Antifungal Therapy in Fungal Necrotizing Soft Tissue Infections

Necrotizing Soft Tissue Infections: A Review

Importance

Necrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.

Observations

NSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate of delayed diagnosis. Laboratory values and imaging help increase suspicion for NSTI, though ultimately, the diagnosis is clinical. Surgical exploration is warranted when there is high suspicion for NSTI, even if the diagnosis is uncertain. Thus, it is acceptable to have a certain rate of negative exploration. Immediate empirical broad-spectrum antibiotics, further tailored based on tissue culture results, are essential and should be continued at least until surgical debridement is complete and the patient shows signs of clinical improvement. Additional research is needed to determine optimal antibiotic duration. Early surgical debridement is crucial for improved outcomes and should be performed as soon as possible, ideally within 6 hours of presentation. Subsequent debridements should be performed every 12 to 24 hours until the patient is showing signs of clinical improvement and there is no additional necrotic tissue within the wound. There are insufficient data to support the routine use of adjunct treatments such as hyperbaric oxygen therapy and intravenous immunoglobulin. However, clinicians should be aware of multiple ongoing efforts to develop more robust diagnostic and treatment strategies.

Conclusions and Relevance

Given the poor outcomes associated with NSTIs, a review of clinically relevant evidence and guidelines is warranted. This review discusses diagnostic and treatment approaches to NSTI while highlighting future directions and promising developments in NSTI management.

Potential antifungal applications of heterometallic silica nanohybrids: A synergistic activity

An estimated 1.7 million fatalities and 150 million cases worldwide are attributed to fungal infections annually, that are in rise due to immunocompromised patient population. The challenges posed by traditional treatments can be addressed with the help of nanotechnology advancements. In this study, Co, Cu, and Ag-were doped into silica nanoparticles. Then the synthesized monometallic silica nanohybrids were combined to formulate heterometallic silica nanohybrids, characterized structurally and morphologically, compared, and evaluated for antifungal activity based on their individual and synergistic activity. The antifungal assays were conducted by using ATCC cultures of Candida albicans and QC samples of Trichophyton rubrum, Microsporum gypseum, and Aspergillus niger. The MIC (ranging from 49.00 to 1560.00 μg/mL), MFC (ranging from 197.00 to 3125.00 μg/mL), IC50 values (ranging from 31.10 to 400.80 μg/mL), and FICI of nanohybrids were determined and compared. Moreover, well diffusion assay was performed. ABTS assay and DPPH assay were conducted to investigate the radical scavenging activity (RSA) of nanohybrids. SEM analysis clearly evidenced the structural deformations of each fungal cells and spores due to the treatment with trimetallic nanohybrid. According to the results, the trimetallic silica nanohybrids exhibited the most powerful synergistic RSA and the most effective antifungal activity, compared to the bimetallic silica nanohybrids.

Nanoarchitectonics for synergistic activity of multimetallic nanohybrids as a possible approach for antimicrobial resistance (AMR)

The global threat posed by antimicrobial resistance (AMR) to public health is an immensurable problem. The effectiveness of treating infections would be more at risk in the absence of effective antimicrobials. Researchers have shown an amplified interest in alternatives, such as developing advanced metallic nanohybrids as new therapeutic candidates for antibiotics due to their promising effectiveness against resistant microorganisms. In recent decades, the antimicrobial activity of monometallic nanoparticles has received extensive study and solid proof, providing new opportunities for developing multimetallic nanohybrid antimicrobials. Advanced metallic nanohybrids are an emerging remedy for a number of issues that develop in the field of medicine. Advanced metallic nanohybrids have shown a promising ability to combat resistant microorganisms due to their overall synergistic activity. Formulating advanced multimetallic nanohybrids falling under the umbrella of the growing field of nanoarchitectonics, which extends beyond nanotechnology. The underlying theory of nanoarchitectonics involves utilizing nanoscale units that follow the concepts of nanotechnology to architect nanomaterials. This review focuses on a comprehensive description of antimicrobial mechanisms of metallic nanohybrids and their enabling future insights on the research directions of developing the nanoarchitectonics of advanced multimetallic nanohybrids as novel antibiotics through their synergistic activity.

Marine-Bioinspired Nanoparticles as Potential Drugs for Multiple Biological Roles

The increased interest in nanomedicine and its applicability for a wide range of biological functions demands the search for raw materials to create nanomaterials. Recent trends have focused on the use of green chemistry to synthesize metal and metal-oxide nanoparticles. Bioactive chemicals have been found in a variety of marine organisms, including invertebrates, marine mammals, fish, algae, plankton, fungi, and bacteria. These marine-derived active chemicals have been widely used for various biological properties. Marine-derived materials, either whole extracts or pure components, are employed in the synthesis of nanoparticles due to their ease of availability, low cost of production, biocompatibility, and low cytotoxicity toward eukaryotic cells. These marine-derived nanomaterials have been employed to treat infectious diseases caused by bacteria, fungi, and viruses as well as treat non-infectious diseases, such as tumors, cancer, inflammatory responses, and diabetes, and support wound healing. Furthermore, several polymeric materials derived from the marine, such as chitosan and alginate, are exploited as nanocarriers in drug delivery. Moreover, a variety of pure bioactive compounds have been loaded onto polymeric nanocarriers and employed to treat infectious and non-infectious diseases. The current review is focused on a thorough overview of nanoparticle synthesis and its biological applications made from their entire extracts or pure chemicals derived from marine sources.

Nanoparticles as antimicrobial and antiviral agents: A literature-based perspective study

The scientific explorations of nanoparticles for their inherent therapeutic potencies as antimicrobial and antiviral agents due to increasing incidences of antibiotic resistance have gained more attention in recent time. This factor amongst others necessitates the search for newer and more effective antimicrobial agents. Several investigations have demonstrated the prospects of nanoparticles in the treatment of various microbial infections. The therapeutic applications of nanoparticles as either delivery agent or broad spectrum inhibition agents in viral and microbial investigations can no longer be overlooked. Their large surface area to volume ratio made them an indispensable substance as delivery agents in many respect. Various materials have been used for the synthesis of nanoparticles with unique properties channelised to meet specific therapeutic requirement. This review focuses on the antibacterial, antifungal, and antiviral potential of nanoparticles with their probable mechanism of action.

The global COVID-19 pandemic at a crossroads: relevant countermeasures and ways ahead

Background

Since the outbreak of novel coronavirus disease (COVID-19) in Wuhan, China at the beginning of December 2019, there have been over 11,200,000 confirmed cases in the world as of the 3^rd July 2020, affecting over 213 countries and regions with nearly 530,000 deaths. The pandemic has been sweeping all continents, North America, Latin America, Europe, Middle East and South Asia among others at an alarming rapidity. Here, we provide an estimate of the scale of the pandemic spread under different scenarios of variation in key influencing parameters with a hybrid model.

Methods

We developed a new hybrid model of infectious disease transmission based on Cellular Automata (CA)-configured SEIR to analyse the COVID-19 outbreak and estimate its transmission pattern. A probabilistic contamination network is embedded in the pandemic transmission model to capture the randomness feature of person-to-person spread of the novel virus. We used the improved SEIR model to quantify the population contact state with isolation measures under different continuous time series contact probability via CA. We adjusted the modelling parameters to verify the model performance in accordance to the data from the reports published by the Chinese Center for Disease Control and Prevention. We simulated several scenarios by varying such key parameters as number of isolation rate, average contact times of the population, number of infected people before taking prevention and control measures, medical level and number of imported cases.

Results

In the baseline model, we identified that the isolation control as the most influencing factor that had the largest impact on decreasing the speed of the reproductive number, accelerating the arrival of the “inflection point” of pandemic prevention and control, and the death rate reduction. We estimated that the probability of people contacts and the number of the onset infected cases before prevention measures also had significant effect on the infection rate reduction with appropriate prevention measures adoption, which partly reflects the impact of timely measure on the severity of the outbreak. We found that imported cases will risk the domestic prevention.

Conclusions

Our modelling results clearly indicate that early-stage preventive measures are the most effective way to contain the pandemic spread and a strong interventionist approach needs to be adopted by policymakers vis-à-vis of the highly contagious nature of the COVID-19. Human resources, intensified isolation and confinement as well as special hospital buildings should be prioritised in countries with large number of infections to constrain the global transmission of the virulent infection. To do so, internationally coordinated actions require to be taken to replicate good practices to less infected countries and regions immediately.