ro13-9904 and Burns

The wound healing process is frequently associated with a number of major clinical challenges, due to the failure of commonly used antibiotics as a remedy for wounds. There have always been fascinating questions about the novel applications of bioactive glasses (BGs) and it is expected that in the next few years these types of materials may play an important role in many aspects of soft tissue regeneration. This research focuses on the feasibility of using silver- and fluoride-containing BGs against multidrug-resistant bacterial strains isolated from patients with burns. According to the results obtained, fluoride did not exhibit antibacterial activity against the tested bacteria, while both 1% and 2% silver-containing BGs inhibited the bacterial growth. It is an important finding that 1% silver-containing BGs showed a potential antibacterial activity without any toxicity against fibroblasts, suggesting that this class of BGs could play a key role in the prevention of infection, reduction of pain, and removal of excessive exudates.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Aztreonam; Burns; Carbenicillin; Cefepime; Ceftazidime; Ceftriaxone; Cell Survival; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Fluorides; Gentamicins; Glass; Humans; Imipenem; Meropenem; Mice; Microbial Sensitivity Tests; NIH 3T3 Cells; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pseudomonas aeruginosa; Silver; Thienamycins; Tobramycin; Wound Infection

The present study was carried out to understand the clonal relationship using enterobacteriaceae repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) among metallo-β-lactamase (MBL) producing multidrug resistant Pseudomonas aeruginosa isolates from burn victims and their susceptibility to commonly used anti-pseudomonal agents. In the present study 94 non-duplicate P. aeruginosa strains from the wound samples of burn patients were included. Identification of the isolates was done by biochemical methods and antibiotic sensitivity was done by disc diffusion method following CLSI (Clinical Laboratory Standard Institute) guidelines. By using imipenem (IPM)-EDTA disk diffusion/double disc synergy method carbapenem resistant organisms were tested for MBL. To define the clonal relationship ERIC-PCR was used. Of the 94 isolates, 18 (19.14%) were found resistant to IPM and MBL production was shown 11 (11.70%) by the IPM-EDTA disc diffusion method. From dendrogram of the ERIC-PCR profile four major clusters were obtained (A, B, C and D). Cluster B contained the majority of the isolates (6 strains 1, 4, 8, 9, 10 and 11). This study using ERIC-PCR of randomly collected isolates exhibits high genetic diversity which rules out cross contamination frequency.

Topics: Amikacin; Anti-Bacterial Agents; beta-Lactamases; Burns; Ceftazidime; Ceftriaxone; Cilastatin; Clavulanic Acid; Colistin; Disk Diffusion Antimicrobial Tests; Drug Combinations; Drug Resistance, Multiple, Bacterial; Genetic Variation; Humans; Imipenem; Minocycline; Netilmicin; Ofloxacin; Phylogeny; Polymerase Chain Reaction; Pseudomonas aeruginosa; Tigecycline

Infections caused by multidrug-resistant pathogens are frequent and life threatening in critically ill patients. To investigate whether severe sepsis affects gut colonization by resistant pathogens and genetic exchange between opportunistic pathogens, we tested the intestinal-colonization ability of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain carrying the SHV-18 resistance gene and the transfer ability of the resistance gene to endogenous Escherichia coli under ceftriaxone treatment in rats with burn injury only or severe sepsis induced by burns plus endotoxin exposure. Without ceftriaxone treatment, the K. pneumoniae strain colonized the intestine in both septic and burned rats for a short time, with clearance occurring earlier in burn-only rats but never in sham burn rats. In both burned and septic rats, the colonization level of the challenge strain dropped at the beginning and then later increased during ceftriaxone treatment, after which it declined gradually. This pattern coincided with the change in resistance of K. pneumoniae to ceftriaxone during and after ceftriaxone treatment. Compared with burn-only injury, severe sepsis had a more significant effect on the change in antimicrobial resistance to ceftriaxone. Only in septic rats was the resistance gene successfully transferred from the challenge strain to endogenous E. coli during ceftriaxone treatment; the gene persisted for at least 4 weeks after ceftriaxone treatment. We concluded that severe sepsis can facilitate intestinal colonization by an exogenous resistant pathogen and the transfer of the resistance gene to a potential endogenous pathogen during antimicrobial treatment.

Topics: Animals; Anti-Bacterial Agents; beta-Lactamases; Burns; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Endotoxins; Escherichia coli; Gene Transfer, Horizontal; Hot Temperature; Intestines; Klebsiella Infections; Klebsiella pneumoniae; Male; Rats; Rats, Sprague-Dawley; Sepsis

Virtually all pediatric cases of Neisseria gonorrhoeae originate from contact with an infected adult. A cutaneous abscess caused by N. gonorrhoeae in a child is extremely rare, especially outside the genital area. We report a case of a 22-month-old boy with a gonococcal cutaneous abscess on the abdominal wall and suggest that N. gonorrhoeae should be included in the differential diagnosis of skin and soft tissue infections in children.

Topics: Abdomen; Abscess; Anti-Bacterial Agents; Azithromycin; Burns; Ceftriaxone; Diagnostic Errors; Drug Therapy, Combination; Emergency Shelter; Environmental Exposure; Gonorrhea; Humans; Infant; Male; Neisseria gonorrhoeae; Skin Diseases, Bacterial; Spouse Abuse

To investigate the effects of rhubarb on intestinal flora and bacterial translocation in septic rats.. One hundred and four Sprague-Dawley (SD) rats were randomly divided into normal control group, burn group, sepsis group, and sepsis with rhubarb treatment group. All the animals except those in the normal control group were given 30% total body surface area (TBSA) III degree burn on their back followed by endotoxin challenge intraperitoneally in a dose of 20 mg/kg 24 hours after the burn injury. The animals were treated with intraperitoneal injection of ceftriaxone 24 hours after the second hit in various groups in a dose of 60 mg/kg, twice a day with a interval of 12 hours. Rhubarb was also given orally with a dose of 50 mg/kg, twice a day with an interval of 12 hours, at the same time. On 1, 3 and 9 days after treatment, intestinal bacilli in colon and the incidence of bacterial translocation in content of large intestine, liver, lung, mesenteric lymph node and blood in each group were determined.. Neither intestinal bacilli in colon nor bacterial translocation showed significant change after the burn injury [(5.86+/-0.62) log cfu/g vs. (5.52+/-0.41) log cfu/g]. The second hit with endotoxin obviously increased the number of intestinal bacilli in colon [(8.96+/-0.73) log cfu/g, P<0.01], in which Colibacillus remain the predominant flora. At the same time, the incidence of Colibacillus translocation was also very high. The antibiotic ceftriaxone markedly reduced the number of Colibacillus on the 3rd and 9th day after the therapy [(4.43+/-0.64) log cfu/g, (5.82+/-0.99) log cfu/g, both P<0.01]. However, the number of some opportunistic pathogens, such as Pseudomonas aeruginosa and Baumanii, significantly increased, and they substituted Colibacillus to become the predominant flora in gut. Furthermore, the species of bacterial translocation also switched to Pseudomonas aeruginosa and Baumanii from Colibacillus. Rhubarb could prevent the loss of enteric bacilli in gut [(8.24+/-1.32) log cfu/g]. Moreover, it also extenuated the effects of antibiotics in diminishing commensal flore in gut. Lastly, the rhubarb could inhibit bacterial translocation at the early stage of sepsis (incidence of translocation on 1 th day of the therapy: 40.62% vs. 6.25%, P<0.05).. Rhubarb can protect the gut microbiogeocoenosis, mitigate the bactericidal effect on antibiotics on commensal flora, and inhibit bacterial translocation at the early stage of sepsis.

Topics: Animals; Anti-Bacterial Agents; Bacterial Translocation; Burns; Ceftriaxone; Disease Models, Animal; Intestines; Male; Probiotics; Random Allocation; Rats; Rats, Sprague-Dawley; Rheum; Sepsis

To investigate bacterial resistance to antimicrobial agents in the background of extensive employment of third-generation cephalosporins in the treatment of burn infection.. Bacterial susceptibility testing was carried out using Kirby-Bauer method.. Out of 259 Gram negative bacilli isolates, 31% of these strains were all resistant to cefotaxime, ceftriaxone, cefoperazone and ceftazidime. In vitro test, susceptibility of 52% third-generation cephlosporins resistant strains were restored by cefoperazone/sulbactum. 23.8% of P. aeruginosa were resistant to imipenem, 51.2% to ciprofloxacin. 28.6% of A. anitratum were resistant to imipenem, 21.4% to ciprofloxacin. 9.9% of enterobacteriaceae were resistant to imipenem, 20.4% to ciprofloxacin. 26.9% of MRSA were resistant to imipenem, 73% to ciprofloxacin. No norvancomycin resistance was detected. 2.7% of E. faecalis were resistant to norvancomycin.. It is likely that the observed resistance to third-generation cephalosporins may be partially due to chromosome-mediated type-1 beta- lactamase.

Topics: Burns; Cefoperazone; Cefotaxime; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Humans; Pseudomonas aeruginosa; Wound Infection

In view of a high positive isolation rate and resistance to antibiotics of Enterobacter cloacae in our department, 32 strains of E. cloacae, which were isolated from blood and infected wounds of burned patients from June through November 1990, were randomly selected to determine their susceptibility to 21 antibiotics and their plasmid patterns. It was found that 29 of 32 strains were resistant to at least nine antibiotics, while the other three strains were relatively sensitive. 27 of 32 strains of E. cloacae were tested for plasmid, and among them, three strains (relatively sensitive to antibiotics) contained no plasmid. The plasmid patterns of the other 24 isolates varied with strains, but all of them had a 80 kb plasmid. The 80 kb plasmid was obviously related to the high isolation rate and high resistance to antibiotics of E. cloacae isolated in our department.

Topics: Burns; Cefoperazone; Ceftazidime; Ceftriaxone; Cephalosporins; Drug Resistance, Multiple; Enterobacter cloacae; Humans; R Factors; Random Allocation; Wound Infection

Topics: Adult; Bacterial Infections; Burns; Ceftriaxone; Female; Half-Life; Humans; Male; Prospective Studies

Effective and safe antibiotic control combined with surgical measures is the mainstay of the management of serious sepsis in burn wounds. To determine the effects of the third-generation cephalosporins on the clinical and bacteriological course of burn sepsis, 30 adult patients with a comparable degree of burn sepsis were treated with cefatriaxon (Ro 13-9904 (Rocephin); Roche). No significant side-effects were observed, and clinical observation showed a marked to moderate improvement in wound sepsis in 26 cases. Of 61 wound cultures obtained after completion of the course of cefatriaxon, only 19 yielded a positive growth. The beneficial role of the third-generation cephalosporins indicated by this prospective trial could be very important in the management of extensive burn wound sepsis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Burns; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged