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Kaul L, Abdo AI, Coenye T, Swift S, Zannettino A, Süss R, Richter K. In vitro and in vivo evaluation of diethyldithiocarbamate with copper ions and its liposomal formulation for the treatment of Staphylococcus aureus and Staphylococcus epidermidis biofilms. Biofilm 2023; 5:100130. [PMID: 37274173 PMCID: PMC10238467 DOI: 10.1016/j.bioflm.2023.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Surgical site infections (SSIs) are mainly caused by Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) biofilms. Biofilms are aggregates of bacteria embedded in a self-produced matrix that offers protection against antibiotics and promotes the spread of antibiotic-resistance in bacteria. Consequently, antibiotic treatment frequently fails, resulting in the need for alternative therapies. The present study describes the in vitro efficacy of the Cu(DDC)2 complex (2:1 M ratio of diethyldithiocarbamate (DDC-) and Cu2+) with additional Cu2+ against S. aureus and S. epidermidis biofilms in models mimicking SSIs and in vitro antibacterial activity of a liposomal Cu(DDC)2 + Cu2+ formulation. The in vitro activity on S. aureus and S. epidermidis biofilms grown on two hernia mesh materials and in a wound model was determined by colony forming unit (CFU) counting. Cu2+-liposomes and Cu(DDC)2-liposomes were prepared, and their antibacterial activity was assessed in vitro using the alamarBlue assay and CFU counting and in vivo using a Galleria mellonella infection model. The combination of 35 μM DDC- and 128 μM Cu2+ inhibited S. aureus and S. epidermidis biofilms on meshes and in a wound infection model. Cu(DDC)2-liposomes + free Cu2+ displayed similar antibiofilm activity to free Cu(DDC)2 + Cu2+, and significantly increased the survival of S. epidermidis-infected larvae. Whilst Cu(DDC)2 + Cu2+ showed substantial antibiofilm activity in vitro against clinically relevant biofilms, its application in mammalian in vivo models is limited by solubility. The liposomal Cu(DDC)2 + Cu2+ formulation showed antibiofilm activity in vitro and antibacterial activity and low toxicity in G. mellonella, making it a suitable water-soluble formulation for future application on infected wounds in animal trials.
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Affiliation(s)
- Laurine Kaul
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Road, Adelaide, SA, 5011, Australia
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104, Freiburg, Germany
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Adrian I. Abdo
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Road, Adelaide, SA, 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Simon Swift
- Department of Molecular Medicine and Pathology, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Andrew Zannettino
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
- Precision Cancer Medicine Theme, South Australian Health & Medical Research Institute, North Terrace, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Regine Süss
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104, Freiburg, Germany
| | - Katharina Richter
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Road, Adelaide, SA, 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, Australia
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ElHawary H, Covone J, Abdulkarim S, Janis JE. Practical Review on Delayed Primary Closure: Basic Science and Clinical Applications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5172. [PMID: 37547342 PMCID: PMC10402984 DOI: 10.1097/gox.0000000000005172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023]
Abstract
Wound healing complications present a significant burden on both patients and health-care systems, and understanding wound healing principles is crucial across medical and surgical specialties to help mitigate such complications. One of these longstanding principles, specifically delayed primary closure (DPC), described as mechanically closing a wound after several days of secondary intention healing, lacks clear consensus on its definition, indications, and outcomes. This practical review examines wound healing fundamentals, focusing on DPC, its execution, indications, and comparative outcomes. A PubMed literature search was conducted to retrieve studies on DPC. Inclusion criteria included comparative studies assessing outcomes and complications between DPC and other closure techniques, as well as articles investigating DPC's underlying physiology. Twenty-three comparative studies met inclusion criteria. DPC wounds have significantly higher partial pressure of oxygen, higher blood flow, and higher rates of collagen synthesis and remodeling activity, all of which help explain DPC wounds' superior mechanical strength. DPC seems most beneficial in contaminated wounds, such as complicated appendectomies, postcardiac surgery wounds, and complicated abdominal wall reconstructions, where it has been associated with lower rates of surgical site infections. This practical review provides an evidence-based approach to DPC, its physiology, technique, and indications. Based on the existing literature, the authors recommend that DPC wounds should be dressed in saline/betadine soaks, changed and irrigated daily, with delayed closure lasting between 3 and 5 days or until the infection has resolved. The clearest indications for DPC are in the context of contaminated abdominal surgery and sternal wound dehiscence post cardiac surgery.
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Affiliation(s)
- Hassan ElHawary
- From the Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Jason Covone
- Faculty of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
| | - Shafic Abdulkarim
- Department of Surgery, McGill University Health Centre, Montréal, Quebec, Canada
| | - Jeffrey E. Janis
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Kaul L, Grundmann CE, Köll-Weber M, Löffler H, Weiz A, Zannettino ACW, Richter K, Süss R. A Thermosensitive, Chitosan-Based Hydrogel as Delivery System for Antibacterial Liposomes to Surgical Site Infections. Pharmaceutics 2022; 14:pharmaceutics14122841. [PMID: 36559332 PMCID: PMC9784289 DOI: 10.3390/pharmaceutics14122841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Prophylaxis and the treatment of surgical site infections (SSIs) with antibiotics frequently fail due to the antibiotic resistance of bacteria and the ability of bacteria to reside in biofilms (i.e., bacterial clusters in a protective matrix). Therefore, alternative antibacterial treatments are required to combat biofilm infections. The combination of diethyldithiocarbamate (DDC-) and copper ions (Cu2+) exhibited antibiofilm activity against the staphylococci species associated with SSIs; however, the formation of a water-insoluble Cu(DDC)2 complex limits its application to SSIs. Here, we describe the development and antibiofilm activity of an injectable gel containing a liposomal formulation of Cu(DDC)2 and Cu2+ (lipogel). Lyophilized liposomes were incorporated into a mixture of chitosan (CS) and beta-glycerophosphate (βGP), and the thermosensitive gelling properties of CS-βGP and the lipogel were determined. The liposomes remained stable after lyophilization over six months at 4-6 °C and -20 °C. The sol-gel transition of the gel and lipogel occurred between 33 and 39 °C, independently of sterilization or storage at -20 °C. CS-βGP is biocompatible and the liposomes were released over time. The lipogel prevented biofilm formation over 2 days and killed 98.7% of the methicillin-resistant Staphylococcus aureus and 99.9% of the Staphylococcus epidermidis biofilms. Therefore, the lipogel is a promising new prophylaxis and treatment strategy for local application to SSIs.
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Affiliation(s)
- Laurine Kaul
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Rd., Adelaide, SA 5011, Australia
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104 Freiburg, Germany
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
- Correspondence:
| | - Clara E. Grundmann
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104 Freiburg, Germany
| | - Monika Köll-Weber
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104 Freiburg, Germany
| | - Hanna Löffler
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104 Freiburg, Germany
| | - Artur Weiz
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104 Freiburg, Germany
| | - Andrew C. W. Zannettino
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
- Precision Cancer Medicine Theme, South Australian Health & Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
- Central Adelaide Local Health Network, 1 Port Rd., Adelaide, SA 5000, Australia
| | - Katharina Richter
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Rd., Adelaide, SA 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
- Institute for Photonics and Advanced Sensing, North Terrace Campus, University of Adelaide, Adelaide, SA 5005, Australia
| | - Regine Süss
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104 Freiburg, Germany
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GAMO GDO, REICHARDT GS, GUETTER CR, PIMENTEL SK. RISK FACTORS FOR SURGICAL WOUND INFECTION AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1675. [PMID: 36043650 PMCID: PMC9423715 DOI: 10.1590/0102-672020220002e1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 05/14/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND: One of the ways to avoid infection after surgical procedures is through
antibiotic prophylaxis. This occurs in cholecystectomies with certain risk
factors for infection. However, some guidelines suggest the use of
antibiotic prophylaxis for all cholecystectomies, although current evidence
does not indicate any advantage of this practice in the absence of risk
factors. AIMS: This study aims to evaluate the incidence of wound infection after elective
laparoscopic cholecystectomies and the use of antibiotic prophylaxis in
these procedures. METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and
cholelithiasis, accounting for different risk factors for wound
infection. RESULTS: There were seven cases of wound infection (1.59%). No antibiotic prophylaxis
regimen significantly altered infection rates. There was a statistically
significant correlation between wound infection and male patients (p=0.013).
No other analyzed risk factor showed a statistical correlation with wound
infection. CONCLUSIONS: The nonuse of antibiotic prophylaxis and other analyzed factors did not
present a significant correlation for the increase in the occurrence of
wound infection. Studies with a larger sample and a control group without
antibiotic prophylaxis are necessary.
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