scholarly journals Reducing Biofilm Infections in Burn Patients’ Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review

2021 ◽  
Vol 18 (24) ◽  
pp. 13195
Author(s):  
Roger E. Thomas ◽  
Bennett Charles Thomas
Keyword(s):  
Medical Equipment ◽  
Light Therapy ◽  
Multidrug Resistant ◽  
Burn Patients ◽  
Acinetobacter Baumanii ◽  
Minimal Inhibitory Concentrations ◽  
Burn Care ◽  
Medical Facilities ◽  
Bacterial Surfaces ◽  
Hospital Cleaning

Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms. Key pathogens are Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Acinetobacter baumanii. Purpose: identify current and novel interventions to reduce biofilms on patients’ burns and hospital surfaces and equipment. Medline and Embase were searched without date or language limits, and 31 possible interventions were prioritised: phages, nano-silver, AgSD-NLs@Cur, Acticoat and Mepilex silver, acetic acid, graphene-metal combinations, CuCo2SO4 nanoparticles, Chlorhexidene acetate nanoemulsion, a hydrogel with moxifloxacin, carbomer, Chitosan and Boswellia, LED light therapy with nano-emodin or antimicrobial blue light + Carvacrol to release reactive oxygen species, mannosidase + trypsin, NCK-10 (a napthalene compound with a decyl chain), antimicrobial peptide PV3 (includes two snake venoms), and polypeptides P03 and PL2. Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes. Scanning electron microscopy identified important changes in bacterial surfaces. Patients with biofilms need isolating and treating before full admission to hospital. Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.

scholarly journals 840. First Report of Pseudomonas aeruginosa Isolates Harboring the CTX-M2 and PER genes in Algeria

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S461-S461
Author(s):  
Marianna Almpani ◽  
Asma Tchakal-Mesbahi ◽  
Merzak Metref ◽  
Vijay K Singh ◽  
Laurence G Rahme
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Multidrug Resistant ◽  
Military Hospital ◽  
Burn Patients ◽  
Beta Lactamases ◽  
First Report ◽  
Burn Care ◽  
The North ◽  
Automated Method ◽  
Genes Encoding

Abstract Background Despite significant improvements in burn care, multidrug-resistant (MDR) Pseudomonas aeruginosa (PA) remains one of the most common causes of life-threatening infections in patients suffering from thermal injuries. The objective of this study is to investigate the prevalence of MDR PA producing Extended-Spectrum Beta-lactamases (ESBLs) and metallo-beta-lactamases (MBLs) in burn patients in Algeria. Methods Between April 2016 and October 2019, 47 non-redundant isolates of PA were collected from 47 burn patients admitted to the Department of Burns at the Military Hospital of Algiers in Algeria. Antibiotic susceptibility testing was performed by agar diffusion and the Phoenix automated method. Resistance genes were identified by PCR, and molecular typing of isolates was carried out by enterobacterial repetitive intergenic consensus (ERIC) sequences-polymerase chain reaction (PCR). Results Among the 47 non-redundant MDR PA strains isolated, 59.57% were phenotypically ESBLs-positive, and 100% were phenotypically MBL-positive. The ESBL-positive isolates were subsequently screened for five groups of bla genes encoding ESBL-type enzymes, namely CTX-M2, PER, TEM, SHV, VEB, and GES. Out of the 28 ESBL-producing strains, 23 (82.14%) were CTX-M2 positive; 18 (38.29%) were PER positive, and 16 (34.04%) were TEM positive, while 5 (17.9%) were co-harboring CTX-M2, TEM, and PER genes. The SHV, VEB, and GES genes were not detected in any of the ESBL positive isolates. Since all isolates were MBL-positive, all 47 strains were screened for the NDM-1, IMP, VIM genes that produce MBLs; however, none of these genes were detected. Additional screening for the OprD gene demonstrated that 45 (95.74%) of the isolates were positive for this gene. Finally, ERIC PCR revealed 6 distinct PA clones among the CTX-M2 positive strains. Table 1: Occurrence of beta-lactamase genes in relation to the antimicrobial susceptibility profiles of the PA isolates. Conclusion This is the first report of CTX-M2-producing PA in the North Africa region and the first to detect CTX-M2-positive and PER-positive PA clinical isolates in Algeria, therefore demonstrating the spread of such MDR strains in this part of the world. Identification of genotypic alterations that confer antibiotic resistance is critical in determining effective antimicrobial strategies. Hence, these findings could potentially guide antibiotic choice decisions. World map with countries where PER- and CTX-M2-postive Pseudomonas aeruginosa isolates have been reported. Disclosures All Authors: No reported disclosures

Surgical Site Infections - A Hospital Havoc: Retrospective Study of Surgical Site Infections in Tertiary Health Care Centre in North East India

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
V Singh ◽  
A B Khyriem, W V Lyngdoh ◽  
C J Lyngdoh
Keyword(s):  
Surgical Site Infection ◽  
Multiple Drug Resistance ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
Multiple Drug ◽  
Site Infection ◽  
Retrospective Case ◽  
Acinetobacter Baumanii ◽  
Health Care Centre ◽  
North East

Objectives - Surgical site infections (SSI) has turn out to be a major problem even in hospital with most modern facilities and standard protocols of pre -operative preparation and antibiotic prophylaxis. Objective of this study is to know the prevalence of surgical site infection among the postoperative patients and to identify the relationship between SSI and etiological pathogens along with their antimicrobial susceptibility at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. Methods - A retrospective case study conducted at NEIGRIHMS, among patients admitted to the surgical departments during the period between January 1st and December 31st 2016. Swabs from the surgical sites were collected under sterile conditions and standard bacteriological tests were performed for identification and appropriate statistical methods were employed to look for association between SSI and etiological pathogens. Results - Out of the 1284 samples included in the study, 192 samples showed evidence of SSI yielding an infection rate of 14.9%. The most commonly isolated bacteria were: Escherichia coli, Acinetobacter baumanii and Staphylococcus aureus, of the gram negative isolates 6.2% were multidrug resistant of which 19% were carbapenem resistant. Conclusion - SSI with multiple drug resistance strains and polymicrobial etiology reflects therapeutic failure. The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) incorporate a proper antibiotic stewardship  b) conduct periodic surveillance to keep a check on SSI d) educate medical staffs regarding the prevention of surgical site infection.

Modulation of the drug resistance by Platonia insignis Mart. extract, ethyl acetate fraction and Morelloflavone/Volkensiflavone (biflavonoids) in Staphylococcus aureus strains overexpressing efflux pump genes

2020 ◽  
Vol 21 ◽  
Author(s):  
Andressa Kelly Ferreira e Silva ◽  
Antonielly Campinho dos Reis ◽  
Emanuelly Elanny Andrade Pinheiroc ◽  
Jonas Nascimento de Sousa ◽  
Felipe Araújo de Alcântara Oliveira ◽  
...  
Keyword(s):  
Natural Products ◽  
Ethyl Acetate ◽  
Native Species ◽  
Efflux Pump ◽  
Public Health Problem ◽  
Ethyl Acetate Fraction ◽  
Multidrug Resistant ◽  
Global Public Health ◽  
Minimal Inhibitory Concentrations ◽  
Subinhibitory Concentrations

Background: Microbial resistance to antibiotics is a global public health problem, which requires urgent attention. Platonia insignis is a native species from the eastern Brazilian Amazon, used in the treatment of burns and wounds. Objectives: To evaluate the antimicrobial activity of the hydroalcoholic extract of P. insignis (PIHA), the ethyl acetate fraction (PIAE), and its subfraction containing a mixture of biflavonoids (BF). Moreover, the effect of these natural products on the antibiotic activity against S. aureus strains overexpressing efflux pump genes was also evaluated. Methods: Minimal inhibitory concentrations were determined against different species of microorganisms. To evaluate the modulatory effect on the Norfloxacin-resistance, the MIC of this antibiotic was determined in the absence and presence of the natural products at subinhibitory concentrations. Inhibition of the EtBr efflux assays were conducted in the absence or presence of the natural products. Results: PIHA showed a microbicidal effect against S. aureus and C. albicans, while PIAE was bacteriosctatic for S. aureus. PIAE and BF at subinhibitory concentrations were able to reduce the MIC of Norfloxacin acting as modulating agents. BF was able to inhibit the efflux of EtBr efflux in S. aureus strains overexpressing specific efflux pump genes. Conclusion: P. inignisis a source of efflux pump inhibitors, including volkensiflavone and morelloflavone which were able to potentiate the Norfloxacin activity by NorA inhibition, being also able to inhibit QacA/B, TetK and MsrA. Volkensiflavone and morelloflavone could be used as adjuvant in the antibiotic therapy of multidrug resistant S. aureus strains overexpressing efflux pumps.

scholarly journals A molecular architectural design that promises potent antimicrobial activity against multidrug-resistant pathogens

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Bing Yuan ◽  
Jiaojiao Liu ◽  
Zhixiong Deng ◽  
Lin Wei ◽  
Wenwen Li ◽  
...  
Keyword(s):  
Architectural Design ◽  
Building Blocks ◽  
Multidrug Resistant ◽  
In Vitro Cytotoxicity ◽  
Antimicrobial Drugs ◽  
Minimal Inhibitory Concentrations ◽  
Antimicrobial Efficiency ◽  
Multidrug Resistant Pathogens

AbstractAddressing the devastating threat of drug-resistant pathogens requires the discovery of new antibiotics with advanced action mechanisms and/or novel strategies for drug design. Herein, from a biophysical perspective, we design a class of synthetic antibacterial complexes with specialized architectures based on melittin (Mel), a natural antimicrobial peptide, and poly(ethylene glycol) (PEG), a clinically available agent, as building blocks that show potent and architecture-modulated antibacterial activity. Among the complexes, the flexibly linear complex consisting of one Mel terminally connected with a long-chained PEG (e.g., PEG12k–1*Mel) shows the most pronounced improvement in performance compared with pristine Mel, with up to 500% improvement in antimicrobial efficiency, excellent in vitro activity against multidrug-resistant pathogens (over a range of minimal inhibitory concentrations of 2–32 µg mL−1), a 68% decrease in in vitro cytotoxicity, and a 57% decrease in in vivo acute toxicity. A lipid-specific mode of action in membrane recognition and an accelerated “channel” effect in perforating the bacterial membrane of the complex are described. Our results introduce a new way to design highly efficient and low-toxicity antimicrobial drugs based on architectural modulations with clinically available agents.

scholarly journals Antimicrobial Activity of Cyclic-Monomeric and Dimeric Derivatives of the Snail-Derived Peptide Cm-p5 against Viral and Multidrug-Resistant Bacterial Strains

Biomolecules ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 745
Author(s):  
Melaine González-García ◽  
Fidel Morales-Vicente ◽  
Erbio Díaz Pico ◽  
Hilda Garay ◽  
Daniel G. Rivera ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Activity ◽  
Antifungal Activity ◽  
Multidrug Resistant ◽  
Moderate Activity ◽  
Dependent Manner ◽  
Bacterial Strains ◽  
Acinetobacter Baumanii ◽  
Concentration Dependent Manner ◽  
Conventional Antibiotics

Cm-p5 is a snail-derived antimicrobial peptide, which demonstrated antifungal activity against the pathogenic strains of Candida albicans. Previously we synthetized a cyclic monomer as well as a parallel and an antiparallel dimer of Cm-p5 with improved antifungal activity. Considering the alarming increase of microbial resistance to conventional antibiotics, here we evaluated the antimicrobial activity of these derivatives against multiresistant and problematic bacteria and against important viral agents. The three peptides showed a moderate activity against Pseudomonas aeruginosa, Klebsiella pneumoniae Extended Spectrum β-Lactamase (ESBL), and Streptococcus agalactiae, with MIC values > 100 µg/mL. They exerted a considerable activity with MIC values between 25–50 µg/mL against Acinetobacter baumanii and Enterococcus faecium. In addition, the two dimers showed a moderate activity against Pseudomonas aeruginosa PA14. The three Cm-p5 derivatives inhibited a virulent extracellular strain of Mycobacterium tuberculosis, in a dose-dependent manner. Moreover, they inhibited Herpes Simplex Virus 2 (HSV-2) infection in a concentration-dependent manner, but had no effect on infection by the Zika Virus (ZIKV) or pseudoparticles of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). At concentrations of >100 µg/mL, the three new Cm-p5 derivatives showed toxicity on different eukaryotic cells tested. Considering a certain cell toxicity but a potential interesting activity against the multiresistant strains of bacteria and HSV-2, our compounds require future structural optimization.

Persistent Acinetobacter baumannii? Look Inside Your Medical Equipment

2004 ◽  
Vol 25 (11) ◽  
pp. 1002-1004 ◽  
Author(s):  
A. T. Bernards ◽  
H. I. J. Harinck ◽  
L. Dijkshoorn ◽  
T. J. K. van der Reijden ◽  
P. J. van den Broek
Keyword(s):  
Acinetobacter Baumannii ◽  
Medical Equipment ◽  
Multidrug Resistant

AbstractTwo outbreaks of multidrug-resistant Acinetobacter baumannii occurred in our hospital. The outbreak strains were eventually isolated from respiratory ventilators, an apparatus used to cool or warm patients, and four continuous veno-venous hemofiltration machines. Removing dust from the machines and replacing all dust filters brought the outbreaks to an end.

scholarly journals Arginine Is a Critical Substrate for the Pathogenesis of Pseudomonas aeruginosa in Burn Wound Infections

mBio ◽  
2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Jake Everett ◽  
Keith Turner ◽  
Qiuxian Cai ◽  
Vernita Gordon ◽  
Marvin Whiteley ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Hospital Setting ◽  
Multidrug Resistant ◽  
Burn Patients ◽  
Burn Wound ◽  
Burn Wounds ◽  
Resistant Strains ◽  
High Doses ◽  
Ubiquitous Presence

ABSTRACT Environmental conditions affect bacterial behavior and can greatly influence the course of an infection. However, the environmental cues that elicit bacterial responses in specific infection sites are relatively unknown. Pseudomonas aeruginosa is ubiquitous in nature and typically innocuous. However, it is also one of the most prevalent causes of fatal sepsis in burn wound patients. The aim of this study was to determine the impact of environmental factors, specifically the availability of arginine, on the pathogenesis of P. aeruginosa in burn wound infections. Comparison of burned versus noninjured tissue revealed that l-arginine (l-Arg) was significantly depleted in burn wounds as a consequence of elevated arginase produced by myeloid-derived suppressor cells. We also observed that l-Arg was a potent chemoattractant for P. aeruginosa, and while low concentrations of l-Arg increased P. aeruginosa’s swimming motility, high concentrations resulted in diminished swimming. Based on these observations, we tested whether the administration of exogenous l-Arg into the burn wound could attenuate the virulence of P. aeruginosa in thermally injured mice. Administration of l-Arg resulted in decreased P. aeruginosa spread and sepsis and increased animal survival. Taken together, these data demonstrate that the availability of environmental arginine greatly influences the virulence of P. aeruginosa in vivo and may represent a promising phenotype-modulating tool for future therapeutic avenues. IMPORTANCE Despite our growing understanding of the pathophysiology of burn wounds and the evolution of techniques and practices to manage infections, sepsis remains a significant medical concern for burn patients. P. aeruginosa continues to be a leader among all causes of bacteremic infections due to its tendency to cause complications in immunocompromised patients and its ubiquitous presence in the hospital setting. With the unforgiving emergence of multidrug-resistant strains, it is critical that alternative strategies to control or prevent septic infections in burn patients be developed in parallel with novel antimicrobial agents. In this study, we observed that administration of l-Arg significantly reduced bacterial spread and sepsis in burned mice infected with P. aeruginosa. Given the safety of l-Arg in high doses and its potential wound-healing benefits, this conditionally essential amino acid may represent a useful tool to modulate bacterial behavior in vivo and prevent sepsis in burn patients. IMPORTANCE Despite our growing understanding of the pathophysiology of burn wounds and the evolution of techniques and practices to manage infections, sepsis remains a significant medical concern for burn patients. P. aeruginosa continues to be a leader among all causes of bacteremic infections due to its tendency to cause complications in immunocompromised patients and its ubiquitous presence in the hospital setting. With the unforgiving emergence of multidrug-resistant strains, it is critical that alternative strategies to control or prevent septic infections in burn patients be developed in parallel with novel antimicrobial agents. In this study, we observed that administration of l-Arg significantly reduced bacterial spread and sepsis in burned mice infected with P. aeruginosa. Given the safety of l-Arg in high doses and its potential wound-healing benefits, this conditionally essential amino acid may represent a useful tool to modulate bacterial behavior in vivo and prevent sepsis in burn patients.

104 Comorbidity Does Not Predict Outcomes After Burn Injury in the Elderly

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S68-S68
Author(s):  
Isabel Bernal ◽  
Rosemary Paine ◽  
Damien W Carter ◽  
Carolyne Falank
Keyword(s):  
Elderly Patients ◽  
Wound Infection ◽  
Burn Injury ◽  
Pearson Correlation ◽  
Graft Loss ◽  
Kidney Injury ◽  
The Elderly ◽  
Burn Patients ◽  
Discharge Disposition ◽  
Burn Care

Abstract Introduction As the population ages; burn centers, especially those with a large rural catchment, will be expected to care for older adults with complex medical co-morbidities. Recent work has shown that %TBSA at which 50% of patients would be expected to die (LD50) for elderly patients is up to 20% lower than non-elderly patients. However, the factors contributing to mortality are unclear. We undertook this study to characterize our experience with elderly burn patients in our rural state and to understand how mortality is affected by comorbid disease. Methods We performed a retrospective review of all burn patients ≥50 years old admitted to our burn center over a 5 year period between January 2014 and December 2018. We collected demographic and injury data including %TBSA, mechanism, inhalation injury status, discharge disposition, length of stay as well as complications including pneumonia, kidney injury, wound infection and graft loss. We calculated the modified Baux score, Charlson Comorbidity Index (CCI) and overall mortality for each patient. The %TBSA and CCI were correlated with complications and mortality using the Pearson correlation coefficient analysis. Results There were 243 patients (35%) who met inclusion criteria out of total of 688 burn admissions during that period. The median age was 60 years (mean 62.2, range: 50–95) and 72.4% were male. The median TBSA was 4% (mean: 8.2%, range: 0.5% - 55%). We found weak correlations between CCI and both pneumonia (R=0.177, p=0.005) and mortality (R=0.1297, p=0.0434). There was also a weak correlation between %TBSA and pneumonia (R=0.3302, p < 0.001), kidney injury (R=0.205, p=0.001), wound infection (R=0.1295, p=0.045) and graft loss (R=0.2616, p< 0.001). Interestingly, in the subgroup with > 15% TBSA burns (n=35), there was no significant correlation with increased complications. For the entire cohort, the predicted mortality based on the mean modified Baux score was 16%. The actual observed mortality was 4.1%. Conclusions Our findings suggest that, in our center, CCI is not predictive of burn related complications or mortality and %TBSA is not predictive of complications or death. The observed to expected mortality ratio was remarkably low. Applicability of Research to Practice As we treat older burn patients, it is important to identify the individual patient factors and hospital specific burn care factors that may improve outcomes in the elderly population.

Sign in / Sign up

Export Citation Format

Share Document