient's clinical course. A multivariate risk assessment that accounts for the regional frequency of P. aeruginosa isolation may be an appropriate way to guide empiric management of chronic wound infections.
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Affiliation(s)
- Sang Phan
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Cafrey He Feng
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Raymond Huang
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Zeng X Lee
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Yer Moua
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Olivia J Phung
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
| | - Justin R Lenhard
- College of Pharmacy, California Northstate University, Elk Grove, CA 95757, USA
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Batista JSJL, Bassetti BR, Kaiser TDL, Vicente CR, Schuenck RP. Impact of microbiological characteristics on the costs of treating diabetic foot infection. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Aragón-Hernández J, Rojas-Bonilla JM, Murillo-Vargas C. Clinical, microbiological and inflammatory markers of severe diabetic foot infections. Diabet Med 2021; 38:e14648. [PMID: 34270826 DOI: 10.1111/dme.14648] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/14/2021] [Indexed: 12/24/2022]
Abstract
AIMS In addition to systemic inflammatory response syndrome (SIRS), various clinical signs, microbiological findings and inflammatory markers could be associated with severe diabetic foot infections (DFI). METHODS This study included a retrospective cohort of 245 patients with DFI treated at San Juan de Dios Hospital in San José de Costa Rica. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CRP/albumin ratio, peripheral blood leucocyte ratios and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system were evaluated. Univariate analysis was carried out between moderate and severe infections. ROC curves were plotted. Cut-off value of inflammatory markers for diagnosing severe infections was established and then dichotomized to be included in a logistic regression model. A score was designed based on its results. RESULTS Skin necrosis (p < 0.01, OR = 8.5, 95% CI = 3.5-20.9), ESR > 94 mm/h (p < 0.01, OR = 2.5, 95% CI = 1.2-5.1), albumin < 2.8 g/dl (p = 0.04, OR = 2.0, 95% CI = 1.0-4.1) and neutrophil-to-lymphocyte ratio (NLR) > 4.52 (p < 0.01, OR = 3.3, 95% CI = 1.6-6.5) were found to be predictive of severe infections. Score >5 had a good diagnosis performance for classifying severe infections. Moderate infections with a score >5 had a worse prognosis than moderate ones. CONCLUSIONS We found an association of necrosis, serum albumin, ESR and NLR values with severe DFI. The presence of these predictive factors of severity in cases of moderate infections was significantly associated with a higher rate of amputations and recurrences, longer duration of antibiotic treatment and longer hospital stays. DFI could be classified as mild, moderate, severe without SIRS and severe.
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Affiliation(s)
- Javier Aragón-Sánchez
- Department of Surgery, Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain
| | | | | | - Javier Aragón-Hernández
- Department of Surgery, Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain
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Eugenol-Containing Essential Oils Loaded onto Chitosan/Polyvinyl Alcohol Blended Films and Their Ability to Eradicate Staphylococcus aureus or Pseudomonas aeruginosa from Infected Microenvironments. Pharmaceutics 2021; 13:pharmaceutics13020195. [PMID: 33540524 PMCID: PMC7912801 DOI: 10.3390/pharmaceutics13020195] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic wounds (CW) create numerous entryways for pathogen invasion and prosperity, further damaging host tissue and hindering its remodeling and repair. Essential oils (EOs) exert quick and efficient antimicrobial (AM) action, unlikely to induce bacterial resistance. Cinnamon leaf and clove oils (CLO and CO) display strong AM activity, namely against Staphylococcus aureus and Pseudomonas aeruginosa. Chitosan (CS) is a natural and biodegradable cationic polysaccharide, also widely known for its AM features. CS and poly (vinyl alcohol) (PVA) films were prepared (ratio 30/70 w/w; 9 wt%) by the solvent casting and phase inversion method. The film's thermal stability and chemical composition data reinforced polymer blending and EO entrapment. Films were supplemented with 1 and 10 wt% of EO in relation to total polymeric mass. The film thickness and degree of swelling (DS) tended to increase with EO content, particularly with 10 wt % CLO (* p < 0.05). UV-visible absorbance scans in the 250-320 cm-1 region confirmed the successful uptake of CLO and CO into CS/PVA films, particularly with films loaded with 10 wt% EO that contained 5.30/5.32 times more CLO/CO than films supplemented with 1 wt% EO. AM testing revealed that CS films alone were effective against both bacteria and capable of eradicating all P. aeruginosa within the hour (*** p < 0.001). Still, loaded CS/PVA films showed significantly improved AM traits in relation to unloaded films within 2 h of contact. This study is a first proof of concept that CLO and CO can be dispersed into CS/PVA films and show bactericidal effects, particularly against S. aureus, this way paving the way for efficient CW therapeutics.
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Dörr S, Freier F, Schlecht M, Lobmann R. Bacterial diversity and inflammatory response at first-time visit in younger and older individuals with diabetic foot infection (DFI). Acta Diabetol 2021; 58:181-189. [PMID: 32944830 DOI: 10.1007/s00592-020-01587-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
AIM Infection of a diabetic foot ulcer (DFU) is common. More than the half of DFUs become infected and 15-20% of them necessitate amputation in course of treatment. Diabetic foot infection (DFI) is therefore the major cause for non-traumatic lower limb amputation in Germany. Prompt and effective treatment of DFI is mandatory to safe limbs and lives. We investigated if there are relevant differences in evoked inflammatory response between different species and age-separated groups. We further investigated if there is an impact of ulcer localization on bacterial diversity. METHODS For a 12-month period, we investigated 353 individuals with infected DFU, their laboratory results and bacterial diversity at first-time visit in a Diabetic Foot Care Center in Southern Germany. RESULTS The ulcer microbiota was dominated by gram-positive species, primary Staphylococcus aureus. The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriaceae (Proteus spp., Enterobacter spp., Escherichia coli and Klebsiella spp.). With increase in age, P. aeruginosa and S. aureus became more frequent, while Streptococci decreased. Ischemic and/or deep wounds were more likely to bear gram-negative species. Inflammatory response did not differ between gram-positive and gram-negative species, while Streptococci and Proteus spp. induced the highest serum inflammation reaction in their category. Streptococci, Enterobacter spp. and E. coli were more frequent in summer, while Enterococci spp., coagulase-negative Staphylococci and P. aeruginosa were more prevalent in winter half-year. DFIs of the forefoot and plantar side are mostly caused by gram-positive species, while Enterobacteriaceae were most frequent in plantar ulcerations. CONCLUSION Gram-positive species dominate bacterial spectrum in DFI. With increase in age, S. aureus, Streptococci and Pseudomonas aeruginosa became more frequent. The inflammatory response did not differ significantly between different species, but gram-negative species were slightly but not significant more frequent in ischemic wounds. Climatic distinction like summer or winter half-year as well as foot ulcer localization seems to influence bacterial diversity in DFUs.
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Affiliation(s)
- Stefan Dörr
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Prießnitzweg 24, 70374, Stuttgart, Germany.
| | - Florian Freier
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Prießnitzweg 24, 70374, Stuttgart, Germany
| | - Michael Schlecht
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Prießnitzweg 24, 70374, Stuttgart, Germany
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Prießnitzweg 24, 70374, Stuttgart, Germany.
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Okereafor K, Ekong I, Okon Markson I, Enwere K. Fingerprint Biometric System Hygiene and the Risk of COVID-19 Transmission. JMIR BIOMEDICAL ENGINEERING 2020. [DOI: 10.2196/19623] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Biometric systems use scanners to verify the identity of human beings by measuring the patterns of their behavioral or physiological characteristics. Some biometric systems are contactless and do not require direct touch to perform these measurements; others, such as fingerprint verification systems, require the user to make direct physical contact with the scanner for a specified duration for the biometric pattern of the user to be properly read and measured. This may increase the possibility of contamination with harmful microbial pathogens or of cross-contamination of food and water by subsequent users. Physical contact also increases the likelihood of inoculation of harmful microbial pathogens into the respiratory tract, thereby triggering infectious diseases. In this viewpoint, we establish the likelihood of infectious disease transmission through touch-based fingerprint biometric devices and discuss control measures to curb the spread of infectious diseases, including COVID-19.
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Pessoa E Costa T, Duarte B, João AL, Coelho M, Formiga A, Pinto M, Neves J. Multidrug-resistant bacteria in diabetic foot infections: Experience from a portuguese tertiary centre. Int Wound J 2020; 17:1835-1839. [PMID: 32820614 PMCID: PMC7948579 DOI: 10.1111/iwj.13473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022] Open
Abstract
In recent years, the emergence of antibiotic resistant pathogens made increasingly difficult to establish appropriate empiric antimicrobial therapy protocols for acute diabetic foot infection (DFI) treatment. Early recognition of the population at-risk for multidrug-resistant (MDR) bacterial infection is of paramount importance in order to decrease large-spectrum antibiotic overuse. This study used retrospective cohort study in a multidisciplinary tertiary diabetic foot unit. Patients with severe DFI were included and divided according to their infection resistance profile (susceptible vs MDR bacteria). Data regarding their comorbidities and length of hospital stay were collected. The primary endpoint was to determine the risk factors for MDR infections and to evaluate if these were associated with an increased length of stay (LOS). A total of 112 microbial isolates were included. Predominance of Gram-positive bacteria was observed and 22.3% of isolated bacteria were MDR. Previous hospitalisation was associated with a higher likelihood of MDR infection. MDR bacterial infection was also associated with an increased LOS (P = .0296). Our study showed a high incidence of MDR bacteria in patients with a DFI, especially in those who had a recent hospitalisation. MDR infections were associated with a prolonged LOS and represent a global public health issue for which emergent measures are needed.
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Affiliation(s)
- Tomás Pessoa E Costa
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Bruno Duarte
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa João
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Miguel Coelho
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Formiga
- Diabetic Foot Unit, General Surgery Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Pinto
- Microbiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - José Neves
- Diabetic Foot Unit, General Surgery Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Jalilian M, Ahmadi Sarbarzeh P, Oubari S. Factors Related to Severity of Diabetic Foot Ulcer: A Systematic Review. Diabetes Metab Syndr Obes 2020; 13:1835-1842. [PMID: 32547145 PMCID: PMC7259447 DOI: 10.2147/dmso.s256243] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is one of the diabetes complications. DFU can be the cause of a high rate of amputation, health-care costs and even death, and this condition occurs in the severity status of DFU. Severity of DFU is the cause of expensive complication incidence. Understanding the factors affecting it can help preventive functions. Adequate evidence for this problem is necessary. The aim of this systematic review is to summarize evidence on severity of diabetic foot ulcer. METHODS A literature search was undertaken in Scopus, PubMed, Elsevier, MEDLINE, Embase, UpToDate and Google Scholar. Observational studies that assessed severity of DFU were included. The data extraction and assessment are on the basis of PRISMA. RESULTS Seven studies were assessed and 25 factors that affect severity of DFU are reported in the studies. The most used score for an estimate of severity was the Wagner scale (n=5). The majority of patients were in G1 and G2 stages (67.5%; basis of Wagner) or have a superficial ulcer (62.84%) on the basis of the Texas Diabetic Wound Classification System. The main factors include high BMI, smoking, lack of diabetes control, type of diabetes treatment and older age. In addition, there were other factors that affect severity of DFU such as vascular complications, bacteria isolated, marital status, gender, high levels of cholesterol and triglycerides. Also, life location, type 2 diabetes, genotype, addiction, long-time DFU and delay to refer patients were other factors. CONCLUSION Twenty-five factors were reported. The majority of these factors related to life-style and can be prevented by self-care functions. The effect of these factors needs further study and the further studies must be better in quality.
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Affiliation(s)
- Milad Jalilian
- Nursing Department, Nursing and Midwifery School, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Correspondence: Milad Jalilian Tel +989187931047 Email
| | - Pegah Ahmadi Sarbarzeh
- Nursing Department, Nursing and Midwifery School, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajad Oubari
- Laboratory Department, Paramedical School, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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