epiglucan and Burns

Acinetobacter baumannii has emerged as one of the leading bacteria for nosocomial infections, especially in burn wards and ICUs. The bacteria can easily form biofilm and readily attach to abiotic and biotic surfaces, resulting in persistent biofilm-mediated infections. Being surrounded by self-produced extracellular polymeric substance (EPS), the microorganisms in biofilm can acquire protective property against detrimental environment and their tolerance toward antibiotics is increased. Poly-β-1-6-N-acetylglucosamine (PNAG), the common constituent of EPS in Acinetobacter baumannii, acts as the key virulence factor and plays a crucial role in biofilm formation process. This review describes the properties and functions of the PNAG and its influence on biofilm formation and drug resistance of Acinetobacter baumannii.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; beta-Glucans; Biofilms; Burns; Cross Infection; Drug Resistance, Multiple, Bacterial

(1,3)-β-D-glucan (BD) assays were developed as a method to rapidly diagnose invasive candidiasis (IC). The incidence of fungal infections and the demands for BD assay are gradually increasing in patients with severe trauma and under intensive care. However, the ideal BD cut-off value to predict IC has not been clarified. In this study, we evaluate the predictability of the BD assay and investigate the optimal cut-off value in patients with severe burn injuries.. From July to December 2018, 134 samples from 86 patients with severe burns were analyzed. Serum BD levels were measured utilizing a Fungitell (Cape Cod Inc.) assay. A receiver operator characteristic (ROC) curve was generated, and the cumulative progression of IC was studied using a Cox proportional hazards model. Partial dependence plots (PDP) was applied to predict the risk of IC.. Eleven patients were diagnosed with IC. BD over 120 pg/mL (HR = 8.68; P = 0.001) was found to be independent predictor of the occurrence of IC, when the multivariable Cox model was adjusted for age, total body surface area, inhalation injury, and antifungal agents. The area under the ROC curve was 0.658 (95% CI, 0.513-0.803), at an optimal cut-off value of 124.7 pg/mL. PDP analysis showed the higher predicted IC occurrence at a BD level of 120-150 pg/mL and TBSA over 60%.. Our findings suggest that BD is an independent predictor for IC, and that a BD level between 120 and 150 pg/mL could be utilized for IC prediction.

Topics: beta-Glucans; Burns; Candidiasis, Invasive; Glucans; Humans; Proteoglycans; ROC Curve

Bioactive dressings are usually produced using natural or synthetic polymers. Recently, special attention has been paid to β-glucans that act as immunomodulators and have pro-healing properties. The aim of this research was to use β-1,3-glucan (curdlan) as a base for the production of bioactive dressing materials (curdlan/agarose and curdlan/chitosan) that were additionally enriched with vitamin C and/or hydrocortisone to improve healing of chronic and burn wounds. The secondary goal of the study was to compressively evaluate biological properties of the biomaterials. In this work, it was shown that vitamin C/hydrocortisone-enriched biomaterials exhibited faster vitamin C release profile than hydrocortisone. Consecutive release of the drugs is a desired phenomenon since it protects wounds against accumulation of high and toxic concentrations of the bioactive molecules. Moreover, biomaterials showed gradual release of low doses of the hydrocortisone, which is beneficial during management of burn wounds with hypergranulation tissue. Among all tested variants of biomaterials, dressing materials enriched with hydrocortisone and a mixture of vitamin C/hydrocortisone showed the best therapeutic potential since they had the ability to significantly reduce MMP-2 synthesis by macrophages and increase TGF-β1 release by skin cells. Moreover, materials containing hydrocortisone and its blend with vitamin C stimulated type I collagen deposition by fibroblasts and positively affected their migration and proliferation. Results of the experiments clearly showed that the developed biomaterials enriched with bioactive agents may be promising dressings for the management of non-healing chronic and burn wounds.

Topics: Anti-Inflammatory Agents; Antioxidants; Ascorbic Acid; Bandages; beta-Glucans; Burns; Collagen Type I; Drug Therapy, Combination; Fibroblasts; Humans; Hydrocortisone; Keratinocytes; Sepharose; Wound Healing

Although the serum 1,3-β-D-glucan test has been used as an early diagnostic marker of candidemia, there are few studies regarding the association of serum 1,3-β-D-glucan levels with candidemia in severe burn patients. The purpose of this study was to elucidate the clinical significance of 1,3-β-D-glucan for the diagnosis of candidemia in severe burn patients. Data from 51 severe burn patients whose serum levels of 1,3-β-D-glucan had been measured for the suspicion of invasive fungal infection were analyzed retrospectively. The primary outcome in this study was the detection of candidemia. The levels of 1,3-β-D-glucan (pg/ml) in candidemia and noncandidemia groups ranged from 41.1 to 600.0 with a median of 90.6 and from 5.0 to 41.3 with a median of 6.8, respectively. A significant difference in the levels of 1,3-β-D-glucan was observed between the two groups. The optimal cutoff value was 40 pg/ml, with a sensitivity of 100% and a specificity of 95%, whereas the conventional cutoff value (11 pg/ml) resulted in a sensitivity of 100% and a specificity of 68%. The 1,3-β-D-glucan test was found to be useful for detecting candidemia in severe burn patients, and the cutoff value might be set to 40 pg/ml to detect it more accurately.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; beta-Glucans; Biomarkers; Burns; Candidemia; Child; Female; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Various creams are available for superficial second-degree burns (SSDB) of the face. We evaluated provitamin pantothenic acid versus β-glucan for SSDB of the face using the O2C laser Doppler system and digital photo analysis. Out of 20 patients (January to December 2012) with facial burns, 7 with SSDB of both cheeks were included to our study. Burned cheek wounds were treated using pantothenic acid or β-glucan. Digital photos of marked regions were taken daily from predefined distances. Microcirculation was measured at marked regions for 7 days at scheduled time points using the O2C laser Doppler. Data were evaluated using the SPSS program (SPSS Inc., Chicago, IL). Wounds treated with β-glucan showed faster reepithelialization. O2C laser Doppler measurements showed faster increase in SO2, microvascular perfusion, hemoglobin content, and blood flow. This correlated good with clinical Vancouver Scar Scale results. Although not statistically significant, β-glucan cream therapy of SSDB results in aesthetically superior outcome and faster reepithelialization.

Topics: Adolescent; Adult; Aged; beta-Glucans; Burns; Facial Injuries; Humans; Laser-Doppler Flowmetry; Middle Aged; Pantothenic Acid; Photography; Provitamins; Skin Cream; Trauma Severity Indices; Vitamin B Complex; Young Adult

Saving the zone of stasis is one of the major goals of burn specialists. Increasing the tissue tolerance to ischaemia and inhibiting inflammation have been proposed to enable salvage of this zone. After a burn, excessive inflammation, including increased vascular permeability, local tissue oedema and neutrophil activation, causes local tissue damage by triggering vascular thrombosis and blocking capillaries, resulting in tissue ischaemia and necrosis. Oxygen radicals also contribute to tissue damage after a burn. However, macrophages play a pivotal role in the response to burn. We studied β-glucan because of its many positive systemic effects that are beneficial to burn healing, including immunomodulatory effects, antioxidant effects (free-radical scavenging activity) and effects associated with the reduction of the inflammatory response. There were four test groups in this study with eight rats in each group. Group 1 was the control group, group 2 was administered a local pomade (bacitracin+neomycin sulphate), group 3 received β-glucan (50 mg kg(-1), orally) + the local pomade and group 4 received β-glucan. Burns were created using a brass comb model. Macroscopic, histopathological and statistical assessments were performed. Samples were harvested on the 3rd, 7th and 21 days for analysis. The neutrophilic infiltration into the zone of stasis was analysed on day 3. Macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation ratios in the zone of stasis were analysed on days 7 and 21. The β-glucan groups (groups 3 and 4) exhibited lower neutrophil counts on the 3rd day, and macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation were very high in these groups on the 7th day. In particular, re-epithelialisation on the 21st day was significantly better in the β-glucan groups. This study demonstrated that β-glucan may prevent neutrophil-dependent tissue damage and burn-induced oxidative injury through its anti-inflammatory and antioxidant properties. We speculate that the inhibition of neutrophil activation preserves vascular patency by preventing capillary blockage. β-Glucan is also a powerful macrophage stimulator, and is therefore very effective in saving the zone of stasis.

Topics: Analysis of Variance; Animals; Antioxidants; beta-Glucans; Burns; Disease Models, Animal; Ischemia; Male; Neutrophils; Rats; Rats, Sprague-Dawley; Skin

Fungal wound infection is a leading cause of burn wound infections, and diagnosis is often delayed as it conventionally requires culture and histopathology. Fungal screening assays have sped diagnosis of invasive fungal infections in other populations. Few studies have evaluated the performance of fungal screening assays outside of the hematologic malignancy and hematopoietic stem cell transplant populations.. We performed a three year retrospective analysis of all fungal screening assays in burn patients in the ICU between 2008 and 2011. The primary goal was to evaluate the correlation between the two available fungal screening assays, (1→3)-β-d-glucan (BG) and galactomannan (GM) assay, and fungal wound colonization (FWC) and infection (FWI). We also evaluated previously hypothesized causes of false positives and their associations with false positives in the burn population.. We identified 53 patients [median 29% total body surface area burned (TBSA), IQR 17-51] with BG or GM serological tests available, of which 15 had a FWI or FWC. FWC/FWI was associated with higher TBSA (p=0.02). BG and GM correlated with TBSA (BG 0.57, p<0.01; GM 0.35, p=0.02), but neither assay was associated with FWI/FWC or species of fungus involved when FWI/FWC was diagnosed.. Positive BG and GM fungal screening assays are not associated with FWI/FWC, or with species of fungus when FWC/FWI is present. BG false positives are common and associated with higher TBSA burns.

Topics: Adult; Antigens, Fungal; beta-Glucans; Biomarkers; Burns; Female; Galactose; Humans; Male; Mannans; Middle Aged; Mycoses; Retrospective Studies; Wound Infection

Serum (1→3)-β-D-glucan (BG) is increasingly used as diagnostic marker for invasive fungal infections. Exposure to gauze may lead to false-positive BG assays. The role of BG is unclear in thermally injured patients who frequently require extensive gauze coverage; therefore, we prospectively evaluated BG levels in burn-injured patients. Serum BG levels were measured in 18 burn patients immediately before application of the first dressing and 12 h after. Patients were stratified by extent of total body surface area (TBSA) requiring gauze coverage: <20%, 20-39%, 40-60% and >60%. BG levels were obtained from patients with non-burn trauma as controls. BG results were positive (>80 pg ml⁻¹) in 9/18 (50%) patients at baseline and in 8/18 (44%) 12 h after application of the first dressing. BG levels were positive in 1/5 (20%) of patients with <20% TBSA requiring gauze and in 10/13 (77%) with ≥ 20% (P < 0.05). None of the control patients had positive BG at any time point and none of the patients had candidemia at baseline. Mean serum BG levels decreased (19.44 pg ml⁻¹) after gauze placement. False-positive serum BG elevations are common in this patient population. Positivity correlates with extent of TBSA injured, but is not impacted by the gauze itself.

Topics: beta-Glucans; Burns; Candida; Candidemia; Female; Humans; Prospective Studies; Proteoglycans

Wound care for partial-thickness burns should alleviate pain, decrease hospital length of stay, and be readily applied to a variety of wounds. The effectiveness of Biobrane (UDL Laboratories, Rockford, IL) is compared with that of Beta Glucan Collagen (BGC; Brennan Medical, St. Paul, MN) in a retrospective cohort study.. A retrospective chart review of all children treated at a tertiary care pediatric hospital between 2003 and 2009 identified patients with partial-thickness burns treated with Biobrane. These patients were compared with historical controls treated with BGC.. A total of 235 children between the ages of 4 weeks and 18 years with an average of 6.0% body surface area partial-thickness burns were treated with Biobrane. In a multivariate statistical analysis, patients treated with Biobrane healed significantly faster than those treated with BGC (Biobrane vs BGC: median, 9 vs 13 days; P = .019; hazard ratio, 1.68). In addition, patients who required inpatient treatment trended toward having shorter length of hospital stay in the Biobrane group (2.6 vs 4.1 days, P = .079).. Partial-thickness burn care consists of early debridement and application of a burn wound dressing. Biobrane dressings result in faster healing compared with BGC and may decrease hospital length of stay for patients requiring inpatient admission.

Topics: Adolescent; beta-Glucans; Burns; Child; Child, Preschool; Coated Materials, Biocompatible; Collagen; Humans; Infant; Occlusive Dressings; Retrospective Studies; Wound Healing

Thermal injury may lead to systemic inflammatory response, and multiple organ failure. Generation of reactive oxygen radicals and lipid peroxidation play important roles in burn-induced remote organ injury. In the present study, we investigated the putative protective effect of local or systemic beta-glucan treatment on burn-induced remote organ injury. Wistar albino rats were exposed to 90 degrees C bath for 10 s to induce thermal trauma. beta-glucan (3.75 mg/rat locally or 50 mg/kg orally) or saline was administered immediately after the trauma and were repeated twice daily in 48 h groups. Rats were decapitated either 6 or 48 h after burn injury and the skin, lung, liver, ileum and kidney tissues were taken for the measurement of malondialdehyde (MDA)--an index of lipid peroxidation--and glutathione (GSH)--a key antioxidant--levels. Neutrophil infiltration was evaluated by the measurement of tissue myeloperoxidase (MPO) activity, while the tumor necrosis factor-alpha (TNF-alpha) levels were measured in serum samples. Skin tissues were also examined microscopically. Severe skin scald injury (30% of total body surface area) caused significant decreases in GSH levels of the liver and intestinal tissues (p<0.01-<0.001), while MDA levels were significantly (p<0.01-p<0.001) increased at post-burn 6 and 48 h. Both local and systemic beta-glucan treatments significantly reversed (p<0.01-p<0.001) the elevations in MDA levels, while reduced GSH levels were reversed back to control levels (p<0.01-p<0.001); and the raised MPO levels were significantly decreased (p<0.05-p<0.001). The results indicate that both systemic and local administration of beta-glucan were effective against burn-induced oxidative tissue damage in the rat. beta-glucans, besides their immunomodulatory effects, have additional antioxidant properties. Therefore, beta-glucans merit consideration as therapeutic agents in the treatment of burn injuries.

Topics: Animals; beta-Glucans; Burns; Female; Glutathione; Lipid Peroxidation; Male; Malondialdehyde; Oxidative Stress; Peroxidase; Rats; Tissue Distribution; Tumor Necrosis Factor-alpha

Beta glucan collagen matrix (BGC), which combines the carbohydrate beta-glucan with collagen, has been used as a temporary coverage for adult partial thickness burns with reported good results. Observed advantages of BGC coverage include reduction of pain, improved healing, and better scar appearance. Potentially even more important in children is the elimination of painful daily dressing changes to the burned epithelial surface, as well as decreased fluid loss. This report details the authors' 2-year experience with BGC in a pediatric burn center.. Retrospective chart review of 225 consecutive pediatric patients treated at our institution between 1997 and 1999 identified 43 patients (19%) with suspected partial thickness burns treated with BGC as the primary wound dressing. BGC was applied to a debrided burn wound and secured with steri-strips, kerlix, and an ace wrap. After 24 hours, adherence of the BGC was confirmed and then left open to air.. The most common cause of burn injury was scald (61%), followed by flame (37%), and contact (2%). The average age of patients was 5.5 years (range, 6 weeks to 16 years) and mean percent total body surface area burned was 9.3% (1% to 35%). Thirty-four patients (79%) had the BGC remain intact while the wound healed underneath, with excellent cosmetic results, minimal analgesic requirements, and no need for repetitive dressing changes. Nine patients (21%) had the BGC removed before wound healing: 6 patients lost the BGC because of progression of the burn to full thickness, 2 had BGC nonadherence over a joint, and 1 had an unexplained nonadherence.. Partial-thickness burns in children can be effectively treated with BGC with good results, even in infants and toddlers. BGC markedly simplifies wound care for the patient and family and seems to significantly decrease postinjury pain.

Topics: Bandages; beta-Glucans; Burns; Child; Child, Preschool; Collagen; Drug Combinations; Female; Glucans; Humans; Male; Retrospective Studies; Skin Transplantation; Treatment Outcome; Wound Healing