ascorbic-acid and Klebsiella-Infections

The definition of sepsis continues to be as dynamic as the management strategies used to treat this. Sepsis-3 has replaced the earlier systemic inflammatory response syndrome (SIRS)-based diagnoses with the rapid Sequential Organ Failure Assessment (SOFA) score assisting in predicting overall prognosis with regards to mortality. Surgeons have an important role in ensuring adequate source control while recognizing the threat of carbapenem-resistance in gram-negative organisms. Rapid diagnostic tests are being used increasingly for the early identification of multi-drug-resistant organisms (MDROs), with a key emphasis on the multidisciplinary alert of results. Novel, higher generation antibiotic agents have been developed for resistance in ESKCAPE (

Topics: Acinetobacter baumannii; Acinetobacter Infections; Angiotensin II; Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Carbapenem-Resistant Enterobacteriaceae; Drug Resistance, Multiple, Bacterial; Duration of Therapy; Enterobacteriaceae Infections; Enterococcus faecium; Enzyme Inhibitors; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Machine Learning; Methicillin-Resistant Staphylococcus aureus; Methylene Blue; Organ Dysfunction Scores; Patient Care Bundles; Postoperative Complications; Practice Guidelines as Topic; Procalcitonin; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Shock, Septic; Staphylococcal Infections; Thiamine; Vancomycin-Resistant Enterococci; Vasoconstrictor Agents; Vitamin B Complex

Children are at high risk of injuries and wounds. The application of medical grade honey is a promising approach to improving the healing of wounds of various origin and severity. However, the use of medical grade honey in young paediatric patients remains limited. The aim of this study is to show the safety, efficacy and usefulness of medical grade honey in abdominal wounds, of different causes, in paediatric patients.. This was a prospective, observational case series evaluating five young infants with abdominal wounds at the General Hospital in Thessaloniki. All wounds were treated in the same manner with daily medical grade honey applied to the wound area and closely monitored.. All treated wounds rapidly presented granulation tissue formation and underwent re-epithelialisation. Peripheral oedema and inflammation decreased upon initial application. Necrotic tissue was effectively debrided when present. Slough was removed and no signs of infection were detected, irrespective of initial wound presentations. Scar formation was minimal and the full range of motion was preserved in all cases.. Based on this case study, medical grade honey is safe and effective in treating different abdominal wounds, including infected or dehisced wounds as well as burns. The easy application and broad applicability make medical grade honey recommendable as a first-line treatment in paediatric patients.

Topics: Abdominal Injuries; Apitherapy; Appendectomy; Appendicitis; Ascorbic Acid; Bacteroides Infections; Burns; Burns, Chemical; Child; Child, Preschool; Dermatologic Agents; Drug Resistance, Multiple, Bacterial; Edema; Female; Gastrostomy; Greece; Honey; Humans; Infant; Infant, Newborn; Inflammation; Klebsiella Infections; Lanolin; Male; Neuroblastoma; Oils, Volatile; Ointments; Prospective Studies; Re-Epithelialization; Retroperitoneal Neoplasms; Surgical Wound Dehiscence; Surgical Wound Infection; Vitamin E; Vitamins; Zinc Oxide

The observation that antioxidant vitamins fail to confer protective benefits in large, well-designed randomized clinical trials has led many to question the role of oxidative stress in the pathogenesis of disease. However, there is little evidence that proposed antioxidants actually scavenge reactive intermediates in vivo. Ascorbate reacts rapidly with oxidants produced by activated neutrophils in vitro, and neutrophils markedly increase their oxidant production when mice are infected intraperitoneally with the gram-negative bacterium Klebsiella pneumoniae. To explore the antioxidant properties of ascorbate in vivo, we therefore used K. pneumoniae infection as a model of oxidative stress. When mice deficient in L-gulono-gamma-lactone oxidase (Gulo(-/-)), the rate-limiting enzyme in ascorbate synthesis, were depleted of ascorbate and infected with K. pneumoniae, they were three times as likely as ascorbate-replete Gulo(-/-)mice to die from infection. Mass spectrometric analysis of peritoneal lavage fluid revealed a marked increase in the levels of oxidized amino acids and of F2-isoprostanes (sensitive and specific markers of lipid oxidation) in infected animals. Surprisingly, there were no significant differences in the levels of the oxidation products in the ascorbate-deficient and -replete Gulo(-/-)mice. Our observations suggest that ascorbate plays a previously unappreciated role in host defense mechanisms against invading pathogens but that the vitamin does not protect amino acids and lipids from oxidative damage during acute inflammation. To examine the oxidation hypothesis of disease, optimal antioxidant regimens that block oxidative reactions in animals and humans need to be identified.

Topics: Amino Acids; Animals; Antioxidants; Ascorbic Acid; Inflammation; Klebsiella Infections; Klebsiella pneumoniae; L-Gulonolactone Oxidase; Lipid Peroxidation; Mice; Mice, Knockout; Oxidation-Reduction; Sepsis

This study involved 27 geriatric patients with asymptomatic chronic bacteriuria; all had indwelling Foley catheters. The treatment regimens (daily oral dosage) were: methenamine mandelate (MM) granules, 4 gm; MM, 4 gm, plus ascorbic acid, 4 gm; and MM, 4 gm, plus ascorbic acid, 4 gm, plus cranberry cocktail, 1 liter--administered according to a cross-over design. Proteus vulgaris, Pseudomonas aeruginosa and E. coli were the most common urinary organisms. Proteus organisms were more often found in alkaline than in acidic urines, but the type of pathogen had no influence on urinary pH. Urinary formaldehyde concentration [HCHO] was lower in patients with Proteus infection (17.7 micrograms/ml) than in those with Pseudomonas (21.9 micrograms/ml) or E. coli infection (21.8 micrograms/ml). However, for Proteus infection, [HCHO] was higher in patients receiving MM plus ascorbic acid than in those receiving MM alone. Addition of cranberry cocktail to ascorbic acid did not enhance urinary pH, [HCHO] or methenamine efficacy. Our data suggest that in Foley catheter patients with chronic asymptomatic bacteriuria secondary to Proteus, Pseudomonas or E. coli infection, the type of urinary pathogen or the urinary pH cannot be used to predict the efficacy of methenamine therapy either with or without urinary acidifying agents.

Topics: Aged; Ascorbic Acid; Bacteriuria; Escherichia coli Infections; Female; Formaldehyde; Humans; Hydrogen-Ion Concentration; Klebsiella Infections; Male; Methenamine; Proteus Infections; Proteus vulgaris; Providencia; Pseudomonas Infections

Topics: Acidosis, Renal Tubular; Adult; Aged; Ammonium Chloride; Ascorbic Acid; Enterobacter; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Klebsiella Infections; Middle Aged; Proteus Infections; Pseudomonas Infections; Urinary Tract Infections; Urine