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Espíndola-Rodríguez NH, Muñoz-Cázares N, Serralta-Peraza LEDS, Díaz-Nuñez JL, Montoya-Reyes F, García-Contreras R, Díaz-Guerrero M, Rivera-Chávez JA, Gutiérrez J, Sotelo-Barrera M, Castillo-Juárez I. Antivirulence and antipathogenic activity of Mayan herbal remedies against Pseudomonas aeruginosa. JOURNAL OF ETHNOPHARMACOLOGY 2024; 332:118373. [PMID: 38782309 DOI: 10.1016/j.jep.2024.118373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Yucatan Peninsula has a privileged wealth of vascular plants with which various Mayan herbal formulations have been developed. However, studies on their antipathogenic and antivirulence properties are scarce. AIM OF THE STUDY Identify antivirulence properties in Mayan herbal remedies and determine their antipathogenic capacity in burn wounds infected with Pseudomonas aeruginosa. MATERIALS AND METHODS An ethnobotanical study was conducted in Mayan communities in central and southern Quintana Roo, Mexico. Furthermore, the antipathogenic capacity of three Mayan herbal remedies was analyzed using an animal model of thermal damage and P. aeruginosa infection. Antivirulence properties were determined by inhibiting phenotypes regulated by quorum sensing (pyocyanin, biofilm, and swarming) and by the secretion of the ExoU toxin. The chemical composition of the most active herbal remedy was analyzed using molecular network analysis. RESULTS It was found that topical administration of the remedy called "herbal soap" (HS) for eleven days maintained 100% survival of the animals, reduced establishment of the bacteria in the burn and prevented its systemic dispersion. Although no curative effect was recorded on tissue damaged by HS treatment, its herbal composition strongly reduced swarming and ExoU secretion. Through analysis of Molecular Networks, it was possible to carry out a global study of its chemical components, and identify the family of oxindole monoterpenoid alkaloids and carboline and tetrahydropyrididole alkaloids. In addition, flavonols, flavan-3-ols, and quinic acid derivatives were detected. CONCLUSIONS The antipathogenic and antivirulence capacity of ancient Mayan remedies makes them a potential resource for developing new antibacterial therapies to treat burns infected by P. aeruginosa.
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Affiliation(s)
- Nadine Heidi Espíndola-Rodríguez
- Laboratorio de Investigación y Aplicación de Fitoquímicos Bioactivos, Posgrado en Botánica, Colegio de Postgraduados, Texcoco, 56230, Mexico.
| | - Naybi Muñoz-Cázares
- Campo Experimental Chetumal, Instituto de Investigaciones Forestales, Agrícolas y Pecuarias, Quintana Roo, 77963, Mexico; Investigadora Posdoctoral CONAHCYT Comisionada al Colegio de Postgraduados-Campus Tabasco, Cárdenas, Tabasco, C. P. 86500, Mexico.
| | | | - José Luis Díaz-Nuñez
- Laboratorio de Investigación y Aplicación de Fitoquímicos Bioactivos, Posgrado en Botánica, Colegio de Postgraduados, Texcoco, 56230, Mexico.
| | - Francisco Montoya-Reyes
- Campo Experimental Chetumal, Instituto de Investigaciones Forestales, Agrícolas y Pecuarias, Quintana Roo, 77963, Mexico.
| | - Rodolfo García-Contreras
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, CDMX, 04510, Mexico.
| | - Miguel Díaz-Guerrero
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, CDMX, 04510, Mexico.
| | - José Alberto Rivera-Chávez
- Departamento de Productos Naturales, Instituto de Química, Universidad Nacional Autónoma de México, CDMX, 04510, Mexico.
| | - Jorge Gutiérrez
- Área de Biología, Departamento de Preparatoria Agrícola, Universidad Autónoma Chapingo, Texcoco, 56230, Mexico.
| | - Mireya Sotelo-Barrera
- Laboratorio de Investigación y Aplicación de Fitoquímicos Bioactivos, Posgrado en Botánica, Colegio de Postgraduados, Texcoco, 56230, Mexico.
| | - Israel Castillo-Juárez
- Laboratorio de Investigación y Aplicación de Fitoquímicos Bioactivos, Posgrado en Botánica, Colegio de Postgraduados, Texcoco, 56230, Mexico; Conahcyt-Instituto de Ciencias Básicas e Ingeniería, Universidad Autónoma del Estado de Hidalgo, Mineral de la Reforma, Hidalgo, 42184, Mexico.
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Wang X, Xu Z, Xia Y, Chen Z, Zong R, Meng Q, Wang W, Zhuang W, Meng X, Chen G. Characterization of an Escherichia coli phage Tequatrovirus YZ2 and its application in bacterial wound infection. Virology 2024; 597:110155. [PMID: 38943783 DOI: 10.1016/j.virol.2024.110155] [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: 03/13/2024] [Revised: 06/05/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
The increasing prevalence of drug-resistant Escherichia coli (E. coli) resulting from the excessive utilization of antibiotics necessitates the immediate exploration of alternative approaches to counteract pathogenic E. coli. Phages, with their unique antibacterial mechanisms, are considered promising candidates for treating bacterial infections. Herein, we isolated a lytic Escherichia phage Tequatrovirus YZ2 (phage YZ2), which belongs to the genus Tequatrovirus. The genome of phage YZ2 consists of 168,356 base pairs with a G + C content of 35.34% and 269 putative open reading frames (ORFs). Of these, 146 ORFs have been annotated as functional proteins associated with nucleotide metabolism, structure, transcription, DNA replication, translation, and lysis. In the mouse model of a skin wound infected by E. coli, phage YZ2 therapy significantly promoted the wound healing. Furthermore, histopathological analysis revealed reductions in IL-1β and TNF-α and increased VEGF levels, indicating the potential of phages as effective antimicrobial agents against E. coli infection.
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Affiliation(s)
- Xuewen Wang
- Institute of Comparative Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, PR China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Zhou Xu
- Institute of Comparative Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, PR China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Yinhe Xia
- Institute of Comparative Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, PR China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Zhiling Chen
- Institute of Comparative Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, PR China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Rongling Zong
- Institute of Comparative Medicine, College of Veterinary Medicine, Yangzhou University, Yangzhou, 225009, PR China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Qingye Meng
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Weijie Wang
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China
| | - Wenzhen Zhuang
- Office of International Cooperation and Exchange, Weifang People's Hospital, Weifang, 261000, PR China.
| | - Xiangjun Meng
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China.
| | - Gang Chen
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266024, PR China.
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Su X, Chi Y, Liu T, Xun H, Wu Y, Liu X, Zheng J, Hu F, Han S, Duan H, Chai J. Black Phosphorus Nanosheets-Based Hydrogel for Efficient Bacterial Inhibition and Accelerating Wound Healing. ACS APPLIED MATERIALS & INTERFACES 2024; 16:43892-43906. [PMID: 39046193 DOI: 10.1021/acsami.4c06075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
With the swift evolution of multidrug-resistant bacteria resulting from the intense and inappropriate use of antibiotics, there is a pressing need for innovative solutions. In this study, a thermosensitive hydrogel was developed for efficient bacterial inhibition and promotion of wound healing. The antibacterial chitosan (CS) thermosensitive hydrogel, cross-linked with two-dimensional photothermal nanomaterial black phosphorus (BP) nanosheets through electrostatic interactions, effectively encapsulates and sustains the release of angiogenic drug deferoxamine mesylate (DFO). This facilitates the acceleration of re-epithelialization and neovascularization by enhancing cell migration and proliferation. Following near-infrared (NIR) treatment, this hydrogel demonstrates rapid eradication of the most common multidrug-resistant bacteria encountered in clinical settings, achieved through physical disruption of bacterial membranes and photothermal therapies. Noteworthy is the significant upregulation of IL-19 expression via STAT3 signaling pathways by the BP/CS-DFO hydrogel in a full-thickness wound model. This results in the polarization of the anti-inflammatory M2 macrophage phenotype, altering the microenvironment to a pro-healing state and enhancing extracellular matrix deposition and blood vessel formation. In conclusion, the BP/CS-DFO hydrogel shows immense promise as a potential clinical candidate for wound healing and antimicrobial therapy. Its innovative design and multifunctional capabilities position it as a valuable asset in combating antibiotic resistance and enhancing efficiency in wound healing.
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Affiliation(s)
- Xiaowei Su
- Chinese PLA Medical School & Chinese PLA General Hospital, Beijing 100853, China
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Yunfei Chi
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Tian Liu
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Haoyi Xun
- Chinese PLA Medical School & Chinese PLA General Hospital, Beijing 100853, China
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Yushou Wu
- Chinese PLA Medical School & Chinese PLA General Hospital, Beijing 100853, China
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Xiangyu Liu
- Chinese PLA Medical School & Chinese PLA General Hospital, Beijing 100853, China
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Jinguang Zheng
- Chinese PLA Medical School & Chinese PLA General Hospital, Beijing 100853, China
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Fangchao Hu
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Shaofang Han
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Hongjie Duan
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
| | - Jiake Chai
- Chinese PLA Medical School & Chinese PLA General Hospital, Beijing 100853, China
- Department of Burn & Plastic Surgery, The Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100048, China
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Trinh S, Dennis J, Warren O, Hobden J, Schoen J, Phelan H, Carter J, Smith AA. Cytokine Profile of Adipose-Derived Stem Cells From Patients With Burn Injuries and Infection. J Surg Res 2024; 301:656-663. [PMID: 39142042 DOI: 10.1016/j.jss.2024.07.022] [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: 03/01/2024] [Revised: 06/24/2024] [Accepted: 07/06/2024] [Indexed: 08/16/2024]
Abstract
INTRODUCTION Adipose-derived stem cells (ASCs) are multipotent stem cells capable of differentiating into many cell lineages. They play an important role in wound healing by secreting cytokines. Prior studies have demonstrated the presence of proinflammatory cytokines in burn wounds. However, no studies have been performed evaluating the cytokines released by burn wounds with infections. We hypothesized that there is an alteration in the paracrine factors secreted by ASCs in burn wounds with concomitant infections. METHODS Adipose tissue was collected from patients with burn injuries at their index operation. ASCs were extracted and grown under standard tissue culture techniques. The supernatant was extracted. Cytokine analyses were performed with multiplex assays. Infection was determined using a burn sepsis protocol. The cytokine profiles of the two groups were compared using a Mann-Whitney U test. RESULTS Sixteen patients were enrolled in the study, 50% with bacterial infection (n = 8). There was no significant difference in the baseline demographics of the two groups (P > 0.05). There were significantly lower concentrations of interleukin 13 and interferon gamma (P < 0.05) in burn patients with concomitant infections. CONCLUSIONS ASCs are critical to burn wound healing. This study demonstrated diminished production of interleukin 13, an immunoregulatory cytokine involved in the antiinflammatory pathway by downregulating macrophage activity. This study also demonstrated significantly lower levels of interferon gamma in patient with burns and concomitant infection. This cytokine is crucial for antimicrobial defenses.
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Affiliation(s)
- Sophia Trinh
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
| | - Jenna Dennis
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Olivia Warren
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jeffery Hobden
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jonathan Schoen
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Herbert Phelan
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jeffrey Carter
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Elsheikh R, Makram AM. Multidrug-Resistant Organisms: The Silent Plight of Burn Patients. J Burn Care Res 2024; 45:877-886. [PMID: 38695094 PMCID: PMC11303128 DOI: 10.1093/jbcr/irae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 07/20/2024]
Abstract
The global increasing spread of multidrug-resistant organisms (MDROs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is patients with burns, who are prone to hyperinfection as they suffer from a hypermetabolic state and weaken immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, we discuss consensuses here. In this review, we aim to present the current knowledge on multidrug resistance with a special focus on patients with burns, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.
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Affiliation(s)
- Randa Elsheikh
- Deanery of Biomedical Sciences at Edinburgh Medical School, University of Edinburgh, Edinburgh EH8 9YL, UK
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Zhao M, Kang M, Wang J, Yang R, Zhong X, Xie Q, Zhou S, Zhang Z, Zheng J, Zhang Y, Guo S, Lin W, Huang J, Guo G, Fu Y, Li B, Fan Z, Li X, Wang D, Chen X, Tang BZ, Liao Y. Stem Cell-Derived Nanovesicles Embedded in Dual-Layered Hydrogel for Programmed ROS Regulation and Comprehensive Tissue Regeneration in Burn Wound Healing. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2401369. [PMID: 38822749 DOI: 10.1002/adma.202401369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/15/2024] [Indexed: 06/03/2024]
Abstract
Burn wounds often bring high risks of delayed healing process and even death. Reactive oxygen species (ROS) play a crucial role in burn wound repair. However, the dynamic process in wound healing requires both the generation of ROS to inhibit bacteria and the subsequent reduction of ROS levels to initiate and promote tissue regeneration, which calls for a more intelligent ROS regulation dressing system. Hence, a dual-layered hydrogel (Dual-Gel) tailored to the process of burn wound repair is designed: the inner layer hydrogel (Gel 2) first responds to bacterial hyaluronidase (Hyal) to deliver aggregation-induced emission photosensitizer functionalized adipose-derived stem cell nanovesicles, which generate ROS upon light irradiation to eliminate bacteria; then the outer layer hydrogel (Gel 1) continuously starts a long-lasting consumption of excess ROS at the wound site to accelerate tissue regeneration. Simultaneously, the stem cell nanovesicles trapped in the burns wound also provide nutrients and mobilize neighboring tissues to thoroughly assist in inflammation regulation, cell proliferation, migration, and angiogenesis. In summary, this study develops an intelligent treatment approach on burn wounds by programmatically regulating ROS and facilitating comprehensive wound tissue repair.
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Affiliation(s)
- Meijiao Zhao
- Institute for Engineering Medicine, Kunming Medical University, Kunming, 650500, China
| | - Miaomiao Kang
- Center for AIE Research, Shenzhen Key Laboratory of Polymer Science and Technology, Guangdong Research Center for Interfacial Engineering of Functional Materials, College of Materials Science and Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Jingru Wang
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, 528000, China
| | - Ronghua Yang
- Department of Burn and Plastic Surgery, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Xiaoping Zhong
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Qihu Xie
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Sitong Zhou
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, 528000, China
| | - Zhijun Zhang
- Center for AIE Research, Shenzhen Key Laboratory of Polymer Science and Technology, Guangdong Research Center for Interfacial Engineering of Functional Materials, College of Materials Science and Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Judun Zheng
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Yixun Zhang
- Department of Burn and Plastic Surgery, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Shuang Guo
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Weiqiang Lin
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Jialin Huang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Genghong Guo
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Yu Fu
- School of Inspection, Ningxia Medical University, Yinchuan, 750004, P. R. China
| | - Bin Li
- School of Inspection, Ningxia Medical University, Yinchuan, 750004, P. R. China
| | - Zhijin Fan
- Institute for Engineering Medicine, Kunming Medical University, Kunming, 650500, China
| | - Xipeng Li
- Institute for Engineering Medicine, Kunming Medical University, Kunming, 650500, China
| | - Dong Wang
- Center for AIE Research, Shenzhen Key Laboratory of Polymer Science and Technology, Guangdong Research Center for Interfacial Engineering of Functional Materials, College of Materials Science and Engineering, Shenzhen University, Shenzhen, 518060, China
| | - Xu Chen
- Institute for Engineering Medicine, Kunming Medical University, Kunming, 650500, China
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China
| | - Ben Zhong Tang
- School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, P. R. China
| | - Yuhui Liao
- Institute for Engineering Medicine, Kunming Medical University, Kunming, 650500, China
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
- School of Inspection, Ningxia Medical University, Yinchuan, 750004, P. R. China
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Ahmed FA, Zia N, Khan SA, Munir T, Mashreky SR, Hashmi M, Al-Ibran E, Rahman AF, Khondoker S, Asif F, Hyder AA, Latif A. Burns in South Asia: Outcomes from South Asian Burn Registry (SABR). Burns 2024; 50:1504-1512. [PMID: 38604825 DOI: 10.1016/j.burns.2024.04.001] [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: 03/14/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND South Asian region contributes 59 % to the global mortality due to burns. However, we find a paucity of literature on the outcomes of burns from low- and middle-income countries (LMICs). South Asian Burn Registry (SABR) is a facility-based burns registry that collected data on in-patient burn care. This study assesses factors associated with mortality, length of hospital stay at the burns center, and functional status of burn patients. METHODS Prospective data was collected from two specialized public sector burn centers between September 2014 - January 2015 from Bangladesh and Pakistan. Multivariable logistic, linear, and ordinal logistic regression was conducted to assess factors associated with inpatient-mortality, length of hospital stay, and functional status at discharge, respectively. RESULTS Data on 883 patients was analyzed. Increased association with mortality was observed with administration of blood product (OR:3, 95 % CI:1.18-7.58) and nutritional support (OR:4.32, 95 % CI:1.55-12.02). Conversely, antibiotic regimens greater than 8 days was associated with decreased mortality (OR:0.1, 95 % CI:0.03-0.41). Associated increase in length of hospital stay was observed in patients with trauma associated with their burn injury, history of seizures (CE:47.93, 95 % CI 12.05-83.80), blood product (CE:22.09, 95 % CI:0.83-43.35) and oxygen administration (CE:23.7, 95 % CI:7.34-40.06). Patients who developed sepsis (OR:6.89, 95 % CI:1.92-24.73) and received blood products during hospitalization (OR:2.55, 95 % CI:1.38- 4.73) were more likely to have poor functional status at discharge. CONCLUSION This study identified multiple factors associated with worse clinical outcomes for burn patients in South Asia. Understanding these parameters can guide targeted efforts to improve the process and quality of burn care in LMICs.
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Affiliation(s)
- Fasih Ali Ahmed
- Centre for Patient Safety, The Aga Khan University, Karachi, Pakistan; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit (IIRU), Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sameer Ahmad Khan
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tahir Munir
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | | | | | - Sazzad Khondoker
- National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Fozia Asif
- Centre for Patient Safety, The Aga Khan University, Karachi, Pakistan
| | - Adnan A Hyder
- The Milken Institute School of Public Health, George Washington University, DC, USA
| | - Asad Latif
- Centre for Patient Safety, The Aga Khan University, Karachi, Pakistan; Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
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Cleland H, Stewardson A, Padiglione A, Tracy L. Bloodstream infections and multidrug resistant bacteria acquisition among burns patients in Australia and New Zealand: A registry-based study. Burns 2024; 50:1544-1554. [PMID: 38714428 DOI: 10.1016/j.burns.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION This study interrogates infection related data in the Burns Registry of Australia and New Zealand (BRANZ), to examine associations of multi-drug resistant organisms (MDROs) and blood stream infection (BSI). METHODS Data between July 2016 and June 2021 were analysed to determine prevalence, risk factors and outcomes associated with BSIs and MDROs: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Pseudomonas spp. (CRP), and carbapenem-resistant Enterobacter (CRE). Data completeness and value for quality improvement activity were assessed. RESULTS We found a low incidence (3.4%) of the resistant organisms of interest, and no change over the study period. Fequency varied between services and increased with age and size of burn. MRSA was the commonest organism in all age groups. A positive BSI result occurred in 1.6% of patients (12.1% of cultures taken) at a median time of 10.2 days post injury. Free text identification of organisms was inconsistently documented. CONCLUSIONS The low rate and patterns of acquisition of MDROs of interest and BSIs is comparable with reports from countries with low incidence of massive burns. Wider adoption of a standardized laboratory reporting framework would help realise the potential of clinical quality registries to provide data which supports evidence based infection prevention initiatives.
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Affiliation(s)
- Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
| | - Andrew Stewardson
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia; Department of Infectious diseases,Central Clinical School, Monash University, Melbourne, Australia
| | - Alex Padiglione
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Lincoln Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Lane LC, Hill DM. A Pilot Analysis for a Multicentric, Retrospective Study on Biodiversity and Difficult-to-Treat Pathogens in Burn Centers across the United States (MICROBE). Pathogens 2024; 13:628. [PMID: 39204229 PMCID: PMC11357020 DOI: 10.3390/pathogens13080628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024] Open
Abstract
Following burn injury, patients are at increased risk of infection and are often cited as having a high incidence of difficult-to-treat pathogens (DTp). The purpose of this study is to determine the incidence of DTp after burn injury, which factors are associated with their development, and subsequent outcomes. This single-center, retrospective study assessed patients with thermal or inhalation injury who had a positive culture resulting in initiation of treatment (i.e., excision, topical, or systemic antimicrobials). Demographic data, pathogen and resistance profiles, and prior exposure to topical and systemic antimicrobials were collected. Pathogens were considered DTp if they were multi-drug-resistant (MDR), extensively drug-resistant (XDR), methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing, AmpC-producing, carbapenem-resistant, difficult-to-treat resistance (DTR) Pseudomonas sp., carbapenem-resistant Acinetobacter baumannii (CRAB), or Stenotrophomonas spp. Sixty-five patients who grew 376 pathogens were included in the final analysis. Two-hundred thirteen (56.7%) pathogens were considered DTp. Prior exposure to 7 of the 11 collected topical antimicrobials and 9 of 11 systemic antimicrobial classes were significantly associated with future development of a DTp. This remained true for six and eight, respectively, after controlling for significant covariates via logistic regression. As there were only four deaths, a Cox-proportional hazard analysis was not feasible. The Kaplan-Meier plot according to DTp revealed a clear divergence in mortality (Log rank p = 0.0583). In this analysis, exposure to topical and systemic antibiotics was associated with the development of DTp. The results from this pilot study will inform the next iteration of multicenter study.
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Affiliation(s)
- Lindey C. Lane
- Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA;
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Lane LC, Todor LA, Hill DM. Letter to the Editor: Multidrug-Resistant Organisms: The Silent Plight of Burn Patients. J Burn Care Res 2024:irae120. [PMID: 39024546 DOI: 10.1093/jbcr/irae120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Lindey C Lane
- From the Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
| | - Lorraine A Todor
- From the Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
| | - David M Hill
- From the Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
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11
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Corcione S, Longo BM, Scabini S, Pivetta E, Curtoni A, Shbaklo N, Costa C, De Rosa FG. Risk factors for mortality in Acinetobacter baumannii bloodstream infections and development of a predictive mortality model. J Glob Antimicrob Resist 2024; 38:317-326. [PMID: 39029658 DOI: 10.1016/j.jgar.2024.06.010] [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: 01/03/2024] [Revised: 06/06/2024] [Accepted: 06/24/2024] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVES Acinetobacter baumannii (A. baumannii) nosocomial infections represent a serious hazard to public health, given high mortality rates and rapid spread of multidrug-resistance. The primary outcome of this study was to evaluate predictors of 14- and 30-d mortality in bloodstream infections (BSIs) due to both carbapenem-resistant and carbapenem-sensitive Acinetobacter. Secondary end points were to identify risk factors for BSIs due to carbapenem-resistant A. baumannii (CRAB) and to develop a predictive model for mortality in CRAB-related BSIs. METHODS Between 2019 and 2023, all consecutive hospitalized adult patients with bacteraemia due to A. baumannii were retrospectively enrolled at a single-centre. RESULTS One hundred twenty-six episodes of BSI caused by A. baumannii were recorded, 89.7% of which were due to CRAB. Recent burn injuries, older age, previous CRAB colonization, and antibiotics exposure were identified as risk factors for acquiring CRAB BSI. Overall, 14-d mortality was observed in 26.1% of the patients and 30-d mortality in 30.9% of the patients. On multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score was associated with both 14- and 30-d mortality, whereas burn injuries correlated with 30-d survival. Concurrent coronavirus disease (COVID) was associated with mortality, although not reaching statistical figures. No major impact of receiving appropriate treatment was observed. Based on these findings, a multivariable model to predict mortality among patients with CRAB BSI was built and internally validated. CONCLUSIONS A. baumannii BSIs are characterized by poor outcomes and limited therapeutic options. This study aimed to assist physicians in prompt identification of patients who are at greater risk of death, contributing to more informed clinical decision making.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Italy; School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Bianca Maria Longo
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Italy.
| | - Silvia Scabini
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Italy
| | | | - Antonio Curtoni
- Microbiology and Virology Unit, University Hospital Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Citta della Salute e della Scienza di Torino, Turin, Italy
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12
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Pallett SJ, Mistry R, Lambert ZL, Woolley SD, Abbara A, Breathnach AO, Lamb LE, Williams A, Mughal N, Moshynets O, Hughes SJ, O'Shea MK, Moore LS. Conflict and catastrophe-related severe burn injuries: A challenging setting for antimicrobial decision-making. J Infect 2024; 89:106224. [PMID: 38986748 DOI: 10.1016/j.jinf.2024.106224] [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: 05/13/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Severe burns are a major component of conflict-related injuries and can result in high rates of mortality. Conflict and disaster-related severe burn injuries present unique challenges in logistic, diagnostic and treatment options, while wider conflict is associated with driving local antimicrobial resistance. We present a targeted review of available literature over the last 10 years on the use of systemic antimicrobial antibiotics in this setting and, given limited available data, provide an expert consensus discussion. While international guidelines do not tend to recommend routine use of prophylactic systemic antibiotics, the challenges of conflict settings and potential for polytrauma are likely to have ongoing impacts on antimicrobial decision-making and use. Efforts must be made to develop a suitable evidence base in this unique setting. In the interim, a pragmatic approach to balancing selective pressures of antimicrobial use with realistic access is possible.
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Affiliation(s)
- Scott Jc Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK.
| | - Rakhee Mistry
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Zoe L Lambert
- Britannia Royal Navy College Dartmouth, College Way, Dartmouth, Devon TQ6 0HJ, UK
| | - Stephen D Woolley
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Aula Abbara
- Faculty of Medicine, Department of Infectious Diseases, Imperial College Praed Street, London W2 1NY, UK
| | - Aodhan O Breathnach
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK; International Health Regulations Strengthening Project, UK Health Security Agency, South Colonnade Canary Wharf, London E14 4PU, UK
| | - Lucy E Lamb
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Infectious Diseases Department, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - Andrew Williams
- Burns Unit, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Nabeela Mughal
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Olena Moshynets
- Institute of Molecular Biology and Genetics of National Academy of Sciences of Ukraine, Kyiv 03143, Ukraine
| | - Stephen J Hughes
- Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK
| | - Matthew K O'Shea
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Luke Sp Moore
- Clinical Infection Department, Chelsea and Westminster Hospital NHS Foundation Trust, SW10 9NH London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
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13
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Han SB, Jeon K, Kim M, Park J, Yoon J, Cho YS, Hur J, Chun W, Kym D. Risk factors for in-hospital acquisition of carbapenem-resistant Enterobacterales in patients with severe burns. J Hosp Infect 2024; 149:165-171. [PMID: 38740304 DOI: 10.1016/j.jhin.2024.04.022] [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: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Although patients with severe burns are prone to severe infections with antibiotic-resistant bacteria and inevitably have some risk factors for carbapenem-resistant Enterobacterales (CRE) acquisition, risk factors for CRE infection or colonization in these patients have not been investigated. AIM To identify the independent risk factors for CRE acquisition in patients with severe burns. METHODS Patients admitted to the burn intensive care unit (BICU) for acute burn care were categorized based on culture results during BICU care into the CRE group and non-CRE group, which included the carbapenem-susceptible Enterobacterales (CSE) and control groups. Clinical and microbiological factors were compared between the CRE and non-CRE groups, and between the CRE and CSE groups to identify independent risk factors for in-hospital CRE acquisition. FINDINGS Among the included 489 patients, 101 (20.7%) and 388 (79.3%) patients were classified in the CRE and non-CRE groups, respectively. The non-CRE group included 91 (18.6%) and 297 (60.7%) patients in the CSE and control groups, respectively. In multivariate analysis between the CRE and non-CRE groups, exposure to other CRE-acquired patients (P = 0.018), abbreviated burn severity index score ≥9 (P = 0.012), and mechanical ventilation (P < 0.001) were associated with CRE acquisition. In multivariate analysis between the CRE and CSE groups, exposure to other CRE-acquired patients was associated with CRE acquisition (P = 0.048). CONCLUSION Considering the limitation of controlling the burn severity in hospitalized patients, enhanced infection control measures for preventing in-hospital CRE transmission among patients with severe burns should be emphasized.
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Affiliation(s)
- S B Han
- Department of Pediatrics, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeong-gi, Korea
| | - K Jeon
- Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - M Kim
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - J Park
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - J Yoon
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Y S Cho
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - J Hur
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - W Chun
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - D Kym
- Department of Surgery and Critical Care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
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Yang Y, Zhang J, Wu S, Deng Y, Wang S, Xie L, Li X, Yang L. Exosome/antimicrobial peptide laden hydrogel wound dressings promote scarless wound healing through miR-21-5p-mediated multiple functions. Biomaterials 2024; 308:122558. [PMID: 38581764 DOI: 10.1016/j.biomaterials.2024.122558] [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: 10/22/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Mesenchymal stem cell (MSC)-based therapy is an effective strategy for regenerative therapy. However, safety and ease of use are still issues to be overcome in clinical applications. Exosomes are naturally derived nanoparticles containing bioactive molecules, which serve as ideal cell-free therapeutic modalities. However, issues such as delivery, long-term preservation and activity maintenance of exosomes are other problems that limit their application. In this study, we proposed the use of rapid freeze-dry-thaw macroporous hydrogels for the encapsulation of HucMSC-derived exosomes (HucMSC-Exos) combined with an antimicrobial peptide coating. This exosome-encapsulated hyaluronic acid macroporous hydrogel HD-DP7/Exo can achieve long-term storage and transport by lyophilization and can be rapidly redissolved for treatment. After comprehensively comparing the therapeutic effects of HucMSC-Exos and HucMSC-loaded hydrogels, we found that HucMSC-Exos could also effectively regulate fibroblasts, vascular endothelial cells, and macrophages and inhibit myofibroblast-mediated fibrosis, thus promoting tissue regeneration and inhibiting scar formation in a mouse model of deep second-degree burn infection healing. These properties of lyophilized storage and whole-process-repair make HD-DP7/Exo have potential application value and application prospects.
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Affiliation(s)
- YuLing Yang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - JiaNi Zhang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - SiWen Wu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yu Deng
- Hangzhou Wutong Tree Pharmaceutical Co., Ltd., Hangzhou, 310018, China
| | - ShiHan Wang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Xie
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - XiaoPeng Li
- Hangzhou Wutong Tree Pharmaceutical Co., Ltd., Hangzhou, 310018, China.
| | - Li Yang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
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15
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Jeon K, Han SB, Kym D, Kim M, Park J, Yoon J, Hur J, Cho YS, Chun W. Central venous catheter tip colonization and associated bloodstream infection in patients with severe burns under routine catheter changing. Am J Infect Control 2024; 52:813-818. [PMID: 38355049 DOI: 10.1016/j.ajic.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although routine changing of central venous catheters (CVCs) is commonly performed in patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream infections (BSIs) is limited in those patients. METHODS The medical records of 214 patients with severe burns who underwent routine CVC changing at 7-day intervals and their results of 686 pairs of CVC tips and concurrent blood cultures were retrospectively reviewed to evaluate the CVC colonization rate and associated BSI pathogens. RESULTS Of the 686 CVCs, 137 (20.0%) were colonized by pathogens, and 81 (59.1%) of them had BSIs caused by the same pathogen. Nonflame burn (P = .002), total body surface area burn ≥30% (P = .004), femoral catheterization (P = .001), CVC changing during pre-existing BSI (P < .001), and renal replacement therapy (P = .017) were associated with catheter-related BSI in the multivariate analysis. Most BSIs were caused by Gram-negative bacteria (most commonly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). CONCLUSIONS The CVC colonization rate in patients with severe burns and routine CVC changing was not high. Lengthening the CVC duration might be attempted in patients at a lower risk of catheter-related BSI although further prospective studies are necessary.
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Affiliation(s)
- Kibum Jeon
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seung Beom Han
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea.
| | - Dohern Kym
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Myongjin Kim
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jongsoo Park
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jaechul Yoon
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jun Hur
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Yong Suk Cho
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Wook Chun
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
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Pérez-Torres D, Martín-Luengo AI, Cuenca-Rubio C, Berezo-García JÁ, Díaz-Rodríguez C, Canas-Pérez I, Fernández-Rodríguez ML, Colmenero-Calleja C, Sánchez-Ballesteros J, Blanco-Schweizer P, Ticona-Espinoza TG, Piqueras-Pérez JM. Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study. Med Intensiva 2024:S2173-5727(24)00139-5. [PMID: 38897897 DOI: 10.1016/j.medine.2024.06.001] [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: 03/28/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU). DESIGN Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups. SETTING Four-bed BU, in a referral University Hospital in Spain. PATIENTS All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded. INTERVENTION SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU. MAIN VARIABLE OF INTEREST Incidence of HAIs during the stay in the BU. SECONDARY OUTCOMES incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints. RESULTS We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21-3.82) and 1.13 (0.54-1.73), respectively (p=0.029). CONCLUSIONS SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.
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Affiliation(s)
- David Pérez-Torres
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Programa de Optimización del Uso de Antimicrobianos (PROA), Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain.
| | - Ana Isabel Martín-Luengo
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cristina Cuenca-Rubio
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José Ángel Berezo-García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cristina Díaz-Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Isabel Canas-Pérez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - María Lorena Fernández-Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cristina Colmenero-Calleja
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Jesús Sánchez-Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo Blanco-Schweizer
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Thalia Gloria Ticona-Espinoza
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José María Piqueras-Pérez
- Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain; Servicio de Cirugía Plástica, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
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Santamaría-Corral G, Pagán I, Aguilera-Correa JJ, Esteban J, García-Quintanilla M. A Novel Bacteriophage Infecting Multi-Drug- and Extended-Drug-Resistant Pseudomonas aeruginosa Strains. Antibiotics (Basel) 2024; 13:523. [PMID: 38927189 PMCID: PMC11200629 DOI: 10.3390/antibiotics13060523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
The prevalence of carbapenem-resistant P. aeruginosa has dramatically increased over the last decade, and antibiotics alone are not enough to eradicate infections caused by this opportunistic pathogen. Phage therapy is a fresh treatment that can be administered under compassionate use, particularly against chronic cases. However, it is necessary to thoroughly characterize the virus before therapeutic application. Our work describes the discovery of the novel sequenced bacteriophage, vB_PaeP-F1Pa, containing an integrase, performs a phylogenetical analysis, describes its stability at a physiological pH and temperature, latent period (40 min), and burst size (394 ± 166 particles per bacterial cell), and demonstrates its ability to infect MDR and XDR P. aeruginosa strains. Moreover, this novel bacteriophage was able to inhibit the growth of bacteria inside preformed biofilms. The present study offers a road map to analyze essential areas for successful phage therapy against MDR and XDR P. aeruginosa infections, and shows that a phage containing an integrase is also able to show good in vitro results, indicating that it is very important to perform a genomic analysis before any clinical use, in order to prevent adverse effects in patients.
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Affiliation(s)
- Guillermo Santamaría-Corral
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (G.S.-C.); (J.J.A.-C.); (M.G.-Q.)
| | - Israel Pagán
- Centro de Biotecnología y Genómica de Plantas UPM-INIA/CSIC and E.T.S. Ingeniería Agronómica, Alimentaria y de Biosistemas, Universidad Politécnica de Madrid, 28223 Madrid, Spain;
| | - John Jairo Aguilera-Correa
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (G.S.-C.); (J.J.A.-C.); (M.G.-Q.)
- CIBERINFEC-Consorcio Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (G.S.-C.); (J.J.A.-C.); (M.G.-Q.)
- CIBERINFEC-Consorcio Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Meritxell García-Quintanilla
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (G.S.-C.); (J.J.A.-C.); (M.G.-Q.)
- CIBERINFEC-Consorcio Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, 28029 Madrid, Spain
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Yang Y, Zeng Q, Hu G, Wang Z, Chen Z, Zhou L, He A, Qian W, Luo Y, Li G. Distribution of Nosocomial Pathogens and Antimicrobial Resistance among Patients with Burn Injuries in China: A Comprehensive Research Synopsis and Meta-Analysis. Infect Dis Ther 2024; 13:1291-1313. [PMID: 38720132 PMCID: PMC11128432 DOI: 10.1007/s40121-024-00983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/25/2024] [Indexed: 05/28/2024] Open
Abstract
INTRODUCTION Over the past decade, numerous studies have described the types of pathogens and their antibiotic resistance patterns in patients with burn injuries in China; however, the findings have generally been inconsistent. We conducted a literature search and meta-analysis to summarize the infection spectra and antimicrobial resistance patterns in patients with burn injuries. METHODS We searched the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Biomedical Literature, Wanfang, and Weipu databases for relevant articles published between January 2010 and December 2023. The DerSimonian-Laird random-effects model was used to estimate the proportions and 95% confidence intervals (CIs) of pathogens among Chinese patients with burn injuries. Meta-regression analyses were performed to explore differences in the proportions of pathogens among different subgroups and their resistance patterns. This study was registered with PROSPERO (CRD42024514386). RESULTS The database searches yielded 2017 records; after removing duplicates and conducting initial screening, 219 articles underwent full-text screening. Ultimately, 60 studies comprising a total of 62,819 isolated strains reported the proportions of pathogens in patients with burn injuries and were included in this meta-analysis. Meta-analyses were conducted on 18 types of pathogens. The most common pathogens causing infections in Chinese patients with burn injuries were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus epidermidis. Similar results were observed in the subgroup analysis focusing on wound infections. Since 2015, there has been a significant decrease in the proportion of Pseudomonas aeruginosa (R2 = 4.89%) and a significant increase in the proportion of Klebsiella pneumoniae (R2 = 9.60%). In terms of antibiotic resistance, there has been a significant decrease in the resistance of Staphylococcus aureus to multiple antibiotics and an increasing trend in the resistance of Klebsiella pneumoniae. CONCLUSIONS We systematically summarized the epidemiological characteristics and antibiotic resistance patterns of pathogens among individuals suffering from burns in China, thus providing guidance for controlling wound infections and promoting optimal empirical antimicrobial therapy. The observed high levels of antibiotic resistance underscore the need for ongoing monitoring of antibiotic usage trends.
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Affiliation(s)
- Yuhui Yang
- School of Nursing, Army Medical University, Chongqing, 400038, China
| | - Qingling Zeng
- Department of Nursing, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Guangyun Hu
- School of Nursing, Army Medical University, Chongqing, 400038, China
| | - Zhenkun Wang
- Center for Disease Control and Prevention of the Central Theater Command of Chinese People's Liberation Army, Beijing, 100042, China
| | - Zongyue Chen
- School of Nursing, Army Medical University, Chongqing, 400038, China
| | - Lang Zhou
- Center for Disease Control and Prevention of the Central Theater Command of Chinese People's Liberation Army, Beijing, 100042, China
| | - Aibo He
- Center for Disease Control and Prevention of the Central Theater Command of Chinese People's Liberation Army, Beijing, 100042, China
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, Chongqing, 400038, China.
| | - Yu Luo
- School of Nursing, Army Medical University, Chongqing, 400038, China.
| | - Gaoming Li
- Center for Disease Control and Prevention of the Central Theater Command of Chinese People's Liberation Army, Beijing, 100042, China.
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19
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Gurbuz K, Das K, Demir M, Suntur BM, Ozlu O, Basaran A, Cil MK, Golbol A. Impacts of intelligent monitoring technology installation and additional modalities on hand hygiene compliance in a burn center: A quasi-experimental longitudinal trial. Burns 2024; 50:1307-1314. [PMID: 38458960 DOI: 10.1016/j.burns.2024.02.020] [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: 08/24/2023] [Revised: 01/23/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The increasing development of intelligent technologies for hand hygiene (HH) compliance audit has the potential to create an alternative to direct observation (DO), which is still considered the gold standard but has disadvantages such as lack of standardized monitoring practices, Hawthorne effect, insufficient sample size, and time/resource consumption. We aimed to share our preliminary results on the impacts of intelligent monitoring technology installation (IMTI) and additional modalities on healthcare workers' (HCWs') HH compliance in a Burn Center, according to the "5 Moments of HH" concept defined by the World Health Organization (WHO). METHODS A quasi-experimental longitudinal trial was conducted over eleven months.The first phase of the three-stage study evaluated basic HH compliances obtained by DO. The system-defined HH performances, which IMTI recorded, were assessed in the second phase. Finally, the effect of IMTI and additional modalities was determined in the third stage. RESULTS 15202 HH events were performed by 41 HCWs, and a total of 20095 HH opportunities were observed. Four hundred fifty-five opportunities were in the preinstallation phase, and 19640 were during the total post-installation period. IMTIdefined performance rates in both Phase 2 (71.2%) and Phase 3 (80.5%) were generally considerably higher than HH compliances obtained from DO (58.5%). Nurses, physical therapy /anesthesia technicians, and housekeeping personnel showed significant increases, which was insignificant in physicians in phase 2. Meanwhile, a sustained increase was observed regarding IMTI and additional modalities of HH compliance of all HCWs in Phase 3. CONCLUSION IMTI has significantly increased HH performance rates. Furthermore, combining the IMTI with additional modalities as components of a multimodal strategy recommended by WHO appears to affect the sustainability of the increasing trend of HCWs' HH compliance.
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Affiliation(s)
- Kayhan Gurbuz
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye.
| | - Koray Das
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Mete Demir
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Bedia Mutay Suntur
- University of Health Sciences, Adana City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkiye
| | - Ozer Ozlu
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Abdulkadir Basaran
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Merve Kilic Cil
- University of Health Sciences, Adana City Training and Research Hospital, Department of Pediatric Infectious Diseases, Adana, Turkiye
| | - Abdullah Golbol
- University of Health Sciences, Adana City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkiye
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20
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Veronica R, Nelwan E, Kumalawati J, Rumende C, Chen K, Simadibrata M, Shatri H, Yunir E. THE EFFECT OF MULTIDRUG-RESISTANT ORGANISM INFECTION ON MORTALITY OF BURN PATIENTS AT RSUPN DR. CIPTO MANGUNKUSUMO. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:159-168. [PMID: 38974796 PMCID: PMC11225273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 07/09/2024]
Abstract
Susceptibility to infection and increased antibiotic resistance place burn patients at risk of infection caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, which can increase morbidity and mortality. A retrospective cohort study using medical record data of patients treated at RSUPN dr. Cipto Mangunkusumo in the period January 2020 to June 2022 was conducted. Of a total 160 subjects in the study period, 82.5% were aged <60 years, 16.88% had comorbidities, the most common cause of burns was fire (86.25%), the use of medical devices was 90.63%, with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%): 45% of MDRO infected patients died. Bivariate analysis was conducted to find the effect of MDRO infection on burn patient mortality (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the role variables, namely: age, comorbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the variables that had an effect on MDRO infection mortality were length of stay and age. MDRO infection has an effect on the mortality rate of burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K. pneumoniae.
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Affiliation(s)
- R.M. Veronica
- University of Indonesia / RS dr. Cipto Mangunkusumo, Jakarta, Indonesia
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21
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Bordeanu-Diaconescu EM, Grosu-Bularda A, Frunza A, Andrei GMC, Costache RA, Dumitru CS, Neagu TP, Lascar I, Hariga CS. The Impact of Burns Involving Over 50% of Total Body Surface Area - a Six-Year Retrospective Study. MAEDICA 2024; 19:247-254. [PMID: 39188841 PMCID: PMC11345052 DOI: 10.26574/maedica.2024.19.2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
BACKGROUND Severe burns pose significant therapeutic challenges due to their complex pathophysiology, the potential for life-threatening complications, long-term sequelae and the need for a multidisciplinary approach. In this retrospective study, we aimed to comprehensively analyze burns involving over 50% of the total body surface area (TBSA) treated in our institution over six years. MATERIALS AND METHODS We performed a retrospective study including 91 patients. The following epidemiological and clinical characteristics were documented: age, sex, comorbidities, admission modality, mechanism of injury, TBSA burned, burn depth, presence of inhalation injury, outcome, length of stay and associated costs. RESULTS In the study group, subjects had a mean age of 54.4 years (24-93), with a male-to-female ratio of 2.5:1. The median percentage of TBSA burned was 70% (50-99%) and 93.4% of patients had third-degree burns. Inhalation injury was present in 71.4% of patients. Flame burns occurred in 90.1% of patients. Prediction scores were assessed, with 60.4% of patients having an ABSI score above 12. Mortality in our study group was 84.61% and 39.5% of patients died in the first week after burn injury. The most frequent systemic complications were respiratory complications (95.6%), followed by cardiocirculatory (93.4%), metabolic (84.6%), hematological (74.7%), renal (64.8%), hepatic (59.3%) and infectious complications (38.4%). CONCLUSIONS Managing major burns is a highly complex process, which requires specialized care and infrastructure to improve outcomes. Extensive burns, especially over 50% TBSA, have high morbidity and mortality, with factors like age, severity and inhalation injury affecting prognosis. A multidisciplinary approach is essential for treatment, addressing not only the burns but also systemic complications to prevent multiple organ dysfunction syndrome and death.
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Affiliation(s)
- Eliza-Maria Bordeanu-Diaconescu
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Andreea Grosu-Bularda
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Adrian Frunza
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Grama Mihaela-Cristina Andrei
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Raducu-Andrei Costache
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Catalina-Stefania Dumitru
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Tiberiu-Paul Neagu
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery and Reconstructive Microsurgery, "Carol Davila" University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania
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22
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Hagiga A, Dheansa B. Multi-resistant organisms in burn patients: an end or a new beginning. Burns 2024; 50:1045-1052. [PMID: 38472000 DOI: 10.1016/j.burns.2024.02.024] [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: 08/25/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Infections are a major cause of morbidity and mortality in burn patients, and the rise of multidrug-resistant organisms (MDROs) has made it more challenging to manage and prevent infections. This review examines the available treatment options for MDROs in burn patients and anticipates the future challenges posed by their increasing prevalence. The review covers new antibiotics, such as Eravacycline and Plazomicin, as well as non-antibiotic therapies, such as bacteriophages and nanoparticles. Future research should focus on examining the long-term efficacy, cost-effectiveness, and in vivo efficacy of different treatment modalities. The potential of alternative therapies, such as probiotics and low-frequency magnetic fields, should also be explored. Accurate and rapid diagnostic and monitoring tools for detecting MDROs in burn patients should be developed. The emergence of MDROs in burn care is a challenge and a new beginning in infection innovation and novel treatments.
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Affiliation(s)
- Ahmed Hagiga
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.
| | - Baljit Dheansa
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
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23
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Nazemidashtarjandi S, Muldur S, Supple MD, Ryan CM, Yonker LM, Karabacak MN, Goverman J, Yarmush M, Irimia D. Monocyte Anisocytosis Changes in Patients after Major Burn Injuries. J Burn Care Res 2024:irae088. [PMID: 38783715 DOI: 10.1093/jbcr/irae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 05/25/2024]
Abstract
The recovery of patients after severe burns is a long and complex process. Recently, genomic analysis of white blood cells from burn and trauma patients revealed excessive and prolonged innate immune activation in patients with complicated outcomes. However, translating this knowledge into practical biomarkers has not been possible yet. Although several biomarkers for monitoring burn patients have been proposed, their ability to accurately distinguish between inflammation stemming from initial tissue destruction, infections, and organ failure complications is limited. Here, we focused on monocytes, critical innate immune cells in the response to burn injured tissues. We measured the monocyte anisocytosis (quantified as monocyte distribution width, MDW, a recently emerged marker of sepsis) throughout the recovery of patients from the time of burn injury until the end of the hospital stay. We observed that MDW increases in patients during the first week after major burns. Among the patients with major burns who survive, MDW starts decreasing in the second week and normalizes by the end of the hospital stay. The duration of hospital stay appears to be proportional to how fast MDW decreases during the second week after the injury. We also found that MDW decreases significantly in most patients after excision and debridement surgeries but not after allo- and auto-graft surgeries. Moreover, high MDW values correlated with a higher rate of positive microbiology blood culture samples and respiratory infections. These findings underscore the importance of monitoring MDW as a potential biomarker for the risk of complications during burn patient recovery.
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Affiliation(s)
- Saeed Nazemidashtarjandi
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Sinan Muldur
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Pediatrics, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
| | - Matthew D Supple
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
| | - Collen M Ryan
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Lael M Yonker
- Department of Pediatrics, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
| | - Murat N Karabacak
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Jeremy Goverman
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Martin Yarmush
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Daniel Irimia
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
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24
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Wang B, Du L, Dong B, Kou E, Wang L, Zhu Y. Current Knowledge and Perspectives of Phage Therapy for Combating Refractory Wound Infections. Int J Mol Sci 2024; 25:5465. [PMID: 38791502 PMCID: PMC11122179 DOI: 10.3390/ijms25105465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Wound infection is one of the most important factors affecting wound healing, so its effective control is critical to promote the process of wound healing. However, with the increasing prevalence of multi-drug-resistant (MDR) bacterial strains, the prevention and treatment of wound infections are now more challenging, imposing heavy medical and financial burdens on patients. Furthermore, the diminishing effectiveness of conventional antimicrobials and the declining research on new antibiotics necessitate the urgent exploration of alternative treatments for wound infections. Recently, phage therapy has been revitalized as a promising strategy to address the challenges posed by bacterial infections in the era of antibiotic resistance. The use of phage therapy in treating infectious diseases has demonstrated positive results. This review provides an overview of the mechanisms, characteristics, and delivery methods of phage therapy for combating pathogenic bacteria. Then, we focus on the clinical application of various phage therapies in managing refractory wound infections, such as diabetic foot infections, as well as traumatic, surgical, and burn wound infections. Additionally, an analysis of the potential obstacles and challenges of phage therapy in clinical practice is presented, along with corresponding strategies for addressing these issues. This review serves to enhance our understanding of phage therapy and provides innovative avenues for addressing refractory infections in wound healing.
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Affiliation(s)
- Bo Wang
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Lin Du
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Baiping Dong
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Erwen Kou
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Liangzhe Wang
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Yuanjie Zhu
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
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25
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De Decker I, Janssens D, De Mey K, Hoeksema H, Simaey M, De Coninck P, Verbelen J, De Pessemier A, Blondeel P, Monstrey S, Claes KE. Assessing antibacterial efficacy of a polyhexanide hydrogel versus alginate-based wound dressing in burns. J Wound Care 2024; 33:335-347. [PMID: 38683776 DOI: 10.12968/jowc.2024.33.5.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Burn injuries pose a heightened risk of infection, which is primarily responsible for increased morbidity and mortality. Factors such as extensive skin damage and compromised immunity exacerbate this vulnerability. Pseudomonas aeruginosa and Staphylococcus aureus are frequently identified in burns, with Gram-negative Pseudomonas aeruginosa often resistant to antibacterial agents. While Flaminal, an alginate-based wound dressing (Flen Health, Belgium), aids wound healing, its antibacterial effects are limited compared with 1% silver sulfadiazine (1% SSD). In contrast, Prontosan Wound Gel X, a betaine and polyhexanide-based hydrogel (B. Braun Medical AG, Switzerland), has been shown to effectively combat various microbes and promotes wound healing. METHOD In this study, two research cohorts were retrospectively established (control group: patients receiving standard of care with the alginate-based wound dressing; intervention group: patients receiving the polyhexanide hydrogel wound dressing), comprising patients admitted to a burn centre between 2019 and 2022. Patients were eligible when continuous wound treatment with either of the two wound dressings was performed. Laser Doppler imaging (LDI) scans were conducted. Regions of interest (ROIs) were selected based on LDI scans and divided into healing time categories. Wound swabs were collected and the presence of Pseudomonas aeruginosa and Staphylococcus aureus was documented. Bacterial load was evaluated using a semiquantitative scale. Wound healing was recorded. RESULTS The control group consisted of 31 patients with 93 ROIs, while the intervention group had 67 ROIs involving 29 patients. Both groups exhibited similar proportions of healing time categories (p>0.05). The polyhexanide hydrogel dressing outperformed the alginate-based dressing in antiseptic efficacy by significantly reducing the incidence of Pseudomonas aeruginosa- and Staphylococcus aureus-positive cultures in patients' wounds. Wound healing time for conservative treatment was comparable between groups. CONCLUSION In this study, the polyhexanide hydrogel dressing minimised Pseudomonas aeruginosa and Staphylococcus aureus colonisation in burn wounds, demonstrating strong antibacterial properties, emphasising its potential to minimise infections in burn injuries.
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Affiliation(s)
- Ignace De Decker
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Dries Janssens
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Kimberly De Mey
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie Simaey
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Petra De Coninck
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Jozef Verbelen
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Alina De Pessemier
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Phillip Blondeel
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Stan Monstrey
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Karel Ey Claes
- Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
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26
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Bebbington E, Miles J, Young A, van Baar ME, Bernal N, Brekke RL, van Dammen L, Elmasry M, Inoue Y, McMullen KA, Paton L, Thamm OC, Tracy LM, Zia N, Singer Y, Dunn K. Exploring the similarities and differences of burn registers globally: Results from a data dictionary comparison study. Burns 2024; 50:850-865. [PMID: 38267291 DOI: 10.1016/j.burns.2024.01.004] [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: 07/15/2023] [Revised: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Pooling and comparing data from the existing global network of burn registers represents a powerful, yet untapped, opportunity to improve burn prevention and care. There have been no studies investigating whether registers are sufficiently similar to allow data comparisons. It is also not known what differences exist that could bias analyses. Understanding this information is essential prior to any future data sharing. The aim of this project was to compare the variables collected in countrywide and intercountry burn registers to understand their similarities and differences. METHODS Register custodians were invited to participate and share their data dictionaries. Inclusion and exclusion criteria were compared to understand each register population. Descriptive statistics were calculated for the number of unique variables. Variables were classified into themes. Definition, method, timing of measurement, and response options were compared for a sample of register concepts. RESULTS 13 burn registries participated in the study. Inclusion criteria varied between registers. Median number of variables per register was 94 (range 28 - 890), of which 24% (range 4.8 - 100%) were required to be collected. Six themes (patient information, admission details, injury, inpatient, outpatient, other) and 41 subthemes were identified. Register concepts of age and timing of injury show similarities in data collection. Intent, mechanism, inhalational injury, infection, and patient death show greater variation in measurement. CONCLUSIONS We found some commonalities between registers and some differences. Commonalities would assist in any future efforts to pool and compare data between registers. Differences between registers could introduce selection and measurement bias, which needs to be addressed in any strategy aiming to facilitate burn register data sharing. We recommend the development of common data elements used in an international minimum data set for burn injuries, including standard definitions and methods of measurement, as the next step in achieving burn register data sharing.
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, Bangor University, Wrexham Academic Unit, Technology Park, Wrexham LL13 7YP, UK.
| | - Joanna Miles
- Plastic and Reconstructive Surgery Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Amber Young
- Bristol Centre for Surgical Research, Bristol Medical School, Department of Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Margriet E van Baar
- Dutch Burn Repository R3, Association of Dutch Burn Centres, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, the Netherlands
| | - Nicole Bernal
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43235, USA; Burn Care Quality Platform, American Burn Association, 311 S. Wacker Drive, Suite 950, Chicago, IL, USA
| | - Ragnvald Ljones Brekke
- Norwegian Burn Registry, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, 5009 Bergen, Norway
| | - Lotte van Dammen
- Burn Centres Outcomes Registry The Netherlands, Dutch Burns Foundation, Zeestraat 29, 1941 AJ Beverwijk, the Netherlands
| | - Moustafa Elmasry
- Burn Unit Database, Swedish Burn Register, Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yoshiaki Inoue
- Japanese Burn Register, Japanese Society for Burn Injuries, Shunkosha Inc. Lambdax Building, 2-4-12 Ohkubo, Shinjuku-ku, Tokyo 169-0072, Japan
| | - Kara A McMullen
- Burn Model System, Burn Model System National Data and Statistical Center, Department of Rehabilitation Medicine, University of Washington, Box 354237, Seattle, WA 98195-4237, USA
| | - Lia Paton
- Care of Burns in Scotland, National Managed Clinical Network, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - Oliver C Thamm
- German Burn Registry, German Society for Burn Treatment (DGV), Luisenstrasse 58-59, 10117 Berlin, Germany; University of Witten/Herdecke, Alfred-Herrenhausen-Strasse 50, 58455 Witten, Germany
| | - Lincoln M Tracy
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Nukhba Zia
- South Asia Burn Registry, Johns Hopkins International Injury Research Unit, Department of International Health, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Yvonne Singer
- School of Nursing and Midwifery, Griffith University, Nathan Campus, 170 Kessels Road, Brisbane, QLD, Australia
| | - Ken Dunn
- Burn Care Informatics Group, NHS, UK
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27
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Zoric A, Bagheri M, von Kohout M, Fardoust T, Fuchs PC, Schiefer JL, Opländer C. High-Intensity Blue Light (450-460 nm) Phototherapy for Pseudomonas aeruginosa-Infected Wounds. Photobiomodul Photomed Laser Surg 2024; 42:356-365. [PMID: 38776546 DOI: 10.1089/photob.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background: Nosocomial wound infection with Pseudomonas aeruginosa (PA) is a serious complication often responsible for the septic mortality of burn patients. Objective: High-intensity antimicrobial blue light (aBL) treatment may represent an alternative therapy for PA infections and will be investigated in this study. Methods: Antibacterial effects of a light-emitting diode array (450-460 nm; 300 mW/cm2; 15/30 min; 270/540 J/cm2) against PA were determined by suspension assay, biofilm assay, and a human skin wound model and compared with 15-min topically applied 3% citric acid (CA) and wound irrigation solution (Prontosan®; PRT). Results: aBL reduced the bacterial number [2.51-3.56 log10 colony-forming unit (CFU)/mL], whereas PRT or CA treatment achieved a 4.64 or 6.60 log10 CFU/mL reduction in suspension assays. aBL reduced biofilm formation by 60-66%. PRT or CA treatment showed reductions by 25% or 13%. Here, aBL reduced bacterial number in biofilms (1.30-1.64 log10 CFU), but to a lower extend than PRT (2.41 log10 CFU) or CA (2.48 log10 CFU). In the wound skin model, aBL (2.21-2.33 log10 CFU) showed a bacterial reduction of the same magnitude as PRT (2.26 log10 CFU) and CA (2.30 log10 CFU). Conclusions: aBL showed a significant antibacterial efficacy against PA and biofilm formation in a short time. However, a clinical application of aBL in wound therapy requires effective active skin cooling and eye protection, which in turn may limit clinical implementation.
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Affiliation(s)
- Andreas Zoric
- Department of Plastic, Reconstructive and Aesthetic Surgery, RKH Hospital Bietigheim-Vaihingen, Bietigheim-Bissingen, Germany
| | - Mahsa Bagheri
- Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Berlin, Germany
| | - Maria von Kohout
- Department of Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Tara Fardoust
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Paul C Fuchs
- Department of Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Jennifer L Schiefer
- Department of Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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28
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Roy S, Mukherjee P, Kundu S, Majumder D, Raychaudhuri V, Choudhury L. Microbial infections in burn patients. Acute Crit Care 2024; 39:214-225. [PMID: 38863352 PMCID: PMC11167422 DOI: 10.4266/acc.2023.01571] [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: 12/08/2023] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 06/13/2024] Open
Abstract
Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.
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Affiliation(s)
- Souvik Roy
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Preeti Mukherjee
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Sutrisha Kundu
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Debashrita Majumder
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Vivek Raychaudhuri
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Lopamudra Choudhury
- Department of Microbiology, Sarsuna College (under Calcutta University), Kolkata, India
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29
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Orbay H, Ziembicki JA, Yassin M, Egro FM. Prevention and Management of Wound Infections in Burn Patients. Clin Plast Surg 2024; 51:255-265. [PMID: 38429048 DOI: 10.1016/j.cps.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
The leading cause of morbidity in burn patients is infection with pneumonia, urinary tract infection, cellulitis, and wound infection being the most common cause. High mortality is due to the immunocompromised status of patients and abundance of multidrug-resistant organisms in burn units. Despite the criteria set forth by American Association of Burn, the diagnosis and treatment of burn infections are not always straightforward. Topical antimicrobials, isolation, hygiene, and personal protective equipment are common preventive measures. Additionally medical and nutritional optimization of the patients is crucial to reverse the immunocompromised status triggered by burn injury.
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Affiliation(s)
- Hakan Orbay
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenny A Ziembicki
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohamed Yassin
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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30
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Alexander C, Hill D. A Retrospective Case-Control Study of Eravacycline for the Treatment of Carbapenem-Resistant Acinetobacter Infections in Patients With Burn Injuries. J Burn Care Res 2024; 45:487-492. [PMID: 37971422 PMCID: PMC10911695 DOI: 10.1093/jbcr/irad183] [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: 06/22/2023] [Indexed: 11/19/2023]
Abstract
Thermal injuries lead to a deficiency in one's natural, protective barrier, resulting in increased susceptibility to pathogens, and often require multiple courses of broad-spectrum antibiotics. Eravacycline (ERA) has shown adequate in vitro activity against multiple multi-drug resistant (MDR) pathogens including Acinetobacter sp. Due to the increasing prevalence of MDR bacteria and the heightened susceptibility of patients with burns to infection, studies are needed to examine the clinical effect of eravacycline in this population. The objective of this retrospective, case-control study was to compare the outcomes of patients with thermal injuries treated with eravacycline versus a matched control for carbapenem-resistant Acinetobacter baumannii (CRAB) infections. Patients with thermal injury admitted to an American Burn Associated-verified burn center from May 1, 2019 to July 31, 2022, who received eravacycline, were randomly matched 4:1 to a historical cohort using a previously established, de-identified dataset of patients treated with colistimethate sodium (CMS) in the same burn center (March 1, 2009 to March 31, 2014), based on % total body surface area (%TBSA), age, and CRAB. A composite favorable outcome was defined as 30-day survival, completion of the course, lack of 14-day recurrence, and lack of acute kidney injury (AKI). Treatment with eravacycline over CMS was not more or less likely to be associated with a favorable response [odds ratio (95% confidence interval), 2.066 (0.456-9.361), P = .347]. Patients treated with CMS had nearly 9-fold higher odds of new-onset AKI versus ERA [8.816 (0.911-85.308), P = .06]. Adverse events were uncommon in the ERA group. There was no difference in mortality.
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Affiliation(s)
- Connor Alexander
- Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
| | - David Hill
- Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
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31
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Zhang M, Liu T, Yang J. Skin neuropathy and immunomodulation in diseases. FUNDAMENTAL RESEARCH 2024; 4:218-225. [PMID: 38933512 PMCID: PMC11197692 DOI: 10.1016/j.fmre.2022.08.016] [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: 07/31/2022] [Revised: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Skin is a vital barrier tissue of the body. Immune responses in the skin must be precisely controlled, which would otherwise cause severe disease conditions such as psoriasis, atopic dermatitis, or pathogenic infection. Research evidence has increasingly demonstrated the essential roles of neural innervations, i.e., sensory and sympathetic signals, in modulating skin immunity. Notably, neuropathic changes of such neural structures have been observed in skin disease conditions, implicating their direct involvement in various pathological processes. An in-depth understanding of the mechanism underlying skin neuropathy and its immunomodulatory effects could help reveal novel entry points for therapeutic interventions. Here, we summarize the neuroimmune interactions between neuropathic events and skin immunity, highlighting the current knowledge and future perspectives of this emerging research frontier.
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Affiliation(s)
- Manze Zhang
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Tingting Liu
- Department of Biochemistry, Weill Cornell Medical College, New York, NY 10065, USA
| | - Jing Yang
- IDG/McGovern Institute for Brain Research, Center for Life Sciences, School of Life Sciences, Peking University, Beijing 100871, China
- Peking University Third Hospital Cancer Center, Beijing 100191, China
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32
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Bai Y, Lang S, Du Y, Hu Q, Li X, Liu G. Metallic-Polyphenolic Nanoparticles Reinforced Cationic Guar Gum Hydrogel for Effectively Treating Burn Wound. Macromol Biosci 2024; 24:e2300396. [PMID: 37831011 DOI: 10.1002/mabi.202300396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/08/2023] [Indexed: 10/14/2023]
Abstract
The development of injectable hydrogel dressings which are long-term moisturizing, easy-to-apply, and effectively inhibiting infection and inflammatory is essential to promote burn wound repairing. Herein, an injectable hydrogel with moisturizing, antibacterial, and anti-inflammation abilities via multiple reversible interactions between cation guar gum (CG) and metallic-polyphenolic nanoparticles (PA-ZnII NPs) is developed. Specifically, PA-ZnII NPs is formed by synergistic complexation of protocatechualdehyde (PA) and zinc ion (Zn2+ ), provides CGPZ hydrogel with plentiful reversible interactions to inhibit the loss of moist. By interacting with PA-ZnII NPs, the CGPZ hydrogel can provide enhanced moisturization for more than 3 days. Moreover, the CGPZ hydrogel can maintain good adhesion for a period of time with injection and self-healing capabilities due to reversible interactions between CG and PA-ZnII NPs. In addition, CGPZ hydrogel exhibits outstanding broad spectrum antibacterial performance, as its killing efficiency against Escherichia coli and Staphylococcus aureus is all greater than 99.99%. Importantly, compared with commercial dressing, the CGPZ hydrogel can promote wound healing faster by inhibiting tissue damage from dysregulated inflammation and accelerating neovascularization. It is believed that the moisturizing CGPZ hydrogel with antibacterial and anti-inflammation performance can serve as a promising dressing for the effective treatment of burn wound.
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Affiliation(s)
- Yangjing Bai
- West China School of Nursing, Sichuan University/Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shiying Lang
- College of Biomass Science and Engineering, Sichuan University, Chengdu, 610065, China
| | - Yangrui Du
- College of Biomass Science and Engineering, Sichuan University, Chengdu, 610065, China
| | - Qinsheng Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedic Surgery, Yaan People's Hospital, Yaan, 625000, China
| | - Xinyun Li
- Dazhou Hospital of Integrated Traditional Chinese and Western medicine, Dazhou, Sichuan, 635000, China
| | - Gongyan Liu
- College of Biomass Science and Engineering, Sichuan University, Chengdu, 610065, China
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33
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Cui Z, Li Y, Qin Y, Li J, Shi L, Wan M, Hu M, Chen Y, Ji Y, Hou Y, Ye F, Liu C. Polymyxin B-targeted liposomal photosensitizer cures MDR A. baumannii burn infections and accelerates wound healing via M 1/M 2 macrophage polarization. J Control Release 2024; 366:297-311. [PMID: 38161034 DOI: 10.1016/j.jconrel.2023.12.046] [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: 07/27/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Multidrug-resistant (MDR) Acinetobacter baumannii infections pose a significant challenge in burn wound management, necessitating the development of innovative therapeutic strategies. In this work, we introduced a novel polymyxin B (PMB)-targeted liposomal photosensitizer, HMME@Lipo-PMB, for precise and potent antimicrobial photodynamic therapy (aPDT) against burn infections induced by MDR A. baumanni. HMME@Lipo-PMB-mediated aPDT exhibited enhanced antibacterial efficacy by specifically targeting and disrupting bacterial cell membranes, and generating increased intracellular ROS. Remarkably, even at low concentrations, this targeted approach significantly reduced bacterial viability in vitro and completely eradicated burn infections induced by MDR A. baumannii in vivo. Additionally, HMME@Lipo-PMB-mediated aPDT facilitated burn infection wound healing by modulating M1/M2 macrophage polarization. It also effectively promoted acute inflammation in the early stage, while attenuated chronic inflammation in the later stage of wound healing. This dynamic modulation promoted the formation of granulation tissue, angiogenesis, and collagen regeneration. These findings demonstrate the tremendous potential of HMME@Lipo-PMB-mediated aPDT as a promising alternative for the treatment of burn infections caused by MDR A. baumannii.
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Affiliation(s)
- Zixin Cui
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an 710061, PR China; Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China
| | - Yiyang Li
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an 710061, PR China; Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China
| | - Yannan Qin
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an 710061, PR China
| | - Jianzhou Li
- Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China
| | - Lei Shi
- Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China
| | - Meijuan Wan
- Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China
| | - Min Hu
- Department of Chemistry, School of Chemistry, Xi'an Jiaotong University, 28 Xianning West Road, Xi'an 710049, PR China
| | - Yunru Chen
- Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China
| | - Yanhong Ji
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an 710061, PR China
| | - Yuzhu Hou
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an 710061, PR China
| | - Feng Ye
- Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, PR China.
| | - Chengcheng Liu
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an 710061, PR China.
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34
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Mondol SM, Islam I, Islam MR, Shakil SK, Rakhi NN, Mustary JF, Amiruzzaman, Gomes DJ, Shahjalal HM, Rahaman MM. Genomic landscape of NDM-1 producing multidrug-resistant Providencia stuartii causing burn wound infections in Bangladesh. Sci Rep 2024; 14:2246. [PMID: 38278862 PMCID: PMC10817959 DOI: 10.1038/s41598-024-51819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024] Open
Abstract
The increasing antimicrobial resistance in Providencia stuartii (P. stuartii) worldwide, particularly concerning for immunocompromised and burn patients, has raised concern in Bangladesh, where the significance of this infectious opportunistic pathogen had been previously overlooked, prompting a need for investigation. The two strains of P. stuartii (P. stuartii SHNIBPS63 and P. stuartii SHNIBPS71) isolated from wound swab of two critically injured burn patients were found to be multidrug-resistant and P. stuartii SHNIBPS63 showed resistance to all the 22 antibiotics tested as well as revealed the co-existence of blaVEB-6 (Class A), blaNDM-1 (Class B), blaOXA-10 (Class D) beta lactamase genes. Complete resistance to carbapenems through the production of NDM-1, is indicative of an alarming situation as carbapenems are considered to be the last line antibiotic to combat this pathogen. Both isolates displayed strong biofilm-forming abilities and exhibited resistance to copper, zinc, and iron, in addition to carrying multiple genes associated with metal resistance and the formation of biofilms. The study also encompassed a pangenome analysis utilizing a dataset of eighty-six publicly available P. stuartii genomes (n = 86), revealing evidence of an open or expanding pangenome for P. stuartii. Also, an extensive genome-wide analysis of all the P. stuartii genomes revealed a concerning global prevalence of diverse antimicrobial resistance genes, with a particular alarm raised over the abundance of carbapenem resistance gene blaNDM-1. Additionally, this study highlighted the notable genetic diversity within P. stuartii, significant informations about phylogenomic relationships and ancestry, as well as potential for cross-species transmission, raising important implications for public health and microbial adaptation across different environments.
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Affiliation(s)
| | - Israt Islam
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Rafiul Islam
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Shahriar Kabir Shakil
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh
| | | | - Jannatul Ferdous Mustary
- Microbiology Department, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, 1000, Bangladesh
| | - Amiruzzaman
- Department of Medicine, Sir Salimullah Medical College, Dhaka, 1000, Bangladesh
| | - Donald James Gomes
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Hussain Md Shahjalal
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Md Mizanur Rahaman
- Department of Microbiology, University of Dhaka, Dhaka, 1000, Bangladesh.
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35
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Rissetto NG, de Oliveira JW, Nisihara R. Main Pathogens Causing Infections and Antibiotic Resistance Profile in Major Burns in Brazil Comparing Two Periods: 2015/2016 and 2019/2020. J Burn Care Res 2024; 45:145-150. [PMID: 37596810 DOI: 10.1093/jbcr/irad123] [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: 05/09/2023] [Indexed: 08/20/2023]
Abstract
Sepsis is the main cause of death in major burns. In this retrospective study conducted in a reference hospital in Brazil, the main agents causing infection and the resistance profile to antibiotics were identified. In addition, the epidemiological profile, length of hospital stay, type of burn, and total body surface area (TBSA) in major burns were collected from medical records, comparing the years 2015/2016 and 2019/2020. In both time periods, there was a predominance of males with a mean age of 43 years. Burns with less than 30% of TBSA predominated. There was a significant increase in positive cultures (P = .00026), from 58.7% to 80%, and an increase in skin punch culture collection from 25.6% to 43.9% in the years 2019/2020. The predominant etiological agent was Pseudomonas aeruginosa, followed by Acinetobacter baumannii resistant to carbapenems, and Staphylococcus aureus in both evaluated periods. The percentage of deaths was higher in 2019/2020 (26.2% vs. 14.6%; P = .026). The length of hospital stay was shorter in the latter period (P = .0081). Sepsis was the cause of death in 81.2% of cases in 2015/2020 and 78.3% in 2019/2020. Among the deaths, P. aeruginosa was the main agent identified. There was no change in the main pathogens and bacterial antibiotic resistance between the 2 time periods.
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Affiliation(s)
- Nicoli Gueno Rissetto
- Department of Medicine, Mackenzie Evangelical School of Medicine, Curitiba, Paraná, Brazil
| | | | - Renato Nisihara
- Department of Medicine, Mackenzie Evangelical School of Medicine, Curitiba, Paraná, Brazil
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36
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Bagheri M, Zoric A, von Kohout M, Fuchs PC, Schiefer JL, Opländer C. The Antimicrobial Efficacy of Topically Applied Mafenide Acetate, Citric Acid and Wound Irrigation Solutions Lavanox and Prontosan against Pseudomonas aeruginosa. Antibiotics (Basel) 2024; 13:42. [PMID: 38247601 PMCID: PMC10812663 DOI: 10.3390/antibiotics13010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Since burn wound infections caused by Pseudomonas aeruginosa (PA) lead to major complications and sepsis, this study evaluates the antimicrobial efficacy of the wound irrigation solutions Prontosan (PRT), Lavanox (LAV), citric acid (CA) and mafenide acetate (MA) using microbiology assays and an ex vivo skin wound model. In suspension assays, all the solutions showed significant reductions in bacterial number (log10 reduction: CA 5.77; LAV 4.91; PRT 4.74; MA 1.23). The biofilm assay revealed that PRT and LAV reduced biofilm formation by ~25% after a 15 min treatment, while PRT was most effective after a 24 h treatment (~68%). The number of PA in biofilms measured directly after a 15 min treatment was reduced most effectively with CA and LAV (log10 reductions ~2.5), whereas after a 24 h treatment, all solutions achieved only 1.36-1.65 log10 reductions. In the skin wound model, PRT and LAV provided the highest bacterial reduction after a 15 min treatment (log10 reduction 1.8-1.9), while MA was more effective after a 22 h treatment (log10 reduction 3.6). The results demonstrated the antimicrobial efficacy of all solutions against PA. Further investigation is needed to explore the potential clinical applications of a combination or alternating use of these solutions for infection prophylaxis and treatment of wound infections caused by PA.
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Affiliation(s)
- Mahsa Bagheri
- Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Walterhoeferstr. 11, 14165 Berlin, Germany
| | - Andreas Zoric
- Plastic, Reconstructive and Aesthetic Surgery, RKH Hospital Bietigheim-Vaihingen, Riedstr. 12, 74321 Bietigheim-Bissingen, Germany
| | - Maria von Kohout
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Paul C. Fuchs
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Jennifer Lynn. Schiefer
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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37
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Bentarhlia N, Kartah BE, Fadil M, El Harkaoui S, Matthäus B, Abboussi O, Abdelmoumen H, Bouhnik O, El Monfalouti H. Exploring the wound-healing and antimicrobial potential of Dittrichia viscosa L lipidic extract: Chemical composition and in vivo evaluation. Fitoterapia 2024; 172:105707. [PMID: 37866421 DOI: 10.1016/j.fitote.2023.105707] [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: 08/08/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
Dittrichia viscosa belongs to the Dittrichia genus, it grows abundantly in the east and northeast of Morocco, and traditionally its fresh leaves are crushed and given for topical application after burns, wounds, and infections. In this study, we examine the wound-healing activity of Dittrichia viscosa lipidic extract in vivo, assess its anti-microbial effect, and explore the specific compounds that contribute to these effects. To assess the effectiveness of wound healing, a burn-induced wound model was employed in Wistar rats, and the levels of hydroxyproline as well as histopathological changes in the skin tissues were evaluated. Furthermore, the antimicrobial potential against Bacillus subtilis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Candida glabrata, and Malassezia furfur was investigated using the agar disc diffusion method. Gas Chromatography-mass spectrometry (GC-MS) and high-performance liquid chromatography (HPLC) techniques were employed to analyze the composition of fatty acids, phytosterols, and tocopherols. Topical application of Dittrichia viscosa lipidic fraction ointment exhibited significant improvements in wound contraction, achieving an impressive rate of 82% within 21 days. Additionally, the lipidic extract of Dittrichia viscosa displayed notable efficacy against various microbial strains, including Candida albicans (25.07 ± 0.2), Candida glabrata (24 ± 0.6), and Malassezia furfur (22 ± 0.7). The primary fatty acids identified in the sample were linolenic acid (58.95% ± 0), oleic acid (16.75% ±0.04), and linoleic acid (11.97% ± 0.1). Notably, the sample contained significant amounts of γ-Tocopherols (732.08 ± 21mg/kg), while the sterol fraction primarily consisted of 7-Campesterol (1937 ± 0 mg/kg), 7-β-Sitosterol (1621 ± 0 mg/kg), and Stigmasterol (1439 ± 26 mg/kg). By its richness in active compound content, Dittrichia viscosa effectively accelerates wound healing while safeguarding against microbial infections.
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Affiliation(s)
- Noura Bentarhlia
- Laboratory of Plant Chemistry, Organic and Bioorganic Synthesis, Faculty of Sciences, Mohammed V University in Rabat, 4 Avenue Ibn Battouta B.P., RP 1014, Morocco
| | - Badr Eddine Kartah
- Laboratory of Plant Chemistry, Organic and Bioorganic Synthesis, Faculty of Sciences, Mohammed V University in Rabat, 4 Avenue Ibn Battouta B.P., RP 1014, Morocco
| | - Mouhcine Fadil
- Laboratory of Applied Organic Chemistry, Faculty of Sciences and Techniques, Sidi Mohamed Ben Abdellah University in Fez, BP 2626, Fes, 30000, Morocco
| | - Said El Harkaoui
- Max Rubner-Institut, Federal Research Institute for Nutrition and Food, Department for Safety and Quality of Cereals, Working Group for Lipid Research, Schützenberg 12, 32756 Detmold, Germany
| | - Bertrand Matthäus
- Max Rubner-Institut, Federal Research Institute for Nutrition and Food, Department for Safety and Quality of Cereals, Working Group for Lipid Research, Schützenberg 12, 32756 Detmold, Germany
| | - Oualid Abboussi
- Team of Physiology and Physiopathology, Research Center in Genomic of Human Pathologies, Faculty of Sciences, Mohammed V University in Rabat, 4 Avenue Ibn Battouta B.P., RP 1014, Morocco
| | - Hanaa Abdelmoumen
- Center for Biotechnology, Biodiversity and Environment, Faculty of Sciences, Mohammed V University in Rabat, 4 Avenue Ibn Battouta B.P., RP 1014, Morocco
| | - Omar Bouhnik
- Center for Biotechnology, Biodiversity and Environment, Faculty of Sciences, Mohammed V University in Rabat, 4 Avenue Ibn Battouta B.P., RP 1014, Morocco
| | - Hanae El Monfalouti
- Laboratory of Plant Chemistry, Organic and Bioorganic Synthesis, Faculty of Sciences, Mohammed V University in Rabat, 4 Avenue Ibn Battouta B.P., RP 1014, Morocco.
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Guan W, Gong C, Wu S, Cui Z, Zheng Y, Li Z, Zhu S, Liu X. Instant Protection Spray for Anti-Infection and Accelerated Healing of Empyrosis. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2306589. [PMID: 37703451 DOI: 10.1002/adma.202306589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/26/2023] [Indexed: 09/15/2023]
Abstract
Distinct from common injuries, deep burns often require a chronic recovery cycle for healing and long-term antibiotic treatment to prevent infection. The rise of drug-resistant bacteria has caused antibiotics to no longer be perfect, and continuous drug use can easily lead to repeated infection and even death. Inspired by wild animals that chew plants to prevent wound infection, probiotic extracts with a structure similar to the tailspike of phage are obtained from Lactobacillus casei and combined with different flavones to design a series of nonantibiotic bactericides. These novel antibacterial agents are combined with a rapid gelation spray with a novel cross-angle layout to form an instant protection spray (IPS) and provide a physical and anti-infectious barrier for burns within 30 s. This IPS is able to sterilize 100.00% and 96.14% of multidrug-resistant Staphylococcus aureus (MRSA) in vitro and in vivo, respectively. In addition, it is found to effectively reduce inflammation in MRSA-infected burns in rats and to promote tissue healing.
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Affiliation(s)
- Wei Guan
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Yaguan Road 135, Tianjin, 300072, China
- Biomedical Materials Engineering Research Center, Hubei Key Laboratory of Polymer Materials, Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, School of Materials Science & Engineering, Hubei University, Wuhan, 430062, China
- School of Materials Science & Engineering, Peking University, Yi-He-Yuan Road 5, Beijing, 100871, China
| | - Caixin Gong
- Biomedical Materials Engineering Research Center, Hubei Key Laboratory of Polymer Materials, Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, School of Materials Science & Engineering, Hubei University, Wuhan, 430062, China
| | - Shuilin Wu
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Yaguan Road 135, Tianjin, 300072, China
- Biomedical Materials Engineering Research Center, Hubei Key Laboratory of Polymer Materials, Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, School of Materials Science & Engineering, Hubei University, Wuhan, 430062, China
- School of Materials Science & Engineering, Peking University, Yi-He-Yuan Road 5, Beijing, 100871, China
| | - Zhenduo Cui
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Yaguan Road 135, Tianjin, 300072, China
| | - Yufeng Zheng
- School of Materials Science & Engineering, Peking University, Yi-He-Yuan Road 5, Beijing, 100871, China
| | - Zhaoyang Li
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Yaguan Road 135, Tianjin, 300072, China
| | - Shengli Zhu
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Yaguan Road 135, Tianjin, 300072, China
| | - Xiangmei Liu
- Biomedical Materials Engineering Research Center, Hubei Key Laboratory of Polymer Materials, Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, School of Materials Science & Engineering, Hubei University, Wuhan, 430062, China
- School of Health Science & Biomedical Engineering, Hebei University of Technology, Xiping Avenue 5340, Tianjin, 300401, China
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Xiao Y, Fang H, Zhu Y, Zhou J, Dai Z, Wang H, Xia Z, Tu Z, Leong KW. Multifunctional Cationic Hyperbranched Polyaminoglycosides that Target Multiple Mediators for Severe Abdominal Trauma Management. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2305273. [PMID: 37997512 PMCID: PMC10767409 DOI: 10.1002/advs.202305273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/12/2023] [Indexed: 11/25/2023]
Abstract
Trauma and its associated complications, including dysregulated inflammatory responses, severe infection, and disseminated intravascular coagulation (DIC), continue to pose lethal threats worldwide. Following injury, cell-free nucleic acids (cfNAs), categorized as damage-associated molecular patterns (DAMPs), are released from dying or dead cells, triggering local and systemic inflammatory responses and coagulation abnormalities that worsen disease progression. Harnessing cfNA scavenging strategies with biomaterials has emerged as a promising approach for treating posttrauma systemic inflammation. In this study, the effectiveness of cationic hyperbranched polyaminoglycosides derived from tobramycin (HPT) and disulfide-included HPT (ss-HPT) in scavenging cfNAs to mitigate posttrauma inflammation and hypercoagulation is investigated. Both cationic polymers demonstrate the ability to suppress DAMP-induced toll-like receptor (TLR) activation, inflammatory cytokine secretion, and hypercoagulation by efficiently scavenging cfNAs. Additionally, HPT and ss-HPT exhibit potent antibacterial efficacy attributed to the presence of tobramycin in their chemical composition. Furthermore, HPT and ss-HPT exhibit favorable modulatory effects on inflammation and therapeutic outcomes in a cecal ligation puncture (CLP) mouse abdominal trauma model. Notably, in vivo studies reveal that ss-HPT displayed high accumulation and retention in injured organs of traumatized mice while maintaining a higher biodegradation rate in healthy mice, contrasting with findings for HPT. Thus, functionalized ss-HPT, a bioreducible polyaminoglycoside, holds promise as an effective option to enhance therapeutic outcomes for trauma patients by alleviating posttrauma inflammation and coagulation complications.
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Affiliation(s)
- Yongqiang Xiao
- Department of Burn Surgerythe First Affiliated HospitalNaval Medical UniversityShanghai200433P. R. China
- Department of Biomedical EngineeringColumbia UniversityNew YorkNY10027USA
- ENT InstituteDepartment of Facial Plastic and Reconstructive SurgeryEye & ENT HospitalFudan UniversityShanghai200031P. R. China
| | - He Fang
- Department of Burn Surgerythe First Affiliated HospitalNaval Medical UniversityShanghai200433P. R. China
| | - Yuefei Zhu
- Department of Biomedical EngineeringColumbia UniversityNew YorkNY10027USA
| | - Jie Zhou
- Department of Breast SurgeryAffiliated Cancer Hospital and InstituteGuangzhou Medical UniversityGuangzhou510095P. R. China
| | - Zhanzhan Dai
- Department of Burn Surgerythe First Affiliated HospitalNaval Medical UniversityShanghai200433P. R. China
| | - Hongxia Wang
- Department of Biomedical EngineeringColumbia UniversityNew YorkNY10027USA
| | - Zhaofan Xia
- Department of Burn Surgerythe First Affiliated HospitalNaval Medical UniversityShanghai200433P. R. China
| | - Zhaoxu Tu
- Department of Biomedical EngineeringColumbia UniversityNew YorkNY10027USA
- The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouGuangdong510655P. R. China
| | - Kam W. Leong
- Department of Biomedical EngineeringColumbia UniversityNew YorkNY10027USA
- Department of Systems BiologyColumbia University Medical CenterNew YorkNY10032USA
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Walters ET, Palackic A, Franco-Mesa C, Shah NR, Erickson MJ, Wolf SE. The impact of COVID-19 on clinical outcomes of burn patients. BURNS & TRAUMA 2023; 11:tkad042. [PMID: 38074193 PMCID: PMC10699731 DOI: 10.1093/burnst/tkad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 03/30/2023] [Accepted: 07/20/2023] [Indexed: 02/12/2024]
Abstract
Background Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517-2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798-4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351-4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326-4.877; p = 0.0001). Conclusions We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.
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Affiliation(s)
- Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Michael J Erickson
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
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Pradhan M, Pethe P. The Molecular Mechanisms Involved in the Hypertrophic Scars Post-Burn Injury. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:549-563. [PMID: 38161582 PMCID: PMC10751863 DOI: 10.59249/rhuf5686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Scar formation is a normal response to skin injuries. During the scar-remodeling phase, scar tissue is usually replaced with normal, functional tissue. However, after deep burn injuries, the scar tissue may persist and lead to contractures around joints, a condition known as hypertrophic scar tissue. Unfortunately, current treatment options for hypertrophic scars, such as surgery and pressure garments, often fail to prevent their reappearance. One of the primary challenges in treating hypertrophic scars is a lack of knowledge about the molecular mechanisms underlying their formation. In this review, we critically analyze studies that have attempted to uncover the molecular mechanisms behind hypertrophic scar formation after severe burn injuries, as well as clinical trials conducted to treat post-burn hypertrophic scars. We found that most clinical trials used pressure garments, laser treatments, steroids, and proliferative inhibitors for hypertrophic scars, with outcomes measured using subjective scar scales. However, fundamental research using human burn injury biopsies has shown that pathways such as Transforming Growth factor β (TGFβ), Phosphatase and tensin homolog (PTEN), and Toll-like receptors (TLRs) could be potentially regulated to reduce scarring. Therefore, we conclude that more testing is necessary to determine the efficacy of these molecular targets in reducing hypertrophic scarring. Specifically, double-blinded clinical trials are needed, where the outcomes can be measured with more robust quantitative molecular parameters.
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Affiliation(s)
- Mugdha Pradhan
- Symbiosis Centre for Stem Cell Research (SCSCR), Symbiosis International
(Deemed University), Lavale, Pune, India
| | - Prasad Pethe
- Symbiosis Centre for Stem Cell Research (SCSCR), Symbiosis International
(Deemed University), Lavale, Pune, India
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Gu F, He W, Zhu D, Yang P, Sun J, Han L. A 10-year retrospective study of methicillin-resistant Staphylococcus aureus from burn wound infection in southeast China from 2013 to 2022. Front Microbiol 2023; 14:1301744. [PMID: 38107851 PMCID: PMC10722408 DOI: 10.3389/fmicb.2023.1301744] [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: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most commonly encountered pathogens among burn patients incurring substantial morbidity and mortality. To investigate the epidemiology and features of MRSA in burn wound infections, we conducted a 10-year retrospective study on MRSA isolated from burn patients with burn wound infections from southeast China from 2013 to 2022. Methods One hundred MRSA isolates (10 isolates each year) from burn wound infection among burn patients from 2013 to 2022 were randomly selected and enrolled. In addition to the clinical data of the 100 burn patients, MRSA isolates were characterized by antimicrobial susceptibility testing, detection of toxin genes, and molecular typing. Results The median time from the onset of burns and admission to MRSA detected was 13 and 5 days, respectively. No MRSA isolate was found resistant to quinupristin/dalfopristin, linezolid, and vancomycin. Toxin gene seg was found most frequently (90%) followed by sea (70%) and eta (64%). CC8 (74%), ST239 (70%), and SCCmec III (72%) were the most common CC, ST, and SCCmec types, respectively. Conclusion ST239-III (70%) was the predominant clone found in MRSA from burn wound infection among burn patients in southeast China. ST239-III was less found from 2018 to 2022. A higher diversity of MRSA clones was observed in these recent 5 years than that from 2013 to 2017.
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Affiliation(s)
- Feifei Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiping He
- Department of Clinical Laboratory, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Dedong Zhu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peilang Yang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyong Sun
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lizhong Han
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gong Y, Wang P, Cao R, Wu J, Ji H, Wang M, Hu C, Huang P, Wang X. Exudate Absorbing and Antimicrobial Hydrogel Integrated with Multifunctional Curcumin-Loaded Magnesium Polyphenol Network for Facilitating Burn Wound Healing. ACS NANO 2023; 17:22355-22370. [PMID: 37930078 DOI: 10.1021/acsnano.3c04556] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Burns are among the most common causes of trauma worldwide. Reducing the healing time of deep burn wounds has always been a major challenge. Traditional dressings not only require a lengthy medical procedure but also cause unbearable pain and secondary damage to patients. In this study, we developed an exudate-absorbing and antimicrobial hydrogel with a curcumin-loaded magnesium polyphenol network (Cur-Mg@PP) to promote burn wound healing. That hydrogel was composed of an ε-poly-l-lysine (ε-PLL)/polymer poly(γ-glutamic acid) (γ-PGA) hydrogel (PP) and curcumin-loaded magnesium polyphenol network (Cur-Mg). Because of the strong water absorption property of ε-PLL and γ-PGA, Cur-Mg@PP powder can quickly absorb the wound exudate and transform into a moist and viscous hydrogel, thus releasing payloads such as magnesium ion (Mg2+) and curcumin (Cur). The released Mg2+ and Cur demonstrated good therapeutic efficacy on analgesic, antioxidant, anti-inflammation, angiogenesis, and tissue regeneration. Our findings provide a strategy for accelerating burn wound healing.
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Affiliation(s)
- Yan Gong
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Pei Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ran Cao
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518055, China
| | - Jiayingzi Wu
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518055, China
| | - Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Peng Huang
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518055, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Moon AY, Bailey EJ, Polanco JA, Kurata WE, Pierce LM. Antibacterial Efficacy of a Chitosan-Based Hydrogel Modified With Epsilon-Poly-l-Lysine Against Pseudomonas aeruginosa in a Murine-Infected Burn Wound Model. Mil Med 2023; 188:52-60. [PMID: 37948238 DOI: 10.1093/milmed/usad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Because antibiotic resistance is increasing worldwide and the leading cause of death in burn patients is an infection, an urgent need exists for nonantibiotic approaches to eliminate multidrug-resistant bacteria from burns to prevent their systemic dissemination and sepsis. We previously demonstrated the significant antibiofilm activity of a chitosan (CS) hydrogel containing the antimicrobial peptide epsilon-poly-l-lysine (EPL) against multidrug-resistant Pseudomonas aeruginosa using ex vivo porcine skin. In this study, we evaluated the in vivo antibacterial efficacy of a CS/EPL hydrogel against P. aeruginosa in a murine burn wound infection model. MATERIALS AND METHODS Full-thickness burns were created on the dorsum using a heated brass rod and were inoculated with bioluminescent, biofilm-forming P. aeruginosa (Xen41). Mice were treated with CS/EPL, CS, or no hydrogel applied topically 2 or 24 hours after inoculation to assess the ability to prevent or eradicate existing biofilms, respectively. Dressing changes occurred daily for 3 days, and in vivo bioluminescence imaging was performed to detect and quantitate bacterial growth. Blood samples were cultured to determine systemic infection. In vitro antibacterial activity and cytotoxicity against human primary dermal fibroblasts, keratinocytes, and mesenchymal stem cells were also assessed. RESULTS CS/EPL treatment initiated at early or delayed time points showed a significant reduction in bioluminescence imaging signal compared to CS on days 2 and 3 of treatment. Mice administered CS/EPL had fewer bloodstream infections, lower weight loss, and greater activity than the untreated and CS groups. CS/EPL reduced bacterial burden by two orders of magnitude in vitro and exhibited low cytotoxicity against human cells. CONCLUSION A topical hydrogel delivering the antimicrobial peptide EPL demonstrates in vivo efficacy to reduce but not eradicate established P. aeruginosa biofilms in infected burn wounds. This biocompatible hydrogel shows promise as an antimicrobial barrier dressing for the sustained protection of burn wounds from external bacterial contamination.
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Affiliation(s)
- Andrea Y Moon
- Department of General Surgery, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Emily J Bailey
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Jonilee A Polanco
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Wendy E Kurata
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
| | - Lisa M Pierce
- Department of Clinical Investigation, Tripler Army Medical Center, Tripler AMC, HI 96859, USA
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Shahriari-Khalaji M, Sattar M, Cao R, Zhu M. Angiogenesis, hemocompatibility and bactericidal effect of bioactive natural polymer-based bilayer adhesive skin substitute for infected burned wound healing. Bioact Mater 2023; 29:177-195. [PMID: 37520303 PMCID: PMC10384635 DOI: 10.1016/j.bioactmat.2023.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Thermal wounds are complex and lethal with irregular shapes, risk of infection, slow healing, and large surface area. The mortality rate in patients with infected burns is twice that of non-infected burns. Developing multifunctional skin substitutes to augment the healing rate of infected burns is vital. Herein, we 3D printed a hydrogel scaffold comprising carboxymethyl chitosan (CMCs) and oxidized alginate grafted catechol (O-AlgCat) on a hydrophobic electrospun layer, forming a bilayer skin substitute (BSS). The functional layer (FL) was fabricated by physiochemical crosslinking to ensure favorable biodegradability. The gallium-containing hydrophobic electrospun layer or backing layer (BL) could mimic the epidermis of skin, avoiding fluid penetration and offering antibacterial activity. 3D printed FL contains catechol, gallium, and biologically active platelet rich fibrin (PRF) to adhere to both tissue and BL, show antibacterial activity, encourage angiogenesis, cell growth, and migration. The fabricated bioactive BSS exhibited noticeable adhesive properties (P ≤ 0.05), significant antibacterial activity (P ≤ 0.05), faster clot formation, and the potential to promote proliferation (P ≤ 0.05) and migration (P ≤ 0.05) of L929 cells. Furthermore, the angiogenesis was significantly higher (P ≤ 0.05) when evaluated in vivo and in ovo. The BSS-covered wounds healed faster due to low inflammation and high collagen density. Based on the obtained results, the fabricated bioactive BSS could be an effective treatment for infected burn wounds.
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Affiliation(s)
- Mina Shahriari-Khalaji
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
| | - Mamoona Sattar
- Research Group of Microbiological Engineering and Medical Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Ran Cao
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Donghua University, Shanghai, 201620, China
| | - Meifang Zhu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China
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Turan TL, Klein HJ, Hackler J, Hoerner L, Rijntjes E, Graf TR, Plock JA, Schomburg L. Serum Selenium-Binding Protein 1 (SELENBP1) in Burn Injury: A Potential Biomarker of Disease Severity and Clinical Course. Antioxidants (Basel) 2023; 12:1927. [PMID: 38001780 PMCID: PMC10669776 DOI: 10.3390/antiox12111927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Oxidative stress, systemic inflammation, and metabolic derangements are hallmarks of burn pathophysiology. Severely burned patients are highly susceptible to infectious complications. Selenium-binding protein 1 (SELENBP1) modulates intracellular redox homeostasis, and elevated serum concentrations have been associated with adverse clinical outcomes in trauma patients. We hypothesized that serum SELENBP1 at hospital admission and during hospitalization may constitute a meaningful biomarker of disease severity and the clinical course in burn injury, with pulmonary infection as primary endpoint. To this end, we conducted a prospective cohort study that included 90 adult patients admitted to the Burn Center of the University Hospital Zurich, Switzerland. Patients were treated according to the local standard of care, with high-dose selenium supplementation during the first week. Serum SELENBP1 was determined at nine time-points up to six months postburn and the data were correlated to clinical parameters. SELENBP1 was initially elevated and rapidly declined within the first day. Baseline SELENBP1 levels correlated positively with the Abbreviated Burn Severity Index (ABSI) (R = 0.408; p < 0.0001). In multiple logistic regression, a higher ABSI was significantly associated with increased pulmonary infection risk (OR, 14.4; 95% CI, 3.2-88.8; p = 0.001). Similarly, baseline SELENBP1 levels constituted a novel but less accurate predictor of pulmonary infection risk (OR, 2.5; 95% CI, 0.7-8.9; p = 0.164). Further studies are needed to explore the additional value of serum SELENBP1 when stratifying patients with respect to the clinical course following major burns and, potentially, for monitoring therapeutic measures aimed at reducing tissue damage and oxidative stress.
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Affiliation(s)
- Tabael L. Turan
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (T.L.T.); (L.H.); (E.R.)
| | - Holger J. Klein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.J.K.); (J.A.P.)
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Julian Hackler
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (T.L.T.); (L.H.); (E.R.)
| | - Livia Hoerner
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (T.L.T.); (L.H.); (E.R.)
| | - Eddy Rijntjes
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (T.L.T.); (L.H.); (E.R.)
| | - Theresia Reding Graf
- Department of Visceral Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jan A. Plock
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.J.K.); (J.A.P.)
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (T.L.T.); (L.H.); (E.R.)
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48
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Xu B, Cai G, Gao Y, Chen M, Xu C, Wang C, Yu D, Qi D, Li R, Wu J. Nanofibrous Dressing with Nanocomposite Monoporous Microspheres for Chemodynamic Antibacterial Therapy and Wound Healing. ACS OMEGA 2023; 8:38481-38493. [PMID: 37867710 PMCID: PMC10586453 DOI: 10.1021/acsomega.3c05271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023]
Abstract
The excessive use of antibiotics and consequent bacterial resistance have emerged as crucial public safety challenges for humanity. As a promising antibacterial treatment, using reactive oxygen species (ROS) can effectively address this problem and has the advantages of being highly efficient and having low toxicity. Herein, electrospinning and electrospraying were employed to fabricate magnesium oxide (MgO)-based nanoparticle composited polycaprolactone (PCL) nanofibrous dressings for the chemodynamic treatment of bacteria-infected wounds. By utilizing electrospraying, erythrocyte-like monoporous PCL microspheres incorporating silver (Ag)- and copper (Cu)-doped MgO nanoparticles were generated, and the unique microsphere-filament structure enabled efficient anchoring on nanofibers. The composite dressings produced high levels of ROS, as confirmed by the 2,7-dichloriflurescin fluorescent probe. The sustained generation of ROS resulted in efficient glutathione oxidation and a remarkable bacterial killing rate of approximately 99% against Staphylococcus aureus (S. aureus). These dressings were found to be effective at treating externally infected wounds. The unique properties of these composite nanofibrous dressings suggest great potential for their use in the medical treatment of bacteria-infected injuries.
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Affiliation(s)
- Bingjie Xu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Guoqiang Cai
- NICE Zhejiang Technology Co., Ltd, Hangzhou 310013, China
- Key Laboratory of Green Cleaning Technology & Detergent of Zhejiang Province, Lishui 323000, China
| | - Yujie Gao
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
- Key Laboratory of Green Cleaning Technology & Detergent of Zhejiang Province, Lishui 323000, China
| | - Mingchao Chen
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Chenlu Xu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Chenglong Wang
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Dan Yu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dongming Qi
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
- Key Laboratory of Green Cleaning Technology & Detergent of Zhejiang Province, Lishui 323000, China
| | - Renhong Li
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Jindan Wu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou 310018, China
- Key Laboratory of Green Cleaning Technology & Detergent of Zhejiang Province, Lishui 323000, China
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49
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Xi L, Wang L, Zhang M, He C, Yang X, Pang Y, Chen H, Cheng F. TNF-R1 Cellular Nanovesicles Loaded on the Thermosensitive F-127 Hydrogel Enhance the Repair of Scalded Skin. ACS Biomater Sci Eng 2023; 9:5843-5854. [PMID: 37043416 PMCID: PMC10566511 DOI: 10.1021/acsbiomaterials.2c01257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/13/2023] [Indexed: 04/13/2023]
Abstract
Excessive inflammatory response after severe scalding is an important cause of delayed wound healing and is even life-threatening. Tumor necrosis factor α (TNF-α) is a key pro-inflammatory factor of skin trauma. Interacting with tumor necrosis factor receptor 1 (TNF-R1), TNF-α causes excessive inflammation and poor prognosis by activating NF-κB pathway. Antagonizing high levels of TNF-α is one of the therapeutic approaches for diseases associated with the overactivation of inflammatory responses. However, the available monoclonal antibodies are limited in their application due to their complex preparation process, high price, and the lack of cell targeting ability leading to systemic toxicity and side effects. In this study, by using a genetic bioengineering technique, we modified TNF-R1 on the cell membrane surface-derived nanovesicles (NVs). We confirmed that TNF-R1 NVs stably expressed TNF-R1 on the membrane surface and interacted with its ligand TNF-α. Furthermore, TNF-R1 NVs competitively antagonized the effect of TNF-α in the wound healing assay in vitro. In the scalded mouse model, TNF-R1 NVs were released continuously from the thermosensitive hydrogel Pluronic F-127, resulting in less inflammation and better wound healing. Our results revealed TNF-R1 NVs as promising cell-free therapeutic agents in alleviating TNF-α-mediated pro-inflammatory signaling and promoting wound repair.
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Affiliation(s)
- Lifang Xi
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
| | - Linglu Wang
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
| | - Manqi Zhang
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
| | - Chao He
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
| | - Xinrui Yang
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
| | - Yuxin Pang
- School
of Pharmacy, Guizhou University of Traditional
Chinese Medicine, Guiyang, Guizhou, 550025, China
| | - Hongbo Chen
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
| | - Fang Cheng
- School
of Pharmaceutical Sciences (Shenzhen), Shenzhen
Campus of Sun Yat-sen University, Shenzhen, China, 518107
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50
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Zhou S, Xiao S, Wang X, Wang X, Han L. Risk Factors and Pathogens of Wound Infection in Burn Inpatients from East China. Antibiotics (Basel) 2023; 12:1432. [PMID: 37760728 PMCID: PMC10525729 DOI: 10.3390/antibiotics12091432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Infection is the predominant contributor to morbidity and mortality in burn patients, and burn wound infection (BWI) is the most common reason. The objective of this research was to analyze the incidence, factors and progression of BWI, in terms of events and bacteria. METHODS Clinical variables of all qualified patients admitted to burn wards were analyzed retrospectively in 2021 at a tertiary hospital in eastern China through univariate analysis and multivariate logistic regression. The Kaplan-Meier method was also used for plotting survival curves. Isolates and resistance data were evaluated to demonstrate the evolution of targeted antibiotics of strains from BWI. RESULTS A total of 580 (median age, 39.5 years (23-56 years); 372/580 (64.14%) male) patients were evaluated, 348 (60.0%) of whom experienced BWI. A variety of factors are associated with BWI. Multivariate logistic regression analysis showed that depth and area of burn and duration from burn to first hospitalization are independent risk factors for BWI. For BWI onset in these patients, 47.24% (274/580) occurred in the first week. The most frequently isolated causative organism was Staphylococcus aureus (15.7%) in patients with BWI. The duration of transition from Gram-positive strains (median 3 days, (2-7 days)) to Gram-negative (median 10 days, (4-17 days)) ones isolated from burn wound shrunk. Hospital length of stay was considered as a protective factor for BWI. CONCLUSION The precise assessment of factors affecting BWI in burn patients enhances prompt and suitable management. Swab cultures for surveillance could be utilized to monitor the microbiological status of burn patients.
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Affiliation(s)
- Siqi Zhou
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (S.Z.); (S.X.)
| | - Shuzhen Xiao
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (S.Z.); (S.X.)
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xuedong Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (S.Z.); (S.X.)
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xuefeng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (S.Z.); (S.X.)
| | - Lizhong Han
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (S.Z.); (S.X.)
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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