mupirocin and Burns

The objective of this study was to observe the clinical effects of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) hydrogel in the treatment of residual wounds of extensive deep partial-thickness burn.. In this study, 21 subjects who sustained deep partial-thickness burns, which did not heal over 8 weeks, were observed. These were randomly assigned to two paired groups: the experimental group (using rhGM-CSF, n = 21) and the control group (using mupirocin ointment, n = 21). The wound dressings were changed once daily. Wound secretion, inflammation, granulation tissues, local and general side effects of the drug, wound healing time, and healing rate at different times were observed and compared between the two groups. The differences in the pathology of new vessels and fibroblasts between the two groups were observed, and their number in immunohistochemistry was detected.. The wound healing time was 17.28 ± 6.70 days in the experimental group. It was significantly shorter than that of the control group (22.14 ± 7.38 days). The healing rates at 10 and 14 days in the experimental group were 54 ± 27% and 60 ± 36%, respectively. These healing rates were remarkably higher than those of the control group (43 ± 27% and 48 ± 30%). On the 3rd, 7th, 10th, and 14th day, the experimental group was obviously superior to the control group in wound inflammation, secretion, and granulation tissues. Furthermore, on the 7th, 10th, 14th, 21st, and 28th day, the bacterial clearance rates of the experimental group (42.85%, 52.38%, 90.47%, 95.24%, and 95.24%) were higher than those of the control group (4.76%, 4.76%, 38.10%, 76.19%, and 80.95%). On the 14th day, the average optical density of the vascular endothelial factor (VEGF) of the experimental group (0.21 ± 0.01) is bigger than that of the control group (0.18 ± 0.02) (P < 0.05), and the average optical density of the fibroblast growth factor (FGF) of the experimental group (0.25 ± 0.01) is also larger than that of the control group (0.18 ± 0.02) (P < 0.05).. rhGM-CSF hydrogel effectively promotes the healing process of residual wounds of extensive deep partial-thickness burns. The hydrogel removed most of the bacteria or inhibited growth, and the local and general side reactions of the drug were mild during the study.

Topics: Administration, Cutaneous; Adult; Anti-Bacterial Agents; Burns; Female; Granulation Tissue; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Male; Middle Aged; Mupirocin; Ointments; Recombinant Proteins; Time Factors; Treatment Outcome; Wound Healing

The aim of this study was to evaluate the efficacy of the topical administration of mupirocin and other practices in central venous catheter (CVC) care to prevent central line-associated bloodstream infections (CLABSI) in patients with major burns.. Patients with major burns admitted to a burn ICU were divided into four groups and disinfected at the CVC exit site with single povidone iodine (PVP-I) or PVP-I plus topical mupirocin ointment three times a day or once a day, respectively. The bacterial colonization of the skin at the CVC exit site and CVC tips and the incidence of CLABSI were recorded, and the risk factors were analyzed.. Administering mupirocin (RR=0.316, p=0.001), increasing the frequency of insertion-site care (RR=0.604, p=0.008), and avoiding cannulation at the burn site (RR=0.148, p<0.001) reduced skin colonization at the CVC insertion site. Topical administration of mupirocin significantly reduces both the bacterial colonization rate at CVC tips (RR=0.316, p=0.001) and the incidence of CLABSI (5.3 vs. 29.1 per 1000 catheter days, p<0.001).. Mupirocin is effective in the prophylaxis of CLABSI. Other CVC care practices were also found to affect the level of bacterial colonization, but their efficacy in preventing CLABSI needs to be evaluated further.

Topics: Acinetobacter Infections; Administration, Cutaneous; Adult; Anti-Bacterial Agents; Bacteremia; Burn Units; Burns; Carrier State; Catheter-Related Infections; Central Venous Catheters; Female; Humans; Male; Middle Aged; Mupirocin; Prospective Studies; Protective Factors; Pseudomonas Infections; Risk Factors; Skin; Staphylococcal Infections; Trauma Severity Indices; Young Adult

Staphylococcus aureus wound colonization frequently occurs in patients with burns and can cause impaired wound healing. Nasal mupirocin application may contribute to the reduction of burn wound colonization of endogenous origin, whereas colonization by the exogenous route can be reduced by blocking cross-infection from other sources. In this study we evaluated whether the implementation of routine treatment of patients and burn center personnel using nasal mupirocin ointment reduces S. aureus burn wound colonization.. We composed three study groups, consisting of a control period (Control), a mupirocin period (MUP), in which patients with burns were all receiving nasal mupirocin at admission, and a mupirocin+personnel period (MUP+P), in which we also screened the burn center personnel and decolonized S. aureus carriers by nasal mupirocin.. The patients who carried S. aureus in their nose and did not have S. aureus burn wound colonization at admission were considered as patients susceptible for the use of nasal mupirocin. In these patients, the S. aureus burn wound colonization rate was the same in all study groups. S. aureus nasal carriage was a significant independent risk factor for burn wound colonization (OR: 3.3; 95% CI: 1.4-7.6) when analyzed within the three study groups.. Although S. aureus carriage is a significant risk factor for developing burn wound colonization, the routine use of nasal mupirocin did not contribute to a reduction of burn wound colonization.

Topics: Administration, Intranasal; Adolescent; Adult; Anti-Bacterial Agents; Burn Units; Burns; Carrier State; Child; Child, Preschool; Humans; Infant; Infectious Disease Transmission, Professional-to-Patient; Middle Aged; Mupirocin; Staphylococcal Infections; Wound Infection; Young Adult

The therapeutic results of 41 cases of S. aureus infected burn wound (average 2.1% TBSA, approximately 200 cm2) treated with Mupirocin are reported in this paper. The effects of Mupirocin was obviously superior to that of SD-Ag used in control group. During the observation period the total effective rate of the studied group was 88.9% (control group: 70%, P < 0.05) and the bacterial clearance rate of S. aureus from the wound was 88.8% (control group: 40% P < 0.05). The sensitivity of 30 strains of S. aureus isolated from burn wounds to 11 varieties of antibiotics indicated that the sensitive rate to Mupirocin was as high as 92.68%, only lower that Vanconmycin. The bacteriological assay (MIC < or = 0.25 mg/L, MIC < or = 4 mg/L) also showed high sensitivity of S. aureus to Mupirocin. We suggest Mupirocin be the first choice of topical antibacterial agents for burn wound with S. aureus infection, especially for infection with MRSA.

Topics: Burns; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Topics: Anti-Bacterial Agents; Bacteriophages; Burns; Fusidic Acid; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; N-Acetylmuramoyl-L-alanine Amidase; Ointments; Staphylococcus aureus

Treatment of infectious skin conditions resulting from wounds and burns with topical antibiotics is challenging, particularly those caused by methicillin-resistant Staphylococcus aureus bacteria (MRSA). This is due to the formation of bacterial biofilms characterized by antimicrobial resistance. Mupirocin (MP), a widely used topical antibiotic, is active against gram-positive bacteria including MRSA. However, MP suffers from sub-optimal therapeutic efficacy due to its poor water-solubility and the significant rise in MP-resistant S. aureus. In this study, the physico-chemical characteristics of MP were modified through nanocrystallization to improve its therapeutic efficacy for the treatment of skin infections. Mupirocin-nanocrystals (MP-NC) were prepared using a nanoprecipitation technique and optimized using a D-optimal response surface design. The optimization of MP-NC produced ultra-small monodisperse spherical particles with a mean diameter of 70 nm and a polydispersity index of 0.2. The design resulted in two optimal MP-NC formulations that were evaluated by performing series of in vitro, ex vivo, microbiological, and in vivo studies. In-vitro results showed a 10-fold increase in the saturation solubility and a 9-fold increase in the dissolution rate of MP-NC. Ex vivo permeation studies, using pig ears skin, showed a 2-fold increase in the dermal deposition of MP-NC with the highest drug deposition occurring at 500-µm skin depth. Moreover, the optimal MP-NC formulations were lyophilized and incorporated into a 2% w/w cream. Microbiological studies revealed a 16-fold decrease in the minimum inhibitory concentration and the minimum bactericidal concentration of MP-NC. In vivo studies, using a rat excision burn wound model, demonstrated rapid and complete healing of infected burn wounds in rats treated with MP-NC cream in comparison to marketed Avoban ointment. Our results suggest that nanocrystallization of MP may provide an avenue through which higher levels of a topically applied MP can be permeated into the skin to reach relevant infectious areas and exert potential local antibacterial effects.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Burns; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nanoparticles; Rats; Swine; Wound Infection

Mupirocin nanoparticle-loaded hydrogel (MLH) was successfully developed. This study focused on the safety of cell lines and the biocompatibility of MLH for wound healing in rat models. MLH was assessed by an analysis of cytotoxicity and the secretion of inflammatory cytokines in cell lines. The cytocompatibility of MLH was compared with mupirocin ointment on full-thickness burn wounds in rats. The results indicated that MLH and blank hydrogel had no toxicity to human epidermal keratinocytes and human fibroblast cells. MLH inhibited lipopolysaccharide (LPS) activity in macrophage-like cells resulting in low nitric oxide production and reduced inflammatory cytokine production (interleukin (IL)-1β) compared with a positive control (LPS only). In burn wounds, MLH and hydrogel healed the wound better than the other groups determined by wound contraction, reduced secretion, and the generation of new blood vessels, as well as promotion of hair follicle cells. Better granulation tissue proliferation, less necrosis, and a lower degree of inflammation were found in the MLH and blank hydrogel than in the mupirocin ointment. The hydrogel group reduced the macrophages (CD68) on day 14 at the edge of the wound. On day 28, T cells (CD3), B cells (CD20), and CD68+ cells were concentrated in the deeper subcutaneous tissue. Additionally, the transforming growth factor β1 (TGF-β1) concentration and matrix prometalloproteinase-2/tissue inhibitor of metalloproteinases-2 ratio in the MLH and hydrogel groups were less than those in the other groups. The MLH formulation was safe and effective in burn wound healing. Therefore, MLH formulations are promising candidates for further evaluation in clinical trials.

Topics: Animals; Anti-Bacterial Agents; Biocompatible Materials; Burns; Cell Line; Cell Movement; Collagen; Disease Models, Animal; Hydrogels; Male; Mupirocin; Nanoparticle Drug Delivery System; Rats; Rats, Sprague-Dawley; Wound Healing

Methicillin-resistant Staphylococcus aureus (MRSA) is frequently implicated in health care-associated outbreaks in burn intensive care units, incurring substantial morbidity and mortality to these high-risk patients and excess costs to health care systems.. MRSA health care-associated infections (HAIs) were noted before and after the implementation of basic infection prevention measures and the subsequent implementation of universal decolonization with intranasal mupirocin. Pulsed-field gel electrophoresis was used to determine the relatedness of clinical isolates. A case-control study was conducted to characterize the risk factors for MRSA HAIs.. Basic interventions failed to decrease the rate of MRSA HAIs, although compliance with these interventions was high throughout the study. MRSA HAIs decreased from 8.53 HAIs per 1,000 patient days before the implementation of intranasal mupirocin to 3.61 HAIs per 1,000 patient days after the implementation of intranasal mupirocin (P = .033). Pulsed-field gel electrophoresis disclosed 10 unique clones with no large clusters. The case-control study revealed a significant association between MRSA HAIs and lengths of stay, body surface area burned, intubation, pressor requirement, leukocytosis, lactic acidosis, development of pneumonia, MRSA colonization, and death.. Basic environmental and behavioral interventions fell short of controlling a low-count, sporadic, and multiclonal MRSA outbreak in the burn intensive care unit of a tertiary medical center. However, the added implementation of universal decolonization with intranasal mupirocin was effective. Burn victims with greater disease severity were at higher risk for MRSA HAIs.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Burn Units; Burns; Cross Infection; Disease Outbreaks; Female; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Staphylococcal Infections; Tertiary Care Centers; Treatment Outcome; Young Adult

There are very few articles in the literature describing continuous models of bacterial infections that mimic disease pathogenesis in humans and animals without using separate cohorts of animals at each stage of disease. In this work, we developed bioluminescent mouse models of partial-thickness scald wound infection and sepsis that mimic disease pathogenesis in humans and animals using a recombinant luciferase-expressing Staphylococcus aureus strain (Xen29). Two days post-scald wound infection, mice were treated twice daily with a 2% topical mupirocin ointment for 7 days. For sepsis experiments, mice were treated intraperitoneally with 6 mg/kg daptomycin 2 h and 6 h post-infection and time to moribund monitored for 72 h. Consistent bacterial burden data were obtained from individual mice by regular photon intensity quantification on a Xenogen IVIS Lumina XRMS Series III biophotonic imaging system, with concomitant significant reduction in photon intensities in drug-treated mice. Post-mortem histopathological examination of wounds and bacterial counts in blood correlated closely with disease severity and total flux obtained from Xen29. The bioluminescent murine models provide a refinement to existing techniques of multiple bacterial enumeration during disease pathogenesis and promote animal usage reduction. The models also provide an efficient and information-rich platform for preclinical efficacy evaluation of new drug classes for treating acute and chronic human and animal bacterial infections.

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Burns; Disease Models, Animal; Luminescent Proteins; Male; Mice; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Wound care treatment is a serious issue faced by the medical staffs due to its variety and complexity. Wound dressings are typically used to manage the various types of wounds. In this study, polyurethane (PU) fibers containing mupirocin (Mu), a commonly used antibiotic in wound care, were fabricated via electrospinning technique. The aim of this study was to develop biomedical electrospun fiber scaffolds for preventing wound infections with good compatibility and to demonstrate their applications as anti-infective burn wound dressings. The surface morphology of fibers was obtained by scanning electron microscopy. FT-IR spectra, water vapor transmission rate, and drug release study in vitro were tested to demonstrate the fiber scaffold characteristic. The prepared PU/Mu composite scaffolds had satisfactory antibacterial activity especially against Staphylococcus aureus. The cell studies revealed that the scaffolds were biocompatible and safe for cell attachment. Histological and immunohistochemical examinations were performed in rats, and the results indicated the histological analysis of tissue stained with H&E showed no obvious inflammation reaction. The results indicated that the electrospun scaffolds were capable of loading and delivering drugs, and could be potentially used as novel antibacterial burn wound dressings.

Topics: Anti-Bacterial Agents; Bandages; Burns; Cell Line; Drug Carriers; Drug Liberation; Electricity; Mupirocin; Polyurethanes; Staphylococcus aureus

A multitude of topical wound treatments are used today. Although it is well established that the micro-environment of healing wounds can be altered to improve healing, it is difficult to measure the subtle differences in outcome where therapies are compared.. We compared wound healing properties between four different topical agents in surgically incised wounds in a pig model. The four topical agents, 5% Povidone-Iodine cream, 1% Silver-Sulphadiazine, 2% Mupirocin, and 1% Silver-Sulphadiazine plus 1mg/100g recombinant-human epithelial growth factor (EGF) were randomly assigned to four test animals each. Test agents were compared to each other and to untreated controls. We investigated existing and new methodologies of measurement of wound healing: clinical and histological visual scoring systems, immuno-histochemistry, and computerized image analysis of the wounds on days 3, 7, and 28.. All agents were found to have improved healing rates with better cellular architecture. Healing was faster, histological appearance resembled normal architecture sooner, clinical appearance improved, mitotic activity was stimulated and more collagen was deposited in comparison to the wounds with no agents. EGF-treated wounds showed an increased rate of epithelisation, but the rate of healing did not correlate well with evaluation of cosmetic outcome.. Topical agents improve all aspects of wound healing. The addition of a human recombinant EGF to Silver-Sulphadiazine increases epithelial growth and amounts of collagen in the regenerating wounds at day 7.

Topics: Administration, Cutaneous; Animals; Anti-Infective Agents; Burns; Cell Proliferation; Dermis; Epidermal Growth Factor; Epidermis; Female; Humans; Image Processing, Computer-Assisted; Immunohistochemistry; Mupirocin; Povidone-Iodine; Re-Epithelialization; Recombinant Proteins; Silver Sulfadiazine; Skin; Swine; Trauma Severity Indices; Wound Healing

Application of plant extracts for the burn/wound treatment is followed over the decades as a common practice and it is an important aspect in clinical management. In this study porous collagen sponges (CS) were prepared using fish scales and were incorporated with mupirocin (CSM) and extracts of Macrotyloma uniflorum (CSPE) separately to impart antimicrobial activity to the sponges. The results showed that the addition of plant extract increased the tensile strength of CSPE and stability against collagenase enzyme. FTIR studies have shown the incorporation of plant extract in CSPE, SEM studies have revealed the porous nature of the sponges and XRD patterns have shown the retention of collagen triple helical structure even after the addition of plant extract. CSPE and CSM have exhibited antimicrobial properties. The sponges prepared were analysed for their in vitro biocompatibility studies using fibroblasts and keratinocyte cell lines and the results have shown their biocompatible nature. Based on the results obtained, CS, CSM and CSPE may be tried as a burn/wound dressing materials, initially, in small animals in vivo.

Topics: Animals; Anti-Infective Agents; Bacillus subtilis; Biocompatible Materials; Burns; Cell Survival; Collagen; Collagenases; Fabaceae; Fishes; Mice; Mupirocin; NIH 3T3 Cells; Plant Extracts; Porosity; Spectroscopy, Fourier Transform Infrared; Staphylococcus aureus; Tensile Strength; Wound Healing; X-Ray Diffraction

To investigate the antibacterial activity of silver sulfadiazine (SD-Ag), mupirocin, and clotrimazole used alone or in combination against methicillin-resistant Staphylococcus aureus (MRSA) isolated from burn wounds.. Eighteen MRSA isolates from wound excretion of 18 burn patients hospitalized in our unit from July to December 2011 were collected continuously and non-repetitively. (1) Minimum inhibitory concentration (MIC), 50% MIC (MIC50), and 90% MIC (MIC90) of SD-Ag, mupirocin, and clotrimazole used alone, those of SD-Ag and mupirocin used in combination, and those of SD-Ag, mupirocin, and clotrimazole used in combination to MRSA were determined by checkerboard agar dilution method. (2) Fractional inhibitory concentration (FIC) index was calculated to determine the combined effect of SD-Ag plus mupirocin, and SD-Ag plus mupirocin and clotrimazole. Synergy with FIC index less than or equal to 0.5 or additivity with FIC index more than 0.5 and less than or equal to 1.0 was regarded as effective, and indifference with FIC index more than 1.0 and less than or equal to 4.0 or antagonism with FIC index more than 4.0 was regarded as ineffective. The effective ratio was compared with overall ratio (assumed as 0) by unilateral binomial distribution test.. The MIC, MIC50, and MIC90 of SD-Ag, mupirocin, and clotrimazole used alone against 18 MRSA isolates were respectively 8, 8, 16 µg/mL; 2, 16, 64 µg/mL; 2, 2, 2 µg/mL. MIC of antimicrobial agents used in combination decreased from 3.1% to 50.0% as compared with that of individual agent used alone. Compared with those of single application of SD-Ag and mupirocin, MIC50 of SD-Ag and that of mupirocin both decreased 75.0%, and MIC90 of them decreased 87.5% when SD-Ag and mupirocin were used in combination. Compared with those of single application of SD-Ag, mupirocin, and clotrimazole, MIC50 of SD-Ag, mupirocin, and clotrimazole respectively decreased 75.0%, 87.5%, and 50.0%; MIC90 of them respectively decreased 87.5%, 96.9%, and 50.0% when SD-Ag, mupirocin, and clotrimazole were used in combination. Among the 18 MRSA isolates, the combined effect of SD-Ag and mupirocin was synergic in 9 isolates, additive in 7 isolates, indifferent in 2 isolates, and antagonistic in 0 isolate; the combined effect of SD-Ag, mupirocin, and clotrimazole was additive in 16 isolates, indifferent in 2 isolates, and antagonistic in 0 isolate. There were statistically significant differences between effective ratio and overall ratio of 18 MRSA isolates treated with combined antimicrobial agents (P values all above 0.01).. For burn wounds at middle and late stages infected with Staphylococcus aureus or Staphylococcus aureus and Fungus, low dose of SD-Ag or combination of above-mentioned antimicrobial agents can effectively control infection and decrease the adverse effect of antimicrobial agents on wound healing.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Burns; Child; Child, Preschool; Clotrimazole; Drug Therapy, Combination; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Silver Sulfadiazine; Young Adult

The rate of the MRSA strains, particularly at burn centers, is increasing worldwide. Detection of mupirocin resistance MRSA strains in the burn centers particularly from personnel will help to control these strains. For this purpose, a total of 116 Staphylococcus aureus isolates from the patients (burns) and personnel (nostrils) in Ahvaz Taleghani hospital (Iran) were investigated. The methicillin and mupirocin resistant isolates were detected by multiplex amplification of the mecA and ileS-2 genes. The mecA was found among 80% of isolates. The rates of mupirocin resistant strains among personnel and patients were 70% and 6%, respectively. The carriage rates of the S. aureus, MRSA and MRSA with high-level mupirocin resistance in the personnel were 40%, 34% and 28%, respectively. In conclusions, the high prevalence of MRSA strains in the patients showed the potential outbreak of the MRSA in the burn center and highlighted the need of antibiotic susceptibility monitoring of MRSA. Moreover being personnel as a main reservoir in terms of MRSA strains with high-level mupirocin resistance emphasizes the screening of the personnel in terms of the MRSA in the healthcare system especially in the burn center.

Topics: Anti-Bacterial Agents; Burns; Drug Resistance, Bacterial; Humans; Iran; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Personnel, Hospital; Prevalence; Staphylococcal Infections

To observe the effect of San-huang-sheng-fu oil on wounds of full-thickness scald in rabbits.. Full-thickness scald wounds with area of 6 cm(2) were reproduced on both sides of the back in 9 experimental rabbits by water vapor. These rabbits were divided into sesame oil (S1), San-huang-sheng-fu oil (S2), and mupirocin ointment (M) groups according to the random number table, with 3 rabbits (6 wounds) in each group. Two wounds of each rabbit in the three groups were respectively treated with sesame oil, San-huang-sheng-fu oil, and mupirocin ointment, in a dose of 0.15 mL/cm(2), 2-3 times per day. The general condition of wounds was observed on post scald day (PSD) 1, 11, 22, and 45. The wound healing time was recorded. The wound healing rate was calculated on PSD 5, 11, 15, and 22. All the rabbits were sacrificed on PSD 45, and wound tissues were subjected to histomorphological study with HE staining. The protein expressions of transforming growth factor β1 (TGF-β1), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were observed with immunofluorescence staining for the other part of wound tissues. Data were processed with one-way analysis of variance or LSD-t test.. (1) The wound healing quality of rabbits in S2 group was better than that in the other two groups. (2) The wound healing time of rabbits in S2 group [(11.2 ± 2.3) d] was significantly shorter than that in S1 group [(21.2 ± 3.1) d, t = 2.591, P < 0.05]. (3) The wound healing rate of rabbit in each group was increased gradually on PSD 5-22. The wound healing rates of rabbits in S2 group on PSD 5-22 were significantly higher than those in S1 group (with t values from 3.920 to 8.605, P values all below 0.05). (4) Histomorphological observation showed that the structure of wound tissues in S2 group was in much better integrity than that in the other two groups, including regenerated hair follicles in the corium layer and regularly arranged collagen fibers. The protein expressions of TGF-β1, bFGF, and VEGF in S2 group were all higher than those in the other two groups.. San-huang-sheng-fu oil can up-regulate the protein expressions of TGF-β1, bFGF, and VEGF, induce vascular regeneration, promote wound healing, and shorten wound healing time.

Topics: Animals; Burns; Disease Models, Animal; Drugs, Chinese Herbal; Fibroblast Growth Factor 2; Mupirocin; Rabbits; Transforming Growth Factor beta1; Vascular Endothelial Growth Factor A; Wound Healing

Previously, we have proposed mupirocin-in-liposomes-in-hydrogel delivery system as advanced delivery system with the potential in treatment of burns. In the current studies, we evaluated the system for its cytotoxicity, ability to prevent biofilm formation, act on the mature biofilms, and finally determined its potential as wound treatment in in vivo mice burn model. The system was found to be nontoxic against HaCaT cells, that is, keratinocytes. It was safe for use and exhibited antibiofilm activity against S. aureus biofilms, although the activity was more significant against planktonic bacteria and prior to biofilm formation than against mature biofilms as shown in the resazurin and the crystal violet assays. An in vivo mice burn model was used to evaluate the biological potential of the system and the healing of burns observed over 28 days. The in vivo data suggest that the delivery system enhances wound healing and is equally potent as the marketed product of mupirocin. Histological examination showed no difference in the quality of the healed scar tissue, whereas the healing time for the new delivery system was shorter as compared to the marketed product. Further animal studies and development of more sophisticated in vivo model are needed for complete evaluation.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Burns; Disease Models, Animal; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Liposomes; Mice; Mupirocin; Staphylococcal Infections; Staphylococcus aureus; Wound Healing

Infections due to Staphylococcus aureus have become increasingly common among burn patients. The antibiotic resistance profile of S. aureus isolates and inducible resistance against clindamycin were investigated in this study. The presence of mecA gene, mupA gene and macrolide resistance genes were detected using PCR and multiplex-PCR. The resistance rate to methicillin, erythromycin and mupirocin were 58.5%, 58% and 40%, respectively. The prevalence of constitutive and inducible resistance among macrolide resistant isolates was 75% and 25%, respectively. Ninety five percent of the isolates were positive for one or more erm genes. The most common genes were ermA (75%), ermC (72%) and ermB (69%), respectively. The ermA gene predominated in the strains with the inducible phenotype, while ermC was more common in the isolates with the constitutive phenotype. The msrA gene was only found in one MRSA isolate with the constitutive phenotype. A total of 27 isolates (25%) carried the mupA gene. All the mupirocin resistant isolates and almost all the erythromycin resistant isolates were also resistant against methicillin which may indicate an outbreak of MRSA isolates with high-level mupirocin and erythromycin resistance in the burn unit assessed.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Burns; Drug Resistance, Multiple, Bacterial; Humans; Iran; Macrolides; Microbial Sensitivity Tests; Mupirocin; Polymerase Chain Reaction; Prevalence; Staphylococcal Skin Infections; Staphylococcus aureus

In this study, our aim is to compare the efficacy of different topical antibacterial agents in a rat model contaminated with a multi drug resistant (MDR) standard Acinetobacter baumannii strain. The study was carried out on 40 Sprague-Dawley rats of 250-300 g each. For the purposes of this study, the rats were divided into 5 groups, with 8 rats in each group: Group 1 control; Group 2 silver sulfadiazine; Group 3 mupirocin; Group 4 Acticoat group; and Group 5 octenidine dihydrochloride group. Following to the formation of the full-thickness burn areas in rats, the MDR A. baumannii standard strain was inoculated into the burned area. The rats in all the groups were sacrificed at the end of the 10th day and subjected to histopathological and microbiological evaluation. In the histopathological evaluation, the lowest inflammatory cell response and bacterial density in the eschar and muscle tissues were observed in the Acticoat group. While these results were found to be statistically significant compared to the silver sulfadiazine group, only the bacterial density in the muscle tissue was found as significant in comparison to the mupirocin and octenidine groups. In the microbiological evaluation, the lowest growth in the muscle tissue culture among all the groups was observed in the Acticoat group. The growth in the eschar tissue culture was significantly lower in the Acticoat and octenidine groups in comparison to the silver sulfadiazine group. At the end of the study, it has been observed that Acticoat was effective both in eschar and muscle, while octenidine was effective in eschar tissues in a rat burn model contaminated with MDR A. baumannii.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Administration, Topical; Animals; Anti-Infective Agents; Burns; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Imines; Mupirocin; Muscles; Polyesters; Polyethylenes; Pyridines; Random Allocation; Rats; Rats, Sprague-Dawley; Silver Sulfadiazine; Skin

Wounds, particularly burns, are prone to colonization of potentially life-threatening bacteria. Local delivery of antimicrobial agents in sufficient quantities and over longer period of time can reduce risk of burn infections. Mupirocin-in-liposomes-in-hydrogels were proposed as advanced delivery system for improved burn therapy. Mupirocin was entrapped in phosphatidylcholine liposomes of various sizes, namely larger (micron size) vesicles entrapping 74% of drug and sonicated vesicles (below 300 nm) entrapping 49% of drug. Liposomes containing mupirocin were incorporated in chitosan hydrogels (10%, w/w). Incorporation of liposomes in hydrogels resulted in prolonged release of liposomally associated mupirocin, as observed in both in vitro and ex vivo studies. The drug release was affected by the vesicle size. Microbiological evaluation of newly developed system confirmed its antimicrobial potential against Staphylococcus aureus and Bacillus subtilis. Bioadhesiveness of the system was compared with the marketed cream containing mupirocin. Our system exhibited superior bioadhesiveness and sustained mupirocin release profiles to marketed product.

Topics: Animals; Anti-Bacterial Agents; Bacillus subtilis; Burns; Chemistry, Pharmaceutical; Chitosan; Delayed-Action Preparations; Drug Delivery Systems; Hydrogel, Polyethylene Glycol Dimethacrylate; Liposomes; Mupirocin; Particle Size; Phosphatidylcholines; Skin; Staphylococcus aureus; Swine; Wound Infection

Topical treatment of burn wounds is essential as reduced blood supply in the burned tissues restricts the effect of systemic antibiotics. On the burn surface, microorganisms exist within a complex structure termed a biofilm, which enhances bacterial resistance to antimicrobial agents significantly. Since bacteria differ in their ability to develop biofilms, the susceptibility of these biofilms to topically applied antibiotics varies, making it essential to identify which topical antibiotics efficiently disrupt or prevent biofilms produced by these pathogens. Yet, a simple in vitro assay to compare the susceptibility of biofilms produced by burn wound isolates to different topical antibiotics has not been reported.. Biofilms were developed by inoculating cellulose disks on agar plates with burn wound isolates and incubating for 24h. The biofilms were then covered for 24h with untreated gauze or gauze coated with antibiotic ointment and remaining microorganisms were quantified and visualized microscopically.. Mupirocin and triple antibiotic ointments significantly reduced biofilms produced by the Staphylococcus aureus and Pseudomonas aeruginosa burn wound isolates tested, as did gentamicin ointment, with the exception of one P. aeruginosa clinical isolate.. The described assay is a practical and reproducible approach to identify topical antibiotics most effective in eliminating biofilms produced by burn wound isolates.

Topics: Analysis of Variance; Anti-Bacterial Agents; Bacitracin; Biofilms; Burns; Drug Therapy, Combination; Gentamicins; Humans; Microbial Sensitivity Tests; Mupirocin; Neomycin; Ointments; Polymyxin B; Pseudomonas aeruginosa; Staphylococcus aureus

Burns are a leading cause of non-natural death in South African infants and children. Conventional care of partial-thickness burns often requires painful, time consuming and costly twice-daily dressing changes to clean the wound and apply antimicrobial topical agents. A new topical nanocrystalline silver-coated NS dressing (Acticoat; Smith & Nephew) has been developed and is the first-line treatment of choice in many burn centres. However, because of its cost the Department of Health has been reluctant to introduce it as a standard of care. We retrospectively studied 4 randomly selected paediatric burn patients, calculating the cost associated with the use of NS dressings and comparing this with the projected costs of three previously standard burn wound treatment regimens. NS dressings were changed every 3 days based on their sustained and slow release of silver ions over 72 hours. Using NS clearly saved costs compared with the three other regimens. The demonstrated cost savings resulted primarily from the decreased number of dressings, and the presumed shorter hospital stay.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Burn Units; Burns; Child; Child, Preschool; Chlorhexidine; Costs and Cost Analysis; Female; Humans; Infant; Male; Mupirocin; Povidone-Iodine; Retrospective Studies; Silver Sulfadiazine; South Africa; Treatment Outcome

There are two important routes for the transmission of Staphylococcus aureus to the burn wound. In the endogenous route, patients naturally carrying S. aureus colonize their own wounds, whereas in the exogenous route burn wounds are cross-infected from other sources. In this study we evaluated the effect of blocking the endogenous route on S. aureus burn wound colonization by mupirocin application in the nose of patients at the time of admission.. From September 2000 to January 2002 all patients with burns admitted to a single dedicated Burn Centre received nasal mupirocin upon admission. This period was compared to two control periods (C1: July 1999 to July 2000 and C2: January 2002 to January 2003) for S. aureus burn wound colonization. The colonization risk was analysed, adjusting for confounding, with Cox proportional hazard regression.. A total of 98 patients did not have S. aureus burn wound colonization at the time of admission and were, thus, considered at risk for S. aureus acquisition during their stay. As compared to C1, the relative risk of acquiring S. aureus in their wound was 0.48 (95% CI: 0.24-0.97) in the mupirocin period and 0.55 (95% CI: 0.28-1.1) during the C2 period. S. aureus nasal/pharyngeal colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2-4.2).. Nasal mupirocin may contribute to risk reduction of S. aureus wound colonization in patients with burns.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Burns; Cross Infection; Drug Administration Routes; Female; Humans; Male; Mupirocin; Nasal Mucosa; Nose; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Previously, we showed that microbial susceptibility to antimicrobials in concentrations non-toxic for human cells in culture could be tested using the wet disc topical antimicrobial assay. In this report, wet disc assay and agar well diffusion assay results were compared testing the susceptibility of Ps. aeruginosa isolates from burn patients to concentrations of Polymyxin B non-toxic for cultured cells. Both assays were performed on the same agar plates. No differences in results were observed. Further agar well diffusion assay testing showed that susceptibility/resistance could be demonstrated when testing several antimicrobials in concentrations non-toxic for cultured cells against a variety of bacteria isolated from burn patients. Therefore, the more familiar agar well diffusion as well as the wet disc assay can be used to test microbial susceptibility to these concentrations of antimicrobials.

Topics: Anti-Infective Agents; Burns; Cells, Cultured; Dose-Response Relationship, Drug; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Mupirocin; Polymyxin B; Pseudomonas aeruginosa; Quinolones

Following the introduction in 1988 of a regimen of selective decontamination of the digestive tract (SDD) for extensively injured patients in our burns centre, colonization rates with Gram-negative organisms declined significantly, but colonization with Staphylococcus aureus was unaffected. In an effort to reduce staphylococcal colonization, the SDD regimen has been supplemented with intranasal mupirocin since 1991. In this paper, 33 consecutive patients with burns of > 30 per cent TBSA who were treated with the supplemental regimen (SDD + M) in 1991 and 1992, were compared with 34 consecutive patients admitted in the previous 2 years who were treated with SDD only. Staph. aureus colonization of wounds, sputum and gastric aspirates was significantly reduced in the SDD + M group. Gram-negative colonization rates and the incidence of clinical infections remained low in both groups. Our experience suggests that decontamination of endogenous bacterial reservoirs, in combination with isolation measures to prevent exogenous colonization, effectively prevents infectious complications in patients with severe burns.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Burns; Child; Child, Preschool; Digestive System; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Aged; Mupirocin; Ointments; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

The microbicidal effect of mupirocin (Bactroban) was studied using an in vitro model of burn eschar in contact with this antimicrobial cream, to indicate its inhibiting action after 1, 2, 4, and 24 h. The microorganisms used were 20 isolates of Ps. aeruginosa, 20 isolates of MRSA, 10 isolates of Staph. epidermidis, 12 isolates of Enterobacteriaceae and eight isolates of Candida albicans. There was a marked effect on Gram-negative bacilli (< 0.1 per cent surviving) by 4 h, whereas on Gram-positive organisms its effect was slower, principally on MRSA with 2.2 per cent survivors by 24 h. The action on Candida was very slow initially, but after 24 h, the mupirocin's effect was marked (< 0.1 per cent survivors). The studies showed that mupirocin (a topical broad-spectrum antimicrobial agent) can be used in vitro against Gram-positive and Gram-negative bacteria and yeasts, which contaminate skin and mucosa. Further clinical experience is required before mupirocin can be used to treat colonized or infected wounds in burned patients.

Topics: Animals; Bacteria; Burns; Candida; Drug Evaluation, Preclinical; In Vitro Techniques; Microbial Sensitivity Tests; Mupirocin; Skin; Skin Diseases, Infectious; Swine

The paper summarizes experience with the application of Bactroban which was used for local antimicrobial treatment in 25 patients at the Burn Centre of the Department of Plastic Surgery, Prague. Various types of deep skin layers with mixed infection were chosen for this therapy, mostly due to Staphylococcus, even though a resistant Staphylococcus never occurred during the testing period. Bactroban was applied in cases where commonly used preparations had failed, and its therapeutical results can be considered positive.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Burns; Child; Child, Preschool; Drug Evaluation; Fatty Acids; Humans; Middle Aged; Mupirocin; Ointments; Wound Infection

Topics: Anti-Bacterial Agents; Burns; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcus aureus; Staphylococcus Phages

Methicillin-resistant Staphylococcus aureus strains (MRSA) have become increasingly prevalent as nosocomial pathogens, especially in burn wounds. MRSA constituted 38% of all S. aureus isolates in our 25-bed burns unit despite the utilization of a combination of 1% silver sulfadiazine and 0.2% chlorhexidine as topical therapy. Mupirocin, a new antibiotic, has proved in vitro and in vivo to be highly effective in the treatment of MRSA infections. A prospective clinical trial with mupirocin ointment in MRSA burn wound infection was untertaken. Forty-five children with 59 discrete burn wounds and from whom MRSA were isolated were treated with 2% mupirocin ointment under occlusive dressings, applied twice daily for 5 days. The average burned area treated was 8% (range, 2 to 20%) of the total body surface area. The burn wounds were assessed clinically and bacteriologically daily. Mupirocin eliminated MRSA in all 59 wounds treated, with the maximum therapeutic response seen within 4 days. In three wounds, gram-negative organisms persisted after 5 days of topical therapy. Treatment was well tolerated by all children. We recommend that mupirocin in its present polyethylene glycol base should be used only on a selective basis, when current prophylactic topical therapy has failed to control MRSA infection in burns of less than 20% of the total body surface area, and that it should be applied only for a limited period of 5 days. The safety and the efficacy of mupirocin in burns exceeding 20% of the total body surface area need to be established.

Topics: Anti-Bacterial Agents; Burns; Child; Child, Preschool; Fatty Acids; Female; Humans; Infant; Male; Methicillin; Mupirocin; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Wound Infection

Methicillin resistant Staphylococcus aureus strains (MRSA) have become increasingly prevalent as pathogenic organisms, especially in burn wounds, with an associated mortality of 20-40% among those clinically infected. Mupirocin ointment, a new topical antibiotic, has proved in vitro and in vivo to be highly effective in the treatment of MRSA infections. A modified Walker burn wound model was used to define the rate of trans-eschar penetration, biodynamic availability and bactericidal efficacy of 2% mupirocin ointment in established MRSA burn wound infection. In-vitro penetration trials confirmed the effective diffusion of mupirocin through 1.5 mm eschar within 2 h. A single topical application of mupirocin resulted in a 98.3% (5.67 x 10(8) cfu/g of tissue--1.0 x 10(7) cfu/g of tissue) reduction in intra-eschar viable organisms within 36 h post application. A second topical application of mupirocin at 24 h resulted in a total reduction of 99.6% in viable intra-eschar organisms (1.85 x 10(8) cfu/gram of tissue--6.76 x 10(5) cfu/g of tissue). It is concluded that mupirocin is highly effective in controlling MRSA burn wound infection and should be applied topically every 24 h.

Topics: Animals; Anti-Bacterial Agents; Biological Availability; Burns; Drug Resistance, Microbial; Fatty Acids; Mupirocin; Ointments; Rats; Staphylococcal Skin Infections; Staphylococcus aureus; Wound Infection

Topics: Anti-Bacterial Agents; Burns; Fatty Acids; Humans; Mupirocin; Pharmaceutical Vehicles; Polyethylene Glycols