Topical Ointment for Management of Infected Wounds

Optimal prevention of microbial infection at the wound site is a priority clinical consideration required to facilitate normal healing process. Topical antimicrobials are commonly used for treatment and prevention of local wound infections. Herein, an anhydrous, hydrophilic, non-greasy, and non-occlusive antimicrobial ointment was formulated by incorporating two main active ingredients, CuO(1−x)ZnOx and (±)-α-bisabolol. CuO(1−x)ZnOx nanocomposite was added to provide a broad-spectrum antimicrobial activity through the release of reactive oxygen species. (±)-α-Bisbolol was added to expedite the wound healing process. Prepared ointment showed very high killing efficacy against a spectrum of bacteria ( ̴6Log reduction) and a pathogenic yeast ( ̴5Log reduction) within 2h of exposure. Results described here would be of great benefit to professionals as wells as for personal use in treating infected wounds.

Anhydrous Topical Ointment for Management of Infected Wounds

Optimal prevention of microbial infection at the wound site is a priority clinical consideration required to facilitate normal healing process. Topical antimicrobials are commonly used for treatment and prevention of local wound infections. Herein, an anhydrous, hydrophilic, non-greasy, and non-occlusive antimicrobial ointment was formulated by incorporating two main active ingredients, CuO(1−x)ZnOx and (±)-α-bisabolol. CuO(1−x)ZnOx nanocomposite was added to provide a broad-spectrum antimicrobial activity through the release of reactive oxygen species. (±)-α-Bisbolol was added to expedite the wound healing process. Prepared ointment showed very high killing efficacy against a spectrum of bacteria ( ̴6Log reduction) and a pathogenic yeast ( ̴5Log reduction) within 2h of exposure. Results described here would be of great benefit to professionals as wells as for personal use in treating infected wounds.

Efficacy of riboflavin/UV-A corneal phototherapy as stand-alone treatment for ulcerative keratitis in horses

The purpose of this study was to assess the efficacy of riboflavin/UV-A corneal phototherapy in comparison with topical antimicrobials for the treatment of corneal ulcers in horses. Nineteen horses with a diagnosis of corneal ulceration were randomised to receive either corneal phototherapy (11 horses) or topical antimicrobial therapy (8 horses). The corneal phototherapy consisted in the application of a riboflavin-enriched ophthalmic solution onto the cornea for 20 min followed by cornea UV-A irradiation at 30 mW/cm² for 3 min using a point-of-care UV-A device. A complete ophthalmological examination was performed at enrolment and then at day 1, 3, 7, 14, 21, 28, 35, 42, and 49 after treatment. The corneal ulcer was considered healed when the fluorescein staining was negative. The corneal phototherapy succeeded in the complete corneal wound healing in 91% cases (10/11 horses) by 12.7 ± 5.5 days. In the topical antimicrobial group, no horse showed improvement of the corneal ulceration (0/8; 0%) and two eyes had a corneal perforation. Six horses, due to an enlarged corneal lesion, underwent corneal phototherapy at day 14 and achieved complete wound healing by 17.2 ± 5.5 days in 83% cases (5/6). The corneal phototherapy was shown to be an effective and safe treatment for equine corneal ulcers.

In vitro activity and resistance rates of topical antimicrobials fusidic acid, mupirocin and ozenoxacin against skin and soft tissue infection pathogens obtained across Canada (CANWARD 2007–18)

Background Current antimicrobial susceptibility/resistance data versus skin and soft tissue infection (SSTI) pathogens help to guide empirical treatment using topical antimicrobials. Objectives To assess the in vitro activity and resistance rates of fusidic acid, mupirocin, ozenoxacin and comparator agents against pathogens isolated from patients with SSTIs in Canada. Methods SSTI isolates of MSSA (n = 422), MRSA (n = 283) and Streptococcus pyogenes (n = 46) obtained from CANWARD 2007–18 were tested using CLSI broth microdilution. Fusidic acid low-level resistance was defined as an MIC of ≥2 mg/L and high-level resistance as an MIC ≥512 mg/L. Mupirocin high-level resistance was defined as an MIC ≥512 mg/L and low-level resistance was an MIC of 2–256 mg/L. Results Low-level and high-level fusidic acid resistance in MSSA was 10.9% and 1.7%, respectively. Low-level and high-level fusidic acid resistance in MRSA was 10.6% and 3.5%, respectively. High-level mupirocin resistance was identified in 1.4% of MSSA and 14.1% of MRSA, respectively. Versus MSSA, ozenoxacin demonstrated MIC50 and MIC90 of 0.004 and 0.25 mg/L, respectively. Against MRSA, ozenoxacin inhibited all isolates at an MIC of ≤0.5 mg/L, including isolates with ciprofloxacin MICs >2 mg/L, clarithromycin-resistant, clindamycin-resistant, high-level fusidic acid-resistant and high-level mupirocin-resistant isolates. Conclusions We conclude that fusidic acid low-level resistance exceeded 10% for both MSSA and MRSA while fusidic acid high-level resistance was ≤3.5%. Mupirocin high-level resistance exceeded 10% in MRSA. Ozenoxacin is active versus SSTI pathogens including MRSA resistant to fluoroquinolones, macrolides, clindamycin, fusidic acid and mupirocin.

TOPICAL ANTIMICROBIAL OINTMENT AND GEL PREPARATION FROM BIOSYNTHESISED SILVER NANOPARTICLE USING TABERNAEMONTANA DIVARICATE

Topical antimicrobials are mainly used to ght against infection caused by any micro-organism like fungi, virus and bacteria. The topical antimicrobial ointment and gel is less toxic compared to the chemical formulation. Tabernaemontana divericata have antimicrobial, antioxidant, antitumor and analgesic effect. It is known for its therapeutic effect in the healing of wound and treatment of various diseases like skin diseases, aches, ascaris, scabies, eye diseases and pain. In the present study, Silver nanoparticle was synthesised from the stem extract of Tabarnaemontana divaricata. 1mM of silver nitrate was used for the synthesis of silver nanoparticle. Ointment and gel preparations were made using biosynthesised nanoparticle and physical evaluation was carried out. Both ointment and gel forms are known to exhibit high antimicrobial activity as compared to the commercially available ointment and gel. They also have antioxidant, anticoagulation, anti-inammatory, anticancer activity and are proved to exhibit less cytotoxic effects. This may be of therapeutic value and be a widely accepted treatment modality.

A National Aged Care Infection and Antimicrobial Use Survey: A Three-Year Report

Background: Australia has ~2,700 aged-care homes and 180 multipurpose services. The annual Aged Care National Antimicrobial Prescribing Survey (AC NAPS), first pilot tested in 2015, is a surveillance tool that can be used in these facilities to monitor infections and antimicrobial use. It assists in identifying priorities for local and national infection control and antimicrobial stewardship interventions. Methods: Nurses or pharmacists collect point prevalence data using standardized data collection forms: (1) A facility form, completed by each participating facility, includes resident-level data fields (eg, number of residents present on the survey day). (2) An infection form is completed for residents with signs and/or symptoms of infection. (3) An antimicrobial form is completed for residents who are prescribed an antimicrobial. Results: Regarding prevalence,for those 31 facilities that participated annually, there was no significant change in either prevalence rate (Table 1). Regarding priority areas for improvement (2018 data only), 64.6% of prescriptions were for residents who did not have signs and/or symptoms of a suspected infection in the week prior to the antimicrobial start date. The most common clinical indications for prescriptions were skin soft-tissue and mucosal infection (18.3%), cystitis (16.0%) and pneumonia (9.4%). Cefalexin (20.3%), clotrimazole (19.0%), and chloramphenicol (7.0%) were the most commonly prescribed antimicrobials. Review or stop dates were not documented for 58.9% of prescriptions. Only 39.2% of antimicrobials were prescribed in the 7 days prior to the survey day; 28.3% were prescribed >6 months prior. Furthermore, 36.3% of all prescriptions were for topical application. In addition, 19.0% of antimicrobials were prescribed for PRN (as needed) administration; most (94.4%) of these were for topical antimicrobials, most commonly clotrimazole (65.4%). Conclusions: The AC NAPS has identified infections and consistent patterns of antimicrobial use that may adversely affect the safety of care for Australian aged-care residents. Interventions are now being developed, implemented, and evaluated to address identified ‘priority areas for improvement.’Funding: NoneDisclosures: None

Efficacy of Topical Antimicrobial Agents Against Bacterial Isolates From Burn Wounds

Topically applied antimicrobials are key to the prevention of infection and mortality in the acute burn population. The purpose of this study was to determine the in vitro effectiveness of commercially available topical antimicrobials, as well as topical preparations that were compounded in our burn care institution. One-hundred twenty microorganisms were tested against these topical antimicrobials and in vitro effectiveness was observed. Results showed that compounded preparations of 1:1:1 + Double Antibiotic (1 part bacitracin: 1 part silver sulfadiazine: 100,000 units/g nystatin + 5 mg/g neomycin sulfate + 500 units/g polymyxin B) and 3:1 + Double Antibiotic (3 part bacitracin: 1 part silver sulfadiazine + 5mg/g neomycin sulfate + 500 units/g polymyxin B) were effective against 100% of the isolates tested. Other topical agents showed moderate effectiveness, thus demonstrating the need for multiple topical agents to reach a broad spectrum of microorganisms. However, the development of topical antimicrobial resistance needs further study.

Improving utilisation of RVNs in dermatology cases

Pressure on veterinary surgeons to prescribe antibiotics can present in many formats, these can include, time, financial and the owner's expectations. Protocols and guidelines set out within the veterinary practice can help veterinary surgeons by providing structures on how to proceed in set circumstances. Veterinary bodies and representative associations have produced literature and guidance notes on antimicrobial use and these can be built into veterinary practice protocols and clinical guidelines. The introduction of an ear cytology microscopic examination being performed prior to antimicrobial prescribing showed an increase in the utilisation of the registered veterinary nurse (RVN) in the performing of this task, and a decrease in the net value of topical antimicrobials being prescribed was noted. The overall financial value to the practice was however increased.

52 Developing a Topical Antibiogram in the Burn Unit

Introduction Antibiograms display susceptibilities based on bacterial growth in response to systemic agents, utilizing automated systems performing bacterial identification and susceptibility testing. There is a paucity of literature regarding burn-specific antibiograms or susceptibility testing of organisms isolated from wound cultures against topical antimicrobials. Our goal was to create an institutional topical antimicrobial antibiogram in burn and dermatologic disorder patients. Methods Institutional topical antimicrobial agent susceptibilities were retrospectively reviewed from 1/1/18-12/31/18. Quantitative biopsies or swabs collected from patients were cultured. Susceptibility plates were prepared by wells aseptically punched into an agar plate and inoculated with antimicrobial creams. Bacterial isolates were then inoculated in melted agar, overlaid onto the susceptibility dish, and incubated. Zones of inhibition (ZOI) were reported in mm; susceptible being any measurable zone and resistant defined as a zone of 0 mm. Isolated organisms were grouped as Gram-positive cocci (GPC), Gram-negative rods (GNR), or yeast-like fungi (YLF). Results In 2018, 21 organisms were tested for susceptibility in 19 patients with positive cultures. Overall susceptibilities of isolates were 71–91%. Overall, susceptibility rates were: gentamicin 71%, mupirocin 77%, silver sulfadiazine 77%, and mafenide 91%. All C. albicans isolates were susceptible to nystatin. Excluding resistant isolates, the median (IQR) ZOI measurements were: gentamicin 10.0 (7.0, 15.0), mupirocin 12.0 (7.5, 27.0), silver sulfadiazine 8.0 (7.0, 10.5), and mafenide 14.5 (10.3, 19.8). Of organisms reported, there were 10 GNR (45%), 8 GPC (36%), and 4 YLF (18%), with P. aeruginosa, MRSA, and C. albicans being most common. For GPC, susceptibility rates were 63–88% and median (IQR) ZOI measurements were: gentamicin 16.0 (8.0, 30.0), mupirocin 27.0 (9.8, 35.5), silver sulfadiazine 10.0 (8.5, 19.0), and mafenide 15.0 (10.0, 22.0). For GNR, susceptibility rates were 70–90% and median (IQR) ZOI measurements were: gentamicin 10.0 (6.0, 11.0), mupirocin 12.0 (7.0, 18.0), silver sulfadiazine 7.5 (7.0, 9.5), and mafenide 15.0 (13.0, 19.0). Conclusions Based on susceptibility profiles of isolated organisms, mafenide appears to be an appropriate first-line empiric agent with an overall susceptibility rate greater than 90% and the largest ZOI amongst topical agents tested. When examining GPC, mupirocin demonstrated the largest ZOI and may be a more appropriate empiric choice if Gram-stain results are available. Applicability of Research to Practice To our knowledge, no previously published studies exist in burn patients examining susceptibilities to topical antimicrobials. These antibiogram-level data provide direction for empiric treatment of wound infections utilizing local susceptibilities for targeted topical coverage.