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Roy S, Mukherjee P, Kundu S, Majumder D, Raychaudhuri V, Choudhury L. Microbial infections in burn patients. Acute Crit Care 2024; 39:214-225. [PMID: 38863352 PMCID: PMC11167422 DOI: 10.4266/acc.2023.01571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 06/13/2024] Open
Abstract
Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.
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Affiliation(s)
- Souvik Roy
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Preeti Mukherjee
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Sutrisha Kundu
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Debashrita Majumder
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Vivek Raychaudhuri
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Lopamudra Choudhury
- Department of Microbiology, Sarsuna College (under Calcutta University), Kolkata, India
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Orbay H, Ziembicki JA, Yassin M, Egro FM. Prevention and Management of Wound Infections in Burn Patients. Clin Plast Surg 2024; 51:255-265. [PMID: 38429048 DOI: 10.1016/j.cps.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
The leading cause of morbidity in burn patients is infection with pneumonia, urinary tract infection, cellulitis, and wound infection being the most common cause. High mortality is due to the immunocompromised status of patients and abundance of multidrug-resistant organisms in burn units. Despite the criteria set forth by American Association of Burn, the diagnosis and treatment of burn infections are not always straightforward. Topical antimicrobials, isolation, hygiene, and personal protective equipment are common preventive measures. Additionally medical and nutritional optimization of the patients is crucial to reverse the immunocompromised status triggered by burn injury.
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Affiliation(s)
- Hakan Orbay
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenny A Ziembicki
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohamed Yassin
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Maitz J, Merlino J, Rizzo S, McKew G, Maitz P. Burn wound infections microbiome and novel approaches using therapeutic microorganisms in burn wound infection control. Adv Drug Deliv Rev 2023; 196:114769. [PMID: 36921627 DOI: 10.1016/j.addr.2023.114769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Affiliation(s)
- J Maitz
- Department of Burns & Reconstructive Surgery, Concord Repatriation General Hospital, Australia; Burns & Reconstructive Surgery Research Group, ANZAC Research Institute, Concord Repatriation General Hospital, Australia; Faculty of Medicine & Health, University of Sydney, Australia.
| | - J Merlino
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Australia; Faculty of Medicine & Health, University of Sydney, Australia
| | - S Rizzo
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Australia
| | - G McKew
- Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Australia; Faculty of Medicine & Health, University of Sydney, Australia
| | - P Maitz
- Department of Burns & Reconstructive Surgery, Concord Repatriation General Hospital, Australia; Burns & Reconstructive Surgery Research Group, ANZAC Research Institute, Concord Repatriation General Hospital, Australia; Faculty of Medicine & Health, University of Sydney, Australia
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Wang P, Zhang Z, Lin R, Lin J, Liu J, Zhou X, Jiang L, Wang Y, Deng X, Lai H, Xiao H. Machine learning links different gene patterns of viral infection to immunosuppression and immune-related biomarkers in severe burns. Front Immunol 2022; 13:1054407. [PMID: 36518755 PMCID: PMC9742460 DOI: 10.3389/fimmu.2022.1054407] [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: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Viral infection, typically disregarded, has a significant role in burns. However, there is still a lack of biomarkers and immunotherapy targets related to viral infections in burns. Methods Virus-related genes (VRGs) that were extracted from Gene Oncology (GO) database were included as hallmarks. Through unsupervised consensus clustering, we divided patients into two VRGs molecular patterns (VRGMPs). Weighted gene co-expression network analysis (WGCNA) was performed to study the relationship between burns and VRGs. Random forest (RF), least absolute shrinkage and selection operator (LASSO) regression, and logistic regression were used to select key genes, which were utilized to construct prognostic signatures by multivariate logistic regression. The risk score of the nomogram defined high- and low-risk groups. We compared immune cells, immune checkpoint-related genes, and prognosis between the two groups. Finally, we used network analysis and molecular docking to predict drugs targeting CD69 and SATB1. Expression of CD69 and SATB1 was validated by qPCR and microarray with the blood sample from the burn patient. Results We established two VRGMPs, which differed in monocytes, neutrophils, dendritic cells, and T cells. In WGCNA, genes were divided into 14 modules, and the black module was correlated with VRGMPs. A total of 65 genes were selected by WGCNA, STRING, and differential expression analysis. The results of GO enrichment analysis were enriched in Th1 and Th2 cell differentiation, B cell receptor signaling pathway, alpha-beta T cell activation, and alpha-beta T cell differentiation. Then the 2-gene signature was constructed by RF, LASSO, and LOGISTIC regression. The signature was an independent prognostic factor and performed well in ROC, calibration, and decision curves. Further, the expression of immune cells and checkpoint genes differed between high- and low-risk groups. CD69 and SATB1 were differentially expressed in burns. Discussion This is the first VRG-based signature (including 2 key genes validated by qPCR) for predicting survival, and it could provide vital guidance to achieve optimized immunotherapy for immunosuppression in burns.
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Affiliation(s)
- Peng Wang
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Zexin Zhang
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Rongjie Lin
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Jiali Lin
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Jiaming Liu
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Xiaoqian Zhou
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Liyuan Jiang
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Yu Wang
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Xudong Deng
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Haijing Lai
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China
| | - Hou’an Xiao
- Department of Burns and Plastic and Cosmetic Surgery, Xi’an Ninth Hospital, Xi’an, China,*Correspondence: Hou’an Xiao,
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Qiao G, Ji W, Sun Z, Wang X, Li P, Jia H, Duan L, Qi F. Isosteviol reduces the acute inflammatory response after burns by upregulating MMP9 in macrophages leading to M2 polarization. Int Immunopharmacol 2022; 106:108609. [PMID: 35176589 DOI: 10.1016/j.intimp.2022.108609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
Isosteviol is a widely known sweetener isolated from the herb Stevia rebaudiana. It is well documented that isosteviol, a derivative of stevioside, has a variety of biological activities, including anti-inflammatory, anti-hypertensive, and cardioprotective effects and alleviation of ischaemia-reperfusion injury. However, the protective mechanism of isosteviol in burn injuryis still unclear. This work aimed to screen and identify the role of macrophage-related genes after burn injury through bioinformatic analysis and biological experiments and to detect the effect of isosteviol on burn inflammation. The results showed that two days after burn injury was considered the acute inflammatory response node, which was when the expression levels of CCL3, CCL4, MMP9, and CD86 in macrophages were significantly changed. Monitoring and regulating these sensitive indicators may help to evaluate the severity of burns and reduce the inflammatory impact of burns on the body. After treatment with isosteviol, during the acute inflammatory phase, the expression of MMP9 was increased, the polarization of macrophages towards the alternatively activated (M2) phenotype was increased, and IL-6 and TNF-α levels were significantly decreased. Our study provides evidence thatisosteviol can reduce inflammation after burn injury by promoting an increase in the M2-classically activated (M1) macrophage ratio and increasing the expression of MMP9 in burn wound tissue during acute inflammation.
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Affiliation(s)
- Gangjie Qiao
- Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Wenbin Ji
- Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Zhaonan Sun
- Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Xiulan Wang
- Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
| | - Peiyuan Li
- Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Haowen Jia
- General Surgery Department, Tianjin Medical University General Hospital, Airport Hospital, 85 East Sixth Road, Dongli District, Tianjin 300300, China.
| | - Lingling Duan
- General Surgery Department, Tianjin Medical University General Hospital, Airport Hospital, 85 East Sixth Road, Dongli District, Tianjin 300300, China
| | - Feng Qi
- Department of General Surgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
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