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Deldar R, D'Arpa P, Moffatt L, Leung K, Shupp J. Cerium Nitrate Treatment in the Management of Burns. Adv Wound Care (New Rochelle) 2022; 11:443-454. [PMID: 34015965 DOI: 10.1089/wound.2020.1330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Significance: The standard of care for deep burn wounds is eschar excision and autologous skin grafting within the first postburn days. However, when this is not practical due to medical reasons, unavailable surgical facilities, or lack of donor sites or other coverage, surgeons have used topical cerium nitrate (CN) in a cream with silver sulfadiazine (SSD) for over four decades to convert the eschar into a pliable and protective crust that facilitates the postponement or staging of eschar excision and grafting. CN+SSD treatment is reported to reduce dressing changes, improve patient comfort, and reduce bacterial burden, with unaffected epithelialization and few complications. Recent Advances: CN aqueous solutions applied topically alone or together with solid silver dressings in animal models have mitigated wound injury progression, wound microbial burden, and systemic immune dysfunction. Critical Issues: CN+SSD cream is not approved by U.S. Food and Drug Administration (FDA) and its efficacy in clinical trials has been challenging to demonstrate. One reason is that CN changes the eschar visibly, introducing unavoidable bias. Also, the market and patient population is small and burn wound presentation is highly variable. Future Directions: For use in settings wherein the once- or twice-daily CN+SSD cream dressing changes are least feasible (low-income, military, and mass casualty settings), it may be possible to develop a solid dressing containing cerium and silver that requires infrequent dressing changes. For future clinical studies, the trial design most suited to comparing silver-containing dressings with and without cerium may be paired difference of matched intrapatient wounds.
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Affiliation(s)
- Romina Deldar
- The Burn Center, Medstar Washington Hospital Center, Washington, District of Columbia, USA.,Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | - Lauren Moffatt
- The Burn Center, Medstar Washington Hospital Center, Washington, District of Columbia, USA.,Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA.,Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Kai Leung
- Division of Combat Wound Repair, US Army Institute of Surgical Research, JBSA-Fort Sam Houston, San Antonio, Texas, USA
| | - Jeffrey Shupp
- The Burn Center, Medstar Washington Hospital Center, Washington, District of Columbia, USA.,Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA.,Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
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Shakiba M, Rezvani Ghomi E, Khosravi F, Jouybar S, Bigham A, Zare M, Abdouss M, Moaref R, Ramakrishna S. Nylon—A material introduction and overview for biomedical applications. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5372] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Erfan Rezvani Ghomi
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering Faculty of Engineering, National University of Singapore Singapore Singapore
| | - Fatemeh Khosravi
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering Faculty of Engineering, National University of Singapore Singapore Singapore
| | - Shirzad Jouybar
- Department of Chemistry Amirkabir University of Technology Tehran Iran
| | - Ashkan Bigham
- Institute of Polymers, Composites and Biomaterials—National Research Council (IPCB‐CNR) Naples Italy
| | - Mina Zare
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering Faculty of Engineering, National University of Singapore Singapore Singapore
| | - Majid Abdouss
- Department of Chemistry Amirkabir University of Technology Tehran Iran
| | - Roxana Moaref
- Department of Polymer Engineering Amirkabir University of Technology Tehran Iran
| | - Seeram Ramakrishna
- Center for Nanotechnology and Sustainability, Department of Mechanical Engineering Faculty of Engineering, National University of Singapore Singapore Singapore
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Singh VK, Seed TM. Repurposing Pharmaceuticals Previously Approved by Regulatory Agencies to Medically Counter Injuries Arising Either Early or Late Following Radiation Exposure. Front Pharmacol 2021; 12:624844. [PMID: 34040517 PMCID: PMC8141805 DOI: 10.3389/fphar.2021.624844] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
The increasing risks of radiological or nuclear attacks or associated accidents have served to renew interest in developing radiation medical countermeasures. The development of prospective countermeasures and the subsequent gain of Food and Drug Administration (FDA) approval are invariably time consuming and expensive processes, especially in terms of generating essential human data. Due to the limited resources for drug development and the need for expedited drug approval, drug developers have turned, in part, to the strategy of repurposing agents for which safety and clinical data are already available. Approval of drugs that are already in clinical use for one indication and are being repurposed for another indication is inherently faster and more cost effective than for new agents that lack regulatory approval of any sort. There are four known growth factors which have been repurposed in the recent past as radiomitigators following the FDA Animal Rule: Neupogen, Neulasta, Leukine, and Nplate. These four drugs were in clinic for several decades for other indications and were repurposed. A large number of additional agents approved by various regulatory authorities for given indications are currently under investigation for dual use for acute radiation syndrome or for delayed pathological effects of acute radiation exposure. The process of drug repurposing, however, is not without its own set of challenges and limitations.
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Affiliation(s)
- Vijay K. Singh
- Division of Radioprotectants, Department of Pharmacology and Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Abstract
Background: Patients with large, acute burn injuries are a major challenge for clinicians. The loss of skin barrier protection against micro-organisms combined with the induced immunosuppression after burn injury makes this population especially vulnerable to infection. For burn-injured patients who survive immediate management considerations and burn resuscitation after acute injury, sepsis remains the primary cause of death. The purpose of this article is to describe current strategies and innovations in burn sepsis prevention and management. Methods: This work reviews the current understanding of the systemic inflammatory response to burn injury and burn sepsis as well as current strategies in insolation and infection prevention, newer burn unit design strategies in the context of infection prevention, and novel therapies being considered in topical antimicrobial wound care management. Results: A review of burn sepsis is key to understanding current paradigms and innovation in burn management and prevention. Key management principles begin from the time of injury and persist throughout the patient's hospital course. This includes use of personal protective equipment, burn unit design considerations, and knowledge of critical care principles such as central venous catheter management strategies. Innovations on wound dressing types, forms, and use have been key to better controlling burn wound sepsis and improving wound healing. Products incorporating nanotechnology, novel anions, oxygen, and even light have been key to introducing previously unconsidered methods to fight or prevent infection. Conclusion: Understanding the pathophysiology and source identification of sepsis from burn wounds has been a key contributor in developing innovative prevention and therapeutic strategies in burn management. The emergence of drug-resistant pathogens and the difficulty of systemic antibiotic agents to reach poorly vascularized wounds have further reinforced the need to anticipate management strategies moving forward. A proactive, multidisciplinary approach is necessary to minimize the morbidity and mortality associated with infection control.
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Affiliation(s)
- Shawn Tejiram
- The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA.,Department of Surgery, Biochemistry, Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA
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Hou J, Chen L, Zhou M, Li J, Liu J, Fang H, Zeng Y, Sun J, Wang Z. Multi-Layered Polyamide/Collagen Scaffolds with Topical Sustained Release of N-Acetylcysteine for Promoting Wound Healing. Int J Nanomedicine 2020; 15:1349-1361. [PMID: 32184590 PMCID: PMC7053812 DOI: 10.2147/ijn.s232190] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background Impaired wound healing might be associated with many issues, especially overactive of reactive oxygen species (ROS), deficiency of blood vessels and immature of epidermis. N-acetylcysteine (NAC), as an antioxidant, could solve these problems by inhibiting overreactive of ROS, promoting revascularization and accelerating re-epithelialization. How to deliver NAC in situ with a controllable releasing speed still remain a challenge. Materials and Methods In this study, we combined collagen (Col) with N-acetylcysteine to perform the characteristics of sustained release and chemically crosslinked Col/NAC composite with polyamide (PA) nanofibers to enhance the mechanical property of collagen and fabricated this multi-layered scaffold (PA-Col/NAC scaffold). The physical properties of the scaffolds such as surface characteristics, water absorption and tensile modulus were tested. Meanwhile, the ability to promote wound healing in vitro and in vivo were investigated. Results These scaffolds were porous and performed great water absorption. The PA-Col/NAC scaffold could sustainably release NAC for at least 14 days. After cell implantation, PA-Col/NAC scaffold showed better cell proliferation and cell migration than the other groups. In vivo, PA-Col/NAC scaffolds could promote wound healing best among all the groups. Conclusion The multi-layered scaffolds could obviously accelerate the process of wound healing and exert better and prolonged effects.
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Affiliation(s)
- Jinfei Hou
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Lifeng Chen
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Muran Zhou
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Jialun Li
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Jian Liu
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Huimin Fang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Yuyang Zeng
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Jiaming Sun
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Zhenxing Wang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China.,Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
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Lang TC, Zhao R, Kim A, Wijewardena A, Vandervord J, Xue M, Jackson CJ. A Critical Update of the Assessment and Acute Management of Patients with Severe Burns. Adv Wound Care (New Rochelle) 2019; 8:607-633. [PMID: 31827977 PMCID: PMC6904939 DOI: 10.1089/wound.2019.0963] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
Significance: Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.
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Affiliation(s)
- Thomas Charles Lang
- Department of Anesthesia, Prince of Wales and Sydney Children's Hospitals, Randwick, Australia
| | - Ruilong Zhao
- Sutton Laboratories, The Kolling Institute, St. Leonards, Australia
| | - Albert Kim
- Department of Critical Care Medicine, Royal North Shore Hospital, St. Leonards, Australia
| | - Aruna Wijewardena
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, St. Leonards, Australia
| | - John Vandervord
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, St. Leonards, Australia
| | - Meilang Xue
- Sutton Laboratories, The Kolling Institute, St. Leonards, Australia
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Connery SA, Yankowitz J, Odibo L, Raitano O, Nikolic-Dorschel D, Louis JM. Effect of using silver nylon dressings to prevent superficial surgical site infection after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol 2019; 221:57.e1-57.e7. [PMID: 30849351 DOI: 10.1016/j.ajog.2019.02.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical site infections are associated with significant healthcare cost and burden. Silver-impregnated dressings have been associated with a decrease in surgical site infections in select populations, but it is unknown whether the benefit can be observed after cesarean deliveries. OBJECTIVE We sought to evaluate the impact of silver nylon dressings in reducing superficial surgical site infections after cesarean delivery. MATERIALS AND METHODS A blinded randomized clinical trial of women undergoing scheduled or unscheduled cesarean delivery at a single site was conducted. Women were recruited for participation from September 2013 to June 2016. Women with vertical skin incisions were excluded. Enrolled participants were randomized to silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient office at 1 week and 6 weeks after delivery. The primary outcome was superficial surgical site infection as defined by Centers for Disease Control criteria at any time within the first 6 weeks after cesarean delivery. A sample size of 330 per group (n = 660) was planned to compare the 2 arms. Data were analyzed using the χ2, Fisher exact test, Student t test, Mann-Whitney U test, and logistic regression where appropriate, and a value of P < .05 was considered significant. RESULTS Among the 657 participants, overall, the primary outcome was similar between the 2 groups (4.6% in the silver nylon group vs 4.2% in the gauze group, P = .96). Women allocated to silver nylon, when compared to those who were allocated to gauze, had similar rates of superficial surgical site infection within 1 week (1.2% vs 0.9%) and within 6 weeks ( 4.6% vs 4.2%) after delivery (P >.99). The 2 groups were similar in age (30.9 ± 5.6 vs 31.0 ± 5.5 years, P = .95), body mass index (36.2 ± 8.7 vs 35.3 ± 8.2 kg/m2, P = .19), pregestational diabetes (6.2% vs 3.4%, P = .14), gestational diabetes (7.9% vs 7.3%, P = .88), cesarean delivery after labor (31.9% vs 31.1%, P = .86), presence of chorioamnionitis (5.2% vs 2.1% P = .06), and operative time (56.4 ± 20.6 vs 55.9 ± 17 minutes, P = .69). After adjusting for clinical and sociodemographic confounding variables, current smoking (adjusted odds ratio, 4.9; 95% confidence interval, 1.8-13.4) body mass index ≥40 kg/m2 (adjusted odds ratio, 3.08; 95% confidence interval, 1.3-6.8), and surgery length (minutes) (adjusted odds ratio, 1.02; 95% confidence interval, 1.002-1.04), but not use of gauze dressing, were associated with superficial surgical site infections. CONCLUSION Among women undergoing cesarean delivery, silver nylon dressing was not more effective than gauze in reducing the risk of superficial surgical site infections.
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Dias FTG, Ingracio AR, Nicoletti NF, Menezes FC, Dall Agnol L, Marinowic DR, Soares RMD, da Costa JC, Falavigna A, Bianchi O. Soybean-modified polyamide-6 mats as a long-term cutaneous wound covering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:957-968. [PMID: 30889770 DOI: 10.1016/j.msec.2019.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/10/2018] [Accepted: 02/06/2019] [Indexed: 01/21/2023]
Abstract
Engineered skin coverings have been adopted clinically to support extensive and deep wounds that result in fewer healthy skin remaining and therefore take longer to heal. Nonetheless, these biomaterials demand intensive labor and an expensive final cost. In comparison to conventional bandages, which do not meet all the requirements of wound care, electrospun fiber mats could potentially provide an excellent environment for healing. In this work, we developed two nanostructured scaffolds based on polyamide-6 (PA-6) to be tested as a wound covering in a rat model of full-thickness incisional wound healing. The central idea was to create a bioconstruct that is simple to implement and biologically safe, with a high survival rate, which provides physical support and biological recognition for new functional tissues. An unmodified PA-6 and a soybean-modified PA-6 were employed as nanofibrillar matrices in this study. The biomaterials showed a dimensional homology to natural extracellular matrix components and neither in vitro toxicity nor in vivo side effects. Both polymeric scaffolds were resistant to the sterilization process and could promote the attachment of 3T3 fibroblast cells, besides successfully incorporating the growth factor PDGF-BB, which had its bioactivity extended for up to 12 h under simulated conditions. The modification of PA-6 chains with a fatty acid derivative increased the scaffold's surface free energy, favoring cell proliferation, collagen formation, and ECM secretion. These results confirm the potential of these materials as a topical dermal covering for skin regeneration.
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Affiliation(s)
| | | | | | - Felipe Castro Menezes
- Poli-BIO, Polymeric Materials Research Group, Institute of Chemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucas Dall Agnol
- Health Sciences Graduate Program, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Daniel Rodrigo Marinowic
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Rosane Michele Duarte Soares
- Poli-BIO, Polymeric Materials Research Group, Institute of Chemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Asdrubal Falavigna
- Health Sciences Graduate Program, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil; Cell Therapy Laboratory (LATEC), Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Otávio Bianchi
- Materials Science Graduate Program (PGMAT), Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil; Health Sciences Graduate Program, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
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Aurora A, Le TD, Akers KS, Blyth DM, Graybill JC, Clemens MS, Chung KK, Rizzo JA. Recurrent bacteremia: A 10-year retrospective study in combat-related burn casualties. Burns 2018; 45:579-588. [PMID: 30385059 DOI: 10.1016/j.burns.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/27/2018] [Accepted: 10/04/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Surviving the first episode of bacteremia predisposes burn casualties to its recurrence. Herein, we investigate the incidence, mortality, bacteriology, and source of infection of recurrent bacteremia in military burn casualties admitted to the U.S. Army Institute of Surgical Research Burn Center over a 10year period. METHODS Bacteremia was defined as the growth of Gram-positive or Gram-negative organisms in a blood culture that excluded probable skin contaminants. Recurrent bacteremia was defined as a subsequent episode of bacteremia ≥7 days after the first episode. Polymicrobial bacteremia was the presence of more than one pathogen in the same blood culture. Bacteremia was attributed to UTI, pneumonia, or wound sepsis. All other bacteremias were considered non-attributable bloodstream infections. Univariate and multivariate analyses determined factors predictive of clinical outcome. RESULTS Out of 952 combat-related burn casualties screened, 166 cases were identified; 63% (non-recurrent) and 37% (recurrent) with median time to recurrence of 20 days. Univariate and multivariate analysis showed that the mortality rate was two and nine-fold, respectively, higher with recurrent bacteremia. Univariate analysis found that except for urinary tract infection, large burn size (>20%), 3rd degree burns, increased injuiry severity, perineal burns, and mechanical ventilator days were independent factors predictive of recurrence of bacteremia as well as increased mortality in the recurrent bacteremia cohort. Acinetobacter baumannii complex (63%) was prevalent in the non-recurrent group, while Klebsiella pneumoniae (46% vs. 30%) and Pseudomonas aeruginosa (35% vs. 26%) were prevalent in recurrent bacteremia. Half of the recurrent bacteremia cases were polymicrobial, compared to 9% in non-recurrent bacteremia. Pneumonia was prevalent in non-recurrent bacteremia (38%) and a combination of pneumonia and wound sepsis (29%) in recurrent bacteremia casualties. CONCLUSIONS Recurrent bacteremia increases mortality in military burn casualties. Additional research is needed to address and mitigate the underlying causes, thereby improving survival.
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Affiliation(s)
- Amit Aurora
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Tuan D Le
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Kevin S Akers
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Dana M Blyth
- Brooke Army Medical Center, JBSA, Fort Sam Houston, TX, United States
| | - John C Graybill
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Michael S Clemens
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Kevin K Chung
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Julie A Rizzo
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
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10
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DiCarlo AL, Cassatt DR, Dowling WE, Esker JL, Hewitt JA, Selivanova O, Williams MS, Price PW. Challenges and Benefits of Repurposing Products for Use during a Radiation Public Health Emergency: Lessons Learned from Biological Threats and other Disease Treatments. Radiat Res 2018; 190:659-676. [PMID: 30160600 DOI: 10.1667/rr15137.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The risk of a radiological or nuclear public health emergency is a major growing concern of the U.S. government. To address a potential incident and ensure that the government is prepared to respond to any subsequent civilian or military casualties, the U.S. Department of Health and Human Services and the Department of Defense have been charged with the development of medical countermeasures (MCMs) to treat the acute and delayed injuries that can result from radiation exposure. Because of the limited budgets in research and development and the high costs associated with bring promising approaches from the bench through advanced product development activities, and ultimately, to regulatory approval, the U.S. government places a priority on repurposing products for which there already exists relevant safety and other important information concerning their use in humans. Generating human data can be a costly and time-consuming process; therefore, the U.S. government has interest in drugs for which such relevant information has been established (e.g., products for another indication), and in determining if they could be repurposed for use as MCMs to treat radiation injuries as well as chemical and biological insults. To explore these possibilities, the National Institute of Allergy and Infectious Diseases (NIAID) convened a workshop including U.S. government, industry and academic subject matter experts, to discuss the challenges and benefits of repurposing products for a radiation indication. Topics covered included a discussion of U.S. government efforts (e.g. funding, stockpiling and making products available for study), as well unique regulatory and other challenges faced when repurposing patent protected or generic drugs. Other discussions involved lessons learned from industry on repurposing pre-license, pipeline products within drug development portfolios. This report reviews the information presented, as well as an overview of discussions from the meeting.
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Affiliation(s)
- Andrea L DiCarlo
- a Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - David R Cassatt
- a Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - William E Dowling
- b Office of Biodefense Research Resources and Translational Research (OBRRTR), Division of Microbiology and Infectious Diseases (DMID), NIAID, NIH, Rockville, Maryland
| | - John L Esker
- c Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS), Washington, DC
| | - Judith A Hewitt
- b Office of Biodefense Research Resources and Translational Research (OBRRTR), Division of Microbiology and Infectious Diseases (DMID), NIAID, NIH, Rockville, Maryland
| | - Oxana Selivanova
- c Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS), Washington, DC
| | - Mark S Williams
- b Office of Biodefense Research Resources and Translational Research (OBRRTR), Division of Microbiology and Infectious Diseases (DMID), NIAID, NIH, Rockville, Maryland
| | - Paul W Price
- d Office of Regulatory Affairs (ORA), DAIT, NIAID, NIH, Rockville, Maryland
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