RESUMEN
Normal skin is the first line of defense in the human body. A burn injury makes the skin susceptible to bacterial infection, thereby delaying wound healing and ultimately leading to sepsis. The chances of biofilm formation are high in burn wounds due to the presence of avascular necrotic tissue. The most common pathogen to cause burn infection and biofilm is Pseudomonas aeruginosa. The purpose of this study was to create a microemulsion (ME) formulation for topical application to treat bacterial burn infection. In the present study, tea tree oil was used as the oil phase, Tween 80 and transcutol were used as surfactants, and water served as the aqueous phase. Pseudo ternary phase diagrams were used to determine the design space. The ranges of components as suggested by the design were chosen, optimization of the microemulsion was performed, and in vitro drug release was assessed. Based on the characterization studies performed, it was found that the microemulsion were formulated properly, and the particle size obtained was within the desired microemulsion range of 10 to 300 nm. The I release study showed that the microemulsion followed an immediate release profile. The formulation was further tested based on its ability to inhibit biofilm formation and bacterial growth. The prepared microemulsion was capable of inhibiting biofilm formation.
Asunto(s)
Antibacterianos , Biopelículas , Quemaduras , Sistemas de Liberación de Medicamentos , Emulsiones , Pseudomonas aeruginosa , Biopelículas/efectos de los fármacos , Quemaduras/tratamiento farmacológico , Quemaduras/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Sistemas de Liberación de Medicamentos/métodos , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Tamaño de la Partícula , Liberación de Fármacos , Tensoactivos/química , Polisorbatos/química , Aceite de Árbol de Té/administración & dosificación , Aceite de Árbol de Té/química , Aceite de Árbol de Té/farmacología , Química Farmacéutica/métodos , HumanosRESUMEN
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management. METHODS: A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients. RESULTS: During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed. CONCLUSIONS: CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.
Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Carbapenémicos , Infección Hospitalaria , Control de Infecciones , Acinetobacter baumannii/genética , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Humanos , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Alemania/epidemiología , Carbapenémicos/farmacología , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Anciano , Adulto , Control de Infecciones/métodos , Epidemiología Molecular , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Quemaduras/microbiología , Quemaduras/complicaciones , Cirugía Plástica , Unidades de Quemados , Secuenciación Completa del Genoma , Incidencia , Pruebas de Sensibilidad MicrobianaRESUMEN
Burn injuries represent a significant problem in clinical practice due to the high risk of infection and the prolonged healing process. Recently, more attention has been given to natural remedies such as water extracts of various medicinal plants, which possess anti-inflammatory and wound healing properties. The aim of this study is to evaluate the efficacy and safety of Satureja montana L. and other water extracts in a burn wound model. The study involved male Californian rabbits (n = 52) divided into eight groups. Burn wounds were modeled on the animals and subsequently treated with gels based on Satureja montana L. and other water extracts. The reparative potential of the epidermis (assessed by Ki-67 expression), the state of local immunity (measured by the number of CD-45 cells), and the anti-inflammatory role of mast cells (measured by tryptase levels) were evaluated. Bacteriological and morphological studies were conducted. The most pronounced bactericidal, reparative, and immunostimulatory effects were observed after the treatment using a gel mixture of water extracts from Satureja montana L., Salvia sclarea, Coriandrum sativum L., and Lavandula angustifolia in equal proportions (1:1:1:1). The other gels also demonstrated high efficacy in treating burn wounds, especially when using a strain of Pseudomonas aeruginosa resistant to several antibiotics. Immunohistochemical studies showed a significant increase in the number of Ki-67-positive cells in the basal layer of the epidermis and a decrease in the number of CD-45-positive cells, indicating improved proliferative activity and reduced inflammation. This study confirms the hypothesis that the use of water extract mixtures significantly enhances the reparative potential, improves the immune response in the treatment of burns, and promotes wound healing. These findings pave the way for further research and the application of complex phytotherapeutic agents, specifically water extracts of medicinal plants containing phenols and antioxidants in burn wound therapy.
Asunto(s)
Quemaduras , Geles , Extractos Vegetales , Plantas Medicinales , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Cicatrización de Heridas , Animales , Conejos , Cicatrización de Heridas/efectos de los fármacos , Extractos Vegetales/farmacología , Extractos Vegetales/química , Quemaduras/tratamiento farmacológico , Quemaduras/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Infecciones por Pseudomonas/tratamiento farmacológico , Plantas Medicinales/química , Masculino , Agua/química , Modelos Animales de Enfermedad , Antibacterianos/farmacologíaRESUMEN
BACKGROUND: Burns are a problem that affects millions of individuals around the world. OBJECTIVE: This research aimed to analyze the genetic characteristics and antibiotic resistance of Staphylococcus aureus strains isolated from patients with burns. Identifying the genetic variations of three local strains of Staphylococcus aureus isolated from burns. MATERIALS AND METHODS: Swab samples were collected from eighty sources (burns). Using sterile swabs containing media collected from patients treated at Baqubah Teaching Hospital between July 2022 and the end of September 2022, these samples were then cultured on blood agar and brain heart infusion agar. A total of twenty-four hours were spent incubating the cultured samples in an aerobic environment at 37 °C. During this time, isolated growing colonies showed characteristic growth, color, and hemolysis, while suspicious colonies were cultured for further identification. RESULTS: Our results indicated the presence of several polymorphisms that were distributed in the investigated samples. However, almost all observed variations were concentrated only in the S2 isolates. The construction of phylogenetic trees confirmed this notion by positioning these S2-based amplicons to distinct categories within Staph. aureus organisms. Furthermore, the phylogenetic tree offered additional tools for the guaranteed identity of the samples that were analyzed. Consequently, the utilization of the PCR-sequencing approach in three DNA samples belonging to these local bacterial isolates has resulted in the confirmation of the identity of this strain. However, particular emphasis should be placed on S2 isolate as it has special variants that differ from its mates, in terms of its metabolic as well as phylogenetic consequences. Therefore, S2 isolates may represent a new strain that requires a whole genome sequencing strategy to validate its identity within Staph. aureus organisms. S.aureus resistance was 100% (Augmentin and Tetracycline), and 90% (Azithromycin and Trimethoprim), while Cefotaxime and Chloramphenicol recorded (75%, and 85%) respectively.
Asunto(s)
Antibacterianos , Quemaduras , Farmacorresistencia Bacteriana , Pruebas de Sensibilidad Microbiana , Filogenia , Infecciones Estafilocócicas , Staphylococcus aureus , Staphylococcus aureus/genética , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Quemaduras/microbiología , Humanos , Antibacterianos/farmacología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Farmacorresistencia Bacteriana/genéticaRESUMEN
Burn wounds are a major burden, with high mortality rates due to infections. Staphylococcus aureus is a major causative agent of burn wound infections, which can be difficult to treat because of antibiotic resistance and biofilm formation. An alternative to antibiotics is the use of bacteriophages, viruses that infect and kill bacteria. We investigated the efficacy of bacteriophage therapy for burn wound infections, in both a porcine and a newly developed human ex vivo skin model. In both models, the efficacy of a reference antibiotic treatment (fusidic acid) and bacteriophage treatment was determined for a single treatment, successive treatment, and prophylaxis. Both models showed a reduction in bacterial load after a single bacteriophage treatment. Increasing the frequency of bacteriophage treatments increased bacteriophage efficacy in the human ex vivo skin model, but not in the porcine model. In both models, prophylaxis with bacteriophages increased treatment efficacy. In all cases, bacteriophage treatment outperformed fusidic acid treatment. Both models allowed investigation of bacteriophage-bacteria dynamics in burn wounds. Overall, bacteriophage treatment outperformed antibiotic control underlining the potential of bacteriophage therapy for the treatment of burn wound infections, especially when used prophylactically.
Asunto(s)
Antibacterianos , Bacteriófagos , Quemaduras , Terapia de Fagos , Infecciones Estafilocócicas , Staphylococcus aureus , Infección de Heridas , Animales , Quemaduras/terapia , Quemaduras/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/virología , Porcinos , Terapia de Fagos/métodos , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Infección de Heridas/terapia , Infección de Heridas/microbiología , Infecciones Estafilocócicas/terapia , Infecciones Estafilocócicas/microbiología , Bacteriófagos/fisiología , Ácido Fusídico/farmacología , Ácido Fusídico/uso terapéutico , Modelos Animales de Enfermedad , Biopelículas/efectos de los fármacos , Piel/microbiologíaRESUMEN
BACKGROUND: Burn patients are at high risk of developing secondary invasive fungal infections due to their compromised skin barrier, extensive use of antibiotics, and immunosuppression. OBJECTIVES: We investigated demographic characteristics and clinical factors associated with Candida infections in intensive care unit (ICU) burn patients, and the in vitro antifungal susceptibility of species of isolates. METHODS: A total of 353 burn patients admitted to three major ICUs of burn centers in Iran were evaluated between 2021 and 2023. Patients were considered as colonisation and candidemia. Demographic characteristics, burn-related factors, and clinical conditions were compared among the groups. Furthermore, we identified fungi at the species level and performed antifungal susceptibility testing according to CLSI guidelines. RESULTS: Overall, 46.2% of patients were colonised with a Candida species, leading to candidemia in 15.3%. The most frequently isolated species from candidemia and burn wound colonisation were Candida parapsilosis (37.0%) and Candida albicans (31.9%), respectively. Risk factors linked to candidemia included larger total body surface area (TBSA) (>50%), older patients, indwelling catheters, diabetes, and an extended ICU stay. Mortality rate was higher among candidemia patients (82.5%) compared to colonised patients (7.3%). The resistance rate of the strains isolated from candidemia to fluconazole and voriconazole was 28% and 18.2%, respectively. CONCLUSION: We found that a higher percentage of TBSA burn injuries, longer hospital stays, and catheterization are important predictors of candidemia. The mortality rate was significantly higher in people infected with non-albicans Candida species. Prevention and treatment strategies for candidemia should be based on updated, regional epidemiological data.
Asunto(s)
Antifúngicos , Quemaduras , Candida , Candidemia , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Humanos , Quemaduras/complicaciones , Quemaduras/microbiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Irán/epidemiología , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Candida/clasificación , Candidemia/microbiología , Candidemia/epidemiología , Candidemia/tratamiento farmacológico , Candidemia/mortalidad , Factores de Riesgo , Candidiasis/microbiología , Candidiasis/epidemiología , Anciano , Fluconazol/uso terapéutico , Fluconazol/farmacología , Adulto Joven , Farmacorresistencia Fúngica , Unidades de QuemadosRESUMEN
OBJECTIVE: Multidrug-resistant (MDR) Acinetobacter baumannii is a major issue within healthcare facilities in Bangladesh due to its frequent association with hospital-acquired infections. In this study we report on a carbapenem-resistant draft genome sequence of an A. baumannii BD20 sample isolated from an infected wound in Bangladesh. METHODS: A. baumannii BD20 was isolated from an infected burn wound. Whole-genome sequencing was carried out and annotated using PGAP and Prokka. Sequence type, antimicrobial resistance genes, virulence factor genes, and metal resistance genes were investigated. Core genome multilocus sequence typing-based phylogenomic analysis between A. baumannii BD20 and 213 A. baumannii strains retrieved from the NCBI GenBank database was performed using the BacWGSTdb 2.0 server. RESULTS: A. baumannii BD20 (MLST 491) was resistant to all the antibiotics tested, except for colistin and polymyxin B. Along with many other antibiotic resistance genes, the isolate harbored three classes of beta lactamase-producing genes: blaGES-11 (class A), blaOXA-69 (class D), blaADC-10 (class C), and blaADC-11 (class C). Additionally, the strain carried several virulence genes and metal resistance determinants, which may contribute to its increased virulence. Core genome MLST-based phylogenomic analysis revealed that A. baumannii BD20 was closely related to another ST491 strain isolated from Singapore. CONCLUSIONS: The findings of this study underscore the growing challenge of MDR A. baumannii, emphasizing the need for vigilant surveillance and infection-control measures in healthcare settings in order to address these emerging threats effectively.
Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Antibacterianos , Farmacorresistencia Bacteriana Múltiple , Tipificación de Secuencias Multilocus , Filogenia , Secuenciación Completa del Genoma , beta-Lactamasas , Acinetobacter baumannii/genética , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Acinetobacter baumannii/clasificación , Acinetobacter baumannii/enzimología , Humanos , beta-Lactamasas/genética , Bangladesh/epidemiología , Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/epidemiología , Antibacterianos/farmacología , Genoma Bacteriano , Infección de Heridas/microbiología , Pruebas de Sensibilidad Microbiana , Factores de Virulencia/genética , Proteínas Bacterianas/genética , Quemaduras/microbiología , Quemaduras/complicaciones , Carbapenémicos/farmacologíaRESUMEN
In the present retrospective study, we have evaluated bacterial pathogens isolated from patients admitted to the Burn Care Unit at the Military Medical Academy, Varna, Bulgaria over a three-year period (January 2019 - December 2021). We also tried to summarize the corresponding antibiotic resistance pattern of the isolated infectious agents. A total of 1030 isolates were obtained from 1912 burn wound samples investigated. There were 553 Gram-positive (53.7%) and 477 Gram-negative (46.3%) isolates. The most common isolates for the study period were coagulase-negative staphylococci (CoNS) (25%), Pseudomonas aeruginosa (17.7%), Staphylococcus aureus (16.6%), Acinetobacter baumannii (7.7%), Enterobacter spp. (7.1%), Escherichia coli (4.4%), Proteus spp. (3.4%), and Klebsiella spp. (2.9%). Glycopeptide antibiotics and linezolid were the most effective drugs against gram-positive isolates, followed by amikacin (for synergistic combinations), whereas colistin, imipenem, meropenem, cefoperazon/sulbactam, and piperacillin/tazobactam were the most active drugs against Gram-negative isolates, and colistin, ampicillin/sulbactam - against A. baumannii.
Asunto(s)
Antibacterianos , Quemaduras , Pruebas de Sensibilidad Microbiana , Infección de Heridas , Bulgaria/epidemiología , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Quemaduras/microbiología , Quemaduras/complicaciones , Estudios Retrospectivos , Infección de Heridas/microbiología , Infección de Heridas/tratamiento farmacológico , Farmacorresistencia Bacteriana , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificación , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Hospitalización , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Femenino , MasculinoRESUMEN
PURPOSE: Severe burn injuries are often accompanied by infections and associated with high morbidity and mortality. This study aimed to compare the prevalence and clinical impact of bacteremia between patients receiving intensive care with and without burns. METHODS: This single-center retrospective cohort study at the University Hospital Vienna, Austria, analyzed blood cultures from intensive care unit (ICU) patients with and without burns (2012-2022) to assess the prevalence of bacteremia, the associated pathogen distribution and the 60-day all-cause mortality. RESULTS: In 1170 ICU patients, 303 with burns and 867 without, the prevalence of bacteremia was similar among patients with at least one blood culture (31/157 [19.7%] versus 44/213 [20.7%], OR [95%CI] = 0.95 [0.57-1.57]). Burn patients exhibited a significantly higher frequency of microbiological sampling (51.5% versus 24.5%, p < 0.001), resulting in a higher overall prevalence of bacteremia (10.2% versus 5.1%, p = 0.002). 16.2% of all identified pathogens were multidrug-resistant (MDR). The 60-day all-cause mortality was higher in patients with MDR pathogens than in patients without bacteremia (41.7% versus 10.6%, p = 0.026). CONCLUSION: Bacteremia prevalence was similar in burn and non-burn patients, with high rates of multidrug-resistant Gram-negative pathogens. The 60-day all-cause mortality was significantly higher in patients with MDR pathogens than in patients without bacteremia.
Asunto(s)
Bacteriemia , Quemaduras , Unidades de Cuidados Intensivos , Humanos , Quemaduras/complicaciones , Quemaduras/microbiología , Quemaduras/epidemiología , Quemaduras/mortalidad , Estudios Retrospectivos , Bacteriemia/epidemiología , Bacteriemia/microbiología , Bacteriemia/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Prevalencia , Anciano , Unidades de Cuidados Intensivos/estadística & datos numéricos , Austria/epidemiología , Adulto , Farmacorresistencia Bacteriana Múltiple , Cuidados Críticos/estadística & datos numéricos , Antibacterianos/uso terapéuticoRESUMEN
Materials and Methods: In a research experiment, 48 male Wistar rats were anesthetized and second-degree burns were induced on their backs. The rats' wounds were then uniformly inoculated with MRSA. Various treatments were applied to the burn wounds daily, including Myrtus ointment, silver nanoparticles, silver nanoparticles-Myrtus ointment, silver sulfadiazine-Myrtus ointment, silver sulfadiazine 1%, mupirocin ointment, and a positive control. The study measured the antimicrobial effects, wound area, percentage of wound healing, antioxidant capacities, malondialdehyde, and nitric oxide concentrations in the serum of the rats. Data analysis was performed using GraphPad software, with one-way ANOVA and Tukey's tests used to determine the statistical significance of the results. Results: Rats treated with Myrtus ointment, silver nanoparticles-Myrtus ointment, and mupirocin had reduced bacterial growth compared to the positive control group, nanoparticle ointment, and silver sulfadiazine (P < 0.05). The wound area of the Myrtus ointment group decreased significantly on the seventh and fourteenth days, as well as the level of MDA and nitric oxide, compared to the other groups. In Myrtus and silver sulfadiazine-Myrtus ointment increased the thickness of the epidermis and dermis compared to the other groups. Conclusion: Based on the anti-inflammatory, antimicrobial, and wound healing properties of Myrtus, with further studies, an ointment of this plant may be used as a main or complementary treatment for burn wound infections caused by MRSA.
Asunto(s)
Antiinflamatorios , Quemaduras , Staphylococcus aureus Resistente a Meticilina , Myrtus , Pomadas , Extractos Vegetales , Hojas de la Planta , Ratas Wistar , Cicatrización de Heridas , Animales , Cicatrización de Heridas/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Quemaduras/tratamiento farmacológico , Quemaduras/microbiología , Extractos Vegetales/farmacología , Masculino , Pomadas/farmacología , Ratas , Antiinflamatorios/farmacología , Hojas de la Planta/química , Myrtus/química , Antiinfecciosos/farmacología , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Nanopartículas del Metal/química , Sulfadiazina de Plata/farmacologíaRESUMEN
The global increasing spread of multidrug-resistant organisms (MDROs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is patients with burns, who are prone to hyperinfection as they suffer from a hypermetabolic state and weaken immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, we discuss consensuses here. In this review, we aim to present the current knowledge on multidrug resistance with a special focus on patients with burns, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.
Asunto(s)
Quemaduras , Farmacorresistencia Bacteriana Múltiple , Humanos , Quemaduras/terapia , Quemaduras/microbiología , Quemaduras/complicaciones , Quemaduras/tratamiento farmacológico , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los AntimicrobianosRESUMEN
BACKGROUND: Split-thickness skin graft (STSG)1 integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL)2 imaging (MolecuLight®), which accurately locates areas of bacterial loads above 104 CFU/gr, for graft site assessment and preparation could yield better outcomes. METHODS: This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>104 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm2) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed. RESULTS: 38 patients were enrolled in the study. The mean total body surface area (TBSA)3 involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %. CONCLUSIONS: FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes. LEVEL OF EVIDENCE: Level IIA, Therapeutic study.
Asunto(s)
Quemaduras , Imagen Óptica , Trasplante de Piel , Humanos , Quemaduras/cirugía , Quemaduras/diagnóstico por imagen , Quemaduras/microbiología , Trasplante de Piel/métodos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Estudios Prospectivos , Imagen Óptica/métodos , Carga Bacteriana/métodos , Anciano , Supervivencia de Injerto , Infección de Heridas/microbiología , Infección de Heridas/diagnóstico por imagen , Superficie Corporal , Adulto JovenRESUMEN
BACKGROUND: Although patients with severe burns are prone to severe infections with antibiotic-resistant bacteria and inevitably have some risk factors for carbapenem-resistant Enterobacterales (CRE) acquisition, risk factors for CRE infection or colonization in these patients have not been investigated. AIM: To identify the independent risk factors for CRE acquisition in patients with severe burns. METHODS: Patients admitted to the burn intensive care unit (BICU) for acute burn care were categorized based on culture results during BICU care into the CRE group and non-CRE group, which included the carbapenem-susceptible Enterobacterales (CSE) and control groups. Clinical and microbiological factors were compared between the CRE and non-CRE groups, and between the CRE and CSE groups to identify independent risk factors for in-hospital CRE acquisition. FINDINGS: Among the included 489 patients, 101 (20.7%) and 388 (79.3%) patients were classified in the CRE and non-CRE groups, respectively. The non-CRE group included 91 (18.6%) and 297 (60.7%) patients in the CSE and control groups, respectively. In multivariate analysis between the CRE and non-CRE groups, exposure to other CRE-acquired patients (P = 0.018), abbreviated burn severity index score ≥9 (P = 0.012), and mechanical ventilation (P < 0.001) were associated with CRE acquisition. In multivariate analysis between the CRE and CSE groups, exposure to other CRE-acquired patients was associated with CRE acquisition (P = 0.048). CONCLUSION: Considering the limitation of controlling the burn severity in hospitalized patients, enhanced infection control measures for preventing in-hospital CRE transmission among patients with severe burns should be emphasized.
Asunto(s)
Quemaduras , Enterobacteriaceae Resistentes a los Carbapenémicos , Infecciones por Enterobacteriaceae , Humanos , Quemaduras/microbiología , Quemaduras/complicaciones , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/epidemiología , Adulto , Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Anciano , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Unidades de Cuidados Intensivos , Carbapenémicos/farmacología , Anciano de 80 o más Años , Estudios Retrospectivos , Adulto Joven , Unidades de Quemados/estadística & datos numéricosRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: The Yucatan Peninsula has a privileged wealth of vascular plants with which various Mayan herbal formulations have been developed. However, studies on their antipathogenic and antivirulence properties are scarce. AIM OF THE STUDY: Identify antivirulence properties in Mayan herbal remedies and determine their antipathogenic capacity in burn wounds infected with Pseudomonas aeruginosa. MATERIALS AND METHODS: An ethnobotanical study was conducted in Mayan communities in central and southern Quintana Roo, Mexico. Furthermore, the antipathogenic capacity of three Mayan herbal remedies was analyzed using an animal model of thermal damage and P. aeruginosa infection. Antivirulence properties were determined by inhibiting phenotypes regulated by quorum sensing (pyocyanin, biofilm, and swarming) and by the secretion of the ExoU toxin. The chemical composition of the most active herbal remedy was analyzed using molecular network analysis. RESULTS: It was found that topical administration of the remedy called "herbal soap" (HS) for eleven days maintained 100% survival of the animals, reduced establishment of the bacteria in the burn and prevented its systemic dispersion. Although no curative effect was recorded on tissue damaged by HS treatment, its herbal composition strongly reduced swarming and ExoU secretion. Through analysis of Molecular Networks, it was possible to carry out a global study of its chemical components, and identify the family of oxindole monoterpenoid alkaloids and carboline and tetrahydropyrididole alkaloids. In addition, flavonols, flavan-3-ols, and quinic acid derivatives were detected. CONCLUSIONS: The antipathogenic and antivirulence capacity of ancient Mayan remedies makes them a potential resource for developing new antibacterial therapies to treat burns infected by P. aeruginosa.
Asunto(s)
Antibacterianos , Quemaduras , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Pseudomonas aeruginosa/efectos de los fármacos , Animales , México , Quemaduras/tratamiento farmacológico , Quemaduras/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Antibacterianos/farmacología , Extractos Vegetales/farmacología , Masculino , Percepción de Quorum/efectos de los fármacos , Virulencia/efectos de los fármacos , Preparaciones de Plantas/farmacología , Preparaciones de Plantas/uso terapéutico , Biopelículas/efectos de los fármacos , Ratones , Plantas Medicinales/química , FitoterapiaRESUMEN
INTRODUCTION: This study interrogates infection related data in the Burns Registry of Australia and New Zealand (BRANZ), to examine associations of multi-drug resistant organisms (MDROs) and blood stream infection (BSI). METHODS: Data between July 2016 and June 2021 were analysed to determine prevalence, risk factors and outcomes associated with BSIs and MDROs: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Pseudomonas spp. (CRP), and carbapenem-resistant Enterobacter (CRE). Data completeness and value for quality improvement activity were assessed. RESULTS: We found a low incidence (3.4%) of the resistant organisms of interest, and no change over the study period. Fequency varied between services and increased with age and size of burn. MRSA was the commonest organism in all age groups. A positive BSI result occurred in 1.6% of patients (12.1% of cultures taken) at a median time of 10.2 days post injury. Free text identification of organisms was inconsistently documented. CONCLUSIONS: The low rate and patterns of acquisition of MDROs of interest and BSIs is comparable with reports from countries with low incidence of massive burns. Wider adoption of a standardized laboratory reporting framework would help realise the potential of clinical quality registries to provide data which supports evidence based infection prevention initiatives.
Asunto(s)
Bacteriemia , Quemaduras , Farmacorresistencia Bacteriana Múltiple , Staphylococcus aureus Resistente a Meticilina , Sistema de Registros , Humanos , Quemaduras/epidemiología , Quemaduras/microbiología , Nueva Zelanda/epidemiología , Masculino , Australia/epidemiología , Persona de Mediana Edad , Femenino , Adulto , Bacteriemia/epidemiología , Bacteriemia/microbiología , Adulto Joven , Adolescente , Anciano , Niño , Preescolar , Lactante , Enterococos Resistentes a la Vancomicina , Infecciones Estafilocócicas/epidemiología , Enterobacteriaceae Resistentes a los Carbapenémicos , Incidencia , Enterobacter , Pseudomonas aeruginosa , Infecciones por Pseudomonas/epidemiología , Prevalencia , Factores de Riesgo , Infecciones por Enterobacteriaceae/epidemiología , Pseudomonas/efectos de los fármacosRESUMEN
The objective of this study was to evaluate the susceptibilities of pathogens isolated from cultures within the first 7 days of admission to the burn center and in the absence of healthcare-associated infection risk factors (HAIRF) to determine if current empiric antibiotics can be narrowed for refinement of an empiric antibiotic prescribing pathway according to the suspected source. A 3-year sample of patients and cultures was utilized in hopes of obtaining at least 30 isolates of the most common pathogens and their respective susceptibilities. A total of 268 clinically relevant (e.g., deemed infectious, versus colonization) pathogens were included in the final sample with sources including wounds, respiratory, blood, urine, and bone. Of the 268 pathogens included, 45% were Gram-negative and 69% of all pathogens were isolated from wound cultures. The existing empiric pathway, vancomycin plus cefepime, covered 98% and 84% of all Gram-positive and Gram-negative pathogens, respectively. In patients without HAIRF, coverage rose to 98% and 90%, respectively. Initial use of vancomycin and cefepime remains adequate for pathogens isolated within 1 week of admission in patients without HAIRF. For pneumonias, a narrower spectrum beta-lactam would not sufficiently cover respiratory pathogens isolated within the first week of admission. Regarding early wound infections, difficult-to-treat pathogens remain as a rare isolate of wound cultures within 1 week of admission.
Asunto(s)
Antibacterianos , Humanos , Antibacterianos/uso terapéutico , Estudios Retrospectivos , Masculino , Femenino , Quemaduras/microbiología , Quemaduras/tratamiento farmacológico , Quemaduras/terapia , Persona de Mediana Edad , Unidades de Quemados , Adulto , Infección de Heridas/microbiología , Infección de Heridas/tratamiento farmacológico , Cefepima/uso terapéutico , Vancomicina/uso terapéutico , Infección Hospitalaria/microbiología , Infección Hospitalaria/tratamiento farmacológico , Pruebas de Sensibilidad MicrobianaRESUMEN
We present our findings on interpatient transmission, epidemic control measures, and the outcomes of a series of ten critically ill burn patients who were either colonized or infected with carbapenem-resistant Acinetobacter baumannii (CRAB). None of the five infected patients achieved clinical cure, and all experienced relapses. Microbiological failure was observed in 40% of the infected patients. The isolated CRAB strains were found to carry blaOXA-23 and armA resistance genes. Despite the lack of clinical cure, all five infected patients survived and were discharged from the Burn Intensive Care Unit.
Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Antibacterianos , Compuestos de Azabiciclo , Carbapenémicos , Ceftazidima , Brotes de Enfermedades , Combinación de Medicamentos , Unidades de Cuidados Intensivos , Sulbactam , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/genética , Acinetobacter baumannii/aislamiento & purificación , Humanos , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/epidemiología , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Masculino , Compuestos de Azabiciclo/uso terapéutico , Compuestos de Azabiciclo/farmacología , Sulbactam/uso terapéutico , Sulbactam/farmacología , Femenino , Persona de Mediana Edad , Adulto , Carbapenémicos/farmacología , Carbapenémicos/uso terapéutico , Ceftazidima/uso terapéutico , Ceftazidima/farmacología , Quemaduras/complicaciones , Quemaduras/microbiología , Quimioterapia Combinada , Resultado del Tratamiento , Anciano , Infección Hospitalaria/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple/genética , beta-Lactamasas/genética , Unidades de QuemadosRESUMEN
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.