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Li H, Liang J, Li P, Li X, Liu Q, Yang S, Zhang C, Liu S, He Y, Tan C. Schizonepeta tenuifolia Briq-Saposhnikovia divaricata decoction alleviates atopic dermatitis via downregulating macrophage TRPV1. Front Pharmacol 2024; 15:1413513. [PMID: 39257398 PMCID: PMC11383762 DOI: 10.3389/fphar.2024.1413513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
Objective Schizonepeta tenuifolia -Saposhnikovia divaricata (Jingjie-Fangfeng, JF) has been used for years to treat allergic inflammatory skin diseases like atopic dermatitis, but the specific effects and mechanisms of JF are still unclear. Purpose We aim to investigate the therapeutic effect and mechanism of JF in MC903-induced atopic dermatitis-like model. Methods JF decoction was subjected to rigorous HPLC and GC analysis. The JF decoction was then freshly prepared and administered to MC903-induced atopic dermatitis -like mice models to investigate its therapeutic effects. Our evaluation focused on several markers of inflammation including the TEWL index, ear thickness, swelling, and specific inflammation indicators such as TSLP, IL33, IgE, and immune cell presence at the lesion sites. We measured Transient Receptor Potential Vanilloid 1 (TRPV1) expression levels through immunofluorescent staining in skin tissue from both atopic dermatitis patients and the MC903-treated mice. Furthermore, TRPV1 expression and macrophage activation markers were measured in LPS/IFN-γ-stimulated Raw264.7 and THP-1 cell models in vitro. Additionally, we developed cell lines that overexpress TRPV1 and investigated how JF treatment affects NF-κB p65 phosphorylation in these cells to understand better the role of TRPV1 in atopic dermatitis. Results The JF decoction met the standards outlined in the Chinese pharmacopeia. The JF decoction significantly alleviated inflammatory skin symptoms and helped restore skin barrier function. Additionally, it reduced the levels of IgE and pro-inflammatory cytokines TSLP, IL-33, and IL-4. There was also a noticeable decrease in mast cell infiltration and degranulation. Notably, JF decoction reduced infiltrated macrophages with limited affection on T cell infiltration. It also decreased F4/80+/TRPV1+ cells in atopic dermatitis mice and TRPV1 expression in LPS/IFNγ-stimulated microphages. Additionally, we observed that CD68+/TRPV1+ cells increased in human atopic dermatitis tissue. Further studies showed that JF water extract (JF-WE) suppressed TRPV1 expression in macrophages, potentially by affecting NF-κB p65 phosphorylation rather than the JAK-STAT6 pathway. Conclusion This study offers initial evidence of the effectiveness of JF-WE in suppressing inflammation in atopic dermatitis. The therapeutic effect might stems from its ability to downregulate TRPV1 expression and subsequent NF-κB p65 phosphorylation in macrophages.
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Affiliation(s)
- Hongmin Li
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Jinyu Liang
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Peifeng Li
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiangzheng Li
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Qing Liu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Songxue Yang
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan Provincial Center for Research and Development of Natural Products, School of Chemical Science and Technology, Yunnan University, Kunming, China
| | - Chunlei Zhang
- Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Shun Liu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yuan He
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Cheng Tan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
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Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Sælen KH, Hatlemark S, Brudvik C, Bergh TH, Bernardshaw SV, Steen K. Does the use of surgical face masks reduce postoperative infections in traumatic wounds sutured outside hospital? A randomized study at a Norwegian casualty center. Scand J Prim Health Care 2024; 42:287-294. [PMID: 38423090 PMCID: PMC11003311 DOI: 10.1080/02813432.2024.2315438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To investigate if wearing surgical face mask by doctors and nurses during suturing of traumatic wounds has any impact on postoperative infection rate. DESIGN Randomized controlled study with masked or unmasked health personnel groups. SETTING A Norwegian Minor Injury Department. SUBJECTS Adult patients with traumatic wounds sutured at the clinic between 7 October 2019 and 28 May 2020. MAIN OUTCOME MEASURES Postoperative infections of sutured wounds. RESULTS One hundred and sixty-five patients with 176 wounds were included in the study. Nine out of 88 wounds (10.2%) in the masked group and 11 out of 88 wounds in the unmasked group (12.5%) had a wound infection. CONCLUSIONS Despite a higher percentage of postoperative infections in the unmasked than in the masked group (12.5% versus 10.2%), the difference was not statistically significant (p = .6). This might imply that the use of facemasks during suture of traumatic wounds in an outpatient setting does not significantly reduce the number of infections. However, due to the covid pandemic, the study had to be prematurely stopped before the planned number of participants had been recruited (n = 594). This increases the risk of type II error.
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Affiliation(s)
- Kristoffer Holen Sælen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Emergency Medicine, Oslo University Hospital, Oslo, Norway
| | - Synne Hatlemark
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of General and Orthopaedic Surgery, District General Hospital of Førde, Førde, Norway
| | - Christina Brudvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Minor Injury Department, Orthopaedic Division, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Hiis Bergh
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Minor Injury Department, Orthopaedic Division, Haukeland University Hospital, Bergen, Norway
| | | | - Knut Steen
- Minor Injury Department, Orthopaedic Division, Haukeland University Hospital, Bergen, Norway
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Zhang M, Feng H, Gao Y, Gao X, Ji Z. Effect of topical antibiotics on the prevention and management of wound infections: A meta-analysis. Int Wound J 2023; 20:4015-4022. [PMID: 37429583 PMCID: PMC10681525 DOI: 10.1111/iwj.14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023] Open
Abstract
A meta-analysis research was implemented to appraise the effect of topical antibiotics (TAs) on the prevention and management of wound infections (WIs). Inclusive literature research was performed until April 2023, and 765 interconnected researches were reviewed. The 11 selected researches included 6500 persons with uncomplicated wounds at the starting point of the research: 2724 of them were utilising TAs, 3318 were utilising placebo and 458 were utilising antiseptics. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of TAs on the prevention and management of WIs by the dichotomous approach and a fixed or random model. TAs had significantly lower WI compared with placebo (OR, 0.59; 95% CI, 0.38-0.92, p = 0.02) and compared with antiseptics (OR, 0.52; 95% CI, 0.31-0.88, p = 0.01) in persons with uncomplicated wounds (UWs). TAs had significantly lower WIs compared with placebo and antiseptics in persons with UWs. However, caution needs to be taken when interacting with their values because of the low sample size of some of the chosen researches and low number of researches found for the comparisons in the meta-analysis.
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Affiliation(s)
- Meixue Zhang
- College of Traditional Chinese MedicineWeifang Medical UniversityWeifangChina
| | - Haonan Feng
- College of Traditional Chinese MedicineWeifang Medical UniversityWeifangChina
| | - Yongtao Gao
- Urology Department IWeifang Hospital of traditional Chinese MedicineWeifangChina
| | - Xiang Gao
- Department of Critical Care MedicineWeifang People's HospitalWeifangChina
| | - Zhixin Ji
- Department of Critical Care MedicineWeifang People's HospitalWeifangChina
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Smith JS. Variations in the aftercare of facial wounds: a survey of maxillofacial clinicians. Br J Oral Maxillofac Surg 2020; 58:552-557. [PMID: 32113727 DOI: 10.1016/j.bjoms.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
Good aftercare of traumatic wounds reduces the risk of infection and improves functional and aesthetic outcomes. Inconsistencies in the instructions given by oral and maxillofacial (OMF) surgeons to patients with facial lacerations have previously been noted. We therefore sent anonymous online surveys to OMF clinicians in the United Kingdom to investigate the extent of the variation in aftercare advice given to patients who have had traumatic lacerations of the skin of the head and neck. Respondents were asked about their current practice, including instructions on how to clean wounds, the provision of cleaning materials, use of topical dressings, and advice regarding dry time; also the number of days before the removal of sutures, and specialist review of facial wounds. A total of 63 responded. There was considerable variation within and between grades regarding the advice given. Advice varied and there was no consensus in any of the areas questioned. Robust evidence on the aftercare of traumatic lacerations is lacking. To develop practical guidelines for advice there is a need for further research in the area and further discussion about the aftercare of lacerations.
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Affiliation(s)
- J S Smith
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
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6
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Kwon D, Genden EM, de Bree R, Rodrigo JP, Rinaldo A, Sanabria A, Rapidis AD, Takes RP, Ferlito A. Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx 2018; 45:1135-1142. [DOI: 10.1016/j.anl.2018.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/05/2018] [Accepted: 03/27/2018] [Indexed: 12/20/2022]
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Wu X, Li K, Li Y, Zhang G. Motivating visible light photocatalytic activity of ultrathin Bi 2O 2(OH) xCl 2-x solid solution with exposed {001} facets by the co-effect of oxygen vacancy and OH replacement. NANOSCALE 2018; 10:15294-15302. [PMID: 30069572 DOI: 10.1039/c8nr04469d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The modification of semiconductors with multi-strategies is an effective and promising way to boost the visible light induced photocatalytic performance of photocatalysts. Herein, we report an effective strategy to boost the visible light photocatalytic activity of an ultrathin Bi2O2(OH)xCl2-x solid solution with an exposed {001} facet by adjusting the concentrations of oxygen vacancies and OH in it. The ultrathin Bi2O2(OH)xCl2-x was synthesized by replacing Cl in BiOCl with OH and the oxygen vacancy was induced by using EG as part of the solvothermal reaction solution. The thickness of the nanosheet and content of OH in the solid solution could be controlled by simply adjusting the pH value of the reaction solution. The Bi2O2(OH)xCl2-x solid solution with an oxygen vacancy and a suitable OH replacement presented a superior visible light photocatalytic activity for the degradation of antibiotics, which was ca. 4 and 2 times higher than those of BiOCl and Bi2O2(OH)Cl, respectively, both with oxygen vacancy modification. This outstanding performance was owing to the enhancement of visible light absorption, molecular oxygen motivation and charge carrier separation by the co-effect of oxygen vacancy and OH replacement, revealed by a photoelectrochemical test and charge density difference simulation, etc. This work might provide a new promising strategy to motivate the visible light photocatalytic performance of photocatalysts.
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Affiliation(s)
- Xiaoyong Wu
- Hubei Key Laboratory of Mineral Resources Processing and Environment, Hubei Provincial Collaborative Innovation Center for High Efficient Utilization of Vanadium Resources, School of Resources and Environmental Engineering, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China.
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Antibiotic prophylaxis regimes for simple hand lacerations. Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tong QJ, Hammer KD, Johnson EM, Zegarra M, Goto M, Lo TS. A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections. Infect Drug Resist 2018; 11:417-425. [PMID: 29588605 PMCID: PMC5858851 DOI: 10.2147/idr.s151293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The prescription of topical antibiotics for the prevention of infections in uncomplicated wounds is common. However, the efficacy is not well reported. Therefore, the objective of the study was to conduct a systematic review and meta-analysis of the available evidence on prevention of uncomplicated wound infections by prophylactic topical antibiotics. Materials and methods The search included Pubmed, Google Scholar, SCOPUS, Embase, Cochrane, ClinicalTrials.gov, International Clinical Trials Registry Platform, National Technical Information Service, and the National Guidelines Clearinghouse. Results We identified eight randomized controlled trials and four quasi-randomized trials that met the criteria for the systematic review. Of these trials, 11 studies were pooled for meta-analysis to compare the effects of topical antibiotics versus placebo and 4 studies were pooled for comparison of effects of topical antibiotics versus topical antiseptics on uncomplicated wounds. Fewer wound infections occurred in the topical antibiotic arms compared to placebo (pooled risk ratio: 0.57 [95% CI: 0.37 to 0.86]; p=0.01 and pooled risk difference: −3.1% [95% CI: −5.8% to −0.34%]; p=0.03). Compared to antiseptics, topical antibiotics demonstrated statistically significant relative risk reduction (pooled risk ratio: 0.56 [95% CI: 0.23 to 0.91]; p=0.02), while there was no significant absolute risk reduction (pooled risk difference: −3.7% [95% CI: −7.9% to +0.6%]; p=0.09). Conclusion Topical antibiotics are effective in reducing wound infections after surgical procedures, but the absolute benefit is small. Given the global emergence of antimicrobial resistance, judicious use of antibiotics is encouraged and use of antiseptics should be considered as a reasonable alternative to topical antibiotics.
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Affiliation(s)
- Qiao-Jing Tong
- Department of Infection Control, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kimberly Dp Hammer
- Research Service, Fargo VA Health Care System.,Department of Internal Medicine, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA
| | - Erika M Johnson
- Library Resources, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA
| | - Milagros Zegarra
- Research Service, Fargo VA Health Care System.,Department of Internal Medicine, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA
| | - Michihiko Goto
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, West Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Tze Shien Lo
- Department of Internal Medicine, University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA.,Infectious Disease Service, Fargo VA Health Care System, Fargo, ND, USA
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10
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Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-860. [PMID: 28592405 DOI: 10.1128/cmr.00112-16] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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Abstract
BACKGROUND Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care. OBJECTIVE Innovations in laceration management have the potential to improve patient experience with this common presentation. DISCUSSION Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit. CONCLUSIONS Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.
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12
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Heal CF, Banks JL, Lepper P, Kontopantelis E, van Driel ML. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection. Br J Surg 2017; 104:1123-1130. [PMID: 28656693 DOI: 10.1002/bjs.10588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/23/2017] [Accepted: 04/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. METHODS The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. RESULTS Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82; very low-quality evidence). CONCLUSION Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis.
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Affiliation(s)
- C F Heal
- Department of General Practice and Rural Medicine, James Cook University, Mackay, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
- Mackay Institute of Research and Innovation, James Cook University, Mackay, Queensland, Australia
| | - J L Banks
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - P Lepper
- College of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - E Kontopantelis
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | - M L van Driel
- Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Navanandan N, Renna-Rodriguez M, DiStefano MC. Pearls in Pediatric Wound Management. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Beam JW, Buckley B, Holcomb WR, Ciocca M. National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma. J Athl Train 2016; 51:1053-1070. [PMID: 28092169 PMCID: PMC5264562 DOI: 10.4085/1062-6050-51.7.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients. BACKGROUND Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications. RECOMMENDATIONS These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.
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Affiliation(s)
- Joel W. Beam
- Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida, Jacksonville
| | - Bernadette Buckley
- Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida, Jacksonville
| | | | - Mario Ciocca
- Department of Sports Medicine, University of North Carolina at Chapel Hill
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Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev 2016; 11:CD011426. [PMID: 27819748 PMCID: PMC6465080 DOI: 10.1002/14651858.cd011426.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Surgical site infections (SSI) can delay wound healing, impair cosmetic outcome and increase healthcare costs. Topical antibiotics are sometimes used to reduce microbial contaminant exposure following surgical procedures, with the aim of reducing SSIs. OBJECTIVES The primary objective of this review was to determine whether the application of topical antibiotics to surgical wounds that are healing by primary intention reduces the incidence of SSI and whether it increases the incidence of adverse outcomes (allergic contact dermatitis, infections with patterns of antibiotic resistance and anaphylaxis). SEARCH METHODS In May 2015 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL. We also searched clinical trial registries for ongoing studies, and bibliographies of relevant publications to identify further eligible trials. There was no restriction of language, date of study or setting. The search was repeated in May 2016 to ensure currency of included studies. SELECTION CRITERIA All randomized controlled trials (RCTs) and quasi-randomised trials that assessed the effects of topical antibiotics (any formulation, including impregnated dressings) in people with surgical wounds healing by primary intention were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and independently extracted data. Two authors then assessed the studies for risk of bias. Risk ratios were calculated for dichotomous variables, and when a sufficient number of comparable trials were available, trials were pooled in a meta-analysis. MAIN RESULTS A total of 10 RCTs and four quasi-randomised trials with 6466 participants met the inclusion criteria. Six studies involved minor procedures conducted in an outpatient or emergency department setting; eight studies involved major surgery conducted in theatre. Nine different topical antibiotics were included. We included two three-arm trials, two four-arm trials and 10 two-arm trials. The control groups comprised; an alternative topical antibiotic (two studies), topical antiseptic (six studies) and no topical antibiotic (10 studies), which comprised inert ointment (five studies) no treatment (four studies) and one study with one arm of each.The risk of bias of the 14 studies varied. Seven studies were at high risk of bias, five at unclear risk of bias and two at low risk of bias. Most risk of bias concerned risk of selection bias.Twelve of the studies (6259 participants) reported infection rates, although we could not extract the data for this outcome from one study. Four studies (3334 participants) measured allergic contact dermatitis as an outcome. Four studies measured positive wound swabs for patterns of antimicrobial resistance, for which there were no outcomes reported. No episodes of anaphylaxis were reported. Topical antibiotic versus no topical antibioticWe pooled the results of eight trials (5427 participants) for the outcome of SSI. Topical antibiotics probably reduce the risk of SSI in people with surgical wounds healing by primary intention compared with no topical antibiotic (RR 0.61, 95% CI 0.42 to 0.87; moderate-quality evidence downgraded once for risk of bias). This equates to 20 fewer SSIs per 1000 patients treated with topical antibiotics (95% CI 7 to 29) and a number needed to treat for one additional beneficial outcome (NNTB) (i.e. prevention of one SSI) of 50.We pooled the results of three trials (3012 participants) for the outcome of allergic contact dermatitis, however this comparison was underpowered, and it is unclear whether topical antibiotics affect the risk of allergic contact dermatitis (RR 3.94, 95% CI 0.46 to 34.00; very low-quality evidence, downgraded twice for risk of bias, once for imprecision). Topical antibiotic versus antiseptic We pooled the results of five trials (1299 participants) for the outcome of SSI. Topical antibiotics probably reduce the risk of SSI in people with surgical wounds healing by primary intention compared with using topical antiseptics (RR 0.49, 95% CI 0.30 to 0.80; moderate-quality evidence downgraded once for risk of bias). This equates to 43 fewer SSIs per 1000 patients treated with topical antibiotics instead of antiseptics (95% CI 17 to 59) and an NNTB of 24.We pooled the results of two trials (541 participants) for the outcome of allergic contact dermatitis; there was no clear difference in the risk of dermatitis between topical antibiotics and antiseptics, however this comparison was underpowered and a difference cannot be ruled out (RR 0.97, 95% CI 0.52 to 1.82; very low-quality evidence, downgraded twice for risk of bias and once for imprecision). Topical antibiotic versus topical antibioticOne study (99 participants) compared mupirocin ointment with a combination ointment of neomycin/polymyxin B/bacitracin zinc for the outcome of SSI. There was no clear difference in the risk of SSI, however this comparison was underpowered (very low-quality evidence downgraded twice for risk of bias, once for imprecision).A four-arm trial involved two antibiotic arms (neomycin sulfate/bacitracin zinc/polymyxin B sulphate combination ointment versus bacitracin zinc, 219 participants). There was no clear difference in risk of SSI between the combination ointment and the bacitracin zinc ointment. The quality of evidence for this outcome was low, downgraded once for risk of bias, and once for imprecision. AUTHORS' CONCLUSIONS Topical antibiotics applied to surgical wounds healing by primary intention probably reduce the risk of SSI relative to no antibiotic, and relative to topical antiseptics (moderate quality evidence). We are unable to draw conclusions regarding the effects of topical antibiotics on adverse outcomes such as allergic contact dermatitis due to lack of statistical power (small sample sizes). We are also unable to draw conclusions regarding the impact of increasing topical antibiotic use on antibiotic resistance. The relative effects of different topical antibiotics are unclear.
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Affiliation(s)
- Clare F Heal
- James Cook UniversityGeneral Practice and Rural MedicineMackay Base HospitalBridge RoadMackayQueenslandAustralia4740
- Anton Breinl Research Centre for Health Systems StrengtheningTownsvilleQueenslandAustralia
| | - Jennifer L Banks
- James Cook UniversitySchool of Medicine and DentistryMackayQueenslandAustralia4740
| | - Phoebe D Lepper
- James Cook UniversitySchool of Medicine and DentistryMackayQueenslandAustralia4740
| | - Evangelos Kontopantelis
- The University of ManchesterCentre for Health Informatics, Institute of Population HealthWilliamson Building, 5th FloorOxford RoadManchesterGreater ManchesterUKM13 9PL
| | - Mieke L van Driel
- The University of QueenslandDiscipline of General Practice, School of MedicineBrisbaneQueenslandAustralia4029
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Katsetos SL, Nagurka R, Caffrey J, Keller SE, Murano T. Antibiotic prophylaxis for oral lacerations: our emergency department's experience. Int J Emerg Med 2016; 9:24. [PMID: 27619925 PMCID: PMC5020007 DOI: 10.1186/s12245-016-0122-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 09/01/2016] [Indexed: 11/14/2022] Open
Abstract
Background The purpose of this study was to examine the emergency physician (EP) practice of prescribing prophylactic antibiotics for patients with oral lacerations. A secondary outcome measure was the infection rate of those who were or were not prescribed antibiotics. Methods The study was a retrospective chart review of 323 patients who presented to a large urban emergency department (ED) between January 1, 2012 and December 31, 2012 with an oral laceration. Results Of the 323 charts reviewed, topical and/or systemic antibiotics were prescribed in the ED to 62 % (199/323) of patients. Of those patients, 38 % (75/199) received only topical antibiotics, 34 % (68/199) received only systemic antibiotics, and 28 % (56/199) were prescribed topical and systemic antibiotics. Thirty-eight percent (124/323) of patients received no antibiotics. Eighteen percent (58/323) of patients returned for follow-up with an infection rate of 10 % (6/58). There was a statistical difference in rates of infection between patients who received antibiotics and who did not receive antibiotics and a statistical difference in rates of infection between patients with complex lacerations who received and did not receive antibiotic. Conclusions This study shows that there is a considerable amount of practice variance in prescribing prophylactic antibiotics for oral lacerations among EPs in our ED. Due to the poor follow-up rate, an accurate infection rate could not be determined. In the future, adequately powered randomized controlled studies may provide compelling data for or against the necessity for prophylactic antibiotic use for oral lacerations.
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Affiliation(s)
- Suzanne Lilley Katsetos
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, M203, Newark, NJ, 07101, USA
| | - Roxanne Nagurka
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, M203, Newark, NJ, 07101, USA.
| | - Jaclyn Caffrey
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, M203, Newark, NJ, 07101, USA
| | - Steven E Keller
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, M203, Newark, NJ, 07101, USA
| | - Tiffany Murano
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, M203, Newark, NJ, 07101, USA
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Recent developments in visible-light photocatalytic degradation of antibiotics. CHINESE JOURNAL OF CATALYSIS 2016. [DOI: 10.1016/s1872-2067(15)61054-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roodsari GS, Zahedi F, Zehtabchi S. The risk of wound infection after simple hand laceration. World J Emerg Med 2015; 6:44-7. [PMID: 25802566 DOI: 10.5847/wjem.j.1920-8642.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 01/11/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This prospective observational study aimed to determine the infection rate of simple hand laceration (SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not. METHODS The study was performed at two urban hospitals enrolling 125 emergency department (ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit (10-14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1-10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals (CI). RESULTS In the 125 patients SHL [median age: 28 (18, 43); range: 1-102 years old; 36% female], 44 (35%, 95% CI: 27%-44%) were given antibiotics in the ED. Wound infection was reported in 6 patients (4.8%, 95% CI: 2%-10%). Age, gender, history of diabetes and wound closure were not associated with wound infection (P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7% (3/44), 95% CI: 2%-10% vs. 4% (3/81), 95% CI: 1%-11%, P=0.66]. Patient's satisfaction with appearance of infected and non-infected wounds were significantly different [7.5 (6, 8) vs. 9 (8, 10), P=0.01]. CONCLUSION Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk of infection.
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Affiliation(s)
- Gholamreza S Roodsari
- Department of Emergency Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Farhad Zahedi
- Department of Emergency Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Shahriar Zehtabchi
- Department of Emergency Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
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Salvatico S, Feuillolay C, Mas Y, Verrière F, Roques C. Bactericidal activity of 3 cutaneous/mucosal antiseptic solutions in the presence of interfering substances: Improvement of the NF EN 13727 European Standard? Med Mal Infect 2015; 45:89-94. [PMID: 25779009 DOI: 10.1016/j.medmal.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/20/2014] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is no standard protocol for the evaluation of antiseptics used for skin and mucous membranes in the presence of interfering substances. Our objective was to suggest trial conditions adapted from the NF EN 13727 standard, for the evaluation of antiseptics used in gynecology and dermatology. METHODS Three antiseptic solutions were tested in vitro: a chlorhexidine-benzalkonium (CB) combination, a hexamidine-chlorhexidine-chlorocresol (HCC) combination, and povidone iodine (P). The adaptation of trial conditions to the standard involved choosing dilutions, solvent, and interfering substances. The activity of solutions was assessed on the recommended strains at concentrations of 97% (pure solution), 50%, and 10% (diluted solution), and 1%. A logarithmic reduction ≥ 5 was expected after 60seconds of contact, to meet requirements of bactericidal activity. RESULTS HCC did not present any bactericidal activity except on P. aeruginosa at a concentration of 97%. P was not bactericidal on E. hirae at any concentration and on S. aureus at 97%. CB had the most homogeneous bactericidal activity with a reduction>5 log on the 4 bacterial strains at concentrations of 97%, 50% and 10%. CONCLUSION Adapting the NF EN 13727 standard allowed assessing the 3 tested solutions: only CB was bactericidal in dirty conditions. This study proved the possibility of validating antiseptic choice in vitro, in current practice conditions, for adjunctive treatment of skin and mucous membranes disorders, primarily of bacterial origin or with a potential of superinfection.
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Affiliation(s)
- S Salvatico
- Fonderephar, 35, chemin des Maraîchers, 31062 Toulouse cedex 9, France
| | - C Feuillolay
- Fonderephar, 35, chemin des Maraîchers, 31062 Toulouse cedex 9, France
| | - Y Mas
- Laboratoire Innotech International, 22, avenue Aristide-Briand, 94110 Arcueil, France
| | - F Verrière
- Laboratoire Innotech International, 22, avenue Aristide-Briand, 94110 Arcueil, France
| | - C Roques
- Fonderephar, 35, chemin des Maraîchers, 31062 Toulouse cedex 9, France; Laboratoire de génie chimique, UMR 5503, UFR pharmacie, université de Toulouse, 35, chemin des Maraîchers, 31062 Toulouse cedex 9, France.
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Lee DH, Kim DY, Yoon SY, Park HS, Yoon HS, Cho S. Retrospective Clinical Trial of Fusidic Acid versus Petrolatum in the Postprocedure Care of Clean Dermatologic Procedures. Ann Dermatol 2015; 27:15-20. [PMID: 25673926 PMCID: PMC4323597 DOI: 10.5021/ad.2015.27.1.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/06/2014] [Accepted: 03/27/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea. OBJECTIVE This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures. METHODS Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records. RESULTS A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups. CONCLUSION Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.
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Affiliation(s)
- Dong Hun Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Dong Young Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - So Young Yoon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun Sun Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Brudvik C, Tariq H, Bernardshaw SV, Steen K. Infeksjoner i sår som er suturert på legevakt. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:759-62. [DOI: 10.4045/tidsskr.13.1536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Quinn RH, Wedmore I, Johnson EL, Islas AA, Anglim A, Zafren K, Bitter C, Mazzorana V. Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment: 2014 Update. Wilderness Environ Med 2014; 25:S118-33. [DOI: 10.1016/j.wem.2014.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/28/2014] [Indexed: 11/25/2022]
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Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment. Wilderness Environ Med 2014; 25:295-310. [DOI: 10.1016/j.wem.2014.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/22/2022]
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Bonomo RA, Van Zile PS, Li Q, Shermock KM, McCormick WG, Kohut B. Topical triple-antibiotic ointment as a novel therapeutic choice in wound management and infection prevention: a practical perspective. Expert Rev Anti Infect Ther 2014; 5:773-82. [PMID: 17914912 DOI: 10.1586/14787210.5.5.773] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Triple-antibiotic ointment (TAO) is a safe and effective topical agent for preventing infections in minor skin trauma. The formulation contains neomycin, polymyxin B and bacitracin in a petrolatum base. TAO is active against the most common disease-causing pathogens found in wounds and on the skin and may be an attractive alternative to oral therapy in select circumstances. Resistance to TAO does not develop readily, and safety studies have shown that the risk of allergic sensitivity to TAO is low. Susceptibility profiles of TAO have remained relatively unchanged since its discovery. Prophylaxis or treatment with TAO should be considered as resistant organisms continue to emerge in the community and hospital setting.
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Affiliation(s)
- Robert A Bonomo
- Case Western Reserve University, Veteran Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106, USA.
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Pangilinan R, Tice A, Tillotson G. Topical antibiotic treatment for uncomplicated skin and skin structure infections: review of the literature. Expert Rev Anti Infect Ther 2014; 7:957-65. [DOI: 10.1586/eri.09.74] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rothrock SG. A single review article cannot define a standard of care for uncomplicated wounds. Ann Emerg Med 2013; 61:502. [PMID: 23522818 DOI: 10.1016/j.annemergmed.2012.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 11/16/2022]
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Marsch G, Mashaqi B, Burgwitz K, Bisdas T, Knigina L, Stiesch M, Haverich A, Kuehn C. Prevention of pacemaker infections with perioperative antimicrobial treatment: an in vitro study. Europace 2013; 16:604-11. [PMID: 23928734 DOI: 10.1093/europace/eut222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The antimicrobial treatment of pacemaker casings with antiseptics (povidone-iodine or octenidine dihydrochloride) or antibiotics (vancomycin, daptomycin, cefuroxime, Tazobac, or nebacetin) was analysed in vitro for its biocompatibility and efficacy in preventing the bacterial adhesion of Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli to cardiac-implantable electrophysiological devices (CIEDs). METHODS AND RESULTS Titan platelets (0.4 cm²) cut from pacemaker casings were impregnated with seven different antimicrobial solutions: two antiseptics and five antibiotics. Subsequently, they were challenged with bacterial contamination by four test strains over a 24 h incubation period. Bacterial adherence was quantified using the colony-forming-unit method after cell recovery with sonication and examined with confocal laser scanning electron microscopy. Simultaneously, the biocompatibility of the antimicrobial impregnation was assessed using pre-treated titan platelets in a culture of human fibroblasts, skeletal myoblasts, and microvascular endothelial cells. After a 48 h incubation, cell vitality was measured using the 2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H/tetrazolium monosodium (WST-8) assay. The immersion of pacemaker casings in antiseptic or antibiotic solutions applies an antimicrobial coating that can significantly reduce bacterial adhesion. The studied impregnations differed in their antimicrobial efficacy and toxicity. CONCLUSION Compared with the two antiseptics and the other tested antibiotics, nebacetin showed the best ratio of efficacy to toxicity. Nebacetin showed good in vitro antibacterial activity against both Gram-positive and Gram-negative pathogens without impairing human cell vitality. It is a safe and effective candidate for CIED impregnation.
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Affiliation(s)
- Georg Marsch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Street 1, D-30625 Hannover, Germany
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Chen YC, Wang YC, Chen WK, Smith M, Huang HM, Huang LC. The effectiveness of a health education intervention on self-care of traumatic wounds. J Clin Nurs 2012; 22:2499-508. [PMID: 23121467 DOI: 10.1111/j.1365-2702.2012.04295.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Yen-Chin Chen
- Department of Emergency Medicine; China Medical University Hospital; Taichung; Taiwan
| | - Yu-Chun Wang
- Trauma and Emergency Center; China Medical University Hospital; Taichung; Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine; China Medical University Hospital; Taichung; Taiwan
| | - Marlaine Smith
- Christine E. Lynn College of Nursing; Florida Atlantic University; Boca Raton; FL; USA
| | - Hsiang-Ming Huang
- Department of Neurosurgery; China Medical University Hospital; Taichung; Taiwan
| | - Li-Chi Huang
- School of Nursing; China Medical University Department of Nursing; China Medical University Hospital; Taichung; Taiwan
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Medel N, Panchal N, Ellis E. Postoperative care of the facial laceration. Craniomaxillofac Trauma Reconstr 2012; 3:189-200. [PMID: 22132257 DOI: 10.1055/s-0030-1268516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations.
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Waterbrook AL, Hiller K, Hays DP, Berkman M. Do topical antibiotics help prevent infection in minor traumatic uncomplicated soft tissue wounds? Ann Emerg Med 2012; 61:86-8. [PMID: 22964473 DOI: 10.1016/j.annemergmed.2012.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Anna L Waterbrook
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
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Shahbazian JH, Hartzell TL, Pandey AK, Azari KK. Allergic dermatitis due to topical antibiotics. West J Emerg Med 2012; 13:380-2. [PMID: 22942939 PMCID: PMC3421979 DOI: 10.5811/westjem.2011.9.6851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/17/2011] [Accepted: 09/06/2011] [Indexed: 11/16/2022] Open
Abstract
In this report we present a case of allergic dermatitis from chronic use of antibiotic ointment mistakenly diagnosed as a localized finger infection.
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Affiliation(s)
- Jonathan H Shahbazian
- David Geffen School of Medicine at UCLA, Department of Orthopedic Surgery, Los Angeles, California
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Heal CF, Buettner PG, Drobetz H. Risk factors for surgical site infection after dermatological surgery. Int J Dermatol 2012; 51:796-803. [DOI: 10.1111/j.1365-4632.2011.05189.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wood LD, Warner NM, Billingsley EM. Infectious complications of dermatologic procedures. Dermatol Ther 2012; 24:558-70. [DOI: 10.1111/j.1529-8019.2012.01453.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Lance D Wood
- Penn State Hershey Department of Dermatology, Hershey, Pennsylvania 17033-0850, USA.
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Abstract
The plastic surgery nurse is often confronted with various acute and chronic wounds. Appropriate wound care can facilitate healing, improve quality of life, decrease pain, and improve cosmesis. Yet, with more than 5,000 products on the market today, it can be difficult to choose the appropriate product. This article reviews some of the basic principles of wound healing and patient assessment and then presents a framework from which to develop a plan of care using appropriate wound care products. Appropriate product selection based on patient assessment and clearly defined wound-healing goals can lead to improved healing and saved health care resources.
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Abstract
BACKGROUND Silver-containing treatments are popular and used in wound treatments to combat a broad spectrum of pathogens, but evidence of their effectiveness in preventing wound infection or promoting healing is lacking. OBJECTIVES To establish the effects of silver-containing wound dressings and topical agents in preventing wound infection and healing of wounds. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (6 May 2009); The Cochrane Central Register of Controlled Trials (CENTRAL) (2009 Issue 2); Ovid MEDLINE (1950 to April Week 4 2009); Ovid EMBASE (1980 to 2009 Week 18); EBSCO CINAHL (1982 to April Week 4 2009) and Digital Dissertations (to May 2009) for relevant trials. We contacted manufacturers and distributors. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing silver-containing wound dressings and topical agents with silver-containing and non silver-containing comparators on uninfected wounds. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed risk of bias, and extracted data. MAIN RESULTS We identified 26 RCTs (2066 patients). Heterogeneity of treatments and outcomes precluded meta-analysis. We grouped results according to wound type, and silver preparation.BurnsThirteen trials compared topical silver (in a variety of formulations - including silver sulphadiazine (SSD) cream) with non-silver dressings. One trial showed fewer infections with silver nitrate when compared with a non-silver dressing, but three trials showed significantly more infection with SSD than with the non-silver dressing.Six trials compared SSD cream with silver-containing dressings. One showed significantly fewer infections with the silver-containing dressing (Hydron AgSD) compared with SSD, the remaining five found no evidence of a difference.One trial compared two silver-containing dressings, and showed a significantly lower infection rate with silver-coated gauze (Acticoat(R)) than with silver nitrate gauze.Other woundsSix trials compared SSD/silver-containing dressings with non-silver dressings (nine dressings in total). Most comparisons (seven) found no significant differences in infection rates; one trial in a variety of wounds exhibited significantly fewer infections with SSD/hydrocolloid, but another, in acute wounds, found significantly more infections with SSD. Only one comparison showed a significant reduction in healing time associated with a silver-containing hydrofibre dressing in diabetic foot ulcers. AUTHORS' CONCLUSIONS There is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection; some poor quality evidence for SSD suggests the opposite.
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Affiliation(s)
- Marja N Storm-Versloot
- Department of Surgery, Academic Medical Centre at the University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ
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37
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Abstract
In managing traumatic wounds, the primary goal is to achieve rapid healing with optimal functional and esthetic results. This is best accomplished by providing an environment that prevents infection of the wound during healing. Despite good wound care, some infections still occur. Accordingly, some investigators argue that prophylactic antibiotics have an important role in the management of certain types of wounds. This article reviews the basis of antibiotic use in preventing wound infection in general and its use in oral and facial wounds in particular.
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Affiliation(s)
- A Omar Abubaker
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, 521 North 11th Street, Richmond, VA 23298, USA.
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Use of Prophylactic Antibiotics in Preventing Infection of Traumatic Injuries. Oral Maxillofac Surg Clin North Am 2009; 21:259-64, vii. [DOI: 10.1016/j.coms.2008.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
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Moran GJ, Talan DA, Abrahamian FM. Antimicrobial Prophylaxis for Wounds and Procedures in the Emergency Department. Infect Dis Clin North Am 2008; 22:117-43, vii. [DOI: 10.1016/j.idc.2007.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Erdur B, Ersoy G, Yilmaz O, Ozkutuk A, Sis B, Karcioglu O, Parlak I, Ayrik C, Aksay E, Guryay M. A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds. Am J Emerg Med 2008; 26:137-43. [PMID: 18272091 DOI: 10.1016/j.ajem.2007.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 03/27/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES This work was conducted to study the prophylactic efficacy of 2 topical antibiotic ointments (mupirocin and nitrofurazone) against wound infection in experimental contaminated crush wounds. METHODS Male Wistar rats underwent two 2-cm incisions at the back side and randomized into 3 groups--placebo (n = 14), mupirocin (n = 14), and nitrofurazone (n = 14)--and infected with either Staphylococcus aureus or S. pyogenes. All wound edges were crushed for 5 seconds with hemostats to simulate crush injury before inoculation of the microorganisms. Half of the wounds were sutured and the other half left open. These wounds were treated 3 times daily for 6 days with topical mupirocin, nitrofurazone, or petrolatum (as placebo). At the end of 6 days, excisional biopsies were taken from wound edges and histopathologic assessments were made based on neutrophilic infiltration, edema formation, myofibroblastic proliferation, and granulation tissue formation. For the microbiologic assessments, quantitative tissue cultures were made. RESULTS In S. aureus-inoculated wounds, mupirocin showed higher antibacterial activity against bacterial colonization and reduced infection rates compared to placebo groups. The same effect was observed for the infection rates in S. pyogenes-inoculated wounds. In S. pyogenes-inoculated open wounds, nitrofurazone showed higher antibacterial activity against infection, but this effect was not observed in closed wounds. In S. pyogenes- and S. aureus-infected wounds, mupirocin treatment significantly lowered infection rates compared to nitrofurazone treatment. Histopathologic examination showed higher myofibroblastic proliferation and higher volume of granulation tissue in the nitrofurazone groups compared to the mupirocin groups. CONCLUSION Topical mupirocin application was effective against crush wound infections inoculated with S. pyogenes and S. aureus. Nitrofurazone provides better granulation tissue formation, but did not effectively prevent bacterial colonization and infection in crush contaminated wounds.
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Affiliation(s)
- Bulent Erdur
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, 20070 Denizli, Turkey.
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43
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Abstract
Wound healing is a complex interchange, orchestrated between cellular components that play their respective parts signaled by and mediated by different cellular instruments of healing. When healing is performed well, the final product is a thing of beauty. When healing is delayed, interrupted, or excessive, then unsightly scars of chronic painful wounds that are frustrating to the patient and physician occur.
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Affiliation(s)
- Margaret K Strecker-McGraw
- Department of Emergency Medicine, Scott and White Hospital, Texas A&M University College of Medicine, 2401 S. 31st Street, Temple, TX 76504, USA.
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44
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Abstract
The primary goal of wound management is to achieve a functional closure with minimal scarring. Preventing infection is important to facilitate the healing process. Most simple, uncomplicated wounds do not need systemic antibiotics but benefit from the use of topical antibiotics. Judicious use of antibiotics reduces unnecessary adverse events and helps reduce the development of resistance. Although antibiotics can help reduce infection risk and promote healing, they are not a substitute for good local wound care, in particular irrigation and surgical débridement. This article reviews the role of antibiotics in emergency department wound management.
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Affiliation(s)
- Yoko Nakamura
- Department of Emergency Medicine, Oregon Health & Science University, 2730 NW Pettygrove Street, Portland, OR 97210-2449, USA
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45
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Abstract
Diligent posttreatment wound care management undoubtedly will improve wound outcome and patient satisfaction. There are limited recommendations in the literature to guide management plans. Nevertheless patients must receive specific instructions to complete wound care. These instructions should include whether a dressing is indicated, which dressing should be used, the duration of use, and the method of application. The plan must explain clearly the reasons for returning for further medical attention, for follow-up, for routine removal of sutures/staples, and an earlier return for possible concerns of infection or dehiscence. Preprinted discharge instruction sheets are useful, and illustrations can be helpful.
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Affiliation(s)
- Paresh R Patel
- Department of Emergency Medicine, Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, Temple, TX 76544, USA
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DeBoard RH, Rondeau DF, Kang CS, Sabbaj A, McManus JG. Principles of Basic Wound Evaluation and Management in the Emergency Department. Emerg Med Clin North Am 2007; 25:23-39. [PMID: 17400071 DOI: 10.1016/j.emc.2006.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The primary objectives of basic wound management center around promoting optimal wound healing and cosmesis. These objectives may be achieved through the systematic assessment, preparation, and repair of the laceration supplemented with appropriate patient care instructions. The meticulous and methodical management of traumatic wounds described in this article will assist the emergency physician in decreasing overall complication rates and help improve patient satisfaction.
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Affiliation(s)
- Ryan H DeBoard
- Department of Emergency Medicine, Madigan Army Medical Center, Bldg. 9040, Fitzsimmons Drive, Tacoma, WA 98431, USA
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47
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Abstract
OBJECTIVES The surgical management and outcome of outpatient care for patients with simple lacerations were compared across three institutions. We examined the variations in wound infection rate, total charge and medical resource use in terms of prophylactic antibiotic prescription, frequency of outpatient visits and required days for stitch removal. DESIGN Retrospective and consecutive chart review. STUDY PARTICIPANTS Patients receiving treatment for simple lacerations in the outpatient departments of three institutions in Japan between June 2000 and August 2001. OUTCOME MEASURES AND METHOD: The basic patient characteristics, treatment method for the laceration and incidence of wound infection were collected. Variations in the wound infection rate were examined across the institutions. We then examined the variations in the medical resource use and total charge for patients without wound infection among the institutions by multiple linear regression model. RESULTS A total of 479 patients were reviewed. The proportion of patients with blunt injury, patients with simple lacerations to the head or face, and those with underlying medical disease were significantly different among the three institutions. The wound infection rate did not significantly differ (1.9% in Institution A, 1.3% in B, 3.0% in C, P = 0.555). The medical resource use for patients without wound infection was significantly different and small in Institution A. CONCLUSION We identified variations in the resource use for completing wound care among three institutions, whereas the wound infection rate revealed no significant difference among the institutions. There existed some room for improvement in the productive efficiency of simple laceration treatment.
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Affiliation(s)
- Kazuaki Kuwabara
- Kyoto University, Graduate School of Medicine, School of Public Health, Department of Healthcare Economics and Quality Managment, Sakyo-ku, Kyoto, Japan
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Campbell RM, Perlis CS, Fisher E, Gloster HM. Gentamicin Ointment versus Petrolatum for Management of Auricular Wounds. Dermatol Surg 2006; 31:664-9. [PMID: 15996417 DOI: 10.1111/j.1524-4725.2005.31610] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgeons frequently create defects on the ear in the treatment of cutaneous malignancies. Potentially significant complications of second-intention healing on the ear are suppurative and inflammatory chondritis. Consequently, many physicians advocate the use of oral or topical prophylactic antibiotics after auricular surgery. OBJECTIVE The purpose of this study is to compare the efficacy of gentamicin ointment with that of petrolatum for the prevention of suppurative chondritis during second-intention healing of auricular wounds after Mohs surgery. METHODS One hundred forty-two patients with a total of 147 second-intention wounds were prospectively selected to receive either gentamicin ointment or petrolatum postoperatively. RESULTS One hundred forty-four wounds were evaluated in a follow-up examination or by telephone interview. Eight (5.56%) wounds developed suppurative chondritis. Four wounds received gentamicin and four received petrolatum, for incidences of 4.76% and 6.67%, respectively. Twelve (8.33%) other wounds developed inflammatory chondritis. Ten (11.90%) received gentamicin and two (3.33%) received petrolatum. CONCLUSIONS There is no statistically significant difference between the use of gentamicin ointment and petrolatum in the prevention of postoperative auricular suppurative chondritis. The data also demonstrate a disproportionate number of cases of inflammatory chondritis in the gentamicin-treated group. This study supports the cost-effective and potentially less irritating use of petrolatum for wound care in this difficult to manage area.
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Affiliation(s)
- Ross M Campbell
- Department of Dermatology, Brown Medical School, Providence, Rhode Island, USA
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Jones RN, Li Q, Kohut B, Biedenbach DJ, Bell J, Turnidge JD. Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. Diagn Microbiol Infect Dis 2006; 54:63-71. [PMID: 16368476 DOI: 10.1016/j.diagmicrobio.2005.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
Triple antibiotic ointment (TAO) containing neomycin, polymyxin B, and bacitracin was launched in the 1950s in the United States (USA) as a prescription product and then was used over the counter (OTC) since the 1970s (USA) to prevent superficial wound infections. In Australia, TAO has been restricted to prescription use. This study 1) determined cross-resistance patterns of neomycin compared with other aminoglycosides; 2) determined the level and trend of resistance to TAO and individual components especially versus mupirocin-resistant strains (USA); and 3) established the baseline TAO activity level against pathogens from Australia. A total of 200 strains (> or =50% gentamicin-resistant) from the United States were used for the cross-resistance study including Staphylococcus aureus (110), coagulase-negative staphylococci (CoNS; 50), Pseudomonas aeruginosa (10), Escherichia coli (20), and other Enterobacteriaceae (10) tested against TAO, bacitracin, polymyxin B, neomycin, amikacin, gentamicin, streptomycin, tobramycin, and mupirocin. Fifty gentamicin-resistant isolates from each year (1997-2002) were used to determine the activity of TAO over time. Baseline resistance rates of TAO among 300 Australian isolates (AGARS Program, 2002-2003) were also studied. Reference broth microdilution methods were used in all phases of this study. At a 1:100 dilution of the ointment concentration, TAO inhibited all CoNS, Pseudomonas aeruginosa, and Enterobacteriaceae isolates, and resistance to TAO among Staphylococcus aureus at this concentration was only 5% in the cross-resistance study. Patterns of susceptibility in the United States did not significantly vary from 1997 to 2002. Australian pathogens showed that TAO was 98% active against methicillin-resistant Staphylococcus aureus and 100% for Enterobacteriaceae, methicillin-susceptible S. aureus, CoNS, and P. aeruginosa, the rates equivalent to those observed in the United States. Mupirocin-resistant S. aureus (5%) and CoNS (47%) were all TAO-susceptible. All Gram-negative species were also mupirocin-resistant, but inhibited by neomycin and/or polymyxin B components of TAO. In conclusion, aminoglycoside resistance patterns differ significantly, and none of the commonly tested agents could accurately predict neomycin resistance. TAO resistance was rare in the United States after extensive OTC use and was not adversely influenced by decades of parenteral aminoglycoside use. Australian surveillance showed high levels of TAO susceptibility in sampled isolates as a baseline for possible OTC availability. TAO maintains a wider spectrum of activity compared with mupirocin and was usable against mupirocin-resistant Gram-positive strains.
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50
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Davis SC, Cazzaniga AL, Eaglstein WH, Mertz PM. Over-the-counter topical antimicrobials: effective treatments? Arch Dermatol Res 2005; 297:190-5. [PMID: 16231147 DOI: 10.1007/s00403-005-0612-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 08/19/2005] [Accepted: 09/15/2005] [Indexed: 11/29/2022]
Abstract
There are many over-the-counter (OTC) bandage products available. In addition to their direct purchase by the public, many physicians provide OTC bandages to their patents after minor surgeries. The aim of this study was to evaluate in a well established porcine model the efficacy against Staphylococcus aureus of four OTC antimicrobial containing bandages as compared to two OTC ointments. Multiple partial thickness wounds were made on the backs of four pigs. The wounds were treated within 20 min after S. aureus inoculation. The wounds were cultured quantitatively at 24 and 48 h. Only one of the antibiotic bandages and one of the topical ointments were effective in reducing S. aureus proliferation in partial thickness wounds. The two treatments that were effective were the only treatments that contained neomycin. Although many OTC bandages and ointments contain antimicrobials, they may not be effective at reducing bacteria in wounds.
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Affiliation(s)
- Stephen C Davis
- Department of Dermatology Cutaneous Surgery, University of Miami School of Medicine, 1600 N.W. 10th Avenue, Room 2089, Miami, FL 33136, USA.
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