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Kilcoyne I, Dechant JE, Kass PH, Nieto JE. Evaluation of the risk of incisional infection in horses following application of protective dressings after exploratory celiotomy for treatment of colic. J Am Vet Med Assoc 2020; 254:1441-1447. [PMID: 31149883 DOI: 10.2460/javma.254.12.1441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess incidence of incisional infection in horses following management with 1 of 3 protective dressings after exploratory celiotomy for treatment of acute signs of abdominal pain (ie, colic) and determine the risk of complications associated with each wound management approach. DESIGN Prospective, randomized, controlled study. ANIMALS 85 horses. PROCEDURES Horses were assigned to 3 groups. After standardized abdominal closure, a sterile cotton towel (group 1) or polyhexamethylene biguanide-impregnated dressing (group 2) was secured over the incision site with 4 or 5 cruciate sutures of nonabsorbable monofilament, or sterile gauze was placed over the site and secured with an iodine-impregnated adhesive drape (group 3). Demographic and clinicopathologic data, intraoperative and postoperative variables, and development of complications were recorded and compared among groups by statistical methods. Follow-up information was collected 30 and 90 days after surgery. Incidence and odds of incisional complications were calculated. RESULTS 75 horses completed the study. Group 3 typically had dressing displacement necessitating removal during anesthetic recovery; dressings were in place for a mean of 44 and 31 hours for groups 1 and 2, respectively. Purulent or persistent serosanguinous incisional discharge (ie, infection) was detected in 11 of 75 (15%) horses (2/24, 0/26, and 9/25 from groups 1, 2, and 3, respectively). Odds of incisional complications were significantly greater for group 3 than for groups 1 or 2. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that risk of infection after celiotomy for treatment of colic is lower for incisions covered with sterile towels or polyhexamethylene biguanide-impregnated dressings secured with sutures than for incisions covered with gauze secured with iodine-impregnated adhesive drapes.
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Zhang C, Brown PJB, Hu Z. Higher functionality of bacterial plasmid DNA in water after peracetic acid disinfection compared with chlorination. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 685:419-427. [PMID: 31176227 DOI: 10.1016/j.scitotenv.2019.05.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/31/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Peracetic acid (PAA) is an emerging disinfectant with a low disinfection by-product formation potential, but how PAA destroys gene function after killing bacteria remains to be studied. Bacterial plasmid DNA is a mobile genetic element that often harbors undesirable genes encoding antibiotic resistance and virulence factors. Even though PAA efficiently kills bacteria, bacterial plasmids and other mobile genetic elements might still be intact and functional after PAA disinfection, posing potential public health and environmental risks. This study evaluated the impact of PAA disinfection on the functionality of plasmid DNA in vivo and compared the results with those from chlorination. We delivered a plasmid DNA harboring two antibiotic resistance genes to Escherichia coli TOP10 to form an antibiotic-resistant bacterium (ARB). The planktonic ARB was treated with PAA and chlorine to find the minimum doses inhibiting the regrowth of the strain. PAA and chlorine stopped the regrowth at 8 ± 1 mg PAA·L-1 and 20 ± 9 mg Cl2·L-1, respectively. The functionality of the plasmid DNA after PAA and chlorine disinfection was then determined at higher doses in vivo. Neither PAA nor chlorine completely destroyed the plasmid DNA. However, chlorine was more efficient than PAA in eliminating the plasmid DNA. PAA at 25 mg PAA·L-1 reduced the transforming activity of the plasmid DNA by less than 0.3 log10 units, whereas chlorine at 25 mg Cl2·L-1 reduced the transforming activity by approximately 1.7 log10 units. Chlorine had a more pronounced impact on the functionality of the plasmid DNA because it oxidizes or destroys bacterial components including plasmid DNA faster than PAA. In addition, environmental scanning electron microscopy shows that chlorination desiccated the cells resulting in the flat cellular structure and possibly more complete loss of plasmid DNA, whereas PAA disinfection had a less impact on cell structure and morphology. This study demonstrates that more plasmid DNA remains functional in water after PAA disinfection than after chlorination. These functional genetic elements could be acquired by other microorganisms via horizontal gene transfer to pose potential public health and environmental risks.
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Affiliation(s)
- Chiqian Zhang
- Department of Civil & Environmental Engineering, University of Missouri, Columbia, MO 65211, United States
| | - Pamela J B Brown
- Division of Biological Sciences, University of Missouri, Columbia, MO 65211, United States
| | - Zhiqiang Hu
- Department of Civil & Environmental Engineering, University of Missouri, Columbia, MO 65211, United States.
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ARAUJO DANIELCUNHADE, FRANÇA LUIZCLÁUDIODEMOURA, CASTILHO ANDRÉMOREIRA, FALCI TIAGOCOSTA, PENIDO TIAGO, REGGIANI ERICGUSTAVO. PREVALENCE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN SPINAL SURGERY PATIENTS. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191803197013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective The objective of this study was to determine the prevalence of patients with colonization of methicillin-resistant Staphylococcus aureus (MRSA) in the nasal mucosa, who underwent elective spinal procedures. Methods Retrospective study of the medical records of all patients submitted to elective procedures, totaling 125 individuals in the period of 2015 and 2017, performed by two spinal surgeons of the Orthopedics and Traumatology Service of Hospital Mater Dei, Belo Horizonte, Minas Gerais. The pre-operative investigation of MRSA consisted of the collection of a nasal swab for microbiological culture. Results Of the 125 patients evaluated, three (2.4%) showed positive results for MRSA nasal colonization. This prevalence is consistent with the international literature, that ranges from 1.5 to 5.9%. Of these patients none had infection of the surgical wound, probably due to the preoperative prophylactic measures. Conclusions Despite the limitations of the study, we found that the prevalence of carriers of this nasal MRSA population is similar to that of populations worldwide . Level of evidence III; Retrospective Study.
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Aurora A, Beasy A, Rizzo JA, Chung KK. The Use of a Silver–Nylon Dressing During Evacuation of Military Burn Casualties. J Burn Care Res 2017; 39:593-597. [DOI: 10.1093/jbcr/irx026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Amit Aurora
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, Texas
| | - Alexander Beasy
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, Texas
| | - Julie A Rizzo
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryl
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryl
- Brooke Army Medical Center, JBSA, Fort Sam Houston, Texas
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Abstract
Background: Since the early 1930s when antibiotics were first introduced, they have revolutionized the way physicians treat infections. Skin conditions from acne to leprosy, which were once shunned by society, are now easily treated with oral antibiotics. Objective: Antibiotics are chemicals derived from bacteria and fungi that uniquely have antibacterial action. The most notable example is penicillin, which is derived from a mold. With hundreds of antibiotics available to the practicing physician, improper use of these drugs has become widespread and expensive and has spawned resistant strains. For the dermatologist, antibiotics are vital weapons in the drug armamentarium for treating various skin conditions. Conclusion: This review explores the newest and most common oral, parenteral, and topical antibiotics used in dermatology, their indications, adverse effects, dosage, and spectrum of activity. Furthermore, systemic antibacterial prophylaxis and vaccines pertinent to dermatology are discussed. The penicillins, cephalosporins, tetracyclines, macrolides, fluoroquinolones, sulfonamides, aminoglycosides, lincosamides, folate inhibitors, and a new synthetic class of drugs, the oxazolidinones, are reviewed. These antibiotics are used to treat a variety of organisms.
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Affiliation(s)
- Daniel A. Carrasco
- Departments of Dermatology, Microbiology/Immunology and Internal Medicine, University of Texas Medical Branch-Galveston, Galveston, Texas, USA
| | - Melody Vander Straten
- Departments of Dermatology, Microbiology/Immunology and Internal Medicine, University of Texas Medical Branch-Galveston, Galveston, Texas, USA
| | - Stephen K. Tyring
- Departments of Dermatology, Microbiology/Immunology and Internal Medicine, University of Texas Medical Branch-Galveston, Galveston, Texas, USA
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Evidence-based (S3) guidelines for diagnostics and treatment of venous leg ulcers. J Eur Acad Dermatol Venereol 2016; 30:1843-1875. [PMID: 27558268 DOI: 10.1111/jdv.13848] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
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Chapter 4 - Treatment of Wounds. J Eur Acad Dermatol Venereol 2016. [PMID: 27558927 DOI: 10.1111/jdv.5_13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Bonomo RA, Van Zile PS, Li Q, Shermock KM, McCormick WG, Kohut B. Topical triple-antibiotic ointment as a novel therapeutic choice in wound management and infection prevention: a practical perspective. Expert Rev Anti Infect Ther 2014; 5:773-82. [PMID: 17914912 DOI: 10.1586/14787210.5.5.773] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Triple-antibiotic ointment (TAO) is a safe and effective topical agent for preventing infections in minor skin trauma. The formulation contains neomycin, polymyxin B and bacitracin in a petrolatum base. TAO is active against the most common disease-causing pathogens found in wounds and on the skin and may be an attractive alternative to oral therapy in select circumstances. Resistance to TAO does not develop readily, and safety studies have shown that the risk of allergic sensitivity to TAO is low. Susceptibility profiles of TAO have remained relatively unchanged since its discovery. Prophylaxis or treatment with TAO should be considered as resistant organisms continue to emerge in the community and hospital setting.
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Affiliation(s)
- Robert A Bonomo
- Case Western Reserve University, Veteran Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA.
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Ng K, Dalen D, Rhine D. Management of hot tar burn using vitamin e ointment containing petroleum and polyoxyethylene sorbitan. CAN J EMERG MED 2013; 15:307-10. [PMID: 23972137 DOI: 10.2310/8000.2013.130970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tar burns are primarily an occupational hazard associated with the road paving or roofing industry. Management of tar burns requires safe and effective removal of solidified tar from the skin using a dissolution or emulsifying agent to prevent inflicting further injury and pain. We report a case of a patient with tar burns on 10% of his body surface area involving the lower arms bilaterally and splashes to the facial area. The tar was efficiently removed with Webber Vitamin E Ointment without toxicity, irritation, or other complications.
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Bisdas T, Beckmann E, Marsch G, Burgwitz K, Wilhelmi M, Kuehn C, Haverich A, Teebken O. Prevention of Vascular Graft Infections with Antibiotic Graft Impregnation Prior to Implantation: In Vitro Comparison between Daptomycin, Rifampin and Nebacetin. Eur J Vasc Endovasc Surg 2012; 43:448-56. [DOI: 10.1016/j.ejvs.2011.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Goullé JP, Saussereau E, Mahieu L, Redon E, Schmutz JL, Buchy F, Guerbet M, Lacroix C. Exposition à l’argent : deux cas d’argyrie. ACTA ACUST UNITED AC 2011. [DOI: 10.1051/ata/2011002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Taylor SC, Averyhart AN, Heath CR. Postprocedural wound-healing efficacy following removal of dermatosis papulosa nigra lesions in an African American population: a comparison of a skin protectant ointment and a topical antibiotic. J Am Acad Dermatol 2011; 64:S30-5. [PMID: 21247663 DOI: 10.1016/j.jaad.2010.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/03/2010] [Accepted: 11/06/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Removal of dermatosis papulosa nigra (DPN) lesions results in superficial cutaneous wounds that are frequently treated with topical antibiotic ointments. We hypothesize that antibiotics are not necessary for effective and safe healing of such wounds. OBJECTIVE This study compared the wound healing efficacy and safety of the skin protectant Aquaphor Healing Ointment (AHO) (Beiersdorf Inc, Wilton, CT) and Polysporin first-aid ointment (Poly/Bac) (polymyxin B sulfate/bacitracin zinc) (Johnson & Johnson, New Brunswick, NJ) after removal of DPN lesions. METHODS This double-blind, split-face, pilot study removed two DPN lesions from each side of the face of 20 African American subjects. Wounds on opposite sides of the face were treated with AHO or Poly/Bac twice daily for 21 days. Wounds were evaluated for erythema, edema, crusting, scabbing, epithelial confluence, melanin confluence, general wound appearance, and subjective irritation on days 1, 3, 7, 10, 14, and 21 after surgery using 5-point scales. RESULTS Wound healing parameter assessments showed no differences between wounds treated with AHO versus Poly/Bac in erythema, edema, epithelial confluence, crusting, scabbing, melanin confluence, or postinflammatory hyperpigmentation at any time point. Subjective irritation was similar between treatments for burning, stinging, itching, tightness, tingling, and pain. No adverse events were reported. LIMITATIONS This was a small study in a homogenous population of African Americans. CONCLUSIONS Postprocedural treatment with AHO and Poly/Bac demonstrated equivalent wound healing in an African American population. These results support the hypothesis that antibiotics are not necessary for safe and effective healing of facial wounds resulting from removal of DPN lesions.
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Affiliation(s)
- Susan C Taylor
- College of Physicians and Surgeons, Columbia University, New York, USA.
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A comparison of antibacterial activity against Methicillin-Resistant Staphylococcus aureus and gram-negative organisms for antimicrobial compounds in a unique composite wound dressing. Adv Skin Wound Care 2010; 23:406-13. [PMID: 20729646 DOI: 10.1097/01.asw.0000383213.95911.bc] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Antibiotic resistance is increasing among organisms that commonly cause wound infections. Therefore, it becomes increasingly desirable to prevent wound infections as systemic antibiotic treatment of established wound infections becomes more difficult, more expensive, and potentially more toxic. The ability to incorporate antimicrobial compounds into modern wound dressings provides an opportunity to prevent wound infections without the risk of systemic toxicity, thus diminishing morbidity, mortality, and cost to the healthcare system. DESIGN In these studies, the authors tested 16 antimicrobial agents in a unique composite wound dressing (TheraGauze; Soluble Systems, LLC, Newport News, Virginia) against clinical methicillin-resistant Staphylococcus aureus isolates and Gram-negative organisms commonly associated with wound infections and antibiotic resistance. Disk diffusion susceptibility testing is used to quantify antimicrobial activity. RESULTS Broad-spectrum antimicrobial activity was found for the following agents in the composite wound dressing: hydrogen peroxide, tobramycin, chlorhexidine digluconate, chlorhexidine gluconate, levofloxacin, and silver. CONCLUSION These studies suggest that potent local antibacterial activity can be achieved with several antimicrobials in this wound dressing.
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Silverberg N, Block S. Uncomplicated skin and skin structure infections in children: diagnosis and current treatment options in the United States. Clin Pediatr (Phila) 2008; 47:211-9. [PMID: 18354031 DOI: 10.1177/0009922807307186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nanette Silverberg
- Department of Dermatology, St Luke's-Roosevelt Hospital Center, New York, New York, USA
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Erdur B, Ersoy G, Yilmaz O, Ozkutuk A, Sis B, Karcioglu O, Parlak I, Ayrik C, Aksay E, Guryay M. A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds. Am J Emerg Med 2008; 26:137-43. [PMID: 18272091 DOI: 10.1016/j.ajem.2007.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 03/27/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES This work was conducted to study the prophylactic efficacy of 2 topical antibiotic ointments (mupirocin and nitrofurazone) against wound infection in experimental contaminated crush wounds. METHODS Male Wistar rats underwent two 2-cm incisions at the back side and randomized into 3 groups--placebo (n = 14), mupirocin (n = 14), and nitrofurazone (n = 14)--and infected with either Staphylococcus aureus or S. pyogenes. All wound edges were crushed for 5 seconds with hemostats to simulate crush injury before inoculation of the microorganisms. Half of the wounds were sutured and the other half left open. These wounds were treated 3 times daily for 6 days with topical mupirocin, nitrofurazone, or petrolatum (as placebo). At the end of 6 days, excisional biopsies were taken from wound edges and histopathologic assessments were made based on neutrophilic infiltration, edema formation, myofibroblastic proliferation, and granulation tissue formation. For the microbiologic assessments, quantitative tissue cultures were made. RESULTS In S. aureus-inoculated wounds, mupirocin showed higher antibacterial activity against bacterial colonization and reduced infection rates compared to placebo groups. The same effect was observed for the infection rates in S. pyogenes-inoculated wounds. In S. pyogenes-inoculated open wounds, nitrofurazone showed higher antibacterial activity against infection, but this effect was not observed in closed wounds. In S. pyogenes- and S. aureus-infected wounds, mupirocin treatment significantly lowered infection rates compared to nitrofurazone treatment. Histopathologic examination showed higher myofibroblastic proliferation and higher volume of granulation tissue in the nitrofurazone groups compared to the mupirocin groups. CONCLUSION Topical mupirocin application was effective against crush wound infections inoculated with S. pyogenes and S. aureus. Nitrofurazone provides better granulation tissue formation, but did not effectively prevent bacterial colonization and infection in crush contaminated wounds.
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Affiliation(s)
- Bulent Erdur
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, 20070 Denizli, Turkey.
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Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management. J Am Acad Dermatol 2008; 58:1-21. [PMID: 18158924 DOI: 10.1016/j.jaad.2007.07.050] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 06/12/2007] [Accepted: 07/21/2007] [Indexed: 12/20/2022]
Abstract
UNLABELLED Topical antibiotics are widely used to treat cutaneous, ocular, and otic infections. Allergic contact dermatitis to topical antibiotics is a rare but well-documented side effect, especially in at-risk populations. The purpose of this article is to review the epidemiology, responsible allergens, and management of allergic contact dermatitis to topical antibiotics. LEARNING OBJECTIVE After completing this learning activity, participants should be able to describe the epidemiology of allergic contact dermatitis related to topical antibiotics; show knowledge of the most common allergenic topical antibiotics; and understand the allergenic cross-reactivity pattern amongst topical antibiotics.
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Thaçi D, Schöfer H. Topische Antibiotika zur Therapie von Hautinfektionen. Hautarzt 2005; 56:381-94; quiz 395. [PMID: 15765214 DOI: 10.1007/s00105-005-0935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To understand the development of bacterial resistance and multi-resistance following treatment with topical and systemic antibiotics is important for dermatologists. Furthermore the sensitization potential and toxicity of antibiotics applied to large skin areas must be considered. The advantage of many topical antibiotics is evident; extremely high concentrations can be achieved in the infected skin usually without any systemic side effects. When an antibiotic is used both systemically and topically, indications should be weighed carefully for topical use, in order to reduce the likelihood of sensitization to an potential systemic agent. Continuous monitoring of the resistance profile of important bacteria is also desirable, in order to preserve the utility of important "reserve antibiotics". In this review the most important topical antibiotics used in Germany are evaluated with regards to efficacy and safety profile.
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Affiliation(s)
- D Thaçi
- Zentrum der Dermatologie und Venerologie der Johann Wolfgang Goethe-Universität, Frankfurt.
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Lee WR, Tobias KM, Bemis DA, Rohrbach BW. In Vitro Efficacy of a Polyhexamethylene Biguanide-Impregnated Gauze Dressing Against Bacteria Found in Veterinary Patients. Vet Surg 2004; 33:404-11. [PMID: 15230846 DOI: 10.1111/j.1532-950x.2004.04059.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the in vitro efficacy of polyhexamethylene biguanide (PHMB)-impregnated gauze dressing in limiting the growth of bacteria both within and underneath the dressing. STUDY DESIGN In vitro study. METHODS Squares of PHMB-impregnated and control gauze were placed on agar plates inoculated with 1 of 11 bacterial species, including 8 multi-resistant organisms. Growth under the gauze was assessed qualitatively after 24-hour incubation. Repeated use of sponges was used to evaluate residual inhibitory activity against Micrococcus lutea and Staphylococcus schleiferi ss. schleiferi. In a second procedure, PHMB-impregnated and control gauze squares were placed in sterile plastic wells and inoculated with 1 of 5 bacterial species, including Pseudomonas spp. and Klebsiella spp. Inhibition of bacterial growth within and underneath the dressing after 24-hour incubation was evaluated by quantifying the numbers of bacteria on the well floor and within each square. RESULTS PHMB-impregnated gauze provided greater inhibition of growth of 4/4 Gram-positive species and 2/6 Gram-negative species on inoculated plates compared with control gauze. Residual inhibitory activity of PHMB-impregnated gauze was significantly greater against M. lutea on all days and against S. schleiferi ss. schleiferi on days 1 and 4 compared with control. No bacteria were recovered from inoculated PHMB-impregnated gauze squares placed in sterile wells or from the well floor underneath. More than 9 x 10(5) colony-forming units (CFU) were recovered from inoculated control samples placed in sterile wells and more than 8.4 x 10(4) CFU were recovered from control well floors. CONCLUSION PHMB-impregnated gauze dressing, when placed on inoculated agar plates, reduces growth of underlying bacteria, particularly Gram-positive species. Wet-inoculated PHMB-impregnated dressing prevents growth of Gram-positive and Gram-negative bacteria both within and underneath the dressing. CLINICAL RELEVANCE PHMB-impregnated dressings may be useful for reducing contamination of underlying wounds by bacterial pathogens.
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Affiliation(s)
- William R Lee
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996-4544, USA
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Abstract
Bacterial skin and skin structure infections (SSSIs) are among the most frequently seen infectious entities in the community setting and occasionally in the institutional setting. A wide variety of SSSIs exist, with cellulitis, impetigo and folliculitis being the most common. Most SSSIs are caused by aerobic staphylococci and streptococci, with aerobic Gram-negative bacilli and anaerobes being involved in more complicated infections. Systemic therapy with a variety of beta-lactams, macrolides and lincosamides (clindamycin) have been the cornerstone of SSSI therapy for many years. With the exception of mupirocin, topical therapy occupies a small therapeutic niche. Despite the emergence of antimicrobial resistance among the pathogens most commonly associated with SSSIs (for example, Streptococcus pyogenes and macrolides; Staphylococcus aureus and methicillin, vancomycin, penicillin and mupirocin), few treatment failures have been reported. The newest antimicrobials reviewed herein (linezolid, quinupristin/dalfopristin, gatifloxacin, gemifloxacin and moxifloxacin) are not a significant improvement upon older agents in the treatment of SSSIs. Perhaps this assessment will change if the penetrance of the antimicrobial resistance patterns described above reach a critical threshold and clinical failures become more widespread.
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Affiliation(s)
- David R P Guay
- College of Pharmacy, University of Minnesota, Weaver-Densford Hall 7-115C, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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Liu ES, Kridel RWH. Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing. Plast Reconstr Surg 2003; 112:282-7. [PMID: 12832906 DOI: 10.1097/01.prs.0000066370.55684.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nasal cysts are rare complications of rhinoplasty, and numerous theories exist regarding their cause. The term "paraffinoma" has been used to describe cyst formation observed after topical antibiotic ointment application with nasal packing in the immediate postoperative period. Such complications are rare but may occur because of the inherent properties of the agent used or a lack of meticulous technique (in the placement of incisions and nasal packing). Three cases of postrhinoplasty cysts with a variety of presentations, including incidental intraoperative findings, bilateral medial canthal masses, and a draining dorsal cyst, are described. Although such cysts are uncommon, techniques to prevent these unwanted sequelae should routinely be used, with the judicious application of non-petroleum-based topical antibiotic preparations.
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Affiliation(s)
- Edmund S Liu
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical School at Houston, USA
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Spann CT, Tutrone WD, Weinberg JM, Scheinfeld N, Ross B. Topical antibacterial agents for wound care: a primer. Dermatol Surg 2003; 29:620-6. [PMID: 12786706 DOI: 10.1046/j.1524-4725.2003.29143.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although often overlooked, topical antibiotic agents play an important role in dermatology. Their many uses include prophylaxis against cutaneous infections, treatment of minor wounds and infections, and elimination of nasal carriage of Staphylococcus aureus. For these indications, they are advantageous over their systemic counterparts because they deliver a higher concentration of medication directly to the desired area and are less frequently implicated in causing bacterial resistance. The ideal topical antibiotic has a broad spectrum of activity, has persistent antibacterial effects, and has minimal toxicity or incidence of allergy.
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Affiliation(s)
- Candace Thornton Spann
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, New York 10025, USA
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Abstract
This article has provided a review of common and some less common approaches to wound healing. Chronic wound healing is one of the more challenging areas of medicine, with a nice balance of the science and art of medicine. An evidence-based, patient-centered approach can be used to effectively improve the care of many difficult to heal ulcers in often frustrated patients. The multidisciplinary wound clinic concept can work to improve the outcomes of patients with leg ulcers.
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Affiliation(s)
- Eliot N Mostow
- Department of Dermatology, Northeast Ohio University College, School of Medicine, 4209 St. Rt. 44, Rootstown, OH 44272, USA.
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Berry DB, Sullins KE. Effects of topical application of antimicrobials and bandaging on healing and granulation tissue formation in wounds of the distal aspect of the limbs in horses. Am J Vet Res 2003; 64:88-92. [PMID: 12518884 DOI: 10.2460/ajvr.2003.64.88] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether povidone iodine ointment or 2 forms of silver sulfadiazine applied topically to wounds of the distal aspect of the limbs in horses affect the rate of second intention healing and to evaluate the additional influence of bandaging with these antimicrobials on granulation tissue formation. ANIMALS 6 healthy adult horses. PROCEDURE Six standardized 2.5-cm2 skin wounds/horse were distributed between the dorsomedial surfaces of the metacarpi and metatarsi. One of the following 6 treatments was applied to each wound: 1% silver sulfadiazine cream with bandage, 1% silver sulfadiazine slow-release matrix with bandage, 1% silver sulfadiazine slow-release matrix without bandage, povidone-iodine ointment with bandage, untreated control with bandage, and untreated control without bandage. Wound area, granulation tissue area, and perimeter were measured by use of planimetry software applied to digital images. Exuberant granulation tissue was excised when present. Days until healing, rate of healing parameter, rate of contraction, and epithelialization were compared among wound treatment groups. RESULTS Healing parameters and mean days to healing did not differ significantly among any of the wound treatment groups. Percentage wound contraction and rate of epithelialization were similar among wound treatments. All bandaged wounds produced exuberant granulation tissue, which was surgically excised; none of the unbandaged wounds produced exuberant granulation tissue. CONCLUSIONS AND CLINICAL RELEVANCE When exuberant granulation tissue is removed, rates of epithelialization and wound contraction were not different among wound treatment groups, whether bandaged or unbandaged. Topical application of 1% silver sulfadiazine slow-release matrix on unbandaged wounds induced the same result as medications applied beneath bandages, but without exuberant granulation tissue formation.
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Affiliation(s)
- Douglass B Berry
- Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, PO Box 1938, Leesburg, VA 20177, USA
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Abstract
BACKGROUND Since the early 1930s when antibiotics were first introduced, they have revolutionized the way physicians treat infections. Skin conditions from acne to leprosy, which were once shunned by society, are now easily treated with oral antibiotics. OBJECTIVE Antibiotics are chemicals derived from bacteria and fungi that uniquely have antibacterial action. The most notable example is penicillin, which is derived from a mold. With hundreds of antibiotics available to the practicing physician, improper use of these drugs has become widespread and expensive and has spawned resistant strains. For the dermatologist, antibiotics are vital weapons in the drug armamentarium for treating various skin conditions. CONCLUSION This review explores the newest and most common oral, parenteral, and topical antibiotics used in dermatology, their indications, adverse effects, dosage, and spectrum of activity. Furthermore, systemic antibacterial prophylaxis and vaccines pertinent to dermatology are discussed. The penicillins, cephalosporins, tetracyclines, macrolides, fluoroquinolones, sulfonamides, aminoglycosides, lincosamides, folate inhibitors, and a new synthetic class of drugs, the oxazolidinones, are reviewed. These antibiotics are used to treat a variety of organisms.
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Affiliation(s)
- Daniel A Carrasco
- Department of Dermatology, University of Texas Medical Branch-Galveston, Galveston, Texas, USA
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Jones T, Mark L, Monroe E, Weiss J, Levy S. A Multicentre, Double-Blind, Parallel-Group Study to Evaluate 3% Erythromycin/5% Benzoyl Peroxide Dual-Pouch Pack for Acne Vulgaris. Clin Drug Investig 2002. [DOI: 10.2165/00044011-200222070-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Successful outcomes in cutaneous surgery depend on a variety of factors, including preoperative assessment of the patient's health and expectations, intraoperative skill and attention to detail, and managing the postoperative period. Once the procedure is complete, careful selection of dressings, provision of adequate analgesia, judicious management of complications and monitoring the phases of early maturation while providing patient education improve the likelihood of long-term patient and physician satisfaction.
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Affiliation(s)
- C J Arpey
- Department of Dermatology, University of Iowa College of Medicine, Iowa City, Iowa, USA
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Keith MP, Spooner K. Persistent localized rash after trauma. Infection or iatrogenic disease? Postgrad Med 2001; 110:37-8. [PMID: 11570204 DOI: 10.3810/pgm.2001.09.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M P Keith
- National Naval Medical Center, Bethesda, USA.
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White RJ, Cooper R, Kingsley A. Wound colonization and infection: the role of topical antimicrobials. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2001; 10:563-78. [PMID: 12066030 DOI: 10.12968/bjon.2001.10.9.9387] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2001] [Indexed: 11/11/2022]
Abstract
Infection and bacterial colonization are important factors in compromised wound healing, particularly in chronic wounds. The current "best practice" for controlling these factors is still unclear. Systemic antibiotics are generally accepted as being the preferred choice for treating infection, provided that ischaemia does not interfere. However, their widespread systemic and topical use is leading to the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem: possible delayed healing if out of balance with the immune system; and as a source for cross-infection. Managing colonization is not yet defined in best practice. The judicious use of dressings, notably those containing certain antiseptic agents, can be valuable in infection control and in promoting healing. This review states the case for taking the antiseptic route as part of the concerted approach to local wound management and infection control.
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Affiliation(s)
- R J White
- School of Applied Sciences, University of Wales-Institute Cardiff, Cardiff, Wales, UK
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