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Abirami G, Alexpandi R, Jayaprakash E, Roshni PS, Ravi AV. Pyrogallol loaded chitosan-based polymeric hydrogel for controlling Acinetobacter baumannii wound infections: Synthesis, characterization, and topical application. Int J Biol Macromol 2024; 259:129161. [PMID: 38181925 DOI: 10.1016/j.ijbiomac.2023.129161] [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: 05/19/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Antibacterial hydrogels have emerged as a promising approach for wound healing, owing to their ability to integrate antibacterial agents into the hydrogel matrix. Benefiting from its remarkable antibacterial and wound-healing attributes, pyrogallol has been introduced into chitosan-gelatin for the inaugural development of an innovative antibacterial polymeric hydrogel tailored for applications in wound healing. Hence, we observed the effectiveness of pyrogallol in inhibiting the growth of A. baumannii, disrupting mature biofilms, and showcasing robust antioxidant activity both in vitro and in vivo. In addition, pyrogallol promoted the migration of human epidermal keratinocytes and exhibited wound healing activity in zebrafish. These findings suggest that pyrogallol holds promise as a therapeutic agent for wound healing. Interestingly, the pyrogallol-loaded chitosan-gelatin (Pyro-CG) hydrogel exhibited enhanced mechanical strength, stability, controlled drug release, biodegradability, antibacterial activity, and biocompatibility. In vivo results established that Pyro-CG hydrogel promotes wound closure and re-epithelialization in A. baumannii-induced wounds in molly fish. Therefore, the prepared Pyro-CG polymeric hydrogel stands poised as a potent and promising agent for wound healing with antibacterial properties. This holds considerable promise for the development of effective therapeutic interventions to address the increasing menace of A. baumannii-induced wound infections.
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Affiliation(s)
- Gurusamy Abirami
- Lab in Microbiology and Marine Biotechnology, Department of Biotechnology, School of Biological Sciences, Alagappa University, Karaikudi 630 003, India
| | - Rajaiah Alexpandi
- Lab in Microbiology and Marine Biotechnology, Department of Biotechnology, School of Biological Sciences, Alagappa University, Karaikudi 630 003, India; The Key Laboratory of Advanced Textile Materials and Manufacturing Technology of Ministry of Education, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - Erusappan Jayaprakash
- Lab in Microbiology and Marine Biotechnology, Department of Biotechnology, School of Biological Sciences, Alagappa University, Karaikudi 630 003, India
| | - Prithiviraj Swasthikka Roshni
- Lab in Microbiology and Marine Biotechnology, Department of Biotechnology, School of Biological Sciences, Alagappa University, Karaikudi 630 003, India
| | - Arumugam Veera Ravi
- Lab in Microbiology and Marine Biotechnology, Department of Biotechnology, School of Biological Sciences, Alagappa University, Karaikudi 630 003, India.
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Ramos C, Lorenz K, Putrinš M, Hind CK, Meos A, Laidmäe I, Tenson T, Sutton JM, Mason AJ, Kogermann K. Fibrous matrices facilitate pleurocidin killing of wound associated bacterial pathogens. Eur J Pharm Sci 2024; 192:106648. [PMID: 37992909 DOI: 10.1016/j.ejps.2023.106648] [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: 05/29/2023] [Revised: 10/20/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
Conventional wound infection treatments neither actively promote wound healing nor address the growing problem of antibacterial resistance. Antimicrobial peptides (AMPs) are natural defense molecules, released from host cells, which may be rapidly bactericidal, modulate host-immune responses, and/or act as endogenous mediators for wound healing. However, their routine clinical use has hitherto been hindered due to their instability in the wound environment. Here we describe an electrospun carrier system for topical application of pleurocidin, demonstrating sufficient AMP release from matrices to kill wound-associated pathogens including Acinetobacter baumannii and Pseudomonas aeruginosa. Pleurocidin can be incorporated into polyvinyl alcohol (PVA) fiber matrices, using coaxial electrospinning, without major drug loss with a peptide content of 0.7% w/w predicted sufficient to kill most wound associated species. Pleurocidin retains its activity on release from the electrospun fiber matrix and completely inhibits growth of two strains of A. baumannii (AYE; ATCC 17978) and other ESKAPE pathogens. Inhibition of P. aeruginosa strains (PAO1; NCTC 13437) is, however, matrix weight per volume dependent, with only larger/thicker matrices maintaining complete inhibition. The resulting estimation of pleurocidin release from the matrix reveals high efficiency, facilitating a greater AMP potency. Wound matrices are often applied in parallel or sequentially with the use of standard wound care with biocides, therefore the presence and effect of biocides on pleurocidin potency was tested. It was revealed that combinations displayed additive or modestly synergistic effects depending on the biocide and pathogens which should be considered during the therapy. Taken together, we show that electrospun, pleurocidin-loaded wound matrices have potential to be investigated for wound infection treatment.
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Affiliation(s)
- Celia Ramos
- Institute of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia; Technology Development Group, UK Health Security Agency, Research and Evaluation, Porton Down, Salisbury SP4 0JG, United Kingdom; Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Science, King´s College London, Franklin-Wilkins Building 150 Stamford Street, London SE1 9NH, United Kingdom
| | - Kairi Lorenz
- Institute of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Marta Putrinš
- Institute of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia; Institute of Technology, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Charlotte K Hind
- Technology Development Group, UK Health Security Agency, Research and Evaluation, Porton Down, Salisbury SP4 0JG, United Kingdom
| | - Andres Meos
- Institute of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Ivo Laidmäe
- Institute of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Tanel Tenson
- Institute of Technology, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - J Mark Sutton
- Technology Development Group, UK Health Security Agency, Research and Evaluation, Porton Down, Salisbury SP4 0JG, United Kingdom; Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Science, King´s College London, Franklin-Wilkins Building 150 Stamford Street, London SE1 9NH, United Kingdom
| | - A James Mason
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Science, King´s College London, Franklin-Wilkins Building 150 Stamford Street, London SE1 9NH, United Kingdom
| | - Karin Kogermann
- Institute of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia.
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Infections in Pediatric Patients With Burn Injury: 6 Years of Experience. Pediatr Infect Dis J 2023; 42:8-12. [PMID: 36476519 DOI: 10.1097/inf.0000000000003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to determine the frequency of bloodstream and wound infections and their possible risk factors in hospitalized children with burn injury. METHODS We performed this retrospective descriptive study from 2015 to 2021. The study subjects consisted of all the pediatric patients hospitalized in the burn unit, from whom microorganisms were isolated either from blood or wound culture samples. RESULTS We detected a total of 142 microorganisms from 97 blood culture samples and 45 wound culture samples. Among the 115 patients, 44 (38.3%) were females and 71 (61.7%) were males, with a median age of 21 months (interquartile range: 14-39 months). Gram-positive bacteria were the most common causative agents of bloodstream infections in patients with burns (54.6%), followed by Gram-negative bacteria (32.9%) and fungi (12.3%). Gram-negative bacteria were the most common causative agent of wound infections (86.7%). Prolonged hospitalization positively correlated with the extent of the burn surface area (P: 0.031), degree of burn (P: 0.001), use of central venous catheter (P: 0.028), and intensive care unit stay (P: 0.044). Independent risk factors for Gram-negative bacteremia and Gram-negative wound infections were the extent of the burn surface area (P: 0.018), degree of burn (P: 0.024) and intensive care unit stay (P: 0.023). The independent risk factor for fungemia was prolonged hospitalization (P: 0.026). CONCLUSIONS To reduce infections, minimizing invasive procedures using a multidisciplinary approach would be beneficial, especially in patients who have a large burn surface area and are expected to have a long hospital stay.
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Zhou J, Ventura CJ, Yu Y, Gao W, Fang RH, Zhang L. Biomimetic Neutrophil Nanotoxoids Elicit Potent Immunity against Acinetobacter baumannii in Multiple Models of Infection. NANO LETTERS 2022; 22:7057-7065. [PMID: 35998891 PMCID: PMC9971251 DOI: 10.1021/acs.nanolett.2c01948] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acinetobacter baumannii is a leading cause of antibiotic-resistant nosocomial infections with high mortality rates, yet there is currently no clinically approved vaccine formulation. During the onset of A. baumannii infection, neutrophils are the primary responders and play a major role in resisting the pathogen. Here, we design a biomimetic nanotoxoid for antivirulence vaccination by using neutrophil membrane-coated nanoparticles to safely capture secreted A. baumannii factors. Vaccination with the nanotoxoid formulation rapidly mobilizes innate immune cells and promotes pathogen-specific adaptive immunity. In murine models of pneumonia, septicemia, and superficial wound infection, immunization with the nanovaccine offers significant protection, improving survival and reducing signs of acute inflammation. Lower bacterial burdens are observed in vaccinated animals regardless of the infection route. Altogether, neutrophil nanotoxoids represent an effective platform for eliciting multivalent immunity to protect against multidrug-resistant A. baumannii in a wide range of disease conditions.
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Affiliation(s)
- Jiarong Zhou
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, U.S.A
| | - Christian J. Ventura
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, U.S.A
| | - Yiyan Yu
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, U.S.A
| | - Weiwei Gao
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, U.S.A
| | - Ronnie H. Fang
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, U.S.A
| | - Liangfang Zhang
- Department of NanoEngineering, Chemical Engineering Program, and Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, U.S.A
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Wang L, Sun D, Chen L, Zhou P, Wang K, Wang F, Lei X, Wang Y, Lu Y, Huang G, Gao X. Development and Clinical Application of a Recombinase Polymerase Amplification-Lateral Flow Strip Assay for Detection of Carbapenem-Resistant Acinetobacter baumannii. Front Cell Infect Microbiol 2022; 12:876552. [PMID: 35646723 PMCID: PMC9131934 DOI: 10.3389/fcimb.2022.876552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 12/19/2022] Open
Abstract
Acinetobacter baumannii is a worldwide, primary cause of respiratory tract infections, septicemia, urinary apparatus infections, and secondary meningitis. It can be fatal. Rapid and accurate detection methods are needed to control the spread of carbapenem-resistant A. baumannii (CRAB). Current molecular diagnostic methods are limited and not suitable for on-site detection. In this study, an isothermal detection method using recombinase polymerase amplification (RPA) combined with a lateral flow strip (LFS) was developed to target the blaOXA-51 and blaOXA-23 genes of A. baumannii. The reaction was completed in about 40 min at 37°C. This method can also effectively distinguish A. baumannii and CRAB. The limit of detection of 100-101 CFU/reaction was equal to that of other detection methods. The detection accuracy was equal to that of the qPCR method with the use of clinical samples. The RPA-LFS assay is portable, rapid, and accurate and could replace existing detection methods for on-site detection of A. baumannii and CRAB.
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Affiliation(s)
- Lei Wang
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
- School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Dunpo Sun
- Department of Acupuncture and Moxibustion, Lianyungang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Lianyungang, China
| | - Li Chen
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
| | - Ping Zhou
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
| | - Kun Wang
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
| | - Fang Wang
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
| | - Xingqi Lei
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
| | - Yan Wang
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
| | - Yingzhi Lu
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
- *Correspondence: Yingzhi Lu, ; Guanhong Huang, ; Xuzhu Gao,
| | - Guanhong Huang
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
- *Correspondence: Yingzhi Lu, ; Guanhong Huang, ; Xuzhu Gao,
| | - Xuzhu Gao
- Department of Central Laboratory, Department of Laboratory Medicine, the Second People’s Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Lianyungang, China
- *Correspondence: Yingzhi Lu, ; Guanhong Huang, ; Xuzhu Gao,
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Liu CW, Hsieh CY, Chen JY. Investigations on the Wound Healing Potential of Tilapia Piscidin (TP)2-5 and TP2-6. Mar Drugs 2022; 20:205. [PMID: 35323503 PMCID: PMC8955782 DOI: 10.3390/md20030205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
Wound healing is a highly orchestrated process involving many cell types, such as keratinocytes, fibroblasts and endothelial cells. This study aimed to evaluate the potential application of synthetic peptides derived from tilapia piscidin (TP)2, TP2-5 and TP2-6 in skin wound healing. The treatment of HaCaT keratinocytes with TP2-5 and TP2-6 did not cause cytotoxicity, but did enhance cell proliferation and migration, which could be attributed to the activation of epidermal growth factor receptor signaling. In CCD-966SK fibroblasts, although TP2-5 (31.25 μg/mL) and TP2-6 (125 μg/mL) showed cytotoxic effects, we observed the significant promotion of cell proliferation and migration at low concentrations. In addition, collagen I, collagen III, and keratinocyte growth factor were upregulated by the peptides. We further found that TP2-5 and TP2-6 showed pro-angiogenic properties, including the enhancement of human umbilical vein endothelial cell (HUVEC) migration and the promotion of neovascularization. In a murine model, wounds treated topically with TP2-5 and TP2-6 were reduced by day 2 post-injury and healed significantly faster than untreated wounds. Taken together, these findings demonstrate that both TP2-5 and TP2-6 have multifaceted effects when used as topical agents for accelerating wound healing.
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Affiliation(s)
| | | | - Jyh-Yih Chen
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, 23-10 Dahuen Road, Jiaushi, Ilan 262, Taiwan; (C.-W.L.); (C.-Y.H.)
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Songsantiphap C, Vanichanan J, Chatsuwan T, Asawanonda P, Boontaveeyuwat E. Methylene Blue-Mediated Antimicrobial Photodynamic Therapy Against Clinical Isolates of Extensively Drug Resistant Gram-Negative Bacteria Causing Nosocomial Infections in Thailand, An In Vitro Study. Front Cell Infect Microbiol 2022; 12:929242. [PMID: 35846758 PMCID: PMC9283779 DOI: 10.3389/fcimb.2022.929242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/31/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/PURPOSE Some multidrug-resistant gram-negative bacteria as a global threat have been recently prioritized for research and development of new treatments. We studied the efficacy of methylene blue-mediated antimicrobial photodynamic therapy (MB-aPDT) for the reduction of extensively drug-resistant Acinetobacter baumannii (XDR-AB) and Pseudomonas aeruginosa (XDR-PS) and multidrug-resistant Klebsiella pneumoniae (MDR-KP) isolated in a university hospital setting in Thailand. METHOD Two isolates of each selected bacterium were collected, XDR-AB1 and AB2, XDR- PS1 and PS2, and MDR-KP1 and KP2. Three triplicate experiments using various MB concentrations alone, various red light fluences alone, as well as the selected non-toxic doses of MB and fluences of red light combined as MB-aPDT were applied on each selected isolate. The colonies were counted [colony forming units (CFU)/ml]. Estimation of the lethal treatment dose defined as reduction of > 2 log10 in CFU/ml compared with untreated bacteria. RESULT There were generally negligible changes in the viable counts of the bacterial suspensions treated with all the MB concentrations (p > 0.05). In the second experiment with the only red light treatments, at fluences higher than 2 J/cm, reduction trend in viable counts across all the isolates was observed. Only for MDR-KP1, however, the lethal dose was achieved with the highest fluence of red light (80 J/cm). With the concentration of MB, 50 and 150 mg/L in the third experiment (MB-aPDT), the greater bacterial reduction was observed in all clinical isolates leading to their lethal viable cell reduction when escalating the light fluence to 80 J/cm. CONCLUSIONS MB-aPDT evidently killed the selected XDR and MDR-gram negative bacteria. In highly drug-resistant crisis era, MB-aPDT could be a promising option, particularly for local infections and infection complicating chronic wounds.
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Affiliation(s)
- Chankiat Songsantiphap
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakapat Vanichanan
- Division of Infectious Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Einapak Boontaveeyuwat
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- *Correspondence: Einapak Boontaveeyuwat,
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Masoumi-Asl H, Heravi FS, Badamchi A, Khanaliha K, Farsimadan M, Naghadalipoor M, Tabasi M, Tabasi E, Tabatabaei A. Molecular characterization and antibiotic resistance pattern of isolated Acinetobacter baumannii in Iran. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tekin R, Yolbaş İ, Bozkurt F, Çevik S, Alay H, Özcan N, Aktar F, Çolak H. Risk Factors for Extensively Drug-Resistant Acinetobacter baumannii in Neonatal Patients. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1721446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction Extensively drug-resistant Acinetobacter baumannii infections (XDRABIs) are significant causes of mortality and morbidity in neonatal patients due to the treatment difficulties and limitations. In the present study, we aimed to evaluate the characteristics and risk factors for XDRABIs acquisition during hospitalization.
Methods We investigated the risk factors of health care-associated infections (HC-AIs) caused by multidrug-resistant A. baumannii in the four neonatal units between January 2008 and December 2018. The patients and the control group's data and culture results were recorded and analyzed on a daily basis.
Results A total of 70 patients infected with XDRABIs and 118 control patients were included in the study. Univariate analysis showed that prematurity, gestation age, birth weight, mechanical ventilation, parenteral nutrition, transfusion, use of glycopeptides, and aminoglycosides were significantly associated with XDRABIs. In the univariate analysis, gestation age, mechanical ventilation, transfusion, parenteral nutrition, use of glycopeptides, carbapenems, and aminoglycosides were significantly associated with mortality. In the multiple logistic regression analysis, gestation age (p = 0.034), transfusion (p < 0.001), and use of glycopeptides (p = 0.019) were determined to be independent predictors of mortality in newborn infants with XDRABIs (R-square = 0.546).
Conclusion Determination of the risk factors, avoiding invasive procedures, rational use of antibiotics will lead to a decrease in the mortality and morbidity rates related to XDRABIs.
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Affiliation(s)
- Recep Tekin
- Department of Infectious Disease and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - İlyas Yolbaş
- Department of Neonatology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Fatma Bozkurt
- Department of Infectious Disease, Diyarbakır Gazi Yaşargil Education and Research Hospital, Sağlık Bilimleri University, Diyarbakir, Turkey
| | - Saliha Çevik
- Department of Infectious Disease, Diyarbakır Children's Hospital, Diyarbakir, Turkey
| | - Handan Alay
- Department of Infectious Disease and Clinical Microbiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Nida Özcan
- Department of Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Fesih Aktar
- Department of Pediatric, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Habibe Çolak
- Department of Infectious Disease, Diyarbakır Children's Hospital, Diyarbakir, Turkey
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Nohl A, Hamsen U, Jensen KO, Sprengel K, Ziegenhain F, Lefering R, Dudda M, Schildhauer TA, Wegner A. Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study. Eur J Trauma Emerg Surg 2020; 48:659-665. [PMID: 33221987 DOI: 10.1007/s00068-020-01545-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome. METHODS Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS). RESULTS Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04-2.89]), ISS (OR 1.01 [95% CI 1.00-1.03]), PRBC's given (OR 1.73 [95% CI 1.09-2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06-7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01-3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p < 0.001). CONCLUSIONS MDRO in severely injured patients are rare but associated with a worse outcome at hospital discharge. We identified potential risk factors for MDRO in severely injured patients. Based on our results, we recommend a standardized screening procedure for major trauma patients.
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Affiliation(s)
- André Nohl
- Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany.
- University of Duisburg-Essen, Essen, Germany.
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Marcel Dudda
- Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | | | - Alexander Wegner
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Chair of Orthopaedics and Trauma Surgery, St. Marien-Hospital Mülheim a. d. Ruhr, University Duisburg-Essen, Mülheim a.d. Ruhr, Germany
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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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Abstract
Background: Blood product transfusion has historically been utilized after major burn injury in the resuscitative as well as the acute phase. Transfusion has been implicated in infection and immunosuppression in many disease states. Recommendations for blood product transfusion has varied, but several landmark studies have helped define optimal burn transfusion strategies with respect to infection. The purpose of this article is to review the evidence describing the relation between transfusion and infection in burn injury during different phases of burn treatment to identify optimal transfusion strategies and suggest future targets for transfusion research in burns. Methods: This article presents the history, current status, and future research directions related to blood and blood product transfusion in burn injury. Results: Patients with burns are subject to infectious complications resulting from the loss of skin and burn-related immunosuppression. The use of blood in burn treatment has varied during both the resuscitative phase and the acute treatment phase. Whole-blood use in resuscitation was replaced with crystalloid infusion. Future trials are examining the role of plasma and albumin in burn resuscitation. A randomized prospective multicenter transfusion trial was able to decrease transfusion by 50% with no change in infection. Further examination of the role of hemostatic resuscitation in burn excision may help to better define transfusion goals. Conclusions: Blood product transfusion in burn injury has varied throughout the last century. Although advances in the understanding of blood transfusion in burn injury have occurred, initiatives to define optimal care better are required.
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Affiliation(s)
- Tina L Palmieri
- Department of Surgery, University of California, Davis, Sacramento, California, USA
- Shriners Hospital for Children Northern California, Sacramento, California, USA
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13
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Chen YY, Wu PF, Chen CS, Chen IH, Huang WT, Wang FD. Trends in microbial profile of burn patients following an event of dust explosion at a tertiary medical center. BMC Infect Dis 2020; 20:193. [PMID: 32131752 PMCID: PMC7057658 DOI: 10.1186/s12879-020-4920-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background Microbial infection is the main cause of increased morbidity and mortality in burn patients, especially infections caused by multiple drug-resistant organisms (MDRO). The purpose of this study was to explore major microbial trends in burn patients. Methods This retrospective study was conducted at burn wards and intensive care units, where burn patients were admitted following an event of dust explosion. Data were collected for a number of variables including severity of burns, demographic and clinical characteristics, laboratory data, and therapeutic devices. Results A total of 1132 specimens were collected from 37 hospitalized burn patients with mean TBSA of 46.1%.The most commonly isolated species were Staphylococcus spp. (22.4%). The highest rate of antibiotic resistance was observed in carbapenem–resistant A. baumannii (14.6%), followed by methicillin-resistant S. aureus (11.3%). For each additional 10% TBSA, the isolation of MDRO increased 2.58–17.57 times (p < 0.05); for each additional 10% of the third-degree burn severity, the risk of MDRO significantly decreased by 47% (95% CI, 0.38–0.73, p < 0.001) by Cox model. Conclusions The proportion of overall microbial isolates increased with the increase in TBSA and duration of time after burns. The extent of TBSA was the most important factor affecting MDRO.
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Affiliation(s)
- Yin-Yin Chen
- Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ping-Feng Wu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Wan-Tsuei Huang
- Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Der Wang
- Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan. .,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Public Health, and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
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Nasr P. Genetics, epidemiology, and clinical manifestations of multidrug-resistant Acinetobacter baumannii. J Hosp Infect 2020; 104:4-11. [DOI: 10.1016/j.jhin.2019.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/24/2022]
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15
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Shahzad S, Willcox M, Shahzad A. Identification of novel in vitro antibacterial action of cloprostenol and evaluation of other non-antibiotics against multi-drug resistant A. baumannii. J Antibiot (Tokyo) 2019; 73:72-75. [DOI: 10.1038/s41429-019-0244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 11/09/2022]
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16
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Valadan Tahbaz S, Azimi L, Asadian M, Lari AR. Evaluation of synergistic effect of tazobactam with meropenem and ciprofloxacin against multi-drug resistant Acinetobacter baumannii isolated from burn patients in Tehran. GMS HYGIENE AND INFECTION CONTROL 2019; 14:Doc08. [PMID: 31538041 PMCID: PMC6734500 DOI: 10.3205/dgkh000324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:Acinetobacter baumannii is an increasingly important cause of nosocomial infections worldwide. In addition to the intrinsic resistance of Acinetobacter baumannii to many antibiotics, available treatment approaches with older antibiotics are significantly associated with an increase in multiresistant strains. The aim of this study was to evaluate the synergistic effect of tazobactam with meropenem and ciprofloxacin against carbapenems and drug resistant Acinetobacter baumannii isolated from burn patients in a tertiary burn center in Tehran. Materials and methods: In this study, a total of 47 clinical isolates of A. baumannii were included from burn patients admitted to the Shahid Motahari Burns Hospital, Tehran, from June 2018 to August 2018. The disk diffusion method was used to determine resistance patterns. The synergistic effect of tazobactam with meropenem and ciprofloxacin was evaluated by determining the MIC. A PCR assay was performed to determine blaOXA-40-like, blaOXA-58-like and blaOXA-24-like. Results: Antibiotic susceptibility testing revealed that all of the isolates were resistant to meropenem and ciprofloxacin. The MIC values decreased in the cases of combined use of ciprofloxacin and meropenem with tazobactam. The blaOXA-24-like gene was the predominant carbapenemase gene (93.6%), followed by blaOXA-40-like, which was detected in 48.9% of isolates. None of the A. baumannii isolates harbored the blaOXA-58-like gene. Conclusions: Based on in-vitro antimicrobial susceptibility in the current study, the MIC of tazobactam combined with meropenem or ciprofloxacin have been shown to be variable. Furthermore, the data acquired from such in vitro conditions should be confirmed by reliable results from sufficiently controlled clinical trials.
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Affiliation(s)
- Sahel Valadan Tahbaz
- Department of Microbiology, Islamic Azad University, North Tehran Branch, Tehran, Iran
| | - Leila Azimi
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahla Asadian
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Vickers ML, Malacova E, Milinovich GJ, Harris P, Eriksson L, Dulhunty JM, Cotta MO. Modifiable risk factors for multidrug-resistant Gram-negative infection in critically ill burn patients: a systematic review and meta-analysis. ANZ J Surg 2019; 89:1256-1260. [PMID: 31480103 DOI: 10.1111/ans.15393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to identify potentially modifiable risk factors for multidrug-resistant Gram-negative colonization or infection in critically ill burn patients. METHODS A systematic search was conducted of PubMed, Embase, CINAHL, Web of Science and Central (Cochrane). Risk factors including antibiotic use and hospital interventions were summarized in a random-effects meta-analysis. Risk of publication bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation method and funnel plots. RESULTS A total of 11 studies met the inclusion criteria. We identified several potentially modifiable risk factors and were able to grade their importance based on effect size. Related to prior antibiotic exposure, extended-spectrum cephalosporins (pooled odds ratio (OR) 7.00, 95% confidence interval (CI) 2.77-17.67), carbapenems (pooled OR 6.65, 95% CI 3.49-12.69), anti-pseudomonal penicillins (pooled OR 4.23, 95% CI 1.23-14.61) and aminoglycosides (pooled OR 4.20, 95% CI 2.10-8.39) were most significant. Related to hospital intervention, urinary catheters (pooled OR 11.76, 95% CI 5.03-27.51), arterial catheters (pooled OR 8.99, 95% CI 3.84-21.04), mechanical ventilation (pooled OR 5.49, 95% CI 2.59-11.63), central venous catheters (pooled OR 4.26, 95% CI 1.03-17.59), transfusion or blood product administration (pooled OR 4.19, 95% CI 1.48-11.89) and hydrotherapy (pooled OR 3.29, 95% CI 1.64-6.63) were most significant. CONCLUSION Prior exposure to extended-spectrum cephalosporins and carbapenems, as well as the use of urinary catheters and arterial catheters pose the greatest threat for infection or colonization with multidrug-resistant Gram-negative organisms in the critically ill burn patient population.
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Affiliation(s)
- Mark L Vickers
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Eva Malacova
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Gabriel J Milinovich
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Patrick Harris
- UQ Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Brisbane, Queensland, Australia
| | - Joel M Dulhunty
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Menino O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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18
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Incidence and mortality of healthcare-associated infections in hospitalized patients with moderate to severe burns. J Crit Care 2019; 54:185-190. [PMID: 31521014 DOI: 10.1016/j.jcrc.2019.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE This study was to examine the incidence of different types, and isolated pathogens, of healthcare-associated infections (HAIs), and also to determine their prognostic factors for mortality. METHODS Prospective surveillance was conducted in a medical center from 2005 through to 2016. Multiple logistic regression analysis was performed to assess prognostic factors of mortality. RESULTS A total of 709 patients with moderate to severe burns were hospitalized. There were 83 patients (11.7%) with HAIs (158 episodes) and 203 isolated pathogens. The most common HAI types were bloodstream infection (BSI) at 39.2% (8.7% of all patients) and central line-associated BSI (mean 4.8 per 1000 central line days). Overall, S. aureus (13.8%) were the most common isolated pathogens, while the most commonly found type of multidrug-resistant pathogen was carbapenems-resistant Enterobacteriaceae (23%). The crude mortality rate was 15.7%, and the independent factors (p < .05) for mortality were BSI (Odds ratio [OR] 2.70), intensive care unit (OR 5.19) and total body surface area with full-thickness injuries ≥50% (OR 5.22). CONCLUSIONS Burn patients with BSI were the most common HAI sites, and this was an independent factor for mortality. Effective integrated care and appropriate infection control can reduce the incidence of infection and death.
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19
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Abstract
BACKGROUND Infection is a common complication of burn injury caused by the loss of skin (the primary defense against micro-organisms) as well as burn-induced immunosuppression. Essentially, survival after burn injury is determined by whether wound healing or infection predominates. The purpose of this article is to describe how burn unit structure and design may impact the incidence of infection after burn injury. METHODS This article describes the special considerations for burn unit structure and design based on burn pathophysiology, including burn-related immunosuppression and wound treatment. Particular emphasis is placed on how burn unit design should consider the immunosuppressed state of the burn patient. RESULTS Because many of the factors that promote wound healing also promote infection, burn unit design must prioritize infection prevention, including segregation and containment, environment layout and function, room cleaning, and isolation. Burn centers should have dedicated facilities with separation of patients, specialized room environment/equipment, and cleaning and wound care disinfection capabilities, with particular attention paid to surfaces, ventilation, temperature control, and patient movement to the operating room, radiology, and therapy. CONCLUSIONS Because of the high infection potential associated with burn injury, burn units require meticulous attention to design and function to minimize patient infection risk.
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Affiliation(s)
- Tina L Palmieri
- 1 Shriners Hospital for Children Northern California, Sacramento, California
- 2 University of California Davis, Davis, California
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20
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Ramakrishnan KM, Ramachandran B, Ravikumar KG, Ravikumar K, Putli S, Jayaraman V, Mathivanan, Ravi, Ganamani A, Babu M. Management of Acinetobacter baumannii infection of burn wound with the evidence of sepsis. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_12_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Falah F, Shokoohizadeh L, Adabi M. Molecular identification and genotyping of Acinetobacter baumannii isolated from burn patients by PCR and ERIC-PCR. Scars Burn Heal 2019; 5:2059513119831369. [PMID: 30815282 PMCID: PMC6383092 DOI: 10.1177/2059513119831369] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acinetobacter baumannii is one of the most important agents of hospital infections. Rapid and accurate identification and genotyping of A. baumannii is very important, especially in burn hospitals in order to prevent the spread of related nosocomial infections and to further epidemiological studies. MATERIAL AND METHODS For two months, 82 A. baumannii isolates were collected from burn wound swabs of patients in a major burn hospital in Tehran. A. baumannii isolates were identified by conventional microbiological test and polymerase chain reaction (PCR) using the primers of blaOXA-51 gene, while the genetic linkage of A. baumannii isolates was investigated by enterobacterial repetitive intragenic consensus (ERIC)-PCR technique. Similarity, a cut-off of ⩾ 95% was considered for classifying the genotypes. RESULTS The molecular test (PCR) confirmed 97.56% of phenotypic results for the detection of A. baumannii isolates. ERIC-PCR results revealed 14 different ERIC patterns (ERIC-types) including 11 common types and three unique types. CONCLUSION Our findings show that we can simply and quickly detect A. baumannii isolates by PCR using blaOXA genes and genetic diversity by ERIC-PCR, respectively. These rapid and simple techniques for the routine screening and identification of clinical A. baumannii isolates could be useful with epidemic potential.
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Affiliation(s)
- Faezeh Falah
- Department of Biology, Tonekabon Branch,
Islamic Azad University, Iran
| | - Leili Shokoohizadeh
- Department of Microbiology, School of
Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Adabi
- Brucellosis Research Center, Hamadan
University of Medical Sciences, Hamadan, Iran
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22
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Vickers ML, Dulhunty JM, Ballard E, Chapman P, Muller M, Roberts JA, Cotta MO. Risk factors for multidrug-resistant Gram-negative infection in burn patients. ANZ J Surg 2017; 88:480-485. [PMID: 28853230 DOI: 10.1111/ans.14144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia. METHODS A retrospective case-control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay. Multivariable conditional logistic regression was used to individually assess risk factors after adjusting for Acute Burn Severity Index. Adjusted odds ratios (ORs) were reported. P-values < 0.25 were considered as potentially important risk factors. RESULTS Factors increasing the risk of MDR Gram-negative infection included superficial partial thickness burn size (OR: 1.08; 95% confidence interval (CI): 1.01-1.16; P-value: 0.034), prior meropenem exposure (OR: 10.39; 95% CI: 0.96-112.00; P-value: 0.054), Gram-negative colonization on admission (OR: 9.23; 95% CI: 0.65-130.15; P-value: 0.10) and escharotomy (OR: 2.66; 95% CI: 0.52-13.65; P-value: 0.24). For cases, mean age was 41 (SD: 13) years, mean total body surface area burned was 47% (SD: 18) and mean days in ICU until MDR specimen collection was 17 (SD: 10) days. CONCLUSION Prior meropenem exposure, Gram-negative colonization on admission, escharotomy and superficial partial thickness burn size may be potentially important factors for increasing the risk of MDR Gram-negative infection in the critically ill burn patient.
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Affiliation(s)
- Mark L Vickers
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Joel M Dulhunty
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Paul Chapman
- Infectious Disease, Caboolture Hospital, Brisbane, Queensland, Australia
| | - Michael Muller
- The Professor Stuart Peg Adult Burns Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Translational Anti-infective Pharmacodynamics, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Menino O Cotta
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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Impact of relocation and environmental cleaning on reducing the incidence of healthcare-associated infection in NICU. World J Pediatr 2017; 13:217-221. [PMID: 28101771 DOI: 10.1007/s12519-017-0001-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/18/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hospital environment remains a risk for healthcare-associated infections (HAIs). This was a prospective study to evaluate the comprehensive impact of relocating a neonatal intensive care unit (NICU) to a new facility and improved environmental cleaning practice on the presence of methicillin-resistant Staphylococcus aureus (MRSA) on inanimate surfaces and the incident rate of HAIs. METHODS New environmental cleaning measures were adopted after the NICU was moved to a new and better-designed location. The effect of moving and the new environmental cleaning practice was investigated by comparing the positive number of MRSA on ward surfaces and the incidence density of HAIs between the baseline and intervention periods. RESULTS Only 2.5% of environmental surfaces were positive for MRSA in the intervention period compared to 44.0% in the baseline period (P<0.001). Likewise, the total incident rate of HAIs declined from 16.8 per 1000 cot-days to 10.0 per 1000 cot-days (P<0.001). CONCLUSION The comprehensive measures of relocating the NICU to a new facility design with improved environmental cleaning practice are effective and significantly reduce the incidence of HAIs.
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24
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Ho AL, Chambers R, Malic C, Papp A. Universal contact precautions do not change the prevalence of antibiotic resistant organisms in a tertiary burn unit. Burns 2017; 43:265-272. [DOI: 10.1016/j.burns.2016.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022]
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Ertugrul S, Aktar F, Yolbas I, Yilmaz A, Elbey B, Yildirim A, Yilmaz K, Tekin R. Risk Factors for Health Care-Associated Bloodstream Infections in a Neonatal Intensive Care Unit. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e5213. [PMID: 28203330 PMCID: PMC5297258 DOI: 10.5812/ijp.5213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/18/2016] [Accepted: 05/28/2016] [Indexed: 11/16/2022]
Abstract
Background Healthcare-associated bloodstream infections (HCA-BSI) are a major cause of morbidity and mortality in neonatal intensive care units (NICUs). Objectives We aimed to determine the causative organisms and risk factors of HCA-BSIs in NICUs. Methods This study was performed between January 2011 and December 2014 in the neonatal intensive care unit of Dicle university, Turkey. The study consisted of 126 patients (infected group) with positive blood culture and 126 randomly selected patients (uninfected control group) with negative blood culture after four days of hospitalization. Results We found that the most common causative agents isolated from nosocomial infections (NIs) were 20.7% Staphylococcus epidermidis, 26.7% Klebsiella spp., and 13.3% Acinetobacter spp. Incidences of low gestational age, low birth weight, vaginal birth type, and long length of hospitalization were higher in the infected neonates than in the uninfected neonates. In the univariate analysis, surgical operation, ventriculoperitoneal shunt, use of umbilical catheter, nasogastric or orogastric tube, urinary catheter, mechanical ventilation, surfactant treatment, erythrocyte transfusion, plasma transfusion, thrombocyte transfusion, total parenteral nutrition infusion, intracranial hemorrhage, length of hospital stay, fifth-minute Apgar score, and total parenteral nutrition time were significantly associated with NIs. In the multiple logistic regression analysis, fifth-minute Apgar, use of erythrocyte transfusion and surgical operation were found as the independent risk factors for HCA-BSI. Conclusions This study determined the causative organisms and risk factors of HCA-BSIs in NICUs.
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Affiliation(s)
- Sabahattin Ertugrul
- Department of Neonatology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Fesih Aktar
- Department of Pediatric Infectious Disease, Medical Faculty, Dicle University, Diyarbakir, Turkey
- Corresponding author: Fesih Aktar, Department of Pediatric Infectious Disease, Medical Faculty, Dicle University, Diyarbakir, Turkey. Tel: +90-5056690064, Fax: +90-4122488523, E-mail:
| | - Ilyas Yolbas
- Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Ahmet Yilmaz
- Department of Family Medicine, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Bilal Elbey
- Department of Immunology, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Ahmet Yildirim
- Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Kamil Yilmaz
- Department of Pediatrics, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Recep Tekin
- Clinical Microbiology and Infectious Disease, Medical Faculty, Dicle University, Diyarbakir, Turkey
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Fore SE, Munchel EC, Goldstein S, Mills J, Vanderwagen S, Stewart D, Colombani P. Comparison of Pediatric Burn Wound Colonization and the Surrounding Environment. Compr Child Adolesc Nurs 2016. [DOI: 10.3109/24694193.2016.1167986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara E. Fore
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Emily C. Munchel
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Seth Goldstein
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Joanne Mills
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sarah Vanderwagen
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dylan Stewart
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Paul Colombani
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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28
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Determining the Independent Risk Factors and Mortality Rate of Nosocomial Infections in Pediatric Patients. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7240864. [PMID: 26981536 PMCID: PMC4770130 DOI: 10.1155/2016/7240864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 11/18/2022]
Abstract
The objective of this study was to determine the rate, independent risk factors, and outcomes of healthcare-associated infections in pediatric patients. This study was performed between 2011 and 2014 in pediatric clinic and intensive care unit. 86 patients and 86 control subjects were included in the study. Of 86 patients with nosocomial infections (NIs), there were 100 NIs episodes and 90 culture growths. The median age was 32.0 months. The median duration of hospital stay of the patients was 30.0 days. The most frequent pathogens were Coagulase-negative Staphylococcus, Acinetobacter spp., Klebsiella spp., and Candida spp. Unconsciousness, prolonged hospitalization, transfusion, mechanical ventilation, use of central venous catheter, enteral feeding via a nasogastric tube, urinary catheter, and receiving carbapenems and glycopeptides were found to be significantly higher in NIs patients. Multivariate logistic regression analysis showed prolonged hospitalization, neutropenia, and use of central venous catheter and carbapenems as the independent risk factors for NIs. In the univariate analysis, unconsciousness, mechanical ventilation, enteral feeding, use of enteral feeding via a nasogastric tube, H2 receptor blockers, and port and urinary catheter were significantly associated with mortality. In the multiple logistic regression analysis, only mechanical ventilation was found as an independent predictor of mortality in patients with NIs.
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Altindis M, Koroglu M, Demiray T, Dal T, Ozdemir M, Sengil AZ, Atasoy AR, Doğan M, Cicek AC, Ece G, Kaya S, Iraz M, Gultepe BS, Temiz H, Kandemir I, Aksaray S, Cetinkol Y, Sahin I, Guducuoglu H, Kilic A, Kocoglu E, Gulhan B, Karabay O. A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria. Jundishapur J Microbiol 2016; 9:e29766. [PMID: 27099693 PMCID: PMC4834024 DOI: 10.5812/jjm.29766] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. OBJECTIVES In this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. MATERIALS AND METHODS Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. The blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. RESULTS Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. Of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. The average growth rate in the bottles of blood cultures during the defined period (1259 - 26,400/year) was 32.3%. Of the growing microorganisms, 67% were causative agents, while 33% were contaminants. The contamination rates of the centers ranged from 1% to 17%. The average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. The most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). CONCLUSIONS The high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.
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Affiliation(s)
- Mustafa Altindis
- Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
- Corresponding author: Mustafa Altindis, Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey. Tel: +90-2642957277, Fax: +90-2642956629, E-mail:
| | - Mehmet Koroglu
- Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Tayfur Demiray
- Department of Clinical Microbiology, Training and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Tuba Dal
- Department of Clinical Microbiology, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Mehmet Ozdemir
- Department of Clinical Microbiology, Meram Medical Faculty Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Zeki Sengil
- Department of Medical Microbiology, Medical Faculty, Medipol University, Istanbul, Turkey
| | - Ali Riza Atasoy
- Department of Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Metin Doğan
- Department of Clinical Microbiology, Meram Medical Faculty Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Aysegul Copur Cicek
- Department of Clinical Microbiology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Gulfem Ece
- Department of Clinical Microbiology, School of Medicine, Izmir University, Izmir, Turkey
| | - Selcuk Kaya
- Department of Clinical Microbiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Meryem Iraz
- Department of Clinical Microbiology, School of Medicine, Bezmi Alem University, Istanbul, Turkey
| | - Bilge Sumbul Gultepe
- Department of Clinical Microbiology, School of Medicine, Bezmi Alem University, Istanbul, Turkey
| | - Hakan Temiz
- Department of Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Idris Kandemir
- Department of Clinical Microbiology, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Sebahat Aksaray
- Department of Clinical Microbiology, Haydarpasa Numune Hospital, Istanbul, Turkey
| | - Yeliz Cetinkol
- Department of Clinical Microbiology, School of Medicine, Ordu University, Ordu, Turkey
| | - Idris Sahin
- Department of Clinical Microbiology, School of Medicine, Duzce University, Duzce, Turkey
| | - Huseyin Guducuoglu
- Department of Clinical Microbiology, School of Medicine, Yuzuncuyil University, Van, Turkey
| | - Abdullah Kilic
- Department of Clinical Microbiology, School of Medicine, Gulhane Military Medical School, Ankara, Turkey
| | - Esra Kocoglu
- Department of Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Baris Gulhan
- Department of Clinical Microbiology, School of Medicine, Erzincan University, Erzincan, Turkey
| | - Oguz Karabay
- Department of Infection Diseases, School of Medicine, Sakarya University, Sakarya, Turkey
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Cavalcante RDS, Canet P, Fortaleza CMCB. Risk factors for the acquisition of imipenem-resistant Acinetobacter baumannii in a burn unit: An appraisal of the effect of colonization pressure. ACTA ACUST UNITED AC 2014; 46:593-8. [PMID: 24918115 DOI: 10.3109/00365548.2014.920103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Imipenem-resistant Acinetobacter baumannii (IRAB) is a major threat for critically ill patients, including those admitted to burn units. Recent studies have suggested that colonization pressure (the proportion of patients or patient-days harbouring the pathogen of interest) is an important driver of the risk for acquisition of multidrug-resistant organisms. With that in mind, we conducted a cohort study, enrolling 208 patients admitted to a burn unit from November 2008 through December 2009. The outcome of interest was the acquisition of IRAB. In addition to the usual risk factors, we assessed the impact of colonization pressure. The number of wound excisions (odds ratio (OR) 12.06, 95% confidence interval (CI) 2.82-51.64) and the number of antimicrobials used (OR 22.82, 95% CI 5.15-101.19) were significant risk factors for the outcome of interest. On the other hand, colonization pressure (measured for whole time of exposure or up to the last 14, 7, or 3 days) was not associated with the risk for IRAB acquisition.
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Affiliation(s)
- Ricardo de Souza Cavalcante
- From the Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista , Botucatu, São Paulo State , Brazil
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