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Oliver MA, Hussein LK, Molina EA, Keyloun JW, McKnight SM, Jimenez LM, Moffatt LT, Shupp JW, Carney BC. Cold atmospheric plasma is bactericidal to wound-relevant pathogens and is compatible with burn wound healing. Burns 2024; 50:1192-1212. [PMID: 38262886 DOI: 10.1016/j.burns.2023.12.012] [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: 01/09/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
Burn wound healing can be significantly delayed by infection leading to increased morbidity and hypertrophic scarring. An optimal antimicrobial agent would have the ability to kill bacteria without negatively affecting the host skin cells that are required for healing. Currently available products provide antimicrobial coverage, but may also cause reductions in cell proliferation and migration. Cold atmospheric plasma is a partially ionized gas that can be produced under atmospheric pressure at room temperature. In this study a novel handheld Aceso Plasma Generator was used to produce and test Aceso Cold Plasma (ACP) in vitro and in vivo. ACP showed a potent ability to eliminate bacterial load in vitro for a number of different species. Deep partial-thickness and full-thickness wounds that were treated with ACP after burning, after excision, after autografting, and at days 5, 7, and 9 did not show any negative effects on their wound healing trajectories. On par with in vitro analysis, bioburden was decreased in treated wounds vs. control. In addition, metrics of hypertrophic scar such as dyschromia, elasticity, trans-epidermal water loss (TEWL), and epidermal and dermal thickness were the same between the two treatment groups.It is likely that ACP can be used to mitigate the risk of bacterial infection during the phase of acute burn injury while patients await surgery for definitive closure. It may also be useful in treating wounds with delayed re-epithelialization that are at risk for infection and hypertrophic scarring. A handheld cold plasma device will be useful in treating all manner of wounds and surgical sites in order to decrease bacterial burden in an efficient and highly effective manner without compromising wound healing.
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Affiliation(s)
- Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Lou'ay K Hussein
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Esteban A Molina
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Sydney M McKnight
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Lesle M Jimenez
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC, United States; Department of Surgery, Georgetown University School of Medicine, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC, United States; Department of Surgery, Georgetown University School of Medicine, Washington, DC, United States; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, United States; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, United States; Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC, United States; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, United States.
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2
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AlHawaj A, AlMadhoob M, Alkhanaizi R, AlHaddad A. Evaluation of White Blood Cell Count, Lymphocyte Percentage, Neutrophil Percentage, and Elevated Temperature as Predictors of Wound Infection in Burn Patients. Cureus 2024; 16:e63172. [PMID: 39070446 PMCID: PMC11273074 DOI: 10.7759/cureus.63172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Infection remains a chief cause of morbidity and mortality among burn patients. The burn wound surface is initially sterile after a thermal injury but eventually gets colonized by microorganisms. A burn wound is considered infected upon the presence of high concentrations of microorganisms in the wound and scab. Burn wound infections can lead to a delay in epidermal maturation, higher scar formation, and sepsis. However, burn patients are commonly misclassified as septic due to the manifestation of systemic inflammatory response syndrome (SIRS) after their injury, despite the presence or absence of an infection. METHODS This is a retrospective review of medical records of patients admitted to the burn unit in Salmaniya Medical Complex in Manama, Bahrain, between the years 2018 and 2020. Demographic data, total body surface area (TBSA), initial temperature, white blood cell count, lymphocyte percentage, neutrophil percentage, and wound cultures were obtained for all subjects. Logistic regression analysis was performed to compare the presence or absence of wound infection by the aforementioned parameters. RESULTS Of 412 cases, 68.2% were male patients, with a mean age for the studied population of 25.1 years (standard deviation (SD)=20.7). Staphylococcus aureus was the most prevalent organism across all of the study population (n=31)(34.4%). Staphylococcus aureus was the most prevalent organism in patients under the age of five, while Pseudomonas aeruginosa was the most common organism among adults older than 65 years of age. TBSA was not found to be a good predictor of wound infection. There was no statistically significant relation between initial temperature and wound culture (p-value=0.056). However, logistic regression revealed that the initial temperature increases the likelihood of positive wound culture by almost three times. CONCLUSION White blood cell count, lymphocyte percentage, and neutrophil percentage were not clinically reliable in predicting burn wound infection. However, initial temperature might be a helpful predictor. Further research is needed to identify reliable clinical parameters of burn wound infections.
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Affiliation(s)
- Ali AlHawaj
- Plastic Surgery, King Fahad Specialist Hospital, Dammam, SAU
- Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | | | - Reem Alkhanaizi
- Plastic Surgery, Royal College of Surgeons in Ireland - Medical University of Bahrain, Muharraq, BHR
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Orbay H, Ziembicki JA, Yassin M, Egro FM. Prevention and Management of Wound Infections in Burn Patients. Clin Plast Surg 2024; 51:255-265. [PMID: 38429048 DOI: 10.1016/j.cps.2023.11.003] [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] [Indexed: 03/03/2024]
Abstract
The leading cause of morbidity in burn patients is infection with pneumonia, urinary tract infection, cellulitis, and wound infection being the most common cause. High mortality is due to the immunocompromised status of patients and abundance of multidrug-resistant organisms in burn units. Despite the criteria set forth by American Association of Burn, the diagnosis and treatment of burn infections are not always straightforward. Topical antimicrobials, isolation, hygiene, and personal protective equipment are common preventive measures. Additionally medical and nutritional optimization of the patients is crucial to reverse the immunocompromised status triggered by burn injury.
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Affiliation(s)
- Hakan Orbay
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenny A Ziembicki
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohamed Yassin
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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4
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Salehi S, Hosseinzadeh-Attar MJ, Alipoor E, Dahmardehei M, Yaseri M, Emami MR, Siadat SD. Effects of hydrolyzed collagen alone or in combination with fish oil on the gut microbiome in patients with major burns. Burns 2024; 50:444-453. [PMID: 38114377 DOI: 10.1016/j.burns.2023.08.017] [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: 12/09/2022] [Revised: 05/08/2023] [Accepted: 08/20/2023] [Indexed: 12/21/2023]
Abstract
Burns are associated with gut dysbiosis. Collagen peptides and omega-3 fatty acids (FAs) are suggested to improve wound healing and the inflammatory response. These are also correlated with microbiome colonization. Therefore, the present study aimed to investigate the effect of hydrolyzed collagen alone or in combination with fish oil on specific species of the gut microbiome in patients with major burns. In this randomized double-blind clinical trial, 57 adults (aged 18-60 years) with 20-45% total body surface area burns were randomised into three groups to receive either 40 gr hydrolyzed collagen +10 ml sunflower oil, 40 g hydrolyzed collagen +10 ml fish oil or placebo, divided into two daily drinks, for two weeks. Gut bacteria were measured using the real-time quantitative polymerase chain reaction (qPCR) method. The mean concentration of Bifidobacterium was significantly reduced in the control (P = 0.002) and collagen (P = 0.005) groups compared with the baseline values, whereas no significant change was observed in the collagen omega-3 group. The Firmicutes to Bacteroidetes ratio decreased significantly in the collagen group (p = 0.002) after supplementation compared to baseline . No significant changes in concentration of Lactobacillus, Enterobacteriaceae, and F.prausnitzii were observed between or within the study groups. Two weeks of supplementation with collagen and omega-3 FAs in patients with major burns did not result in a significant difference in the concentration of bacteria measured between the study groups. However, the addition of omega-3 FAs prevented a significant reduction in gut Bifidobacterium. Future studies are suggested to investigate the potential efficacy of these nutrients in improving the gut microbiota and clinical outcomes in major burns. REGISTRATION NUMBER: IRCT20131125015536N9.
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Affiliation(s)
- Shiva Salehi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Alipoor
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Emami
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Davar Siadat
- Mycobacteriology and Pulmonary Research Department, Pasteur Institute of Iran, Tehran, Iran
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5
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Lazzaro A, De Girolamo G, Filippi V, Innocenti GP, Santinelli L, Ceccarelli G, Trecarichi EM, Torti C, Mastroianni CM, d’Ettorre G, Russo A. The Interplay between Host Defense, Infection, and Clinical Status in Septic Patients: A Narrative Review. Int J Mol Sci 2022; 23:ijms23020803. [PMID: 35054993 PMCID: PMC8776148 DOI: 10.3390/ijms23020803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 01/08/2023] Open
Abstract
Sepsis is a life-threatening condition that arises when the body's response to an infection injures its own tissues and organs. Despite significant morbidity and mortality throughout the world, its pathogenesis and mechanisms are not clearly understood. In this narrative review, we aimed to summarize the recent developments in our understanding of the hallmarks of sepsis pathogenesis (immune and adaptive immune response, the complement system, the endothelial disfunction, and autophagy) and highlight novel laboratory diagnostic approaches. Clinical management is also discussed with pivotal consideration for antimicrobic therapy management in particular settings, such as intensive care unit, altered renal function, obesity, and burn patients.
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Affiliation(s)
- Alessandro Lazzaro
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Gabriella De Girolamo
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Valeria Filippi
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Giuseppe Pietro Innocenti
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Letizia Santinelli
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (E.M.T.); (C.T.)
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (E.M.T.); (C.T.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy; (A.L.); (G.D.G.); (V.F.); (G.P.I.); (L.S.); (G.C.); (C.M.M.); (G.d.)
| | - Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (E.M.T.); (C.T.)
- Correspondence:
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6
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Lee JW, Kim JY, Lee NR, Lee YH. Effect of pulsed electromagnetic fields stimulation on ischemic skin model. Electromagn Biol Med 2022; 41:15-24. [PMID: 34380341 DOI: 10.1080/15368378.2021.1963763] [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: 02/22/2021] [Accepted: 05/01/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to evaluate the effect of Pulsed Electromagnetic Fields (PEMF) in improving blood flow reduction and tissue necrosis of ischemic animal induced by skin flap. In each experiment, twenty rats (280-320 g) were randomly divided into control group (n = 10) and PEMF (n = 10) group. All of the rats were performed skin flap in back. In the PEMF group, PEMF (1 Hz, 10 mT) was performed in each experiment. In Experiment-1 (n = 20), PEMF was performed for 90 minutes. In Experiment-2 (n = 20), additionally, a blocking film was inserted, and suture was performed to induce necrosis. PEMF was performed for 30 minutes each day for 7 days. As a result of Speckle-Flow Index (SFI) analysis, in the control group, blood flow continued to decrease immediately after the procedure. In the PEMF group, blood flow was remained constant after 30 minutes and increased after 60 minutes. The blood flow in a specific region substantially increased from the initial state. As a result of skin necrosis analysis, the progression rate in the PEMF group was slower than that of the control group. The rate of necrosis in the PEMF group decreased dramatically from the 6th day, and there was a statistically significant difference between the two groups at the 7th day (p < .05). In this study, it was confirmed that PEMF (1 Hz, 10 mT) has a blood flow improvement and skin tissue necrosis alleviation in the ischemic flap animal model.
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Affiliation(s)
- Ja-Woo Lee
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Jun-Young Kim
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Na-Ra Lee
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Yong-Heum Lee
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
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7
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Sun T, Ying W, Wang S, Chen C, Sun P, Tan J. Clinical Application of Vacuum Sealing Drainage for the Treatment of Deep Burn Wounds. Am Surg 2021:31348211054527. [PMID: 34797180 DOI: 10.1177/00031348211054527] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to determine the effect of the clinical application of vacuum sealing drainage (VSD) on the treatment of deep burn wounds. METHODS This single-blind, randomized, controlled study included patients who were admitted to our hospital with deep burns from January 2018 to December 2020; the patients were randomly divided into the VSD and control (CON) groups. The number of days from treatment to skin grafting; survival rate of the first skin graft; rate of positive bacterial culture; visual analog scale (VAS) pain score; and durations of wound healing, antibiotic drug use, and hospitalization were analyzed and compared between the groups. RESULTS The application of VSD significantly shortened the number of days from treatment to skin grafting (P < .05); improved the survival rate of the first skin graft in patients with severe burns (P < .05); reduced the rate of positive bacterial culture (P < .05); reduced the VAS pain score (P < .05); and shortened the durations of wound healing (P < .05), antibiotic drug use (P < .05), and hospitalization (P < .05). CONCLUSION Vacuum sealing drainage had a good clinical effect on the recovery of deep burn wounds.
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Affiliation(s)
- Tao Sun
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Wenjie Ying
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Shuangshuang Wang
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Caiqiang Chen
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Pengyu Sun
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Jinglei Tan
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
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8
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Khaledi M, Afkhami H, Matouri RN, Dezfuli AAZ, Bakhti S. Effective Strategies to Deal With Infection in Burn Patient. J Burn Care Res 2021; 43:931-935. [PMID: 34935044 DOI: 10.1093/jbcr/irab226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment of bacterial infection is difficult. Treatment protocol of burned patient is hard. Furthermore, treatment in burned patients is accompanied with problems such as complexity in diagnosis of infection's agent, multiple infections, being painful, and involving with different organelles. There are different infections of Gram-positive and Gram-negative bacteria in burned patients. From important bacteria can be noted to Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus that have high range of morbidity and mortality. Treatment of those bacterial infections is extremely important. Hence, many studies about methods of treatment of bacterial infections have published. Herein, we have suggested practical methods for example ant virulence therapies, nanotechnology, vaccine, and photodynamic therapy in treatment of bacterial infections. Those methods have been done in many researches and had good effect.
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Affiliation(s)
- Mansoor Khaledi
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Hamed Afkhami
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Raed Nezhad Matouri
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahriar Bakhti
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
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9
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Brennan PG, Wright K, Miles MVP, Lintner AC, Alexander KM, Kahn SA. Delineating the Role of Serum Immunoglobulin Titers in Burn Patients at High Risk for Herpes Simplex Virus Infection. J Burn Care Res 2021; 42:646-650. [PMID: 33861351 DOI: 10.1093/jbcr/irz197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Herpes simplex virus (HSV) is common in the population and reactivation of latent infection often occurs in times of physiologic stress, including postburn injury. Active HSV infection complicates burn injury recovery and increases morbidity. A retrospective chart review of high-risk burn patients (≥20%TBSA and/or facial burns) who had screening HSV immunoglobulin titers drawn from 2015 to 2018 was conducted. Titer levels and morbidity-related outcomes were compared between patients who developed active infection and those who did not. Fifty-six patients had serum HSV titers measured. Twenty-nine patients (52%) developed clinical signs of HSV infection, almost all of which (97%) suffered facial burns. Titers were ordered on median hospital day 1.5 (0.00-4.0) and infection occurred on day 8.0 (2.0-16). Median HSV-1,2 IgM titers were significantly increased in patients who developed clinically active HSV infection (0.71 [0.44-1.1] vs 0.52 [0.34-0.74], P = .02). Median HSV-1 IgG (P = .65) and HSV-2 IgG titers (P = .97) were not different between groups. Patients who developed active infection had a comparable hospital length of stay (27 [9.5-40] days vs 20 [8.0-28] days, P = .17) and ICU length of stay (26 [13-49] days vs 19 [11-27] days, P = .09) to those who did not develop infection. There was no difference in mortality. Increased HSV-1 and 2 IgM screening levels were associated with an increased risk of developing active HSV infection, and offer a specific screening modality in high-risk patients. Elevated IgM titers warrant further consideration for administration of HSV prophylaxis, as earlier intervention may prevent infection onset and minimize morbidity.
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Affiliation(s)
- Phillip G Brennan
- Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama
| | - Kelsea Wright
- Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama
| | - M Victoria P Miles
- Department of Surgery, University of South Alabama Medical Center, Mobile
| | - Alicia C Lintner
- Arnold Luterman Regional Burn Center, University of South Alabama Medical Center, Mobile
| | - Kaitlin M Alexander
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Mobile, Alabama
| | - Steven A Kahn
- Arnold Luterman Regional Burn Center, University of South Alabama Medical Center, Mobile
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10
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Liu Z, Liu L, Cheng X, Gao L. Expression and predictive value of HIF-1α and VEGF in patients with burns following treatment. Exp Ther Med 2020; 20:141. [PMID: 33093879 PMCID: PMC7571334 DOI: 10.3892/etm.2020.9270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022] Open
Abstract
The present study aimed to investigate the expression and predictive value of serum hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in patients with burns following treatment. A total of 84 patients with burns treated in Jinan City People's Hospital (Jinan, China) between June 2015 and August 2017 were selected and their clinical information was collected. The expression levels of HIF-1α and VEGF before and after treatment were detected via ELISA, and HIF-1α and VEGF levels in patients with effective and ineffective treatment were compared. The predictive values of HIF-1α and VEGF in clinical efficacy were determined using receiver operating characteristic (ROC) curves, and independent risk factors affecting treatment inefficacy were analyzed via multivariate logistic regression. It was revealed that HIF-1α decreased significantly (P<0.05) while VEGF significantly increased in patients after treatment. Patients with effective treatment presented significantly lower HIF-1α levels and higher VEGF levels compared with those with ineffective treatment. The ROC curve indicated that the area under the curve (AUC) of HIF-1α for treatment efficacy was 0.795, the 95% CI was 0.666-0.924, the specificity and sensitivity were 68.75 and 80.88%, respectively, and the Youden index was 49.63%. For VEGF, the AUC, 95% CI, specificity, sensitivity and Youden index were 0.826, 0.725-0.928, 68.75, 82.35 and 51.10% respectively. Moreover, under the joint detection of HIF-1α and VEGF, the AUC was 0.847, 95% CI was 0.746-0.947, specificity and sensitivity were 87.50 and 66.18%, respectively, with a Youden index of 53.68%. Multivariate analysis demonstrated that higher HIF-1α level, lower VEGF level and higher burn degree before treatment were independent risk factors for treatment inefficacy. HIF-1α levels decreased and VEGF levels increased in burn patients after treatment. HIF-1α and VEGF before treatment may therefore serve as predictors for treatment efficacy.
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Affiliation(s)
- Zhufeng Liu
- Department of Burn Dermatology, Jinan City People's Hospital, Jinan, Shandong 271100, P.R. China
| | - Ling Liu
- Department of Burn Dermatology, Jinan City People's Hospital, Jinan, Shandong 271100, P.R. China
| | - Xuejuan Cheng
- Department of Nursing, The People's Hospital of Zouping City, Binzhou, Shandong 256200, P.R. China
| | - Liming Gao
- Department of Burn Dermatology, Jinan City People's Hospital, Jinan, Shandong 271100, P.R. China
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11
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Chato-Astrain J, Chato-Astrain I, Sánchez-Porras D, García-García ÓD, Bermejo-Casares F, Vairo C, Villar-Vidal M, Gainza G, Villullas S, Oruezabal RI, Ponce-Polo Á, Garzón I, Carriel V, Campos F, Alaminos M. Generation of a novel human dermal substitute functionalized with antibiotic-loaded nanostructured lipid carriers (NLCs) with antimicrobial properties for tissue engineering. J Nanobiotechnology 2020; 18:174. [PMID: 33228673 PMCID: PMC7686763 DOI: 10.1186/s12951-020-00732-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment of patients affected by severe burns is challenging, especially due to the high risk of Pseudomonas infection. In the present work, we have generated a novel model of bioartificial human dermis substitute by tissue engineering to treat infected wounds using fibrin-agarose biomaterials functionalized with nanostructured lipid carriers (NLCs) loaded with two anti-Pseudomonas antibiotics: sodium colistimethate (SCM) and amikacin (AMK). RESULTS Results show that the novel tissue-like substitutes have strong antibacterial effect on Pseudomonas cultures, directly proportional to the NLC concentration. Free DNA quantification, WST-1 and Caspase 7 immunohistochemical assays in the functionalized dermis substitute demonstrated that neither cell viability nor cell proliferation were affected by functionalization in most study groups. Furthermore, immunohistochemistry for PCNA and KI67 and histochemistry for collagen and proteoglycans revealed that cells proliferated and were metabolically active in the functionalized tissue with no differences with controls. When functionalized tissues were biomechanically characterized, we found that NLCs were able to improve some of the major biomechanical properties of these artificial tissues, although this strongly depended on the type and concentration of NLCs. CONCLUSIONS These results suggest that functionalization of fibrin-agarose human dermal substitutes with antibiotic-loaded NLCs is able to improve the antibacterial and biomechanical properties of these substitutes with no detectable side effects. This opens the door to future clinical use of functionalized tissues.
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Affiliation(s)
- Jesús Chato-Astrain
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Isabel Chato-Astrain
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
| | - David Sánchez-Porras
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Óscar-Darío García-García
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Fabiola Bermejo-Casares
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
| | - Claudia Vairo
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510, Miñano, Spain
| | | | - Garazi Gainza
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510, Miñano, Spain
| | - Silvia Villullas
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510, Miñano, Spain
| | | | - Ángela Ponce-Polo
- Red Andaluza de Diseño Y Traslación de Terapias Avanzadas, Sevilla, Spain
| | - Ingrid Garzón
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Víctor Carriel
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Fernando Campos
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain.
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain.
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, Faculty of Medicine, University of Granada, Avenida de la Investigación 11, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
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12
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Viral Infections in Burn Patients: A State-Of-The-Art Review. Viruses 2020; 12:v12111315. [PMID: 33213058 PMCID: PMC7698518 DOI: 10.3390/v12111315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Infections that are triggered by the accompanying immunosuppression in patients with burn wounds are very common regardless of age. Among burn patients, the most frequently diagnosed infections include the bacterial ones primarily caused by Pseudomonas aeruginosa or Klebsiella pneumonia, as well as fungal infections with the etiology of Candida spp. or Aspergillus spp. Besides, burn wounds are highly susceptible to viral infections mainly due to the impaired immune responses and defective functions of the immune cells within the wound microenvironment. The most prevalent viruses that invade burn wounds include herpes simplex virus (HSV), cytomegalovirus (CMV), human papilloma virus (HPV), and varicella zoster virus (VZV). Likewise, less prevalent infections such as those caused by the orf virus or Epstein-Barr Virus (EBV) might also occur in immunosuppressed burn patients. Viral infections result in increased morbidity and mortality rates in severely burned patients. Additionally, a positive correlation between the hospitalization duration and the severity of the viral infection has been demonstrated. Viral infections trigger the occurrence of various complications, ranging from mild symptoms to even fatal incidents. Accurate detection of viral infection is of great clinical importance because of the possibility for a quicker introduction of proper treatment therapy and shortening of hospitalization time. The aim of this paper is to provide a comprehensive review of the literature and summarize the findings regarding the most common viral infections in immunosuppressed burn patients.
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13
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Mirzaei B, Bazgir ZN, Goli HR, Iranpour F, Mohammadi F, Babaei R. Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran. BMC Res Notes 2020; 13:380. [PMID: 32778154 PMCID: PMC7418330 DOI: 10.1186/s13104-020-05224-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Multi and extensively drug-resistant (MDR and XDR), Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are two main causative agents of nosocomial infections leading to increased morbidity and mortality. We aim to study the prevalence of MDR and XDR-A. baumannii and P. aeruginosa phenotypes in clinical specimens. We conducted this for 1 year (2017-2018) and isolated bacteria from the clinical samples. Then, XDR and MDR strains were determined by susceptibility testing (disc diffusion). RESULTS Out of 3248 clinical samples, A. baumannii and P. aeruginosa strains were detected in 309(9.51%) of them. Susceptibility testing indicated that (16.50%) and (15.53%) of the P. aeruginosa and (74.75%) and (73.13%) of the A. baumannii isolates were screened as the MDR and XDR strains. The frequency of MDR isolates was higher in wound samples 222 (71.8%). This rate in behavioral intensive care unit (BICU) and restoration ward, were 187 (60.5%) and 63 (20.4%). The frequency of XDR isolates in BICU 187 (59.54%), restoration 58(18.77%), and burns 30 (9.70%) were assessed as well. Considering high isolation rates of MDR and XDR of mentioned strains, it is necessary to apply prevention criteria for eradication of the mentioned bacteria from hospital wards.
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Affiliation(s)
- Bahman Mirzaei
- Department of Medical Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran. .,Department of Medical Microbiology and Virology, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran.
| | - Zahra Norouzi Bazgir
- Department of Medical Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran.,Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Reza Goli
- Department of Medical Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran
| | - Fatemeh Iranpour
- Department of Medical Microbiology and Virology, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran
| | - Fatemeh Mohammadi
- Department of Medical Microbiology and Virology, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran
| | - Ryhaneh Babaei
- Department of Medical Microbiology and Virology, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran
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14
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Chang J, Hejna E, Fu CY, Bajani F, Tatabe L, Schlanser V, Kaminsky M, Dennis A, Starr F, Messer T, Poulakidas S, Bokhari F. Patients With Combined Thermal and Intraabdominal Injuries: More Salvageable Than Not. J Burn Care Res 2020; 41:835-840. [PMID: 32266403 DOI: 10.1093/jbcr/iraa052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims to better characterize the course and outcome of the uncommon subset of trauma patients with combined thermal and intraabdominal organ injuries. The National Trauma Data Bank was queried for burn patients with intraabdominal injury treated in all U.S. trauma centers from July 1, 2011 to June 30, 2015. General demographics, Glasgow coma scale (GCS), shock index (SI), Abbreviated Injury Scale (AIS) for burn, Injury Severity Score (ISS), blood transfusions, and abdominal surgery were evaluated. During the 5-year study period, there were 334 burn patients with intraabdominal injury, 39 (13.2%) of which received abdominal surgery. Burn patients who underwent operations had more severe injuries reflected by higher SI, AIS, ISS, blood transfusion, and worse outcomes including higher mortality, longer hospital and ICU length of stay, and more ventilator days compared to patients who did not undergo an operation. Nonsurvivors also exhibited more severe injuries, and a higher proportion received abdominal operation compared to survivors. Multivariate logistic regression analysis revealed that GCS on arrival, SI, AIS, ISS, blood transfusion, and abdominal operation to be independent risk factors for mortality. Propensity score matching to control covariables (mean age, systolic blood pressure on arrival, GCS on arrival, SI, ISS, time to operation, blood transfusion, and comorbidities) showed that of trauma patients who received abdominal operation, those with concomitant burn injury exhibited a higher rate of complications but no significant difference in mortality compared to those without burns, suggesting that patients with concomitant burns are not less salvageable than nonburned trauma patients.
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Affiliation(s)
- Jaimie Chang
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Emily Hejna
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois.,Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Leah Tatabe
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
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15
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Govender R, Hornsby N, Kimemia D, Van Niekerk A. The role of concomitant alcohol and drug use in increased risk for burn mortality outcomes. Burns 2019; 46:58-64. [PMID: 31843286 DOI: 10.1016/j.burns.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/16/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Burn injuries are a major cause of mortality and morbidity in low- and middle-income countries, with high rates in Sub-Saharan Africa. The risks may be heightened for persons who present with concomitant use of alcohol and illicit substances, which increase the risk for injury and severely compromise prognosis following injury. METHODS This study utilised a national dataset on hospitalised burns in South Africa to explore the risk for mortality relative to morbidity. To assess the influence of alcohol and drugs in mortality outcomes, the analysis was restricted to adult cases, 18 years and older (N = 918). The primary statistical procedures used in the analysis were logistic regression models. FINDINGS The results indicate that burn victims with full thickness and partial thickness burn degree and more than 30% TBSA had a significantly increased risk of mortality. In addition, the risk for mortality was increased ten times when concomitant alcohol and drugs were indicated compared to cases where these were absent. The length of stay in hospital diminished the risk for mortality by about 10%. INTERPRETATION The findings may be explained by the role of skin as the main barrier against infections and the concurrent increase in risk of infection based on the degree and extent of any damage. The combined presence of both alcohol and drugs may predispose towards more severe burns and greatly compromise liver function with heightened risk for sepsis and death.
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Affiliation(s)
- Rajen Govender
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa.
| | - Nancy Hornsby
- Violence, Injury and Peace Research Unit, South African Medical Research Council and University of South Africa, Tygerberg, South Africa
| | - David Kimemia
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa; Violence, Injury and Peace Research Unit, South African Medical Research Council and University of South Africa, Tygerberg, South Africa
| | - Ashley Van Niekerk
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa; Violence, Injury and Peace Research Unit, South African Medical Research Council and University of South Africa, Tygerberg, South Africa
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16
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Vinaik R, Barayan D, Shahrokhi S, Jeschke MG. Management and prevention of drug resistant infections in burn patients. Expert Rev Anti Infect Ther 2019; 17:607-619. [PMID: 31353976 DOI: 10.1080/14787210.2019.1648208] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Despite modern advances, the primary cause of death after burns remains infection and sepsis. A key factor in determining outcomes is colonization with multi-drug resistant (MDR) organisms. Infections secondary to MDR organisms are challenging due to lack of adequate antibiotic treatment, subsequently prolonging hospital stay and increasing risk of adverse outcomes. Areas covered: This review highlights the most frequent organisms colonizing burn wounds as well as the most common MDR bacterial infections. Additionally, we discuss different treatment modalities and MDR infection prevention strategies as their appropriate management would minimize morbidity and mortality in this population. We conducted a search for articles on PubMed, Web of Science, Embase, Cochrane, Scopus and UpToDate with applied search strategies including a combination of: "burns, 'thermal injury,' 'infections,' 'sepsis,' 'drug resistance,' and 'antimicrobials.' Expert opinion: Management and prevention of MDR infections in burns is an ongoing challenge. We highlight the importance of preventative over therapeutic strategies, which are easy to implement and cost-effective. Additionally, targeted, limited use of antimicrobials can be beneficial in burn patients. A promising future area of investigation within this field is post-trauma microbiome profiling. Currently, the best treatment strategy for MDR in burn patients is prevention.
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Affiliation(s)
- Roohi Vinaik
- a Sunnybrook Research Institute , Toronto , Canada
| | | | - Shahriar Shahrokhi
- b Department of Surgery, Division of Plastic Surgery, University of Toronto , Toronto , Canada.,c Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto , Canada
| | - Marc G Jeschke
- a Sunnybrook Research Institute , Toronto , Canada.,b Department of Surgery, Division of Plastic Surgery, University of Toronto , Toronto , Canada.,c Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto , Canada.,d Department of Immunology, University of Toronto , Toronto , Canada
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17
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Zhu Q, Jiang M, Liu Q, Yan S, Feng L, Lan Y, Shan G, Xue W, Guo R. Enhanced healing activity of burn wound infection by a dextran-HA hydrogel enriched with sanguinarine. Biomater Sci 2018; 6:2472-2486. [PMID: 30066700 DOI: 10.1039/c8bm00478a] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Burn wounds are associated with a series of risks, such as infection and pathologic scar tissue formation, which significantly delay wound healing and lead to complications. In this study, we successfully fabricated a dextran-hyaluronic acid (Dex-HA) hydrogel enriched with sanguinarine (SA) incorporated into gelatin microspheres (GMs), which had high porosity, good swelling ratio, enhanced NIH-3T3 fibroblast cell proliferation, and sustained SA release profile. The in vitro degradation results indicate that the SA/GMs/Dex-HA hydrogel can be degraded. The in vitro antibacterial tests showed that the SA/GMs/Dex-HA hydrogel can inhibit methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli). We evaluated the wound-healing effects and antibacterial properties of SA/GMs/Dex-HA hydrogels in a rat full-thickness burn infection model. The hematoxylin-eosin (H&E) and Masson's trichrome staining results of the SA/GMs/Dex-HA hydrogel showed that it improved re-epithelialization and enhanced extracellular matrix remodeling, and immunohistochemistry results showed that the expression of TGF-β1 and TNF-α was decreased, while the TGF-β3 expression was increased. Our findings suggest that the SA/GMs/Dex-HA hydrogel provides a potential way for infected burn treatment with high-quality and efficient scar inhibition.
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Affiliation(s)
- Qiyu Zhu
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou 510632, China.
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18
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Avci V, Kocak OF. Treatment algorithm in 960 pediatric burn cases: A review of etiology and epidemiology. Pak J Med Sci 2018; 34:1185-1190. [PMID: 30344573 PMCID: PMC6191793 DOI: 10.12669/pjms.345.15101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Burn injuries are one of the most significant threats to life in both undeveloped and developing countries. In this study, we evaluate the demographic characteristics and treatment methods in pediatric burn cases admitted to our clinic. Methods: A total of 960 patients aged 0–16 years old who were referred to our center with burn injuries between 2015 and 2016 were analyzed in terms of sex, age, etiology, epidemiology, burn percentage, the degree of burn, hospitalization duration, morbidity-mortality, and treatment methods. Results: In the present study, 512 male and 448 female patients were included. Burns were seen mostly among the patients aged 2–4, and the majority of them were extremity burns. The mean hospitalization duration was 10±6.7 days, and the most common source of burn injury was from hot liquids. Conclusion: Burn injuries are a pediatric emergency that needs to be emphasized to reduce occurrences due to the long hospitalization period, the unfavorable mortality and morbidity rates, and increased treatment costs. It is possible to obtain more positive results by way of a standard and easily applicable treatment algorithm in cases of burn injury.
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Affiliation(s)
- Veli Avci
- Veli Avci, MD. Department of Pediatric Surgery, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | - Omer Faruk Kocak
- Omer Faruk Kocak, MD. Department of Plastic, Reconstructive and Aesthetic Surgery, Yuzuncu Yil University, Medical Faculty, Van, Turkey
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19
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Comparison of Automated Methods Versus the American Burn Association Sepsis Definition to Identify Sepsis and Sepsis With Organ Dysfunction/Septic Shock in Burn-Injured Adults. J Burn Care Res 2018; 38:312-318. [PMID: 28230556 DOI: 10.1097/bcr.0000000000000504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To develop an algorithm to identify sepsis and sepsis with organ dysfunction/septic shock in burn-injured patients incorporating criteria from the American Burn Association sepsis definition that possesses good test characteristics compared with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9) codes and an algorithm previously validated in nonburn-injured septic patients (Martin et al method). This was a retrospective cohort study of consecutive patients admitted to the burn intensive care unit between January 2008 and March 2015. Of the 4761 admitted, 8.6% (n = 407) met inclusion criteria, of which the case rate for sepsis was 34.2% (n = 139; n = 48 sepsis; n = 91 sepsis with organ dysfunction/septic shock). For sepsis identification, the novel algorithm had an accuracy of 86.0% (95% CI: 82.2-89.2%), sensitivity of 66.9% (95% CI: 59.1-74.7%), and specificity of 95.9% (95% CI: 93.5-98.3%). The novel algorithm had better discrimination (0.81, 95% CI: 0.77-0.86) than the ICD-9 method (0.77, 95% CI: 0.73-0.81), although this was not significant (P = .08). For sepsis with organ dysfunction/septic shock, the novel algorithm plus vasopressors (0.67, 95% CI: 0.63-0.72) and the ICD-9 method (0.63, 95% CI: 0.58-0.68) performed equivocal (P = 0.15) but the Martin method (0.76, 95% CI: 0.71-0.81) had superior discrimination than other methods (P < .01). The novel algorithm is an accurate and simple tool to identify sepsis in the burn cohort with good sensitivity and specificity and equivocal discriminative ability to ICD-9 coding. The Martin method had superior discriminative ability for identifying sepsis with organ dysfunction/septic shock in burn-injured patients than either the novel algorithm plus vasopressors or ICD-9 coding.
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20
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Cabral L, Afreixo V, Meireles R, Vaz M, Chaves C, Caetano M, Almeida L, Paiva JA. Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients. BURNS & TRAUMA 2018; 6:10. [PMID: 29610766 PMCID: PMC5878422 DOI: 10.1186/s41038-018-0112-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
Background Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients' survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. Methods One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS© 23.0 IBM© for Windows©. Results There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. Conclusion Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units; meanwhile, more accurate approaches are not available.
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Affiliation(s)
- Luís Cabral
- 1Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal.,2Autonomous Section of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- 3CIDMA - Center for Research and Development in Mathematics and Applications, iBiMED, Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Rita Meireles
- 1Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Miguel Vaz
- 1Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Catarina Chaves
- 4Clinical Pathology Department, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Marisa Caetano
- 5Pharmacy Department, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Luís Almeida
- 6MedinUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Artur Paiva
- 7Department of Emergency and Intensive Care Medicine, Centro Hospitalar São João, Porto, Portugal.,8Faculty of Medicine, University of Porto, Grupo de Infecção e Sépsis, Porto, Portugal
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Yuce Y, Acar HA, Erkal KH, Arditi NB. Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war. Saudi Med J 2017; 38:93-96. [PMID: 28042637 PMCID: PMC5278073 DOI: 10.15537/smj.2017.1.16448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kırdar Kartal Educating and Training Hospital Burn Centre of İstanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns >15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients.
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Affiliation(s)
- Yucel Yuce
- Department of Anesthesiology and Reanimation, Dr. Lutfi Kirdar Education and Research Hospital, Kartal, Istanbul, Turkey. E-mail.
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Author's reply. Med Intensiva 2016; 40:596. [PMID: 27267772 DOI: 10.1016/j.medin.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
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