nystatin-a1 and Burns

Topics: Amphotericin B; Anti-Bacterial Agents; Antibiotics, Antineoplastic; Burns; Candida albicans; Candidiasis; Catheterization; Central Nervous System Diseases; Diabetes Complications; Diagnosis, Differential; Fluorescent Antibody Technique; Fluorouracil; Hemagglutination Inhibition Tests; Humans; Hydrogen-Ion Concentration; Immunologic Deficiency Syndromes; Immunosuppression Therapy; Lung Diseases, Fungal; Nystatin; Pneumonia, Pneumocystis; Pyelonephritis; Respiratory Hypersensitivity; Sepsis; Serologic Tests

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.

Topics: Administration, Topical; Anti-Infective Agents, Local; Bacitracin; Burns; Humans; Neomycin; Nystatin; Ointments; Polymyxin B; Silver Sulfadiazine; Therapeutic Irrigation; Wound Infection

In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed.. In total 32 adult Wistar rats (body weight 200-220 g) were used. Silver-coated dressing (Acticoat™®), chlorhexidine acetate 0.5% (Bactigrass®) and Mycostatine (Nystatin®) were compared to assess the antifungal effect of a once-daily application on experimental rat 15% full-skin thickness burn wound seeded 24h earlier with a 10(8) CFU/mL standard strain of C. albicans ATCC 90028. All the animals were sacrificed at post burn day 7. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined, in addition to the cultures of left ventricle blood and lung biopsies.. While there were significant differences between Acticoat™® group (4 ± 10 × 10(4)) and control group (5 ± 6 × 10(6)), and between Nystatin group (4 ± 4 × 10(4)) and control group (P=0.01, P=0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2 ± 3 × 10(4)) and control group (P=0.7) respectively. Acticoat™® and Nystatin were sufficient to prevent to C. albicans from invading to the muscle and from causing systemic infection.. The animal data suggest that nystatin is the most effective agents in the treatment of C. albicans-contaminated burn wounds, and Acticoat™® is a choice of treatment on fungal burn wound infection with antibacterial effect and the particular advantage of limiting the frequency of replacement of the dressing.

Topics: Administration, Topical; Animals; Anti-Infective Agents, Local; Antifungal Agents; Bandages; Burns; Candida albicans; Candidiasis; Chlorhexidine; Disease Models, Animal; Male; Nystatin; Polyesters; Polyethylenes; Rats; Rats, Wistar

Inhibition of wound contraction by topical anti microbial agents has been described. The purpose of this study was to further investigate that phenomenon and to explore the effect that other agents such as Aloe vera might have on this process. Full-thickness excised wounds were created on the dorsum of Sprague-Dawley rats under anaesthesia. The wounds were treated with topical agents three times daily for fourteen days, then observed until healed. Groups were: saline control, placebo (aqueous cream) control, silver sulphadiazine (SSD) cream 1%, SSD 0.5%, SSD 1% with Aloe vera, SSD 1% with nystatin, nystatin. Wound surface areas were measured each three days. Time to 50% and 90% healing was compared using ANOVA. Wound half-life and healing times were shortest in the SSD/Aloe vera and nystatin groups (P<0.05) and longest in the 1% SSD and saline control groups. The placebo group (aqueous cream) healed in a significantly shorter time (P<0.05) than the control (saline) group. Wound contraction was delayed by saline and SSD. Nystatin and Aloe vera, when added to SSD, reversed that effect. These data suggest that a dry wound (saline) heals slowly. Infection control without delay of wound healing is most appealing and clinical trials are planned.

Topics: Administration, Topical; Aloe; Animals; Anti-Bacterial Agents; Antifungal Agents; Burns; Combined Modality Therapy; Male; Models, Animal; Nystatin; Ointments; Phytotherapy; Rats; Rats, Sprague-Dawley; Silver Sulfadiazine; Sodium Chloride; Treatment Outcome; Wound Healing

In a prospective study, 132 patients were investigated for yeast infection of burn wounds. Ten patients (7.6%) were infected with Candida species. All patients with yeast infections were also infected with bacteria with the exception of one patient who was infected with Candida tropicalis alone. The predominant yeast recovered was Candida krusei. Yeast infection was found to be more common in the younger age group. The isolation of a Candida species alone from one patient and Candida isolation from patients with sepsis in burn wounds indicate a significant role for yeasts in the production of infection in burn wounds. Therefore, special cultures for yeasts are recommended for all cases of burn wound infection.

Topics: Administration, Topical; Adolescent; Adult; Aged; Antifungal Agents; Burns; Candidiasis; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Mycoses; Nystatin; Prevalence; Prospective Studies

Angioinvasive fungal infections have a significant morbidity and mortality in the immunocompromised host. Massive burns produce a profound derangement in cellular immunity along with a loss of cutaneous barrier function. Treatment of fungal burn wound infections poses a difficult therapeutic challenge. We present a new method of treatment for angioinvasive fungal infections with nystatin powder at a concentration of 6,000,000 units/g. It proved to be efficacious in four consecutive severely burned patients affected by massive angioinvasive fungal infection. Both superficial and deep tissue infections were eradicated without any other therapeutic interventions or adverse effects on wound healing.

Topics: Administration, Topical; Antifungal Agents; Aspergillus; Biopsy; Burns; Child; Drug Therapy, Combination; Fusarium; Humans; Itraconazole; Mycoses; Nystatin; Powders; Retrospective Studies; Skin Transplantation; Trauma Severity Indices; Treatment Outcome; Wound Healing; Wound Infection

Topics: Administration, Cutaneous; Antifungal Agents; Burns; Candidiasis; Cross Infection; Fungemia; Humans; Nystatin

Cultured skin grafts are destroyed more easily than split-thickness skin grafts by common burn wound organisms, including gram-negative and gram-positive bacteria and fungi. To increase the survival and engraftment of cultured skin grafts, formulations of antimicrobial agents were tested for cytotoxicity to cultured human keratinocytes and fibroblasts and for activity against common organisms from burn wounds. On the basis of previous studies, a base formulation containing neomycin (40 micrograms/ml), polymyxin B (700 U/ml), and mupirocin (40 micrograms/ml) was prepared, to which ciprofloxacin (20 micrograms/ml) or norfloxacin (20 micrograms/ml) and amphotericin B (0.25 microgram/ml) or nystatin (100 U/ml) were added. Toxicity to cultured human cells was determined by the growth response of cell cultures (n = 6) to each drug combination over 4 days. Activity against clinical isolates (n = 40) of Staphylococcus aureus, Pseudomonas aeruginosa, other gram-negative bacteria, and Candida spp. was determined by the wet disc assay. Analysis of variance testing showed no significant differences in the growth of keratinocytes or fibroblasts under control or experimental conditions. Medium without antimicrobial agents was not effective against any of the 40 microbial strains tested. The base formulation was effective against all bacterial strains tested but against none of the fungi, while all experimental formulations were effective against all microbial strains tested. These findings suggest that neomycin, mupirocin, and polymyxin B may be combined with a quinolone and an antimycotic agent to provide broad antimicrobial activity for a formulation for topical use with cultured skin on burns. However, the formulations described here are strictly experimental and are not recommended for clinical use without further evaluation.

Topics: Administration, Topical; Amphotericin B; Burns; Candida; Cells, Cultured; Ciprofloxacin; Culture Techniques; Drug Therapy, Combination; Enterobacteriaceae; Fibroblasts; Humans; Keratinocytes; Microbial Sensitivity Tests; Norfloxacin; Nystatin; Skin; Skin, Artificial; Staphylococcus aureus

Yeast isolates from burned patients were analyzed retrospectively for a 7-year period (1984-1991). Topical nystatin was used routinely in the burn wound dressing as antifungal therapy beginning in July 1986. Nystatin used was associated with a significant decrease in overall yeast acquisitions in burn wounds; yeasts were isolated from 15.5% of admitted patients before the use of nystatin vs. 10.5% with use of nystatin (odds ratio [OR] = 0.64; 95% confidence interval [CI], 0.48-0.86). New acquisitions of Candida rugosa in burn wounds increased from 0.36% of admissions during the period July 1984 to June 1986 (before nystatin use) to 5.25% in the period July 1986 to June 1991 (during use of nystatin) (OR = 15.3; 95% CI, 4.1-128). The incidence of fungemia decreased from 3.25% of admissions in the pre-nystatin period to 1.43% in the postnystatin period (OR = 0.43; 95% CI, 0.22-0.87). C. rugosa caused none of 18 fungemias in the former period and 15 of 21 in the latter period (P = .002). Susceptibility testing of recent C. rugosa isolates demonstrated resistance to nystatin and moderate susceptibility to amphotericin B and fluconazole. Topical nystatin use was associated with a decrease in fungemias and acquisition of yeasts in burn wounds but with an increase in colonization and fungemias caused by nystatin-resistant, amphotericin B-susceptible C. rugosa.

Topics: Amphotericin B; Burn Units; Burns; Candida; Candidiasis; Case-Control Studies; Cross Infection; Fluconazole; Flucytosine; Humans; Ketoconazole; Microbial Sensitivity Tests; Nystatin; Retrospective Studies

Cultured epidermal skin has become an adjunctive therapy for treatment of major burn injuries, but its effectiveness is greatly limited due to destruction by microbial contamination. To evaluate candidate drugs for use with cultured skin, a combined cytotoxicity-antimicrobial assay system was developed for determination of toxicity to cultured human keratinocytes and fibroblasts, and to common burn wound organisms (20 bacterial and 4 fungal strains). Candidate agents including Hibiclens (n = 3), amikacin, piperacillin, norfloxacin, and nystatin were tested separately and in combination (n = 6 each) for inhibition of growth of human cells and lytic activity on microorganisms in the wet disc assay. The data showed that: (1) Hibiclens was uniformly toxic to both cultured human cells and microorganisms; (2) norfloxacin had dose-dependent toxicity to human cells and broad effectiveness against microorganisms; and (3) norfloxacin (25 micrograms/mL) plus nystatin (100 U/mL) had low toxicity to human cells and high toxicity to both Gram-positive and Gram-negative bacteria (20 of 20) and fungi (4 of 4). Selection of topical antimicrobial drugs by these assays may improve effectiveness of cultured skin for burns and may be extended to the control of other surgical wound infections.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Burns; Candida; Cells, Cultured; Chlorhexidine; Humans; Microbial Sensitivity Tests; Nystatin; Skin; Skin Transplantation

The incidence of opportunistic infections after thermal injury is high. Since 1985, we have been practicing Candida prophylaxis using nystatin "swish-and-swallow" and topical therapy. Patients treated between 1980 and 1984 served as controls and received no Candida prophylaxis. Although mean burn size, full-thickness injury, and age were comparable, the incidence of Candida colonization (26.7% vs 15.6%), infection (21.3% vs 10.0%), and sepsis (12.2% vs none) was significantly different between control and nystatin-treated groups, respectively. With prophylaxis, the incidence of Candida wound infection has been significantly reduced, and systemic candidiasis has been eradicated, eliminating the need for toxic systemic antifungal agents.

Topics: Administration, Buccal; Administration, Topical; Burns; Candidiasis; Child; Child, Preschool; Fungemia; Humans; Nystatin; Retrospective Studies; Wound Infection

The increased incidence of Candida burn wound infection and septicemia in massively burned patients is well known. One thousand thirty six patients were admitted from January 1982 through December 1986. Nystatin prophylaxis, both oral and topical, was initiated in October 1984 and 472 patients were treated. The control group was comprised of the 564 patients treated January 1982 through September 1984. There was a significant difference (p less than 0.005) between the groups in the number of Candida colonized patients, the numbers of Candida burn wound infections, the incidence of multi-organ system involvement/failure, and the occurrence of Candida sepsis. There has not been a Candida burn wound infection in this institution since June 1985. Nystatin, given orally as a 'swish and swallow' or mixed 1:1 with either silver sulfadiazine or polymyxin B/bacitracin, has eradicated Candida burn wound infections and septicemia from this institution and thus obviated the need for systemic antifungals such as amphotericin B.

Topics: Administration, Topical; Bacitracin; Bacteriological Techniques; Burns; Candidiasis; Child; Child, Preschool; Debridement; Drug Therapy, Combination; Humans; Nystatin; Polymyxin B; Retrospective Studies; Wound Infection

1. A synthetic burn dressing made from polyethylene glycol - 400 (PEG) and poly-2-hydroxyethyl methacrylate (PHEMA) can be prepared to contain topical antimicrobial agents. 2. Sheets of these antimicrobial loaded dressings may be applied to the wounds or alternatively, the synthetic dressing incorporating the active drugs may be formed directly on the burn wound from the PEG-PHEMA drug mixture. 3. The antimicrobials (silver sulfadiazine, gentamicin and nystatin) are continuously and effectively released from the solid dressing over 2-11 days.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Bandages; Burns; Candida albicans; Delayed-Action Preparations; Gentamicins; Nystatin; Polyethylene Glycols; Polyhydroxyethyl Methacrylate; Polymethacrylic Acids; Pseudomonas aeruginosa; Rats; Sulfadiazine; Wound Infection

An oral prophylactic antibiotic regimen (neomycin-erythromycin-nystatin) aimed at suppression of the bowel flora was utilized in 20 patients with thermal injury treated in a laminar flow burn unit with strict sterile technique and reverse isolation. The regimen was utilized for an average of 24 days. Surface cultures were obtained twice weekly from multiple areas of the burn wound, and burn wound biopsies were performed one to two times weekly. These patients were compared prospectively with a group of 10 patients treated in otherwise identical fashion, save for the omission of the antibiotic suppressive regimen. Bacterial colonization of the burn wound occurred an average of 19 days after admission in the group receiving antibiotics compared to 4 days after admission in the control group (p less than 0.01). Positive burn biopsies (more than 10(5) bacteria per gm of tissue) were observed twice as often in the group not receiving antibiotics (p less than 0.16) as were infectious complications of several types: bacteremia, burn wound sepsis, urinary tract infections, pneumonitis, cellulitis (0.10 less than p less than 0.20). Staphylococcal or fungal overgrowth were not encountered in the patients receiving prophylactic antibiotics, nor was there an adverse effect on serum creatinine levels with the prolonged use of neomycin.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Burns; Cellulitis; Child; Child, Preschool; Erythromycin; Escherichia coli; Humans; Intestines; Middle Aged; Neomycin; Nystatin; Pneumonia; Prospective Studies; Sepsis; Staphylococcus aureus; Urinary Tract Infections

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Burns; Child; Child, Preschool; Erythromycin; Humans; Intensive Care Units; Middle Aged; Neomycin; Nystatin

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Burns; Child; Child, Preschool; Erythromycin; Humans; Intestines; Middle Aged; Neomycin; Nystatin; Time Factors

The incidence of yeasts in the oral cavity, rectum and urine of a population of 60 children hospitalized for treatment of acute second and third degree burns was approximately the same at the time of their admission as would be expected in healthy subjects. After hospitalization, the incidence of yeasts was reduced in the intestinal tract of acute patients who received nystatin orally but increased in the oral cavity. The majority of 418 yeasts were inhibited in vitro by less than 50 units/ml nystatin and only 6 yeasts were resistant to more than 3.1 mug/ml amphotericin B. The oral cavity appeared to act as a significant reservoir from which yeasts spread to cause or contribute to the deaths of 2 of 5 patients who died during the study.

Topics: Adolescent; Burns; Candida; Candida albicans; Child; Female; Humans; Male; Mouth; Nystatin; Rectum; Urine; Wound Infection; Yeasts

Topics: Animals; Burns; Candidiasis; Child; Dogs; Haplorhini; Humans; Intestinal Mucosa; Macaca; Nystatin; Sepsis; Surgical Wound Infection; Wound Infection

Topics: Amphotericin B; Burns; Dermatomycoses; Humans; Male; Middle Aged; Nystatin

Topics: Adolescent; Blood Urea Nitrogen; Burns; Candida; Child; Child, Preschool; Drug Synergism; Endotoxins; Gentamicins; Humans; Hydrotherapy; Infant; Neomycin; Nystatin; Penicillins; Sepsis; Sulfadiazine; Wound Infection

Topics: Adult; Burns; Candidiasis; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Nystatin; Sulfonamides; Toluene

Topics: Amphotericin B; Anti-Infective Agents, Local; Burns; Candidiasis, Oral; Denture, Complete; Humans; Nystatin; Oral Health

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Burns; Candida; Chlortetracycline; Colistin; Erythromycin; Erythromycin Ethylsuccinate; gamma-Globulins; Humans; Male; Neomycin; Nystatin; Penicillin Resistance; Penicillins; Ristocetin; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline; Wound Infection