Silver Sulfadiazine Eradicates Antibiotic-Tolerant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms in Patients with Infected Diabetic Foot Ulcers

Infections are among the most frequent and challenging events in diabetic foot ulcers (DFUs). Pathogenic bacteria growing in biofilms within host tissue are highly tolerant to environmental and chemical agents, including antibiotics. The present study was aimed at assessing the use of silver sulfadiazine (SSD) for wound healing and infection control in 16 patients with DFUs harboring biofilm-growing Staphylococcus aureus and Pseudomonas aeruginosa. All patients received a treatment based on a dressing protocol including disinfection, cleansing, application of SSD, and application of nonadherent gauze, followed by sterile gauze and tibio-breech bandage, in preparation for toilet surgery after 30 days of treatment. Clinical parameters were analyzed by the T.I.M.E. classification system. In addition, the activity of SSD against biofilm-growing S. aureus and P. aeruginosa isolates was assessed in vitro. A total of 16 patients with S. aureus and P. aeruginosa infected DFUs were included in the study. Clinical data showed a statistically significant (p < 0.002) improvement of patients’ DFUs after 30 days of treatment with SSD with significant amelioration of all the parameters analyzed. Notably, after 30 days of treatment, resolution of infection was observed in all DFUs. In vitro analysis showed that both S. aureus and P. aeruginosa isolates developed complex and highly structured biofilms. Antibiotic susceptibility profiles indicated that biofilm cultures were significantly (p ≤ 0.002) more tolerant to all tested antimicrobials than their planktonic counterparts. However, SSD was found to be effective against fully developed biofilms of both S. aureus and P. aeruginosa at concentrations below those normally used in clinical preparations (10 mg/mL). These results strongly suggest that the topical administration of SSD may represent an effective alternative to conventional antibiotics for the successful treatment of DFUs infected by biofilm-growing S. aureus and P. aeruginosa.

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Efektivitas Kompres Iodine Terhadap Zona Hambat Staphylococcus Aureus Pada Ulkus Diabetikum

Jurnal Keperawatan Indonesia ◽

10.7454/jki.v16i3.323 ◽

2013 ◽

Vol 16 (3) ◽

pp. 139-144

Author(s):

Asep Kuswandi ◽

Kusmiyati Kusmiyati ◽

Holikin Holikin

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Wound Care ◽

Positive Culture ◽

Foot Ulcers ◽

Distilled Water ◽

Diabetic Foot Ulcers ◽

Average Size

AbstrakUlkus diabetikum merupakan salah satu komplikasi kronis diabetes melitus dan menjadi penyebab amputasi kaki. Infeksi pada ulkus tersebut umumnya disebabkan oleh Staphylococcus aureus. Salah satu teknik pencegahan amputasi kaki diabetes adalah perawatan ulkus. Berbagai jenis bahan kompres ulkus diabetikum yang telah dikenal selama ini adalah:kompres madu, gula, Iodine, dan NaCl 0,9%. Penelitian ini bertujuan mengetahui efektifitas bahan kompres ulkus terhadap daya hambat Staphylococcus aureus. Penelitian ini merupakan penelitian eksperimen in vitro menggunakan satu faktor perlakuan yaitu zona hambat bahan kompres terhadap Staphylococcus aureus pada ulkus diabetikum. Enam jenis bahan yang diuji adalah aquadest, gula, Iodine 10%, campuran gula dan Iodine 10 %, madu, dan NaCl 0,9 %. Eksperimen dilakukan sebanyak 10 kali untuk mengetahui rerata luas daya hambatnya selama 24 jam. Sampel diambil dari ulkus diabetikum. Staphylococcus aureus diisolasi dari ulkus tersebut untuk eksperimen dengan berbagai bahan kompres ulkus. Hasil penelitian menunjukkan bahwa zona hambat madu rata-rata sebesar 0,4 mm, gula 3,0 mm, aquadest 0,0 mm, NaCl 0,9% 0,0 mm, Iodine 10% 8,3 mm dan campuran gula-Iodine 6,0 mm. Zona hambat terluas dihasilkan dari uji menggunakkan Iodine 10% (8,3 mm). Sementara campuran gula Iodine 10% menghasilkan zona hambat seluas 6 mm dan gula menghasilkan 3 mm. Penelitian ini merekomendasikan jika ditemukan Staphylococcus aureus maka dilakukan kompres Iodine 10% dengan kasa steril. Penelitian selanjutnya dengan metode in vivo perlu dilakukan untuk mengetahui efektifitas cairan Iodine pada ulkus diabetikum.Kata Kunci: kompres ulkus, staphylococcus aureus, ulkus diabetikum, zona hambatAbstractEffectivity of Iodine Compress to Blocking Zone of Staphylococcus aureus in Diabetes Ulcers. Diabetic foot ulcers is one of diabetes chronic complications that might lead to leg amputations. Staphylococcus aureus is known as the cause of infection in diabetic foot ulcers. One of techniques to prevent diabetic foot amputations is wound care. Various materials are known to be used to compress diabetic foot ulcers. These include of using honey, sugar, 10% of Iodine and 0.9% of NaCl. This study aimed ttify to identify the effectiveness of various wound care materials to block Staphylococcus aureus. This is an in vitro experiment study to investigate the effetiveness of six wound care materials used to wounds compress: distilled water, sugar, 10% of Iodine, a mixture of sugar and Iodine, honey and 0.9% of NaCl. Experiments were carried out in 10 times to determine the average size of block area in 24 hours. Staphylococcus aureus were isolated and soiled with various wound compressss materialls. The results showed that honey produced 0.4 mm of a blocking zone, 3.0 mm for glucose, 0.0 mm for distilled water, 0.0 mm for 0.9% of NaCl, 8.3 mm for 10% of Iodine, and 6.0 mm for mixed-Iodine Sugar. Ten percents of Iodine produced the widest zone to block Staphylicoccus aureus. This study recommends of apllying a 10% of Iodine compress if there is a positive culture of Staphylococcus aureus. A further in vivo study is a necessity to investigate the effectiveness of Iodine to diabetes foot ulcers.Keywords: blocking zone, diabetic foot ulcers, Staphylococcus aureus, wound compress

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Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734618793557 ◽

2018 ◽

Vol 17 (3) ◽

pp. 161-168 ◽

Cited By ~ 5

Author(s):

Mousab Yousef Al Ayed ◽

Mutasem Ababneh ◽

Asirvatham Alwin Robert ◽

Aus Alzaid ◽

Rania Ahmed Ahmed ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Saudi Arabia ◽

Diabetic Foot ◽

Antibiotic Sensitivity ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Gram Positive ◽

Gram Negative ◽

Klebsiella Spp

We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.

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Efficacy of Maggot Therapy on Staphylococcus aureus and Pseudomonas aeruginosa in Diabetic Foot Ulcers

Journal of Wound Ostomy and Continence Nursing ◽

10.1097/won.0000000000000496 ◽

2019 ◽

Vol 46 (1) ◽

pp. 25-29 ◽

Cited By ~ 9

Author(s):

Azam Malekian ◽

Gholamreza Esmaeeli Djavid ◽

Kamran Akbarzadeh ◽

Mehdi Soltandallal ◽

Yavar Rassi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Maggot Therapy

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Therapeutic Properties of Honey for the Management of Wounds; Is There a Role in the Armamentarium of Diabetic Foot Ulcer Treatment? Results From In vitro and In vivo Studies

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211026819 ◽

2021 ◽

pp. 153473462110268

Author(s):

Ioanna A. Anastasiou ◽

Ioanna Eleftheriadou ◽

Anastasios Tentolouris ◽

Georgia Samakidou ◽

Nikolaos Papanas ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Diabetic Animal ◽

Cochrane Library ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Diabetic Wound ◽

Diabetic Wound Healing ◽

Therapeutic Properties

Diabetic foot ulcers are one of the most dreadful complications of diabetes mellitus and efforts to accelerate diabetic wound healing are of paramount importance to prevent ulcer infections and subsequent lower-limb amputations. There are several treatment approaches for the management of diabetic foot ulcers and honey seems to be a safe and cost-effective therapeutic approach on top of standard of care. The aim of this review was to summarize the therapeutic properties of honey and the data regarding its possible favorable effects on diabetic wound healing. A literature search of articles from 1986 until April 2021 was performed using MEDLINE, EMBASE, and the Cochrane Library to assess for studies examining the therapeutic wound healing properties of honey, it's in vitro effect, and the efficacy and/or mechanism of action of several types of honey used for the treatment of diabetic animal wounds. Honey has antioxidant, anti-inflammatory, and antibacterial properties and in vitro studies of keratinocytes and fibroblasts, as well as studies in diabetic animal models show that treatment with honey is associated with increased re-epithelialization and collagen production, higher wound contraction, and faster wound healing. The use of honey could be a promising approach for the management of diabetic foot ulcers.

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Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana

Pathogens ◽

10.3390/pathogens10080937 ◽

2021 ◽

Vol 10 (8) ◽

pp. 937

Author(s):

Ramzy B. Anafo ◽

Yacoba Atiase ◽

Nicholas T. K. D. Dayie ◽

Fleischer C. N. Kotey ◽

Patience B. Tetteh-Quarcoo ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Multidrug Resistance ◽

Teaching Hospital ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Coagulase Negative Staphylococci ◽

Methicillin Resistant ◽

Mrsa Infection

Aim: This study investigated the spectrum of bacteria infecting the ulcers of individuals with diabetes at the Korle Bu Teaching Hospital in Accra, Ghana, focusing on Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA), with respect to their prevalence, factors predisposing to their infection of the ulcers, and antimicrobial resistance patterns. Methodology: This cross-sectional study was conducted at The Ulcer Clinic, Department of Surgery, Korle Bu Teaching Hospital, involving 100 diabetic foot ulcer patients. The ulcer of each study participant was swabbed and cultured bacteriologically, following standard procedures. Antimicrobial susceptibility testing was done for all S. aureus isolated, using the Kirby-Bauer method. Results: In total, 96% of the participants had their ulcers infected—32.3% (n = 31) of these had their ulcers infected with one bacterium, 47.9% (n = 46) with two bacteria, 18.8% (n = 18) with three bacteria, and 1.0% (n = 1) with four bacteria. The prevalence of S. aureus and MRSA were 19% and 6%, respectively. The distribution of the other bacteria was as follows: coagulase-negative Staphylococci (CoNS) (54%), Escherichia coli (24%), Pseudomonas spp. (19%), Citrobacter koseri and Morganella morgana (12% each), Klebsiella oxytoca (11%), Proteus vulgaris (8%), Enterococcus spp. (6%), Klebsiella pneumoniae (5%), Proteus mirabilis and Enterobacter spp. (4%), Klebsiella spp. (2%), and Streptococcus spp. (1%). The resistance rates of S. aureus decreased across penicillin (100%, n = 19), tetracycline (47.4%, n = 9), cotrimoxazole (42.1%, n = 8), cefoxitin (31.6%, n = 6), erythromycin and clindamycin (26.3% each, n = 5), norfloxacin and gentamicin (15.8% each, n = 3), rifampicin (10.5%, n = 2), linezolid (5.3%, n = 1), and fusidic acid (0.0%, n = 0). The proportion of multidrug resistance was 47.4% (n = 9). Except for foot ulcer infection with coagulase-negative Staphylococci, which was protective of S. aureus infection of the ulcers (OR = 0.029, p = 0.001, 95% CI = 0.004–0.231), no predictor of S. aureus, MRSA, or polymicrobial ulcer infection was identified. Conclusions: The prevalence of S. aureus and MRSA infection of the diabetic foot ulcers were high, but lower than those of the predominant infector, coagulase-negative Staphylococci and the next highest infecting agent, E. coli. Diabetic foot ulcers’ infection with coagulase-negative Staphylococci protected against their infection with S. aureus. The prevalence of multidrug resistance was high, highlighting the need to further intensify antimicrobial stewardship programmes.

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Staphylococcus aureus Serves as an Iron Source for Pseudomonas aeruginosa during In Vivo Coculture

Journal of Bacteriology ◽

10.1128/jb.187.2.554-566.2005 ◽

2005 ◽

Vol 187 (2) ◽

pp. 554-566 ◽

Cited By ~ 174

Author(s):

Lauren M. Mashburn ◽

Amy M. Jett ◽

Darrin R. Akins ◽

Marvin Whiteley

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Pathogenic Bacteria ◽

Iron Acquisition ◽

Low Oxygen ◽

Dialysis Membrane ◽

Opportunistic Human Pathogen ◽

The Impact

ABSTRACT Pseudomonas aeruginosa is a gram-negative opportunistic human pathogen often infecting the lungs of individuals with the heritable disease cystic fibrosis and the peritoneum of individuals undergoing continuous ambulatory peritoneal dialysis. Often these infections are not caused by colonization with P. aeruginosa alone but instead by a consortium of pathogenic bacteria. Little is known about growth and persistence of P. aeruginosa in vivo, and less is known about the impact of coinfecting bacteria on P. aeruginosa pathogenesis and physiology. In this study, a rat dialysis membrane peritoneal model was used to evaluate the in vivo transcriptome of P. aeruginosa in monoculture and in coculture with Staphylococcus aureus. Monoculture results indicate that approximately 5% of all P. aeruginosa genes are differentially regulated during growth in vivo compared to in vitro controls. Included in this analysis are genes important for iron acquisition and growth in low-oxygen environments. The presence of S. aureus caused decreased transcription of P. aeruginosa iron-regulated genes during in vivo coculture, indicating that the presence of S. aureus increases usable iron for P. aeruginosa in this environment. We propose a model where P. aeruginosa lyses S. aureus and uses released iron for growth in low-iron environments.

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Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0038 ◽

2013 ◽

Vol 20 (4) ◽

pp. 389-393 ◽

Cited By ~ 2

Author(s):

Teodora Chiţă ◽

Delia Muntean ◽

Luminiţa Badiţoiu ◽

Bogdan Timar ◽

Roxana Moldovan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Staphylococcus Aureus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Resistance Pattern ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Bacterial Strains ◽

Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

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