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Ozketen A, Karaman O, Ozdemir A, Soysal I, Kizilenis C, Nteli Chatzioglou A, Cicek YA, Kolemen S, Gunbas G. Selenophene-Modified Boron Dipyrromethene-Based Photosensitizers Exhibit Photodynamic Inhibition on a Broad Range of Bacteria. ACS OMEGA 2022; 7:33916-33925. [PMID: 36188264 PMCID: PMC9520714 DOI: 10.1021/acsomega.2c02868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/05/2022] [Indexed: 05/05/2023]
Abstract
Microorganisms are crucial for human survival in view of both mutualistic and pathogen interactions. The control of the balance could be achieved by use of the antibiotics. There is a continuous arms race that exists between the pathogen and the antibiotics. The emergence of multidrug-resistant (MDR) bacteria threatens health even for insignificant injuries. However, the discovery of new antibiotics is not a fast process, and the healthcare system will suffer if the evolution of MDR lingers in its current frequency. The cationic photosensitizers (PSs) provide a unique approach to develop novel, light-inducible antimicrobial drugs. Here, we examine the antimicrobial activity of innovative selenophene-modified boron dipyrromethene (BODIPY)-based PSs on a variety of Gram (+) and Gram (-) bacteria. The candidates demonstrate a level of confidence in both light-dependent and independent inhibition of bacterial growth. Among them, selenophene conjugated PS candidates (BOD-Se and BOD-Se-I) are promising agents to induce photodynamic inhibition (PDI) on all experimented bacteria: E. coli, S. aureus, B. cereus, and P. aeruginosa. Further characterizations revealed that photocleavage ability on DNA molecules could be potentially advantageous over extracellular DNA possessing biofilm-forming bacteria such as B. cereus and P. aeruginosa. Microscopy analysis with fluorescent BOD-H confirmed the colocalization on GFP expressing E. coli.
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Affiliation(s)
| | - Osman Karaman
- Department
of Chemistry, Middle East Technical University, Ankara 06800, Turkey
| | - Alara Ozdemir
- Department
of Chemistry, Middle East Technical University, Ankara 06800, Turkey
| | - Isil Soysal
- Department
of Chemistry, Middle East Technical University, Ankara 06800, Turkey
| | - Caglayan Kizilenis
- Department
of Chemistry, Middle East Technical University, Ankara 06800, Turkey
| | | | - Yagiz Anil Cicek
- Department
of Chemistry, Middle East Technical University, Ankara 06800, Turkey
| | - Safacan Kolemen
- Department
of Chemistry, Koc University, Istanbul 34450, Turkey
| | - Gorkem Gunbas
- Department
of Chemistry, Middle East Technical University, Ankara 06800, Turkey
- Biochemistry
Graduate Program, Middle East Technical
University, Ankara 06800, Turkey
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2
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Liu X, Liu S, Mai B, Su X, Guo X, Chang Y, Dong W, Wang W, Feng X. Synergistic gentamicin-photodynamic therapy against resistant bacteria in burn wound infections. Photodiagnosis Photodyn Ther 2022; 39:103034. [PMID: 35882288 DOI: 10.1016/j.pdpdt.2022.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multi-resistant bacteria, a result of the abuse of antibiotics, have greatly frustrated the effectiveness of antibiotics and produced a variety of side-effects. The combination of antibiotics with other therapies like antimicrobial photodynamic therapy (aPDT) may provide a useful strategy for fighting resistant bacteria. Here, the synergistic bactericidal effects of toluidine blue (TB)-aPDT and gentamicin (GEN) were evaluated in vitro and in vivo. METHODS The Post-antibacterial effects were measured at 600 nm (OD600) by a microplate reader. The bacterial envelope and biofilm were observed by a field emission scanning electron microscope. The expression of oxidative stress and Agr system-related genes was analyzed by qRT-PCR after GEN combined with TB-aPDT (GEN&aPDT). Besides, the burn infection model was established to investigate the cloning efficiency of immobilized bacteria, wound healing and inflammatory factors in the lesions. RESULTS GEN&aPDT could inhibit the growth of S. aureus and multidrug-resistant S. aureus (MDR S. aureus) for up to 15 h, and destroyed the cell envelope and biofilm structure of S. aureus and MDR S. aureus. During the process, ROS played an important role, inducing oxidative stress and downregulating the expression of AgrA, AgrB and PSM in the Agr system, resulting in decreased bacterial virulence and infectivity. In addition, GEN&aPDT cotreatment could effectively promoted wound healing in burn-infected mice by reducing the numbers of bacterial colonization in the wound, decreasing the content of inflammatory factors, and increasing the expression of growth factors. CONCLUSION The present study confirmed a bactericidal synergy between GEN and aPDT in vitro and in vivo, therein, the oxidative stress exhibited an important role in decreasing bacterial virulence and infectivity, which may bring new ideas for the treatment of bacterial resistance.
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Affiliation(s)
- Xin Liu
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Shupei Liu
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Bingjie Mai
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Xiaomin Su
- Shaanxi Blood Center, Xi'an 710061, Shaanxi, China
| | - Xiaoyu Guo
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Yawei Chang
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Wenzhuo Dong
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Weiqing Wang
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China
| | - Xiaolan Feng
- Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, College of Life Sciences, Shaanxi Normal University, Xi'an 710119, Shaanxi, China.
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Calum H, Trøstrup H, Laulund AS, Thomsen K, Christophersen L, Høiby N, Moser C. Murine burn lesion model for studying acute and chronic wound infections. APMIS 2022; 130:477-490. [PMID: 35441434 DOI: 10.1111/apm.13228] [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: 03/05/2021] [Accepted: 04/13/2022] [Indexed: 02/05/2023]
Abstract
Acute wounds, such as thermal injury, and chronic wounds are challenging for patients and the healthcare system around the world. Thermal injury of considerable size induces immunosuppression, which renders the patient susceptible to wound infections, but also in other foci like the airways and urinary tract. Infected thermal lesions can progress to chronic wounds with biofilm making them more difficult to treat. While animal models have their limitations, murine wound models are still the best tool at the moment to identify strategies to overcome these challenges. Here, we present a murine burn model, which has been developed to study biofilm formation, the significance of wound healing, and for identifying novel treatment candidates. Investigating the effect of a thermal injury in mice, we observed that 48 h after introduction of the injury, the mice showed a reduction in polymorphonuclear neutrophil granulocytes (PMNs) and a reduced capacity for phagocytosis and oxidative burst. Regarding the chronic wound, Pseudomonas aeruginosa biofilm arrested wound healing and kept the wound in an inflammatory state, but suppressing PMN function by means of the PMN factor S100A8/A9, corresponding to observations in human venous leg ulcers. Monotherapy and dual treatment with S100A8/A9 and ciprofloxacin on P. aeruginosa biofilm-infected murine wounds have been investigated. In combination, S100A8/A9 and ciprofloxacin reduced the bacterial quantity, lowered the proinflammatory response, and increased anti-inflammatory cytokines after 4 days of treatment. When the treatment was prolonged, an additional prevention of resistance development was detected in all the dual-treated mice. In the present review, we provide data on using the murine model for research with the aim of better understanding pathophysiology of wounds and for identifying novel treatments for humans suffering from these lesions.
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Affiliation(s)
- Henrik Calum
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hannah Trøstrup
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Sofie Laulund
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Thomsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Christophersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology (ISIM), University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
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Hayashida K, Yamakawa S. Topical odour management in burn patients. BURNS & TRAUMA 2021; 9:tkab025. [PMID: 34458382 PMCID: PMC8389170 DOI: 10.1093/burnst/tkab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/25/2021] [Indexed: 12/31/2022]
Abstract
Preventing microbial colonization or infections that cause offensive smells may lead to odor reduction. As both anaerobic and aerobic bacteria cause the release of malodor from wounds, the most direct way of avoiding or eliminating wound odor is to prevent or eradicate the responsible infection through the debridement of necrotic tissues. However, some burn patients with malodorous wounds are unable to undergo debridement due to systemic conditions, especially in the acute stage. Moreover, the optimal drug doses and dressings to ensure the efficacy and cost-effectiveness of odorous burn wound management is unclear. The purpose of this commentary is to outline the odor management options available for burn patients, focusing on topical strategies. Numerous potential therapies for treating odorous wounds after burn injuries are suggested.
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Affiliation(s)
- Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-0021, Japan
| | - Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-0021, Japan
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Moinuddin K, Alanazi DS, Alsomali BA, Alotaibi M, Parameaswari PJ, Ali S. Prescription Pattern of Empirical Antibiotic Therapy in the Burn Unit of a Tertiary Care Setting in the Kingdom of Saudi Arabia. J Pharm Bioallied Sci 2021; 13:188-192. [PMID: 34349478 PMCID: PMC8291108 DOI: 10.4103/jpbs.jpbs_478_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background: It is crucial to follow rational prescribing practices while prescribing antibiotics for burn patients, thus leading to better patient outcomes. The objective of this study was to assess the initiation of empirical antibiotics in the burn unit. Methods: A prospective cross-sectional study was conducted in a large tertiary care setting of the Kingdom of Saudi Arabia between August 2016 and December 2018. Results: A total of 102 hospitalized burn patients were included in this study, of whom 84 (82.4%) were males. Burns were classified as first degree, second degree, third degree, or fourth degree depending on their severity and extent of penetration into the skin. The majority (81.3%) of the patients suffered from flame burn, followed by scald (9.85), chemical (6.9%), and electrical (2%) types of burns. Broad-spectrum antibiotic such as piperacillin/tazobactam (40.57%) was the most common empirically prescribed antibiotic. In 35 patients (34.3%), there was a change in antibiotic after culture findings. Conclusion: This study demonstrated that 40% of antibiotic therapy decisions followed the recommended clinical guidelines. This study also found that Gram-negative microorganisms such as Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus were ubiquitous in our burn unit. The study results will facilitate to develop antibiogram for our study setting, thus reducing antibiotic resistance. Further studies are needed to explore the extent and consequences of irrational antibiotic prescriptions in critically ill burn patients.
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Affiliation(s)
- Khaja Moinuddin
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Deemah Sattam Alanazi
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Maram Alotaibi
- Pharmaceutical Care Department, King Abdul Aziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Dalgic N, Sahin A, Karadag CA, Sancar M. Comparison of non-burn-specific systemic inflammatory response syndrome criteria and burn-specific American Burn Association systemic inflammatory response syndrome criteria in paediatric burned patients. J Paediatr Child Health 2020; 56:1623-1628. [PMID: 32841443 DOI: 10.1111/jpc.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
AIM We aim to investigate the diagnostic value of newly defined criteria for the systemic inflammatory response syndrome (SIRS) for paediatric burn patients by the American Burn Association (ABA) by comparing the non-burn-specific SIRS criteria for children. METHODS A total of 147 paediatric burn patients were included in this study. Patients diagnosed with sepsis were included in the sepsis group. Clinical parameters were obtained from the electronic medical records at the time of preliminary sepsis diagnosis. Both the non-burn-specific SIRS criteria and the burn-specific ABA SIRS criteria were applied to both the sepsis group and the non-sepsis group. RESULTS Of 147 patients, 50 had sepsis according to the non-burn-specific sepsis criteria. When the 50-patient sepsis group was compared to the 97-patient non-sepsis group, the sepsis group had a significantly higher duration of hospitalisation, burn percentage, burn state and abbreviated burn scoring index (ABSI) (P < 0.05). The specificity of the two scales was 29.9% for the non-burn-specific SIRS and 74.2% for the burn-specific ABA SIRS. The sensitivity for the burn-specific ABA SIRS was calculated as 58%, the sensitivity for the non-burn-specific SIRS was 100%. While positive predictive value was calculated as 42.4% for the non-burn-specific SIRS, this value was found as 53.7% for the burn-specific ABA SIRS criteria. The correlation coefficient between the non-burn-specific SIRS and the burn-specific ABA SIRS was 0.378 (P < 0.001). CONCLUSIONS Our study underlines the need for widespread use of more specific and sensitive burn-specific clinical criteria to early diagnosis of infection in burn patients to prevent unnecessary antibiotic usage.
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Affiliation(s)
- Nazan Dalgic
- Sisli Etfal Training and Research Hospital, Division of Pediatric Infectious Diseases, University of Health Sciences, Istanbul, Turkey
| | - Ayse Sahin
- Sisli Etfal Training and Research Hospital, Division of Pediatric Infectious Diseases, University of Health Sciences, Istanbul, Turkey
| | - Cetin A Karadag
- Sisli Etfal Training and Research Hospital, Division of Pediatric Surgery, University of Health Sciences, Istanbul, Turkey
| | - Mesut Sancar
- Faculty of Pharmacy, Department of Clinical Pharmacy, Marmara University, Istanbul, Turkey
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Abstract
Background: Infection is the most common complication and cause of death in patients suffering burn injuries. These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology. Diagnosis and management of infections rely on physical examination, cultures, and the pathology of the burn wound. Method: We performed an electronic search for articles in the Google Scholar and PubMed databases using the search terms "burn sepsis," "burn infection," and "burn critical care." Results: Multiple factors increase burn patients' risk of invasive infection and sepsis, including underlying factors and co-morbidities, the percent total body surface area of the burn, delays in burn wound excision, and microbial virulence/bacterial count. Organisms causing burn wound infection differ, depending on the time since injury and its location; and diagnosis is multi-factorial. The most common pathogens remain Staphylococcus and Pseudomonas spp. Conclusion: Overall, the recognition of burn sepsis is based on clinical findings. Treatment consists of a combination of local dressings, early burn excision, and systemic antimicrobial therapy. The mortality rate has decreased significantly over the past 10 years, but continued efforts at timely management and infection prevention are essential.
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Affiliation(s)
- Josephine A D'Abbondanza
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shahriar Shahrokhi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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8
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Guest JF, Fuller GW, Edwards J. Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes. BMJ Open 2020; 10:e035345. [PMID: 32273318 PMCID: PMC7245389 DOI: 10.1136/bmjopen-2019-035345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK. DESIGN Retrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns. SETTING Primary and secondary care sectors in the UK. PRIMARY AND SECONDARY OUTCOME MEASURES Patients' characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management. RESULTS Diagnosis was incomplete in 63% of patients' records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients' wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients' records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively. CONCLUSIONS Due to incomplete documentation in the patients' records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients' records, integration of care between different providers, wound healing rates and reducing infection.
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Affiliation(s)
- Julian F Guest
- Catalyst Consultants, Rickmansworth, UK
- King's College London, London, UK
| | | | - Jacky Edwards
- Burns Nurse Consultant, Burn Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Knackstedt R, Gatherwright J. The role of thermal injury on intestinal bacterial translocation and the mitigating role of probiotics: A review of animal and human studies. Burns 2019; 46:1005-1012. [PMID: 31351819 DOI: 10.1016/j.burns.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/26/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Burn patients represent a combination of nutritionally deplete and calorically demanding individuals who are susceptible to morbidity and mortality. A source of sepsis in thermal injury patients is the gastrointestinal tract with its interaction of normal and potentially pathogenic bacteria. The normal flora of the intestines maintains the equilibrium of the gut and prevents bacterial translocation (BT) through numerous mechanisms, all of which are disrupted as a consequence of thermal injury. Probiotic supplements with varying strains of bacteria have the potential to stabilize the integrity of the gut lining and decrease the incidence of BT after thermal injury. METHODS A literature review was conducted for animal and human studies in English addressing probiotic therapy in thermal injury. Keywords, "probiotics," "thermal injury" and "burn" were utilized. Reference lists for each analyzed article were also examined to ensure completeness of literature search. Each article was reviewed for methodology, results and conclusions. RESULTS Eleven and six unique articles were identified addressing probiotics in thermal injury in animal and human studies, respectively. Heterogeneity between studies and limited demographic and outcome reporting prevented meta-analysis and comprehensive recommendations to be formalized. CONCLUSION While heterogeneity did not allow for meta-analysis, the results overall suggest a preventative, if not therapeutic, potential for probiotics in patients after thermal injury. Despite initial concern that probiotic therapy could lead to systemic infection in immune compromised individuals, this was not observed in the analyzed studies. Numerous unanswered questions exist in regards to optimizing probiotic therapy in patients after thermal injury.
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Affiliation(s)
- Rebecca Knackstedt
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, United States.
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Davies A, Teare L, Falder S, Coy K, Dumville JC, Collins D, Moore L, Dheansa B, Jenkins ATA, Booth S, Agha R, Shah M, Marlow K, Young A. Protocol for the development of a core indicator set for reporting burn wound infection in trials: ICon-B study. BMJ Open 2019; 9:e026056. [PMID: 31092650 PMCID: PMC6530370 DOI: 10.1136/bmjopen-2018-026056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Systematic reviews of high-quality randomised controlled trials are necessary to identify effective interventions to impact burn wound infection (BWI) outcomes. Evidence synthesis requires that BWI is reported in a consistent manner. Cochrane reviews investigating interventions for burns report that the indicators used to diagnose BWI are variable or not described, indicating a need to standardise reporting. BWI is complex and diagnosed by clinician judgement, informed by patient-reported symptoms, clinical signs, serum markers of inflammation and bacteria in the wound. Indicators for reporting BWI should be important for diagnosis, frequently observed in patients with BWI and assessed as part of routine healthcare. A minimum (core) set of indicators of BWI, reported consistently, will facilitate evidence synthesis and support clinical decision-making. AIMS The Infection Consensus in Burns study aims to identify a core indicator set for reporting the diagnosis of BWI in research studies. METHODS (1) Evidence review: a systematic review of indicators used in trials and observational studies reporting BWI outcomes to identify a long list of candidate indicators; (2) refinement of the long list into a smaller set of survey questions with an expert steering group; (3) a two-round Delphi survey with 100 multidisciplinary expert stakeholders, to achieve consensus on a short list of indicators; (4) a consensus meeting with expert stakeholders to agree on the BWI core indicator set. ETHICS AND DISSEMINATION Participants will be recruited through professional bodies, such that ethical approval from the National Health Service (NHS) Health Research Authority (HRA) is not needed. The core indicator set will be disseminated through peer-reviewed publication, co-production with journal editors, research funders and professional bodies, and presentation at national conferences. PROSPERO REGISTRATION NUMBER CRD42018096647.
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Affiliation(s)
- Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Louise Teare
- Department of Microbiology, Chelmsford Hospital, Chelmsford, UK
| | - Sian Falder
- Burns and Plastic Surgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Karen Coy
- Centre for Children’s Burns Research, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social work, The University of Manchester, Manchester, UK
| | - Declan Collins
- Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Luke Moore
- Department of Microbiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- National Institute for Health Research Health Protection Research Unit, Imperial College London, London, UK
| | - Baljit Dheansa
- Department of Plastic Surgery and Burns, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | - Simon Booth
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Riaz Agha
- Department of Plastic Surgery, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Mamta Shah
- Department of Plastic Surgery, Royal Manchester Children’s Hospital, Manchester, UK
| | - Karen Marlow
- Burns and Plastic Surgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Amber Young
- Centre for Children’s Burns Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
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Sürmeli M, Maçin S, Akyön Y, Kayikçioğlu AU. The protective effect ofLactobacillus plantarumagainst meticillin-resistantStaphylococcus aureusinfections: an experimental animal model. J Wound Care 2019; 28:s29-s34. [DOI: 10.12968/jowc.2019.28.sup3b.s29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Mehmet Sürmeli
- Plastic, Reconstructive and Aesthetic Surgery Specialist, Istanbul Bağcilar Research and Training Hospital, Merkez Mah, Department of Plastic, Reconstructive and Aesthetic Surgery, 34200 Bağcilar, Istanbul, Turkey
| | - Salih Maçin
- Microbiology and Medical Microbiology Specialist, Selçuk University Faculty of Medicine Departmant of Medical Microbiology, Konya, Turkey
| | - Yakut Akyön
- Professor of Microbiology and Medical Microbiology, Hacettepe University Faculty of Medicine, Sihhiye Ankara, Turkey
| | - Aycan Uğur Kayikçioğlu
- Professor of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye Ankara, Turkey
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12
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Wound healing after cultured epithelial autografting in patients with massive burn injury: A cohort study. J Plast Reconstr Aesthet Surg 2019; 72:427-437. [DOI: 10.1016/j.bjps.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/12/2018] [Accepted: 11/03/2018] [Indexed: 01/26/2023]
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13
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Chen JW, Lau YY, Krishnan T, Chan KG, Chang CY. Recent Advances in Molecular Diagnosis of Pseudomonasaeruginosa Infection by State-of-the-Art Genotyping Techniques. Front Microbiol 2018; 9:1104. [PMID: 29892277 PMCID: PMC5985333 DOI: 10.3389/fmicb.2018.01104] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/08/2018] [Indexed: 12/02/2022] Open
Abstract
Pseudomonas aeruginosa is a rod-shaped Gram-negative bacterium which is notably known as a pathogen in humans, animals, and plants. Infections caused by P. aeruginosa especially in hospitalized patients are often life-threatening and rapidly increasing worldwide throughout the years. Recently, multidrug-resistant P. aeruginosa has taken a toll on humans' health due to the inefficiency of antimicrobial agents. Therefore, the rapid and advanced diagnostic techniques to accurately detect this bacterium particularly in clinical samples are indeed necessary to ensure timely and effective treatments and to prevent outbreaks. This review aims to discuss most recent of state-of-the-art molecular diagnostic techniques enabling fast and accurate detection and identification of P. aeruginosa based on well-developed genotyping techniques, e.g., polymerase chain reaction, pulse-field gel electrophoresis, and next generation sequencing. The advantages and limitations of each of the methods are also reviewed.
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Affiliation(s)
- Jian-Woon Chen
- International Genome Centre, Jiangsu University, Zhenjiang, China
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Yin Yin Lau
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Thiba Krishnan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok-Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Chien-Yi Chang
- School of Chemistry and Biosciences, University of Bradford, Bradford, United Kingdom
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Memariani H, Shahbazzadeh D, Sabatier JM, Pooshang Bagheri K. Membrane-active peptide PV3 efficiently eradicates multidrug-resistant Pseudomonas aeruginosa
in a mouse model of burn infection. APMIS 2018; 126:114-122. [DOI: 10.1111/apm.12791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/02/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Hamed Memariani
- Venom and Biotherapeutics Molecules Lab.; Medical Biotechnology Department; Biotechnology Research Center; Pasteur Institute of Iran; Tehran Iran
| | - Delavar Shahbazzadeh
- Venom and Biotherapeutics Molecules Lab.; Medical Biotechnology Department; Biotechnology Research Center; Pasteur Institute of Iran; Tehran Iran
| | - Jean-Marc Sabatier
- INSERM; Aix Marseille Université; UMRs 1097; Parc scientifique et technologique de Luminy; Marseille France
| | - Kamran Pooshang Bagheri
- Venom and Biotherapeutics Molecules Lab.; Medical Biotechnology Department; Biotechnology Research Center; Pasteur Institute of Iran; Tehran Iran
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Le Guern F, Sol V, Ouk C, Arnoux P, Frochot C, Ouk TS. Enhanced Photobactericidal and Targeting Properties of a Cationic Porphyrin following the Attachment of Polymyxin B. Bioconjug Chem 2017; 28:2493-2506. [PMID: 28853858 DOI: 10.1021/acs.bioconjchem.7b00516] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A novel compound consisting of a cationic porphyrin covalently attached to a derivative of polymyxin B has been synthesized and presents enhanced activity and targeting properties compared to the usual cationic porphyrins recognized as efficient photosensitizers in photodynamic antimicrobial chemotherapy (PACT). A synthesis pathway was established to preserve the bactericidal activity of the peptide. Accordingly, the N-terminal amino acid (l-2,4-diaminobutyric acid) of polymyxin B (PMB) was switched for a cysteine residue. Then, the resulting derivative of PMB was covalently bound to 5-(4-aminophenyl)-10,15,20-tri(4-N-methylpyridyl)-21H,23H-porphyrin using a thiol-maleimide "click" coupling. The peptide-coupled photosensitizer has demonstrated an improved PACT efficiency compared to the cationic porphyrin alone. This enhancement has been observed against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli in particular. Flow cytometry analyses and confocal imaging microscopy demonstrated that the porphyrin-peptide conjugate selectively adhered to the cell walls of either Gram-positive or Gram-negative bacteria, thus justifying the damages induced by singlet oxygen production.
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Affiliation(s)
- Florent Le Guern
- Université de Limoges, Laboratoire de Chimie des Substances Naturelles , EA 1069, 123 Avenue Albert Thomas, 87060 Limoges, CEDEX, France
| | - Vincent Sol
- Université de Limoges, Laboratoire de Chimie des Substances Naturelles , EA 1069, 123 Avenue Albert Thomas, 87060 Limoges, CEDEX, France
| | - Catherine Ouk
- Université de Limoges, BISCEm , 87000 Limoges, France
| | - Philippe Arnoux
- Laboratoire Réactions et Génie des Procédés (LRGP), UMR 7274 CNRS Université de Lorraine, ENSIC , 1 rue Grandville, 54000 Nancy, France
| | - Céline Frochot
- Laboratoire Réactions et Génie des Procédés (LRGP), UMR 7274 CNRS Université de Lorraine, ENSIC , 1 rue Grandville, 54000 Nancy, France
| | - Tan-Sothea Ouk
- Université de Limoges, Laboratoire de Chimie des Substances Naturelles , EA 1069, 123 Avenue Albert Thomas, 87060 Limoges, CEDEX, France
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Gutzler L, Schiestl C, Meuli M, Oliveira C. Toxic shock syndrome in paediatric thermal injuries: A case series and systematic literature review. Burns 2017; 44:e1-e12. [PMID: 28867411 DOI: 10.1016/j.burns.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 05/30/2017] [Accepted: 07/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Toxic shock syndrome (TSS) is a rare, but potentially life-threatening complication of thermal injuries in children. The study objective was to systematically review the literature on paediatric TSS after burns or scalds, and describe our experience with this condition in Switzerland. METHODS All tertiary paediatric healthcare centres managing burns and scalds in Switzerland were inquired. A systematic literature review was performed using EMBASE (1947-2016), MEDLINE (1946-2016), Web of Science (1900-2016) and Google Scholar in October 2016. Data on patient characteristics, symptoms, laboratory parameters, management and outcome were extracted from paper and electronic patient charts. Descriptive statistics were performed. RESULTS The literature review revealed 25 articles describing 59 cases observed in 10 countries (UK, USA, Hungary, Austria, Sweden, Denmark, Israel, Japan, Spain, Switzerland) from 1985 to 2016. The patient age ranged from 8 months to 8 years at the time point of TSS-diagnosis. The injured total body surface area ranged from <1% to 41%. Forty-one patients suffered from scalds, 6 from burns and in 12 cases the type of injury was not specified. The TSS-diagnosis was made 1-7days after thermal injury. Nineteen children underwent admission to the Intensive Care Unit. Six children died from TSS. In Switzerland, we identified 11 consecutive cases between 07/2001 and 06/2011 (median age 15 months, range 9 months-14 years; 9 male, 2 female; 3 burns, 8 scalds; 7% median total body surface area (TBSA), range 2-30%). Diagnosis of TSS was made on day 5 after injury in median (range 3-34 days). Eight of eleven patients received intensive care. Survivors (10/11) suffered no long-term sequelae besides scars. One 13-month old boy died 3days after a 7%-TBSA scald. CONCLUSIONS Toxic shock syndrome is an important complication of paediatric burns in Switzerland and several other countries world-wide. Diagnosis and management remain challenging. Awareness among treating clinicians is crucial for a favourable outcome.
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Affiliation(s)
- Linda Gutzler
- Instistute for Anaesthesiology, University Hospital Zurich, Switzerland
| | - Clemens Schiestl
- Pediatric Burns Center, Plastic and Reconstructive Surgery, Department of Paediatric Surgery, University Children's Hospital Zurich, Switzerland
| | - Martin Meuli
- Pediatric Burns Center, Plastic and Reconstructive Surgery, Department of Paediatric Surgery, University Children's Hospital Zurich, Switzerland
| | - Carol Oliveira
- Pediatric Burns Center, Plastic and Reconstructive Surgery, Department of Paediatric Surgery, University Children's Hospital Zurich, Switzerland; Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Pallavali RR, Degati VL, Lomada D, Reddy MC, Durbaka VRP. Isolation and in vitro evaluation of bacteriophages against MDR-bacterial isolates from septic wound infections. PLoS One 2017; 12:e0179245. [PMID: 28719657 PMCID: PMC5515400 DOI: 10.1371/journal.pone.0179245] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/28/2017] [Indexed: 12/27/2022] Open
Abstract
Multi-drug resistance has become a major problem for the treatment of pathogenic bacterial infections. The use of bacteriophages is an attractive approach to overcome the problem of drug resistance in several pathogens that cause fatal diseases. Our study aimed to isolate multi drug resistant bacteria from patients with septic wounds and then isolate and apply bacteriophages in vitro as alternative therapeutic agents. Pus samples were aseptically collected from Rajiv Gandhi Institute of Medical Science (RIMS), Kadapa, A.P., and samples were analyzed by gram staining, evaluating morphological characteristics, and biochemical methods. MDR-bacterial strains were collected using the Kirby-Bauer disk diffusion method against a variety of antibiotics. Bacteriophages were collected and tested in vitro for lytic activity against MDR-bacterial isolates. Analysis of the pus swab samples revealed that the most of the isolates detected had Pseudomonas aeruginosa as the predominant bacterium, followed by Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli. Our results suggested that gram-negative bacteria were more predominant than gram-positive bacteria in septic wounds; most of these isolates were resistant to ampicillin, amoxicillin, penicillin, vancomycin and tetracycline. All the gram-positive isolates (100%) were multi-drug resistant, whereas 86% of the gram-negative isolates had a drug resistant nature. Further bacteriophages isolated from sewage demonstrated perfect lytic activity against the multi-drug resistant bacteria causing septic wounds. In vitro analysis of the isolated bacteriophages demonstrated perfect lysis against the corresponding MDR-bacteria, and these isolated phages may be promising as a first choice for prophylaxis against wound sepsis, Moreover, phage therapy does not enhance multi-drug resistance in bacteria and could work simultaneously on a wide variety of MDR-bacteria when used in a bacteriophage cocktail. Hence, our results suggest that these bacteriophages could be potential therapeutic options for treating septic wounds caused by P. aeruginosa, S. aureus, K. pneumoniae and E. coli.
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Affiliation(s)
| | | | - Dakshayani Lomada
- Department of Genetic and Genomics, Yogi Vemana University, Kadapa, AP, India
| | - Madhava C Reddy
- Department of Biotechnology and Bioinformatics, Yogi Vemana University, Kadapa, AP, India
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Norbury W, Herndon DN, Tanksley J, Jeschke MG, Finnerty CC. Infection in Burns. Surg Infect (Larchmt) 2016; 17:250-5. [PMID: 26978531 DOI: 10.1089/sur.2013.134] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developments in critical care and surgical approaches to treating burn wounds, together with newer antimicrobial treatments, have significantly reduced the morbidity and mortality rates associated with this injury. METHODS Review of the pertinent English-language literature. RESULTS Several resistant organisms have emerged as the maleficent cause of invasive infection in burn patients, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas, Acinetobacter, non-albicans Candida spp., and Aspergillus. Advances in antimicrobial therapies and the release of new classes of antibiotics have certainly added to the armamentarium of therapeutic resources for the clinician. CONCLUSION Strict infection control measures, constant wound surveillance with regular sampling of tissues for quantitative culture, and early excision and wound closure remain the principal adjuncts to control of invasive infections in burn patients.
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Affiliation(s)
| | - David N Herndon
- 1 Shriners Hospitals for Children , Galveston, Texas.,2 Department of Surgery, University of Texas Medical Branch , Galveston, Texas
| | - Jessica Tanksley
- 1 Shriners Hospitals for Children , Galveston, Texas.,2 Department of Surgery, University of Texas Medical Branch , Galveston, Texas
| | - Marc G Jeschke
- 3 Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery, Division of Plastic Surgery and Department of Immunology, University of Toronto , Toronto, Ontario, Canada
| | - Celeste C Finnerty
- 1 Shriners Hospitals for Children , Galveston, Texas.,2 Department of Surgery, University of Texas Medical Branch , Galveston, Texas.,4 Institute for Translational Science and Sealy Center for Molecular Medicine, University of Texas Medical Branch , Galveston, Texas
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Garland M, Zeller KA, Shetty AK. Toxic shock syndrome due to methicillin-resistant Staphylococcus aureus infection after a pediatric scald burn. Am J Emerg Med 2016; 34:1735.e1-2. [DOI: 10.1016/j.ajem.2015.12.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 11/25/2022] Open
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Fransén J, Huss FRM, Nilsson LE, Rydell U, Sjöberg F, Hanberger H. Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-2012. Burns 2016; 42:1295-303. [PMID: 27241732 DOI: 10.1016/j.burns.2016.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Patients with burn trauma are at risk for infections caused by antibiotic resistant bacteria (ABR) with subsequent increase in morbidity and mortality. As part of the Swedish strategic program against antibiotic resistance in intensive care (ICU-Strama), we have surveyed the distribution of species and ABR in isolates from patients admitted to a Swedish burn center at Linköping University Hospital from 1994 through 2012. In an international comparison Strama has been successful in reducing the antibiotic consumption among animals and humans in primary care. The aim of this study was to investigate the antibiotic consumption pressure and resistance rates in a Swedish burn unit. METHODS Microbiology data, total body surface area (TBSA), patient days, and mortality were collected from a hospital database for all patients admitted to the Burn Center at the University Hospital of Linköping from April 1994 through December 2012. RESULTS A total of 1570 patients were admitted with a mean annual admission rate of 83 patients (range: 57-152). 15,006 microbiology cultures (approximately 10 per patient) were collected during the study period and of these 4531 were positive (approximately 3 per patient). The annual mean total body surface area (TBSA) was 13.4% (range 9.5-18.5) with an annual mortality rate of 5.4% (range 1-8%). The MRSA incidence was 1.7% (15/866) which corresponds to an MRSA incidence of 0.34/1000 admission days (TAD). Corresponding figures were for Escherichia coli resistant to 3(rd) generation cephalosporins (ESBL phenotype) 8% (13/170) and 0.3/TAD, Klebsiella spp. ESBL phenotype 5% (6/134) and 0.14/TAD, carbapenem resistant Pseudomonas aeruginosa 26% (56/209) and 1.28/TAD, and carbapenem resistant Acinetobacter spp. 3% (2/64) and 0.04/TAD. CONCLUSIONS Our results show a sustained low risk for MRSA and high, although not increasing, risk for carbapenem resistant P. aeruginosa.
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Affiliation(s)
- Jian Fransén
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden.
| | - Fredrik R M Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden; Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lennart E Nilsson
- Department of Clinical and Experimental Medicine, Clinical Microbiology, Linköping University, Linköping, Sweden
| | - Ulf Rydell
- Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden
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Madhusudhan VL. Efficacy of 1% acetic acid in the treatment of chronic wounds infected with Pseudomonas aeruginosa: prospective randomised controlled clinical trial. Int Wound J 2015; 13:1129-1136. [PMID: 25851059 DOI: 10.1111/iwj.12428] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/06/2015] [Accepted: 01/24/2015] [Indexed: 12/01/2022] Open
Abstract
Chronic wounds are those wounds that are persistent and do not respond to any sort of treatment. The concept of using topical antiseptics on open wounds is to prevent and treat infections. They also help to shorten the time taken to heal the wounds. The use of topical agents on wounds to prevent infection is a minimal ability to develop resistance to the microorganisms. Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen with innate resistance to many antibiotics. In places that are economically backward, these problems get compounded by the inability of patients to afford newer expensive drugs. Topically applied dilute acetic acid, which is cheap and easily available, has been found to be effective in such chronic wounds. In the present study, an attempt has been made to use 1% acetic acid as the sole antimicrobial agent for the treatment of pseudomonal wound infections. A control limb was used in which the wounds were treated with normal saline. Our objective was to evaluate the efficacy of acetic acid in low concentration of 1% in chronic wounds infected with P. aeruginosa. This was a prospective study conducted over a period of 6 months. INCLUSION CRITERIA All patients with chronic wounds infected with P. aeruginosa. EXCLUSION CRITERIA Wounds due to massive burns, suspected malignancy, immunocompromised individuals and individuals with sepsis. A total of 32 patients enrolled in the study. Subjects were randomised equally to the 1% acetic acid group and saline dressing group. None of the patients received any systemic antibiotics during the study period and received twice daily dressings. The endpoint of the treatment was wounds free of P. aeruginosa. The duration of treatment required to eliminate the Pseudomonas from the wounds in the acetic acid group was on an average 7 days less than that required by the saline group. P value was <0·001. In the 1% acetic acid group irrespective of the sensitivity of the organism to antibiotics, Pseudomonas organisms were eliminated within the same time period - 4·5 days. In the saline group, susceptible organisms were eliminated within 11·5 days and multidrug-resistant organisms were eliminated by 15·5 days. 1% acetic acid is a simple, safe and effective topical antiseptic that can be used in the elimination of P. aeruginosa from chronic infected wounds.
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Affiliation(s)
- V L Madhusudhan
- Department of Plastic Surgery, Christian Medical College, Vellore, India
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Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, Dickson WA, Whitaker IS. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. PLoS One 2014; 9:e95042. [PMID: 24751699 PMCID: PMC3994014 DOI: 10.1371/journal.pone.0095042] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.
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Affiliation(s)
- Ernest A. Azzopardi
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Elayne Azzopardi
- Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom
| | - Liberato Camilleri
- Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta
| | - Jorge Villapalos
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - Dean E. Boyce
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Peter Dziewulski
- St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - William A. Dickson
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
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Boekema BKHL, Pool L, Ulrich MMW. The effect of a honey based gel and silver sulphadiazine on bacterial infections of in vitro burn wounds. Burns 2012; 39:754-9. [PMID: 23036845 DOI: 10.1016/j.burns.2012.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/03/2012] [Accepted: 09/04/2012] [Indexed: 11/28/2022]
Abstract
Bacterial contamination remains a constant threat in burn wound care. Topical treatments to combat contaminations have good bactericidal effects but can have detrimental effects for the healing process. Treatments with for example silver can increase healing times. Honey based products can be a good alternative as it is antibacterial and patient-friendly. We evaluated the bactericidal and cytotoxic effects of a honey based gel and silver sulphadiazine in a human burn wound model with Pseudomonas aeruginosa. After adding 10(5)colony forming units of P. aeruginosa, topical treatments were applied on the burn wound models. After 2, 12, 24, 28 and 70 h, bacteria were dislodged and counted by plating dilutions. Cytotoxic effects were evaluated histologically in samples of burn wound models treated topically for 3 weeks, without bacteria. L-Mesitran Soft significantly reduced the bacterial load (5-log reduction) up to 24h but did not completely eliminate bacteria from the burn wounds. After Flammazine(®) treatment, only a few colony forming units were observed at all time points. In contrast, re-epithelialization was significantly reduced after application of Flammazine(®) compared to L-Mesitran Soft or control. This in vitro model of burn wound infection can be used to evaluate topical treatments. L-Mesitran Soft is a good alternative for treating burn wounds but the slightly lower bactericidal activity in the burn wound model warrants a higher frequency of application.
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Affiliation(s)
- B K H L Boekema
- Association of Dutch Burn Centres, PO Box 1015, 1940 EA Beverwijk, The Netherlands.
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Muthaiyan A, Biswas D, Crandall PG, Wilkinson BJ, Ricke SC. Application of orange essential oil as an antistaphylococcal agent in a dressing model. Altern Ther Health Med 2012; 12:125. [PMID: 22894560 PMCID: PMC3522527 DOI: 10.1186/1472-6882-12-125] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 08/08/2012] [Indexed: 11/12/2022]
Abstract
Background Staphylococcus aureus is the pathogen most often and prevalently involved in skin and soft tissue infections. In recent decades outbreaks of methicillin-resistant S. aureus (MRSA) have created major problems for skin therapy, and burn and wound care units. Topical antimicrobials are most important component of wound infection therapy. Alternative therapies are being sought for treatment of MRSA and one area of interest is the use of essential oils. With the increasing interest in the use and application of natural products, we screened the potential application of terpeneless cold pressed Valencia orange oil (CPV) for topical therapy against MRSA using an in vitro dressing model and skin keratinocyte cell culture model. Methods The inhibitory effect of CPV was determined by disc diffusion vapor assay for MRSA and vancomycin intermediate-resistant S. aureus (VISA) strains. Antistaphylococcal effect of CPV in an in vitro dressing model was tested on S. aureus inoculated tryptic soya agar plate. Bactericidal effect of CPV on MRSA and VISA infected keratinocyte cells was examined by enumeration of extra- and intra-cellular bacterial cells at different treatment time points. Cytotoxic effects on human skin cells was tested by adding CPV to the keratinocyte (HEK001) cells grown in serum free KSFM media, and observed by phase-contrast microscope. Results CPV vapour effectively inhibited the MRSA and VISA strains in both disc diffusion vapour assay and in vitro dressing model. Compared to untreated control addition of 0.1% CPV to MRSA infected keratinocyte decreased the viable MRSA cells by 2 log CFU/mL in 1 h and in VISA strain 3 log CFU/mL reduction was observed in 1 h. After 3 h viable S. aureus cells were not detected in the 0.2% CPV treatment. Bactericidal concentration of CPV did not show any cytotoxic effect on the human skin keratinocyte cells in vitro. Conclusions At lower concentration addition of CPV to keratinocytes infected with MRSA and VISA rapidly killed the bacterial cells without causing any toxic effect to the keratinocytes. Therefore, the results of this study warrant further in vivo study to evaluate the potential of CPV as a topical antistaphylococcal agent.
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Thorn RMS, Greenman J. Microbial volatile compounds in health and disease conditions. J Breath Res 2012; 6:024001. [PMID: 22556190 PMCID: PMC7106765 DOI: 10.1088/1752-7155/6/2/024001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/12/2012] [Indexed: 12/24/2022]
Abstract
Microbial cultures and/or microbial associated diseases often have a characteristic smell. Volatile organic compounds (VOCs) are produced by all microorganisms as part of their normal metabolism. The types and classes of VOC produced is wide, including fatty acids and their derivatives (e.g. hydrocarbons, aliphatic alcohols and ketones), aromatic compounds, nitrogen containing compounds, and volatile sulfur compounds. A diversity of ecological niches exist in the human body which can support a polymicrobial community, with the exact VOC profile of a given anatomical site being dependent on that produced by both the host component and the microbial species present. The detection of VOCs is of interest to various disciplines, hence numerous analytical approaches have been developed to accurately characterize and measure VOCs in the laboratory, often from patient derived samples. Using these technological advancements it is evident that VOCs are indicative of both health and disease states. Many of these techniques are still largely confined to the research laboratory, but it is envisaged that in future bedside 'VOC profiling' will enable rapid characterization of microbial associated disease, providing vital information to healthcare practitioners.
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Affiliation(s)
- Robin Michael Statham Thorn
- Centre for Research in Biomedicine, Department of Applied Sciences, University of the West of England, Bristol, Frenchay Campus, Coldharbour Lane, BS16 1QY, UK
| | - John Greenman
- Centre for Research in Biomedicine, Department of Applied Sciences, University of the West of England, Bristol, Frenchay Campus, Coldharbour Lane, BS16 1QY, UK
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In vitro studies of toxic shock toxin-1-secreting Staphylococcus aureus and implications for burn care in children. Pediatr Infect Dis J 2012; 31:e73-7. [PMID: 22301473 DOI: 10.1097/inf.0b013e3182493b21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The main etiologic agent of toxic shock syndrome is the toxic shock syndrome toxin-1 (TSST-1) protein secreted by Staphylococcus aureus. Diagnosis of toxic shock syndrome is difficult and is significantly underdiagnosed in young children with burns due to the nonspecific presentation coupled with a rapid deterioration in patient condition. METHODS The lytic and cytolytic activity of a number of clinical and laboratory TSST-1-positive strains of methicillin-susceptible S. aureus (101, 253, 279 and RN4282, respectively) and Pseudomonas aeruginosa PAO1 strain were tested in vitro using an assay designed to assess the relative exotoxin activity of bacteria using phospholipid vesicles and a T cell toxicity assay. In addition, the activity of lytic exotoxins such as δ -toxin and the secretion of nonlytic TSST-1 toxin from S. aureus was measured using the vesicle assay and Western blotting over the 20-hour growth of TSST-1-positive S. aureus culture. RESULTS Both the vesicle and T cell assays suggest a lytic exotoxin-mediated mechanism of vesicle rupture and T cell death, with high levels of vesicle lysis and T cell toxicity. It is important to note that the clinical TSST-1-positive methicillin-susceptible S. aureus strains exhibited lytic exotoxin production as well as TSST-1 expression as confirmed by Western blot. CONCLUSION We suggest that there is no correlation between the expression of TSST-1 and lack of exotoxin production. We also suggest that apurulence in an S. aureus-infected burn wound in a child should not be used to rule out toxic shock syndrome.
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Goh CH, Heng PWS, Chan LW. Alginates as a useful natural polymer for microencapsulation and therapeutic applications. Carbohydr Polym 2012. [DOI: 10.1016/j.carbpol.2011.11.012] [Citation(s) in RCA: 259] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Said SS, El-Halfawy OM, El-Gowelli HM, Aloufy AK, Boraei NA, El-Khordagui LK. Bioburden-responsive antimicrobial PLGA ultrafine fibers for wound healing. Eur J Pharm Biopharm 2012; 80:85-94. [DOI: 10.1016/j.ejpb.2011.08.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/14/2011] [Accepted: 08/31/2011] [Indexed: 01/13/2023]
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Høgsberg T, Bjarnsholt T, Thomsen JS, Kirketerp-Møller K. Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa: a retrospective study. PLoS One 2011; 6:e20492. [PMID: 21655269 PMCID: PMC3105064 DOI: 10.1371/journal.pone.0020492] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/28/2011] [Indexed: 11/19/2022] Open
Abstract
The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous leg ulcers on 91 extremities, from the 1st of March 2005 until the 31st of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p = 0,001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p = 0,001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts.
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Affiliation(s)
- Trine Høgsberg
- Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Institute for International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Klaus Kirketerp-Møller
- Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Orthopedic Department, Hvidovre University Hospital, Copenhagen, Denmark
- * E-mail:
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Thorn RMS, Reynolds DM, Greenman J. Multivariate analysis of bacterial volatile compound profiles for discrimination between selected species and strains in vitro. J Microbiol Methods 2011; 84:258-64. [DOI: 10.1016/j.mimet.2010.12.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
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Malik KI, Malik MAN, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. Int Wound J 2011; 7:413-7. [PMID: 20649832 DOI: 10.1111/j.1742-481x.2010.00717.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Burn injury is associated with a high incidence of death and disability; yet, its management remains problematic and costly. We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40% of body surface area and compared its results with those of silver sulphadiazine (SSD). In this randomised comparative clinical trial, carried out Burn Center of POF Hospital, Wah Cantt, Pakistan, from May 2007 to February 2008, 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD (13·47 ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns.
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Peñuelas O, Cerdá E, Espino J, García-Domínguez J, Hierro PG, de la Cal MA, Lorente JA. Limb intracompartmental sepsis in burn patients associated with occult infection. Burns 2009; 36:558-64. [PMID: 19819076 DOI: 10.1016/j.burns.2009.06.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 06/02/2009] [Accepted: 06/02/2009] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intracompartmental sepsis (IS) is a rare complication in burn patients. IS presents in patients with inadequate perfusion of intracompartmental tissues with subsequent ischaemic necrosis and infection. Contributing factors include high-volume resuscitation, delayed escharotomies and previous bacteraemias. We describe the profile of a series of patients who developed IS in our Intensive Care Burn Unit (ICBU). METHODS We carried out a retrospective chart review of patients admitted to an ICBU over a 5-year period. RESULTS Seven patients of 659 admissions (1.0%) developed IS involving the extremities. Diagnosis was based on the identification of purulent drainage and local swelling associated with signs of sepsis of unknown origin. Total body surface area (TBSA) burned averaged 67.4% and full-thickness body surface area (FTBSA) burned averaged 48.4%. All patients were sedated and mechanically ventilated. The first 24-h fluid requirements averaged 6.0 ml kg(-1) per %TBSA burn (range 3.5-7.0 ml kg(-1)per %TBSA). Escharotomies were performed in five patients within the first 24h of admission. Median time of diagnosis of IS was 23 days from admission (range 11-45 days). Four patients developed bacteraemia caused by the same microorganism infecting the soft tissue. In five cases, the infecting microorganism had previously colonised the overlying burned skin. Three patients required amputation of the affected limb. CONCLUSION IS is a devastating infectious complication which appears late after large burns. Predisposing factors include high-volume resuscitation, delayed escharotomies, colonisation of the overlying skin and previous bacteraemias. Earlier diagnosis and management are needed to attain a better outcome.
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Affiliation(s)
- Oscar Peñuelas
- Intensive Care and Burn Unit, Hospital Universitario de Getafe, Spain.
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Abstract
Bacterial colonisation and infection remain the major causes of delayed healing and graft rejection following burns. Topical treatment is necessary to reduce the incidence of burn wound infection. Silver sulphadiazine (SD-Ag) is an often used microbicidal agent. However, this treatment produces adverse reactions and side-effects. On the basis of experimental data and clinical application of lactobacilli as probiotics, we performed this exploratory study to establish the effectiveness of bacteriotherapy with topical application of the innocuous bacteria Lactobacillus plantarum cultured in De Man, Rogosa and Sharpe medium to provide an alternative method for burn treatment using SD-Ag as a reference. These innocuous bacteria would compete with other bacteria that are wound pathogens and would modify the wound environment and promote tissue repair. Eighty burned patients from the Plastic Surgery and Burns Unit were grouped into infected (delayed) second- and third-degree and non infected (early) third-degree burns and treated with L. plantarum or SD-Ag. The proportion of patients with delayed second-degree burns was 0.71 for L. plantarum and 0.73 for SD-Ag (relative rate: -2.72%) with respect to the decrease in bacterial load (<10(5) bacteria/g of tissue), promotion of granulating tissue wound bed and healing. In early third-degree burns, the values were 0.75 for L. plantarum and 0.84 for SD-Ag (relative rate: -1.07%) in preventing wound infection and promotion of granulation tissue, 0.90 in graft taking for both treatments (relative rate: 0%) and 0.75 for L. plantarum and 0.77 for SD-Ag (relative rate: -2.60%) in healing. In delayed third-degree burns, values were 0.83 for L. plantarum and 0.71 for SD-Ag (relative rate: +16.90%) with respect to the decrease in the bacterial load (<10(5) bacteria/g of tissue) and providing a granulating tissue wound bed, 0.90 in graft taking for both treatments (relative rate: 0%) and 0.75 for L. plantarum and 0.64 for SD-Ag (relative rate: + 17.19%) in healing. Although the number of patients (between 12 and 15 per group) did not enable the application of a power statistical test, these results suggest that the L. plantarum treatment should be studied in greater depth and could be used as a valid alternative for the topical treatment of burns.
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Affiliation(s)
- Maria C Peral
- Cátedra de Biología, Departamento Biomédico, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
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Srinivasan S, Vartak AM, Patil A, Saldanha J. Bacteriology of the burn wound at the Bai Jerbai Wadia Hospital for children, Mumbai, India-A 13-year study, Part I-Bacteriological profile. Indian J Plast Surg 2009; 42:213-8. [PMID: 20368860 PMCID: PMC2845367 DOI: 10.4103/0970-0358.59284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM To study which organisms were prevalent in our burn unit and their antibiotic sensitivity pattern in brief. METHOD Microbiological data of 1534 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 13 years (1994-2006) was reviewed retrospectively. A total of 9333 swabs were cultured and antibiotic sensitivities to the isolated organisms determined. The age group of patients admitted to our facility ranged from one month to 15 years. RESULT Klebsiella was the predominant organism in our set-up (33.91%), closely followed by Pseudomonas (31.84%). The antibiotic sensitivities of the isolated organisms are discussed in detail in the text. CONCLUSION Every treatment facility has microorganisms unique to it and these change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection-related morbidity and mortality are improved.
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Affiliation(s)
- Shankar Srinivasan
- Department of Burns and Plastic Surgery, B.J. Wadia Hospital for Children, Parel, Mumbai, India
| | - Arvind M. Vartak
- Department of Burns and Plastic Surgery, B.J. Wadia Hospital for Children, Parel, Mumbai, India
| | - Aakanksha Patil
- Department of Burns and Plastic Surgery, B.J. Wadia Hospital for Children, Parel, Mumbai, India
| | - Jovita Saldanha
- Department of Burns and Plastic Surgery, B.J. Wadia Hospital for Children, Parel, Mumbai, India
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Calum H, Moser C, Jensen PØ, Christophersen L, Maling DS, van Gennip M, Bjarnsholt T, Hougen HP, Givskov M, Jacobsen GK, Høiby N. Thermal injury induces impaired function in polymorphonuclear neutrophil granulocytes and reduced control of burn wound infection. Clin Exp Immunol 2008; 156:102-10. [PMID: 19210518 DOI: 10.1111/j.1365-2249.2008.03861.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6% third-degree burn injury was induced in mice with a hot-air blower. The third-degree burn was confirmed histologically. The mice were allocated into five groups: control, shave, burn, infection and burn infection group. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization of the skin showed a more polymorphonuclear neutrophil granulocytes (PMNs)-dominated inflammation in the group of mice with infected burn wound compared with the with burn wound group. In contrast, a higher degree of inflammation was observed in the burn wound group compared with the group of mice with infected burn wound. Furthermore, the oxidative burst and the phagocytic capacity of the PMNs were reduced in the group of mice with burn wound. Using this novel mouse model of thermal injury a decline of peripheral leucocytes was observed, whereas the increased local inflammatory response at the site of infection showed reduced capacity to contain and eliminate the infection.
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Affiliation(s)
- H Calum
- Department of Clinical Microbiology, Rigshospitalet, Denmark.
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Barnea Y, Carmeli Y, Neville LF, Kahel-Reifer H, Eren R, Dagan S, Navon-Venezia S. Therapy with anti-flagellin A monoclonal antibody limits Pseudomonas aeruginosa invasiveness in a mouse burn wound sepsis model. Burns 2008; 35:390-6. [PMID: 18951715 DOI: 10.1016/j.burns.2008.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of an anti-flagellin sub-type monoclonal antibody (anti-fla-a) on Pseudomonas aeruginosa infection in a mouse burn model and to assay bacterial dissemination and invasiveness. METHODS After immediate post-burn infection with P. aeruginosa, mortality and morbidity (daily weight changes) were monitored in mice treated with anti-fla-a as compared to untreated mice. Bacterial dissemination and invasiveness were monitored by bacterial counts at the burn site and spleen. Three different timing regimens for anti-fla-a treatment were studied: (a) prophylaxis (pre-infection), (b) therapeutic (post-infection), and (c) combined mode. RESULTS Combined regimen of anti-fla-a markedly improved survival of mice infected with P. aeruginosa from 6% to 96% (p<0.0001), similar to treatment with Imipenem. Furthermore, a significant improvement in survival was obtained when anti-fla-a was given prior to (75% survival) or post-infection (50% survival). It reduced bacterial load in the spleen (p=0.01), preventing bacterial sepsis. CONCLUSION Anti-fla-a is effective in reducing mortality and morbidity in murine P. aeruginosa-infected burn model.
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Affiliation(s)
- Yoav Barnea
- Division of Epidemiology & Laboratory for Molecular Epidemiology and Antimicrobials Research, Israel.
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Goh CH, Heng PWS, Huang EPE, Li BKH, Chan LW. Interactions of antimicrobial compounds with cross-linking agents of alginate dressings. J Antimicrob Chemother 2008; 62:105-8. [DOI: 10.1093/jac/dkn168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ranasinghe K, Cross SE, Venkatesh B. Antibiotic Dosing in Burn Injury: Should We be Looking at the Tissues more Closely? Intensive Care Med 2007. [DOI: 10.1007/0-387-35096-9_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cerdá E, Abella A, de la Cal MA, Lorente JA, García-Hierro P, van Saene HKF, Alía I, Aranguren A. Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit: a 9-year prospective study. Ann Surg 2007; 245:397-407. [PMID: 17435547 PMCID: PMC1877020 DOI: 10.1097/01.sla.0000250418.14359.31] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of enteral vancomycin in controlling MRSA endemicity in an intensive care burn unit. SUMMARY BACKGROUND DATA MRSA is a serious clinical and epidemiologic problem. It is not uncommon that the traditional maneuvers, detection and isolation of carriers, fail to control endemicity due to MRSA. METHODS All patients admitted to an Intensive Care Burn unit from January 1995 to February 2004 have been included in this prospective cohort study comprised 2 different periods. During period 1 (January 1995 to January 2000), barrier and isolation measures were enforced. During period 2 (February 2000 to February 2004), patients received enteral vancomycin 4 times daily in addition to selective digestive decontamination. RESULTS A total of 777 patients were enrolled into the study: 402 in period 1, and 375 in period 2. There were no significant differences in the characteristics of patients between the 2 periods, except for the total body surface burned area, 30.3% in period 1 and 25.61% in period 2 (P = 0.009). There was a significant reduction in the incidence of patients who acquired MRSA from 115 in period 1 to 25 in period 2 (RR, 0.22; 95% confidence interval [CI], 0.15-0.34). Similar reductions were observed in the number of patients with wound (RR, 0.20; 95% CI, 0.12-0.32), blood (RR, 0.13; 95% CI, 0.04-0.35), and tracheal aspirate (RR, 0.07; 95% CI, 0.03-0.19), samples positive for MRSA. There was no emergence of either vancomycin-resistant enterococci or Staphylococcus aureus with intermediate sensitivity to glycopeptides in period 2. CONCLUSIONS Enteral vancomycin is an effective and safe method to control MRSA in intensive care burn units without VRE.
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Affiliation(s)
- Enrique Cerdá
- Department of Critical Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
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Jarman A, Duggal A, Korus L, Tredget EE. Toxic shock syndrome in an adult burn patient. Burns 2007; 33:1051-3. [PMID: 17467907 DOI: 10.1016/j.burns.2006.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 10/03/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Abdulaziz Jarman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada T6G 2B7
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Barnea Y, Carmeli Y, Kuzmenko B, Gur E, Hammer-Munz O, Navon-Venezia S. The establishment of a Pseudomonas aeruginosa-infected burn-wound sepsis model and the effect of imipenem treatment. Ann Plast Surg 2006; 56:674-9. [PMID: 16721084 DOI: 10.1097/01.sap.0000203984.62284.7a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We present a standardized Pseudomonas aeruginosa (PA) infected burn-wound model in mice for evaluating new antimicrobials and therapy strategies for PA infections and demonstrate the effect of the antibiotic imipenem in this model. METHODS A 6%-8% total body surface area, full-thickness, scald-burn wound was induced in anesthetized mice. Two study groups (PA-infected burn) were compared with 1 treatment group (systemic imipenem) and 3 control groups (noninfected burn, infected nonburned, and burn with distant infection). Seven-day mortality, quantitative culture from eschars and from spleens, weight loss, and time to healing were compared. RESULTS The 25%-100% mortality rate in the nontreated PA-infected burn group was directly related to the infecting inoculum. Imipenem treatment reduced the mortality rate to 0-17%. No control animal died. Systemic bacterial dissemination at 48 hours was significantly higher in the study group. Morbidity paralleled survival results. Wound healing was quicker in the imipenem-treated group and control groups compared with the infected nontreated group. CONCLUSIONS The mice model is a useful tool for evaluating new antibacterial agents and strategies for treating PA-infected burn injuries. Imipenem was found to be efficacious in the treatment of severe PA sepsis.
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Affiliation(s)
- Yoav Barnea
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.
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Affiliation(s)
- Deirdre Church
- Calgary Laboratory Services, 9-3535 Research Rd. N.W., Calgary, Alberta, Canada T2L 2K8.
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Banfi S, Caruso E, Buccafurni L, Battini V, Zazzaron S, Barbieri P, Orlandi V. Antibacterial activity of tetraaryl-porphyrin photosensitizers: an in vitro study on Gram negative and Gram positive bacteria. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2006; 85:28-38. [PMID: 16737820 DOI: 10.1016/j.jphotobiol.2006.04.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 04/19/2006] [Accepted: 04/19/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Photodynamic therapy exploits visible light and photosensitizers to inactivate cells and this methodology is currently used for the treatment of several types of malignancy. Although various tumours are successfully treated with PSs and light, the application on microorganisms (photodynamic antimicrobial chemotherapy) has not yet found specific medical applications and still remains an open field of fundamental research. PURPOSE The assessment of the effect of a panel of seven tetraaryl-porphyrins, two commercial (PS 1 and 2) and five synthetic (PS 3-7) in in vitro experiments against Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. METHODS Three of the new photosensitizers (PS 3, 4 and 5) are tetracationic porphyrins and were prepared by N-alkylation of 5,10,15,20-tetra-4-pyridylporphyrin with a large excess of different benzyl chlorides; compound 7 is a dicationic porphyrin and was obtained in a similar way using a lower excess of 4-methoxybenzyl chloride. The neutral porphyrin (PS 6) was previously described. Dose-response curves were obtained titrating the survivors of cell suspensions (10(8)cfu/ml) exposed to the PSs and irradiated with visible light (total fluence rate 266 J/cm2). RESULTS The non ionic porphyrin 6 was the least active PS against all the tested bacteria. Cationic PSs 3, 4, 5 and 7 were more active than the commercial 1 and 2. The Gram positive S. aureus was more sensitive to all the PSs than the Gram negative E. coli and P. aeruginosa, the latter being the more resistant one. Compound 7 was found particularly efficient against P. aeruginosa, causing a 7 log units reduction of survivors at a concentration of 8 microM. CONCLUSIONS The reported results confirm that the presence of positively charged groups on porphyrin frame is fundamental for PSs antibacterial activity, however our data suggest that a moderate degree of lipophilicity, achievable by the introduction of aromatic hydrocarbon side chains on the pyridyl moieties, may improve PSs efficiency. Furthermore dicationic porphyrin 7 seems to be more efficient than the corresponding tetracationic derivatives thus emphasizing an interesting feature involved in the PSs activity.
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Affiliation(s)
- Stefano Banfi
- Department of Structural and Functional Biology, University of Insubria, Via H.J. Dunant 3, 21100 Varese, Italy.
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Barnea Y, Carmeli Y, Gur E, Kuzmenko B, Gat A, Neville LF, Eren R, Dagan S, Navon-Venezia S. Efficacy of Antibodies against the N-Terminal of Pseudomonas aeruginosa Flagellin for Treating Infections in a Murine Burn Wound Model. Plast Reconstr Surg 2006; 117:2284-91. [PMID: 16772930 DOI: 10.1097/01.prs.0000218768.34429.e0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an era of increasing drug resistance, immunotherapy is a desirable treatment against Pseudomonas aeruginosa infections. The flagellum, which is an important pseudomonal virulence factor, was targeted for immunotherapy. The aim of the study was to evaluate the efficacy of polyclonal immunotherapy targeted against the N-terminal of flagellin (anti-N'-fla-b) for treating severe P. aeruginosa infection in a murine burn wound model. METHODS Groups of 12 mice were infected (subeschar) with P. aeruginosa strain PA01, and were treated either with systemic anti-N'-fla-b immunoglobulin G (IgG), nonspecific IgG, or imipenem. The control groups included mice with burn alone, mice with untreated infected burn, and mice without burn infected with P. aeruginosa. Three separate regimens were examined: prophylaxis (preinfection), therapeutic (postinfection), and combined. The efficacy of anti-N'-fla-b was evaluated by monitoring the mortality and morbidity (relative weight loss) during a period of 2 weeks. RESULTS Anti-N'-fla-b IgG immunotherapy significantly decreased the mortality rate of infected burned mice followed by severe P. aeruginosa infection. The mortality rate in the anti-N'-fla-b-treated groups ranged from 0 to 17 percent compared with 58 to 83 percent in nontreated groups infected with 2 to 5 x 10(6) colony-forming units of P. aeruginosa (p < 0.05). The mortality rate in the anti-N'-fla-b-treated groups was similar to that of groups treated with imipenem. The three tested regimens yielded similar results. Morbidity paralleled survival results. Histopathologic examination revealed an earlier reepithelialization of the infected wound in the anti-N'-fla-b-treated mice compared with untreated mice. CONCLUSION Immunotherapy with anti-N'-fla-b IgG, given either as prophylaxis or therapeutically, effectively reduced mortality and morbidity and improved wound healing in a severely P. aeruginosa-infected murine burn model.
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Affiliation(s)
- Yoav Barnea
- Department of Plastic and Reconstructive Surgery, Division of Epidemiology and Laboratory for Molecular Epidemiology and Antimicrobials Research, Pathology Institute, Tel-Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
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Serour F, Stein M, Gorenstein A, Somekh E. Early burn related gram positive systemic infection in children admitted to a pediatric surgical ward. Burns 2006; 32:352-6. [PMID: 16527412 DOI: 10.1016/j.burns.2005.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2005] [Accepted: 10/20/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gram positive infections, including toxic shock syndrome (TSS), may be an early complication following burns, especially in children. OBJECTIVE To identify risk factors associated with early burn related gram positive systemic infection (EBGI) in children admitted to a Pediatric Surgical Ward. METHODS A retrospective analysis of the records of all EBGI patients treated from January 1995 to December 2004. EBGI patients were defined as having systemic signs of infection appearing in the first 48 h following the burn and associated with: (1) clinical signs of toxin mediated illness and/or (2) positive blood culture of either Staphylococcus aureus or group A beta hemolytic Streptococcus. Demographic and clinical data were also collected from the charts of 150 randomly selected burn patients admitted during the study period. RESULTS We identified 13 cases of EBGI (2.5%) among 518 children admitted for thermal burns (mean age: 2.4 years). Three had bacteremia without rash. The 10 other patients were diagnosed as having a toxin mediated disease. S. aureus grew from the burn wound in six patients. All EBGI patients recovered following antibiotic therapy. Significant differences between the groups included: percentage of burned body surface area (6.9% versus 3.9%), and head and face localization (64% versus 31%) in the EBGI and control groups, respectively. CONCLUSIONS EBGI is not rare even in pediatric patients with minor-moderate burns. Burns localized to the face or the head may be predisposing factor for such an infection.
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Affiliation(s)
- Francis Serour
- Department of Pediatric Surgery, The E. Wolfson Medical Center, P.O. Box 5, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Poindexter BJ, Bhat S, Buja LM, Bick RJ, Milner SM. Localization of antimicrobial peptides in normal and burned skin. Burns 2006; 32:402-7. [PMID: 16621313 DOI: 10.1016/j.burns.2006.01.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 01/18/2006] [Indexed: 11/28/2022]
Abstract
Severe burn causes immunosuppression, and the eschar remains a perfect culture medium for microbial growth. The resulting sepsis is a common complication of burns with a high mortality. The skin produces a number of molecules including antimicrobial peptides (AMPs) that act in the first line of host defense. Previous studies from our laboratory suggested decreased expression of human beta-defensin-2 (HBD-2) in burned wounds. Here, we have expanded our work by identifying HBD-1, HBD-2, HBD-3 and human neutrophil peptide (HNP) in normal and burn skin samples using fluorescence deconvolution microscopy. In normal skin, HBD-1 was localized to the perinuclear region of keratinocytes, while HBD-2 was seen primarily in the stratum basale of the epidermis. HBD-3 was found in dendritic cells of the stratum spinosum. HNP was distributed in a somewhat random pattern in the papillary dermis. In burned skin, in which the epidermis had been destroyed or disrupted, the presence of HBD-1 was localized to dermal glandular structures and hair shafts. HBD-2 was found in both the upper portions of the remaining keratin layers, and localized to lower, f-actin containing, acini-like structures, a pattern also evident with HBD-3. We conclude that although the upper layers of skin are destroyed and disrupted by burn, cells in the lower portions of the skin demonstrate an ability to synthesize most of the AMPs, thereby maintaining some barrier against infection. The results of these studies further contribute to an understanding of the role of AMPs in the pathophysiology of cutaneous burn and the possibility of using these sites for upregulation of AMP synthesis in the prevention of burn sepsis.
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Affiliation(s)
- Brian J Poindexter
- The Department of Pathology and Laboratory Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA
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Abstract
Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.
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Unal S, Ersoz G, Demirkan F, Arslan E, Tütüncü N, Sari A. Analysis of skin-graft loss due to infection: infection-related graft loss. Ann Plast Surg 2006; 55:102-6. [PMID: 15985801 DOI: 10.1097/01.sap.0000164531.23770.60] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This prospective study was performed to analyze the causes of infection-related skin-graft loss in a general population of plastic and reconstructive surgery patients. One hundred thirty-two patients who received either full- or split-thickness skin grafts to reconstruct soft-tissue defects were included. The tissue defects were grouped according to the cause as follows: vascular ulcers (9.2%), burns (14.5%), traumatic tissue defects (36.6%), and flap donor-site defects (39.7%). In all cases, the preoperative evaluation indicated an adequate wound-bed preparation. However, graft loss secondary to infection was recorded in 31 patients (23.5%). The microbiological cultures revealed Pseudomonas aeruginosa in 58.1% of the cases (P<0.05), followed by Staphylococcus aureus, Enterobacter, enterococci, and Acinetobacter; 58.3% of grafts in vascular ulcers, 47.4% of grafts in burns, 16.7% of grafts in traumatic-tissue defects; and 13.5% of grafts in donor-site defects were lost due to infection. Vascular ulcers and burns were more commonly associated with graft losses due to infection than other tissue defects (P<0.001). No correlation was found between the etiological cause of the defects and the microorganisms cultured. However, Pseudomonas infections were more fulminant and caused an increased reoperation rate 4.2 times (P<0.05). Full-thickness grafts were more resistant to infection than split-thickness grafts (P<0.05). Graft loss due to infection was also more common in grafts applied to the lower extremities or when performed at multiple sites. In conclusion, 23.7% of skin grafts were lost due to infection in a group of general plastic surgery patients. Infection-related graft loss was more commonly encountered in vascular ulcers and burn wounds, and the most common cause was Pseudomonas aeruginosa.
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Affiliation(s)
- Sakir Unal
- Department of Plastic Surgery, Mersin University School of Medicine, Mersin, Turkey
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Yildirim S, Nursal TZ, Tarim A, Torer N, Noyan T, Demiroglu YZ, Moray G, Haberal M. Bacteriological Profile and Antibiotic Resistance: Comparison of Findings in a Burn Intensive Care Unit, Other Intensive Care Units, and the Hospital Services Unit of a Single Center. ACTA ACUST UNITED AC 2005; 26:488-92. [PMID: 16278563 DOI: 10.1097/01.bcr.0000185454.72237.c6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of the study was to define the bacteriological profile and antibiotic resistance patterns of a burn intensive care unit (ICU) and to compare them with the patterns from three other hospital areas in the same center (ie, cardiovascular-coronary ICU, a general ICU, and the hospital service unit). Bacterial isolates were collected prospectively from the burned patients and the patients from the other hospital areas between May 2001 and November 2003. In the burn ICU, Pseudomonas aeruginosa was the isolated pathogen most frequently (40.4%), followed by Staphylococcus aureus (29.3%) and Acinetobacter spp. (9.8%). S. aureus was the most common isolated pathogen in other hospital areas. The agents that were most effective against P. aeruginosa in the burn ICU were piperacillin/tazobactam and sulbactam/cefoperazon. We observed higher antimicrobial resistance in burn ICU than in the other hospital areas studied. In conclusion, bacteriological profile and antibiotic resistance patterns of patients in the burn ICU are significantly different from those in other ICUs and hospital units at our center. This knowledge is crucial for early treatment of infections in burned patients.
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Affiliation(s)
- Sedat Yildirim
- Department of General Surgery, Baskent University Adana Teaching and Medical Research Center, Adana, Turkey
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