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This work aimed to select a safe and bacteriocin-producing isolate of Lactobacillus to use it as a probiotic for treating Pseudomonas aeruginosa associated with burn infections. For this purpose, 151 burn wound swabs were collected from patients to isolate the most common multi-drug resistance Pseudomonas aeruginosa that could be used as an indicator. In addition, thirty-six Lactobacillus isolates were collected from different sources and subjected to a screening program to evaluate their antagonism activities against MDR P. aeruginosa. Based on results, the isolate Lactobacillus HLB12 showed a highest bacteriocin production which was further characterized as Limosilactobacillus fermentum through 16s ribosomal RNA. Several tests were performed to study the properties of Limosilactobacillus fermentum HLB12, particularly its biosafety and suitability to be a successful probiotic. Results showed that L. fermentum HLB12 was resistant to β-lactams group such as ticarcillin/clavulanate. Whereas it was sensitive to amikacin, ciprofloxacin and levofloxacin. Moreover, the results confirmed that L. fermentum HLB12 was safe as a probiotic without any health impacts as it has no hemolytic activity. Furthermore, results revealed that this bacterium was strongly adherent and good biofilm producer, had high autoaggregation capability and high ability of adhering with Pseudomonas aeruginosa. Limosilactobacillus fermentum cells were successfully incorporated into a gel base formula. The results revealed that cells kept their viability over 21 days with an ability to produce and release the bacteriocin. The formula was tested in vitro and results showed a high antagonistic activity against Pseudomonas aeruginosa. Next, the formula was tested in vivo to treat rabbit models with full-thickness skin burn. Upon examining the healing process, results showed signs of remodeling stage by day four and scar tissue formation by day nine. The results supported the idea of using probiotic as an alternative method for the treatment with antibiotics. [ABSTRACT FROM AUTHOR]

Normal skin is the first line of defense in the human body. A burn injury makes the skin susceptible to bacterial infection, thereby delaying wound healing and ultimately leading to sepsis. The chances of biofilm formation are high in burn wounds due to the presence of avascular necrotic tissue. The most common pathogen to cause burn infection and biofilm is Pseudomonas aeruginosa. The purpose of this study was to create a microemulsion (ME) formulation for topical application to treat bacterial burn infection. In the present study, tea tree oil was used as the oil phase, Tween 80 and transcutol were used as surfactants, and water served as the aqueous phase. Pseudo ternary phase diagrams were used to determine the design space. The ranges of components as suggested by the design were chosen, optimization of the microemulsion was performed, and in vitro drug release was assessed. Based on the characterization studies performed, it was found that the microemulsion were formulated properly, and the particle size obtained was within the desired microemulsion range of 10 to 300 nm. The I release study showed that the microemulsion followed an immediate release profile. The formulation was further tested based on its ability to inhibit biofilm formation and bacterial growth. The prepared microemulsion was capable of inhibiting biofilm formation. [ABSTRACT FROM AUTHOR]

Mucormycosis is an uncommon infection but is increasing in prevalence. Cutaneous disease is associated with burns and traumatic injuries. Cutaneous mucormycosis is the least deadly form but mortality is still approximately 36%. Burn superinfection with mucormycosis is increasingly common and can be an insidious process that may not present until the disease disseminates. We present the case of a 30-year-old male who presented to the emergency department for a rash. A rash with yellow crusting was noted to involve his scalp, face, ear, right shoulder, and parts of both feet. He had been placed on antibiotics by an urgent care a few days prior to presenting. He denied systemic symptoms, chemical exposure, change in detergent, autoimmune diseases, or travel. The patient has a history of intravenous opioid and dissociative abuse and had multiple episodes of syncope—including at his work in a factory where there were hot metals, refrigerants, and numerous corrosive chemicals. Surgical debridement revealed mucormycosis on pathology. The patient was treated with isavuconazole, surgical debridement, and skin grafting. He experienced complete recovery. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically review the efficacy and safety of silver sulfadiazine ointment in local treatment of burn. METHODS: PubMed, Embase, the Cochrane Library and other databases were retrieved to collect the randomized controlled study with silver sulfadiazine ointment in local treatment of burn ( intervention with silver sulfadiazine and control with other materials). The retrieval time was from Jan. 1st, 2010 to Jun. 1st, 2022. For the included randomized controlled studies, Cochrane bias risk assessment tool was used to evaluate study quality, and RevMan 5. 3 software was used for Meta-analysis to compare the wound healing time and infection rate of burn treated by silver sulfadiazine and other materials. RESULTS: Totally 11 studies were included. Meta-analysis results showed that compared with other materials, silver sulfadiazine could not shorten the wound healing time of burn, and the difference was not statistically significant (MD= -0. 31,95%CI = -2. 89-2. 26,P = 0. 81). Meanwhile, there was no significant difference in the infection rate between silver sulfadiazine group and other materials group (18. 09% vs. 14. 81%, P>0. 05). CONCLUSIONS: Based on current clinical studies, silver sulfadiazine has shown worse effect on wound healing in burn than other materials. No differences are observed between silver sulfadiazine and other materials in the prevention of infection. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae is among the most frequent microorganisms isolated from infections of burn wounds. This cross-sectional study aimed to investigate the distribution of multi-drug resistant (MDR) K. pneumoniae in two burn hospitals and the antibiotic resistance profile in different burn regions of the same patient. It was performed in two hospitals (Al-Zahraa and Al-Karama) in Al-Kut, Iraq, between January and May 2022. Totally, 100 burn swabs were collected from 40 patients of both genders suffering from burn wound infections, with ages ranging between 3 and 50 years. Klebsiella pneumoniae were isolated and identified using conventional methods followed by VITEK®2 system and confirmed via polymerase chain reaction targeting the gapA gene. Then, the antimicrobial susceptibility pattern was studied by the VITEK®2 system. Of the 100 burn wound swabs, 20 isolates were K. pneumoniae. Fifty five percent (11 out of 20) of K. pneumoniae isolated in the current study were MDR and 35% of the isolates had the extended spectrum beta-lactamase (ESBL) which is the main antibiotic resistance mechanism. Furthermore, the bacteria isolated from different burned areas of the same patient showed variable pattern of antibiotic susceptibility. To conclude, K. pneumoniae contaminating the burn wards in the Iraqi hospitals are mostly MDR, against which tigecycline is the most effective antibiotic. [ABSTRACT FROM AUTHOR]

Prolonged inflammation and infection in burns may cause inadequate healing. Platelet granules contain anti-inflammatory mediators that impact wound healing. Synthetic platelets (SPs) avoid portability and storage difficulties of natural platelets and can be loaded with bioactive agents. We evaluated wound healing outcomes in deep partial-thickness (DPT) burns treated topically with SP loaded with antibiotics. Thirty DPT burns were created on the dorsum of two Red Duroc hybrid pigs. Six wounds were randomized into five groups: SP alone, SP loaded with gentamicin vesicles, SP with gentamicin mixture, vehicle control (saline), or dry gauze. Wounds were assessed from postburn days 3-90. Primary outcome was re-epithelialization percentage at postburn day 28. Secondary outcomes included wound contraction percentage, superficial blood flow relative to normal skin controls, and bacterial load score. Results showed that re-epithelialization with the standard of care (SOC) was 98%, SP alone measured 100%, SP loaded with gentamicin vesicles was 100%, and SP with gentamicin mixture was 100%. Wound contraction was 5.7% in the SOC and was ∼10% in both the SP loaded with gentamicin vesicles and SP with gentamicin mixture groups. Superficial blood flow in the SOC was 102.5%, SP alone was 170%, the SP loaded was 155%, and gentamicin mixture 162.5%. Bacterial load score in the SOC was 2.2/5.0 and was significantly less at 0.8/5.0 in SP loaded with gentamicin vesicles (P > 0.05). SP and gentamicin mixture scored 2.7 and 2.3/5.0. Topical SP treatment did not significantly improve outcomes. However, SP loaded with gentamicin-infused vesicles decreased bacterial load. [ABSTRACT FROM AUTHOR]

One of the most common bacteria in nosocomial and burn infections is Pseudomonas aeruginosa. Due to the high antibiotic resistance of P. aeruginosa and the lack of other effective therapeutic agents, treating diseases caused by this bacterium could be challenging. Therefore, finding novel solutions to control and prevent highly resistant strains of P. aeruginosa is paramount. After isolation and identification of Lactobacilli with known probiotic properties such as L. acidophilus, L. paracasei, L. rhamnosus, and L. bulgaricus using PCR technique, and preparation of their corresponding phage (PAO1 Φ), probiotics and phage were used individually and in combination to treat burn infection caused by P. aeruginosa in a mouse model. The results revealed that the combination of phage with probiotics can be highly effective for treating P. aeruginosa burn infections. Our study showed that the most effective multiple cocktails of Lactobacilli for the treatment of P. aeruginosa infection, were L. rhamnosus + L. bulgaricus + L. paracasei cocktail in mixture with phage (PAO1 Φ). The study proposes an alternative method for the treatment of P. aeruginosa infections. The combination of probiotics with phage could be proposed as a new therapeutic agent for treating P. aeruginosa infections. [ABSTRACT FROM AUTHOR]

Background and Aim: Pseudomonas aeruginosa (P. aeruginosa) is an important causative organism of burn infection. Several virulence factors are implicated in P. aeruginosa colonization and invasion, making P. aeruginosa infection's outcome worse. Type III secretion system (T3SS) effector proteins are among these virulence factors. The present study evaluated the frequency of genes encoding T3SS effectors as a virulence determinant in P. aeruginosa isolates from burn patients. Materials and Methods: Wound swabs were collected from burn patients admitted to the Plastic and Reconstructive Surgery Center, Mansoura University, Egypt, and identified by different microbiological testing methods. The modified Kirby Bauer's disc diffusion method was used to test the antibiotic susceptibility of P. aeruginosa isolates against different antibiotics. Prevalence and the presence of exo genes that encode type T3SS proteins (exoS, exoT, exoU, and exoY) in P. aeruginosa isolates were evaluated by the multiplex PCR. Chi-square and Fisher's test were used for statistical analysis. Results: A total of 45 P. aeruginosa isolates were identified from 101 burn patients, including 27 males and 18 females, with a mean age of 15.78±2.65 years old. P. aeruginosa isolates were mostly susceptible to piperacillin/tazobactam and imipenem (73.33 and 62.22%), respectively; while the lowest susceptibility rates were in ceftazidime (4.44%), Tobramycin (4.44%), and ceftriaxone (6.67%). The exoY and exoT genes were detected in 100% of the P. aeruginosa isolates, while 62.22% and 42.22% of clinical isolates harbored exoS and exoU genes, respectively. Conclusion: This study established a correlation between T3SS proteins, particularly exoS and exoU genes and antimicrobial resistance in P. aeruginosa isolates from burn infection. [ABSTRACT FROM AUTHOR]

Abstract Failure in the treatment of P. aeruginosa, due to its broad spectrum of resistance, has been associated with increased patient mortality. One alternative approach for infection control is quorum quenching which was found to decrease virulence of such pathogen. In this study, the efficiency of a recombinant Ahl-1 lactonase formulated as a hydrogel was investigated to control the infection of multidrug resistant (MDR) P. aeruginosa infected burn using a murine model. The recombinant N-acylhomoserine lactonase (Ahl-1) was formulated as a hydrogel. To test its ability to control the infection of MDR P. aeruginosa, a thermal injury model was used. Survival rate, and systemic spread of the infection were evaluated. Histopathological examination of the animal dorsal skin was also done for monitoring the healing and cellular changes at the site of infection. Survival rate in the treated group was 100% relative to 40% in the control group. A decrease of up to 3 logs of bacterial count in the blood samples of the treated animals relative to the control group and a decrease of up to 4 logs and 2.3 logs of bacteria in lung and liver samples, respectively were observed. Histopathological examination revealed more enhanced healing process in the treated group. Accordingly, by promoting healing of infected MDR P. aeruginosa burn and by reducing systemic spread of the infection as well as decreasing mortality rate, Ahl-1 hydrogel application is a promising strategy that can be used to combat and control P. aeruginosa burn infections.

Vibrio vulnificus is an invasive marine bacterium that causes a variety of serious infectious diseases. With the increasing multidrug-resistant variants, treatment of V. vulnificus infections is becoming more difficult. In this study, we explored antimicrobial blue light (aBL; 405 nm wavelength) for the treatment of V. vulnificus infections. We first assessed the efficacy of aBL against five strains of V. vulnificus in vitro. Next, we identified and quantified intracellular porphyrins in V. vulnificus to provide mechanistic insights. Additionally, we measured intracellular reactive oxygen species (ROS) production and bacterial membrane permeabilization following aBL exposures. Lastly, we conducted a preclinical study to investigate the efficacy and safety of aBL for the prevention and treatment of burn infections caused by V. vulnificus in mice. We found that aBL effectively killed V. vulnificus in vitro in both planktonic and biofilm states, with up to a 5.17- and 4.57-log10 CFU reduction being achieved, respectively, following an aBL exposure of 216 J/cm2. Protoporphyrin IX and coproporphyrins were predominant in all the strains. Additionally, intracellular ROS was significantly increased following aBL exposures (P < 0.01), and there was evidence of aBL-induced permeabilization of the bacterial membrane (P < 0.0001). In the preclinical studies, we found that female mice treated with aBL 30min after bacterial inoculation showed a survival rate of 81%following 7 days of observation, while only 28% survival was observed in untreated female mice (P < 0.001). At 6 h post-inoculation, an 86% survival was achieved in aBL-treated female mice (P = 0.0002). For male mice, 86 and 63% survival rates were achieved when aBL treatment was given 30min and 6 h after bacterial inoculation, respectively, compared to 32%survival in the untreatedmice (P = 0.0004 and P = 0.04). aBL did not reduce cellular proliferation or induce apoptosis. We found five cytokines were significantly upregulated in the males after aBL treatment, including MCSF (P < 0.001), MCP-5 (P < 0.01), TNF RII (P < 0.01), CXCL1 (P < 0.01), and TIMP-1 (P < 0.05), and one in the females (TIMP-1; P < 0.05), suggesting that aBL may induce certain inflammatory processes. In conclusion, aBL may potentially be applied to prevent and treat V. vulnificus infections. [ABSTRACT FROM AUTHOR]

Vibrio vulnificus is an invasive marine bacterium that causes a variety of serious infectious diseases. With the increasing multidrug-resistant variants, treatment of V. vulnificus infections is becoming more difficult. In this study, we explored antimicrobial blue light (aBL; 405 nm wavelength) for the treatment of V. vulnificus infections. We first assessed the efficacy of aBL against five strains of V. vulnificus in vitro. Next, we identified and quantified intracellular porphyrins in V. vulnificus to provide mechanistic insights. Additionally, we measured intracellular reactive oxygen species (ROS) production and bacterial membrane permeabilization following aBL exposures. Lastly, we conducted a preclinical study to investigate the efficacy and safety of aBL for the prevention and treatment of burn infections caused by V. vulnificus in mice. We found that aBL effectively killed V. vulnificus in vitro in both planktonic and biofilm states, with up to a 5.17- and 4.57-log10 CFU reduction being achieved, respectively, following an aBL exposure of 216 J/cm2. Protoporphyrin IX and coproporphyrins were predominant in all the strains. Additionally, intracellular ROS was significantly increased following aBL exposures (P < 0.01), and there was evidence of aBL-induced permeabilization of the bacterial membrane (P < 0.0001). In the preclinical studies, we found that female mice treated with aBL 30 min after bacterial inoculation showed a survival rate of 81% following 7 days of observation, while only 28% survival was observed in untreated female mice (P < 0.001). At 6 h post-inoculation, an 86% survival was achieved in aBL-treated female mice (P = 0.0002). For male mice, 86 and 63% survival rates were achieved when aBL treatment was given 30 min and 6 h after bacterial inoculation, respectively, compared to 32% survival in the untreated mice (P = 0.0004 and P = 0.04). aBL did not reduce cellular proliferation or induce apoptosis. We found five cytokines were significantly upregulated in the males after aBL treatment, including MCSF (P < 0.001), MCP-5 (P < 0.01), TNF RII (P < 0.01), CXCL1 (P < 0.01), and TIMP-1 (P < 0.05), and one in the females (TIMP-1; P < 0.05), suggesting that aBL may induce certain inflammatory processes. In conclusion, aBL may potentially be applied to prevent and treat V. vulnificus infections.

In this study, 225 isolates of Pseudomonas aeruginosa were recovered from burn wounds in major hospitals in Duhok and Erbil, Iraq, between April 2015 and September 2015. A total of 136 of these isolates were from men, comprising 60.4% of the total, whereas 89 (39.6%) were recovered from women. One hundred of these isolates were selected (50 from each province of Erbil and Duhok) and subjected to 16 different antibiotics using the disc diffusion method. The isolates showed a high level of resistance to most of the tested antibiotics, with 90% of the isolates being multidrug resistant. Imipenem was considered as the most effective antibiotic against these isolates with a resistant rate of 47%. The genome of all of these isolates were successfully amplified and produced a single band for the 16S rDNA locus with a molecular weight of about 956 base pairs, which was used to confirm, at the molecular level, that all these isolates were indeed P. aeruginosa. The results of the detection of five virulence-related genes including opr1, toxA, exoS, lasB, and nan1 revealed that 10 of these isolates, accounting for 10%, lacked any of the tested virulence markers. The opr1 gene, as a marker for the presence of a pathogenicity island, was the most dominant marker among all the virulence markers and was detected in 90 isolates (90%), followed by the toxA and exoS genes, which were both observed in 86 (86%) isolates, whereas the lasB gene was found in 82 (82%) isolates and the nan1 gene in 35 (35%) of the isolates, respectively.

Background: The nanotechnology considers as one of the most promising technologies in the treatment of diseases and the manufacture of drugs with high efficiency. This review highlighted on the designing of nanoparticles (NPs) for therapeutics. The size of nanoparticle important in reaching to the target and get out from the body by kidney. Nanostructured and nanocrystalline nanomaterials are the two basic types of nanomaterials. The safe of nanoparticle is one of the most attractive attribute of nanoparticle when it will chose as a medicine. Dendrimers are extensively employed in therapeutic implementation because of their structural attribution of this component. Moreover, the capsid protein of virus is extremely natural nanoparticles can be used in medicine. Nanogels can be used for biological sensors, and other biological applications and administration of pharmaceuticals. Beside that there are many nanoparticles that have many medical applications, i.e. nanodiamonds (NDs), metallic NPs, quantum dots (QDs), Silica-Based NPs (SBNPs), Lipid-Based Nanoparticles (Liposomes). Conclusion: One of the most important applications of NPs, which was highlighted in this review, is the use of nanoparticles in the treatment of microbial contaminated burns. Finally, it can be concluded that the using of NPs and nanomaterials with no cytotoxic effect in medication are considered one of the most important technologies that have emerged in recent years.

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Aim. To identify the frequency of occurrence of staphylococcal enterotoxins of the SEC and SEI type produced by Staphylococcus aureus strains isolated from patients with different nosology. As you know, the infection process in them proceeds with severe intoxication without vomiting and intestinal disorders.Materials and methods. 79 strains were studied (43 were isolated in case of pneumonia, 13 - in burns, 11 - in sepsis) S. aureus in the presence of SES and SEI using enzymelinked immunosorbent assay (ELISA).Results. It was found that 48.3% of S. aureus strains isolated from patients with pneumonia produced SEC and 72.1% - SEI. The frequency of occurrence of S. aureus strains producing SEC and SEI isolated in patients with burn infections was 23.0 and 15.4%, respectively. 36.4% of staphylococcal strains isolated in patients with sepsis produced SEC, 45.5% - SEI.Discussion. It was found that the proportion of S. aureus cultures producing SEC enterotoxins during sepsis is significantly higher than the strains producing SEB (5.4%) and much smaller than SEA (75.6%). A high percentage of SEI-positive strains was found compared to strains that produce the classic enterotoxins SEA, SEB and SEC isolated from pneumonia. In burn infections, the proportions of strains producing SEC and SEI were 15.4 and 23.0%, respectively, which is significantly lower than SEA (92.9%).Conclusion. The data obtained indicate the need to identify staphylococcus strains that produce both classic and newly discovered enterotoxins, which are crucial virulence factors leading to lethal sepsis, infectious endocarditis and toxic shock syndrome to eliminate them.

Hossein Rahimi,1 Shahla Roudbarmohammadi,1 Hamid Delavari H,2 Maryam Roudbary31Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; 2Department of Materials Engineering, Faculty of Engineering, Tarbiat Modares University, Tehran, Iran; 3Department of Medical Mycology and Parasitology, School of Medicine, Iran University of Medical Sciences, Tehran, IranBackground: Candida albicans as an opportunistic fungus is one of the most important causes of late-onset morbidity and mortality in patients with major burns and severely impaired immune system. In recent years, the emergence of resistance to opportunistic fungi and toxicity of antimicrobial drugs make it necessary to develop new drugs.Methods: In the present study, we investigated anticandidal effects of indolicidin, as a representative of host defense peptide, conjugated with gold nanoparticles in fluconazole-resistant clinical isolates of C. albicans. After characterizing the conjugation of indolicidin using biophysical methodologies, the cytotoxicity and hemolytic activity of the nanocomplex were examined. In addition, the expression level of ERG11, responsible for antifungal resistance, and the immunomodulatory effect of peptide-nanomaterial conjugates were assessed.Results: Our data indicated that the nanocomplex was nontoxic for the fibroblast cells and erythrocytes. Treatment with the nanocomplex significantly reduced the expression levels of the ERG11 gene in fluconazole-resistant C. albicans isolates and the iNOS gene in macrophages.Conclusion: The study data provides a chance to develop innovative therapies for the treatment of C. albicans burn infections. However, further investigation is required to examine the efficiency of the nanocomplex.Keywords: burn infection, Candida albicans, indolicidin, gold nanoparticles, antimicrobial peptides

Failure in the treatment of P. aeruginosa, due to its broad spectrum of resistance, has been associated with increased patient mortality. One alternative approach for infection control is quorum quenching which was found to decrease virulence of such pathogen. In this study, the efficiency of a recombinant Ahl-1 lactonase formulated as a hydrogel was investigated to control the infection of multidrug resistant (MDR) P. aeruginosa infected burn using a murine model. The recombinant N-acylhomoserine lactonase (Ahl-1) was formulated as a hydrogel. To test its ability to control the infection of MDR P. aeruginosa, a thermal injury model was used. Survival rate, and systemic spread of the infection were evaluated. Histopathological examination of the animal dorsal skin was also done for monitoring the healing and cellular changes at the site of infection. Survival rate in the treated group was 100% relative to 40% in the control group. A decrease of up to 3 logs of bacterial count in the blood samples of the treated animals relative to the control group and a decrease of up to 4 logs and 2.3 logs of bacteria in lung and liver samples, respectively were observed. Histopathological examination revealed more enhanced healing process in the treated group. Accordingly, by promoting healing of infected MDR P. aeruginosa burn and by reducing systemic spread of the infection as well as decreasing mortality rate, Ahl-1 hydrogel application is a promising strategy that can be used to combat and control P. aeruginosa burn infections. [ABSTRACT FROM AUTHOR]

Infection is the leading cause of complications and deaths after burns. However, the difference in infection patterns between the burn intensive care unit (BICU) and burn common wards (BCW) have not been clearly investigated. The present study aimed to compare the infection profile, antimicrobial resistance, and their changing patterns in burn patients in BICU and BCW. Clinical samples were analyzed between January 1, 2011, and December 31, 2019, in the Institute of Burn Research in Southwest China. The patient information, pathogen distribution, sources, and antimicrobial resistance were retrospectively collected. A total of 3457 and 4219 strains were detected in BICU and BCW, respectively. Wound secretions accounted for 86.6% and 44.9% in BCW and BICU, respectively. Compared with samples in BCW, samples in BICU had more fungi (11.8% vs. 8.1%), more Gram-negative bacteria (60.0% vs. 50.8%), and less Gram-positive bacteria (28.2% vs. 41.1%). Acinetobacter baumannii were the most common pathogen in BICU, compared with Staphylococcus aureus in BCW. S. aureus was the most frequent pathogen in wound secretions and tissues from both BICU and BCW. However, A. baumannii were the first in blood, sputum, and catheter samples from BICU. Overall, the multidrug-resistance (MDR) rate was higher in BICU than in BCW. However, the gap between BICU and BCW gradually shortened from 2011 to 2019. The prevalence of MDR A. baumannii and Klebsiella pneumonia significantly increased, especially in BCW. Furthermore, Carbapenem resistance among K. pneumoniae significantly increased in BICU (4.5% in 2011 vs. 40% in 2019) and BCW (0 in 2011 vs. 40% in 2019). However, the percentage of MDR P. aeruginosa sharply dropped from 85.7% to 24.5% in BICU. The incidence of MRSA was significantly higher in BICU than in BCW (94.2% vs. 71.0%) and stayed at a high level in BICU (89.5% to 96.3%). C. tropicalis and C. albicans were the two most frequent fungi. No resistance to Amphotericin B was detected. Our study shows that the infection profile is different between BICU and BCW, and multidrug resistance is more serious in BICU than BCW. Therefore, different infection-control strategies should be emphasized in different burn populations.

Infection is the leading cause of complications and deaths after burns. However, the difference in infection patterns between the burn intensive care unit (BICU) and burn common wards (BCW) have not been clearly investigated. The present study aimed to compare the infection profile, antimicrobial resistance, and their changing patterns in burn patients in BICU and BCW. Clinical samples were analyzed between January 1, 2011, and December 31, 2019, in the Institute of Burn Research in Southwest China. The patient information, pathogen distribution, sources, and antimicrobial resistance were retrospectively collected. A total of 3457 and 4219 strains were detected in BICU and BCW, respectively. Wound secretions accounted for 86.6% and 44.9% in BCW and BICU, respectively. Compared with samples in BCW, samples in BICU had more fungi (11.8% vs. 8.1%), more Gram-negative bacteria (60.0% vs. 50.8%), and less Gram-positive bacteria (28.2% vs. 41.1%). Acinetobacter baumannii were the most common pathogen in BICU, compared with Staphylococcus aureus in BCW. S. aureus was the most frequent pathogen in wound secretions and tissues from both BICU and BCW. However, A. baumannii were the first in blood, sputum, and catheter samples from BICU. Overall, the multidrug-resistance (MDR) rate was higher in BICU than in BCW. However, the gap between BICU and BCW gradually shortened from 2011 to 2019. The prevalence of MDR A. baumannii and Klebsiella pneumonia significantly increased, especially in BCW. Furthermore, Carbapenem resistance among K. pneumoniae significantly increased in BICU (4.5% in 2011 vs. 40% in 2019) and BCW (0 in 2011 vs. 40% in 2019). However, the percentage of MDR P. aeruginosa sharply dropped from 85.7% to 24.5% in BICU. The incidence of MRSA was significantly higher in BICU than in BCW (94.2% vs. 71.0%) and stayed at a high level in BICU (89.5% to 96.3%). C. tropicalis and C. albicans were the two most frequent fungi. No resistance to Amphotericin B was detected. Our study shows that the infection profile is different between BICU and BCW, and multidrug resistance is more serious in BICU than BCW. Therefore, different infection-control strategies should be emphasized in different burn populations. [ABSTRACT FROM AUTHOR]

Background: Infection is the most common complication and cause of death in patients suffering burn injuries. These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology. Diagnosis and management of infections rely on physical examination, cultures, and the pathology of the burn wound. Method: We performed an electronic search for articles in the Google Scholar and PubMed databases using the search terms "burn sepsis," "burn infection," and "burn critical care." Results: Multiple factors increase burn patients' risk of invasive infection and sepsis, including underlying factors and co-morbidities, the percent total body surface area of the burn, delays in burn wound excision, and microbial virulence/bacterial count. Organisms causing burn wound infection differ, depending on the time since injury and its location; and diagnosis is multi-factorial. The most common pathogens remain Staphylococcus and Pseudomonas spp. Conclusion: Overall, the recognition of burn sepsis is based on clinical findings. Treatment consists of a combination of local dressings, early burn excision, and systemic antimicrobial therapy. The mortality rate has decreased significantly over the past 10 years, but continued efforts at timely management and infection prevention are essential. [ABSTRACT FROM AUTHOR]

Burn injury and wound is a pig problem that assists the pathogens to grow and cause infection. 149 burn injury swabs were taken from different site of the patients’ body ages (11-53 years old). All samples were tested to isolate the sigificant microorganisms that found in burn injury. Antibiotics test was performed by using disc diffusion way that stated by Kirby-Baucer. Results appeared that the most frequent pathogen in burn injury was Pseudomonas aeruginosa 33(22.14%) and followed by E.coli 31(20.8%), Staphylococcus aureus 28(18.79%), Proteus vulgaris 26(17.48%), Coagulase-negative Staphylococci 12(8.05%), Proteus mirabilis 10(6.71%), Klebsiella pneumonia 5(3.35%) and Candida spp. 4(2.68%) respectively. Antibiotic test showed that Staphylococcus aureus was a high resistance against Gentamycin and ciprofloxacin, but it was sensitive to Vancomycin and Imipenem. Coagulase negative Staphylococci showed a resistance to Gentamicin, Ciprofloxacin and Ceftazidime, but it was sensitive to Amikacin, Oxacillin, Cefotaxim, Vancomycin, Imipenem and Cefepime. P. aeruginosa showed resistance against Cefotaxime, Aztreonam, Gentamicin and Ceftazidime. Whlist it showed a high sensitivity against Imipenem, Cefepime and Tobramycin. E.coli showed a high resistance against Ceftriaxone, Ciprofloxacin and Cephalothin. whilst it showed a high sensitivity against Ticarcillin/clavulanic acid, Imipenem, Cefepime and Tobramycin. Proteus vulgaris showed a high resistance against Ceftriaxone, Ceftazidime, Amikacin, Cephalothin and Gentamicin. Whilst it showed a high sensitivity against Cefotaxime, Aztreonam, Ticarcillin/clavulanic acid and Imipenem. Proteus mirabilis showed resistance against Amikacin, Ciprofloxacin, Ceftriaxone, Gentamicin and Cephalothin. Whilst it showed a high sensitivity against Ceftazidime, Cefotaxime, Aztreonam, Ticarcillin/clavulanic acid, Imipenem, Cefepime and Tobramycin. Klebsiella pneumonia showed resistance against Ciprofloxacin, Ceftazidime, Cefotaxime and Aztreonam. whilst it showed a high sensitivity against Ceftriaxone, Amikacin, Gentamicin, Cephalothin, Ticarcillin/clavulanic acid, Imipenem, Cefepime and Tobramycin. The current study was aimed to determine the most frequent pathogens in burn injury and test their antibiotics susceptibility in hospitalize patients in Najaf city. [ABSTRACT FROM AUTHOR]

Background and purpose: Pseudomonas aeruginosa is one of the most important pathogens of burn infections in hospitals. It causes infection by producing some virulence factors such as exoS and exoT cytotoxins. The aim of this study was to evaluate the frequency of exoS and exoT genes among P.aeruginosa isolated from wound infections in burn patients and the relationship between the presences of these genes and antibiotic resistance. Materials and methods: In this descriptive cross-sectional study, the wounds of 80 burned patients in Sari Zare Hospital were sampled during April, May, and June 2016. After identification by biochemical tests, 18 isolates of P.aeruginosa were obtained. Antimicrobial susceptibility to 8 antibiotics was determined by disk diffusion method. PCR was performed for detection of exoS and exoT genes. Data was analyzed in SPSS V21 applying Chi-square. The significance level was considered at P

Bingjie Mai,1,2 Yiru Gao,1,2 Min Li,1,2 Xiaobing Wang,1,2 Kun Zhang,1,2 Quanhong Liu,1,2 Chuanshan Xu,3 Pan Wang1,2 1Key Laboratory of Medicinal Resources and Natural Pharmaceutical Chemistry, Ministry of Education, 2National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest China, College of Life Sciences, Shaanxi Normal University, Xi’an, 3School of Chinese Medicine, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China Background and objectives: Antibiotic resistance has emerged as one of the most important determinants of outcome in patients with serious infections, along with the virulence of the underlying pathogen. Photodynamic antimicrobial chemotherapy (PACT) has been proposed as an alternative approach for the inactivation of bacteria. This study aims to evaluate the antibacterial effect of sinoporphyrin sodium (DVDMS)-mediated PACT on Staphylococcus aureus and multidrug resistant S. aureus in vitro and in vivo.Materials and methods: Bacteria were incubated with DVDMS and exposed to treatment with light. After PACT treatment, colony-forming units were counted to estimate the bactericidal effect. Intracellular reactive oxygen-species production was detected by flow cytometry. Flow cytometry and fluorescence-microscopy detection of bacterial cell-membrane permeability. Enzyme-linked immunosorbent assays were used to determine expression of VEGF, TGFβ1, TNFα, IL6, and bFGF factors in burn infection.Results: DVDMS-PACT effectively killed bacterial proliferation. Intracellular ROS levels were enhanced obviously in the PACT-treatment group. SYTO 9 and propidium iodide staining showed a decrease in the ratio of green:red fluorescence intensity in the PACT-treatment group in comparison to the control group. Enzyme-linked immunosorbent-assay results revealed that in the healing process, the expression of bFGF, TGFβ1, and VEGF in the treatment group were higher than in the control group, which inhibited inflammation-factor secretion. In addition, skin-tissue bacteria were reduced after treatment.Conclusion: These results indicate that DVDMS-PACT presents significant bactericidal activity and promotes wound healing after burn infections. Keywords: PACT, antibacterial efficacy, burn infection, MDR

Background: Systemic inflammatory response syndrome (SIRS) can occur as a physiological response without indicating a burn infection. The Centers for Disease Control and Prevention's (CDC's) clinical sepsis criteria for infection screening may not be accurate with burn patients, especially for diagnosing central line-associated bloodstream infections (CLABSIs). New clinical sepsis criteria were therefore proposed by the American Burn Association (ABA) in 2007. Nonetheless, no study has compared the accuracy of the ABA and CDC clinical sepsis criteria for burn-CLABSI diagnoses. Objective: The present study aimed to investigate the relative accuracies of the ABA and CDC clinical sepsis criteria for burn- CLABSI diagnoses, and to report the CLABSI incidence at Siriraj Hospital's Burn Unit. Materials and Methods: A retrospective chart review was conducted of burn patients admitted to the Burn Unit 2007 to 2015. Patients with central venous catheter insertions were included. Details of demographic data; comorbidities; burn type; total burn surface area; and type, duration, and purpose of the central lines were analyzed. The sensitivities and specificities of the ABA and CDC clinical sepsis criteria for CLABSI diagnoses were compared. Results: Of the 101 patients enrolled, CLABSIs were diagnosed in 38 (37.8%). The most common infection site was the internal jugular vein (33%), with CLABSIs occurring most frequently with non-dialysis double lumen catheters. The sensitivity and specificity of the ABA criteria were 76.3% and 93.6%, respectively, with an 85.9% accuracy. Conclusion: The ABA clinical sepsis criteria can be used to diagnose CLABSI in burn patients with acceptable accuracy and a higher specificity than the CDC criteria. [ABSTRACT FROM AUTHOR]

Infection following burn injury is critical, especially for patients with large total body surface area burns and in skin graft donor sites. Although various aspects of a-tocopherol acetate (a-TA) beneficial effects on wound healing have been validated, it appears that no study has specifically addressed its antimicrobial potential. The purpose of this study was to explore the therapeutic efficacy of topical application of a-TA in terms of bacterial load reduction. Between January 2018 and June 2018, 20 patients with mid-deep and deep burn wounds were included in the present study (average TBSA approximately 42%, range 25-67%). Patient average age was 47.75 years (range 25-72 years), 8 were male. In each patient two clinically similar areas were identified and treated every 24 hours with topical application of α-TA in the form of Filme Olio® (Group 1) and conventional medication (Group 2). All the patients had positive results for bacterial cultures before treatment. Despite the presence of initial bacterial infection, a quicker reduction of exudates and pain and a progressive and faster bacterial load reduction was observed in Group 1. Negative cultures were obtained after 3 days on average in Group 1 (range 1-6 days) and 8 days in Group 2 (range 5-9 days). This study clearly shows the importance of the therapeutic targeting of infection in the treatment of burns. α-TA may represent a safe, simple and inexpensive method for improving the healing of difficult wounds with local infection. [ABSTRACT FROM AUTHOR]

Background: Burn infections are one of the most common serious illnesses caused by pathogens, mainly by both gram-negative and gram-positive bacteria. The aim of this study was to detect of the prevalence of multi-drug resistant and extended-spectrum β-lactamase-producing (ESBL) bacteria isolated from inpatients with burn infection and the antimicrobials sensitivity patterns of all bacterial isolates during three years. Methods: This cross-sectional study was performed in Al-Najaf Central Hospital in Al-Najaf City, Iraq from January 2015 to December 2017. A total of 295 burns swabs were collected from hospitalized patients with burn infection. All grown bacterial isolates were identified by standardized microbiological tests. Antimicrobials susceptibility testing was done using the disc diffusion method. Multi-drug, extensive-drug and pan-drug resistant bacteria and extended-spectrum β-lactamase-producing bacteria were determined according to standardized methods and guidelines. Results: Of the 295 burn swabs, 513 different bacteria strains were isolated. Pseudomonas aeruginosa was the most common bacteria with 142 isolates (27.6%) followed by methicillin resistance Staphylococcus aureus 106 isolates (20.6%), while Staphylococcus typhi was the least common bacteria with only 17 isolates (3.3%). 323 (63%) different bacterial strains were isolated from patients who stayed in hospital for 15 days. Most bacterial isolates were resistant to most antimicrobials with high percentages. Out of the 513 bacterial isolates; only 33 isolates (6.4%) were resistant to imipenem 10µg and 464 isolates (90.4%) were multi-drug resistant, 20 isolates (14%) were extensive-drug resistant and 17 isolates (3.3%) were pan-drug resistant. Pseudomonas aeruginosa was the most common ESBL-producing bacteria (51 isolates-35.9%). Conclusions: There was a high prevalence of multi-drug resistant bacteria in burn infection in Al-Najaf hospital. Pseudomonas aeruginosa was the most common multi-drug resistant bacteria, and the most common of ESBL bacteria causing burn infection over the three years.

Children with burn injuries are prone to increased risk for infection. Pantoea agglomerans is a particularly uncommon microorganism related to burn wound infections. A previously healthy, 28-month-old-boy was admitted with scald due to hot water. His general condition was moderate with normal vital signs. He had full thickness (right anterior forearm, 1.5%) and partial thickness (upper part of left arm, 0.5%; left anterior forearm, 2%; right thigh, 1%; right leg, 0.5%; left thigh, 0.5%; and left leg, 1%) burn wounds with totally estimated surface area percentage of 7%. Laboratory findings (hemogram, C-reactive protein, erythrocyte sedimentation rate, and blood biochemistry) were unremarkable. As well as hemodynamic stabilization and nutritional support, daily dressing with silver sulfadiazine was performed. Ten days later, grafting was carried out as the wound on right anterior forearm did not heal. Prophylactic intravenous cefazolin treatment (50mg/kg/day) was started. Four days after operation, he had 38.8°C fever and wound infection was realized. Gram stain of the swab revealed gram negative rods. Antibiotic treatment changed to ceftriaxone (75 mg/kg/day). While blood culture was negative, swab culture grew Pantoea agglomerans, resistant to cefazolin, sensitive to ceftriaxone. His fever subsided after 24 hours of ceftriaxone treatment and he was discharged on the 10th day. His immunological investigation was normal. One week later on control examination, his lesion was epithelized. Burn wound infections in pediatric age group can be caused by rare organisms. Other than presence of immunodeficiency, a graft tissue may ease this situation. [Med-Science 2016; 5(3.000): 878-83]

Introduction: Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. (1) The main purpose of this study was to determine the prevalence of bacterial wound infection in critically ill burn patients in surgical intensive care unit in Egypt. Objectives: The aim of this study was to determine the bacterial isolates in sever burn wound infection, suitability to antibiotics and there are mortalities. Methods: We conducted a one year retrospective study in the surgical ICU. Wound swab Culture and sensitivity reports of admitted patients. All the patients of all age groups suffering with flame burnt and both sexes having complete Culture and sensitivity reports were included. Results: The main finding of the current study described herein was the percent of isolates from burn wound (60%). The most common organism was pseudomonas (49%). Multidrug resistant gram negative organisms represent about 60% of the isolates. Pattern of antibiotic sensitivity was 84% for colistin, 39% for amikacin and 35% for imipenem. The mortalities in our study were 80%.

Abstract Background and Objectives: Pseudomonas aeruginosa is the most common organism, which is separated from the burn infections. Due to increased antibiotic resistance, there are many problems to deal with the infections caused by Pseudomonas aeruginosa. This study aimed to determine the resistance to antibiotics against clinical isolates of Pseudomonas using phenotype methods. Material and Methods: 100 strains of Pseudomonas aeruginosa were collected from the burn patients in Taleghani hospital in Ahwaz, Iran, during a six-month period. After phenotypically initial identification, antibiotic sensitivity of isolated strains to conventional antibiotics against Pseudomonas aeruginosa was determined using a disk diffusion technique, and Phenotypic screening for MBLs production was performed. Results: the maximum percentage was related to wound infection and the frequencies of the resistance to imipenem, meropenem, piperacillin, piperacillin-tazobactam, ceftazidime, gentamicin, amikacin, and ciprofloxacin, doripenem, ertapenem and colistin sulphate, were 70%, 53%, 83%, 67%, 91%, 88%, 84%, 84%, 33%, 90%, and 0%, respectively. The use of CD Test methods was approved for determining resistance to Carbapenems. Conclusion: antibiotic resistance to Pseudomonas aeruginosa is increasing and colistin sulphate is the most effective antibiotic. Keywords: Pseudomonas Aeruginosa; Burn Infection; Antibiotic Resistance.

The aim of this study was to evaluate the topical bactericidal activity of peptide PV3 against a MDR isolate of Pseudomonas aeruginosa in a mouse model of burn infection. The structural analysis of PV3 by circular dichroism spectroscopy indicated a low peptide helical content in water, whereas a high helical content was observed in the presence of the more hydrophobic 50% (v/v) trifluoroethanol/water buffer. A confocal microscopy analysis indicated that the main action of PV3 occurred at the membrane of bacteria. Peptide PV3 exhibited superior in vitro anti‐Pseudomonas activity and killing kinetics as compared with doripenem. A single dose of the topically applied peptide PV3 (4 × MBC, 120 min) was found to be sufficient to eradicate MDRP. aeruginosa in a bacterially infected mouse burn wound model, whereas doripenem (4 × MBC) failed to eradicate the initial inoculum. This indicates a potent and fast PV3‐associated bactericidal activity, contrary to doripenem. An in‐depth analysis of mouse skin by histopathology revealed that peptide PV3 (4 × MBC) did not induce any topical skin toxicity. Overall, the data strongly suggest that peptide PV3 might be a potent candidate antimicrobial agent active on antibiotic‐resistant isolates of pathogenic bacteria. [ABSTRACT FROM AUTHOR]

In addition to the nature and extent of the thermal injury influencing infections, the type and quantity of microorganisms that colonize the burn wound appear to influence the risk of invasive wound infection. A total of 80 patients with second degree burns were enrolled in this study with a gender ratio of 1.22:1 (44 females and 36 males). They were at both Imam Ali and Al-kindy hospitals in Baghdad. Culturing of the burn areas and antibiotic sensitivity were tested at three different times (48 h, 5th day and 10th day) of the patients entry to the burn units in hospitals to detect the most frequent microorganisms isolated from burn injuries and then determine the antibiotic they are sensitive to. The most frequent microorganisms were Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and then S. aureus, while Acinetobacter baumannii has a clear percentage. Mixed culture have been also found in both survivor and non-survivor, especially P. aeruginosa and K. pneumoniae. A high percentage of resistance was found among clinical isolates in general to the commonly used antibiotics. [ABSTRACT FROM AUTHOR]

Background and purpose: Pseudomonas aeruginosa is one of the most important pathogens of burn infections in hospitals. It causes infection by producing some virulence factors such as exoS and exoT cytotoxins. The aim of this study was to evaluate the frequency of exoS and exoT genes among P.aeruginosa isolated from wound infections in burn patients and the relationship between the presences of these genes and antibiotic resistance. Materials and methods: In this descriptive cross-sectional study, the wounds of 80 burned patients in Sari Zare Hospital were sampled during April, May, and June 2016. After identification by biochemical tests, 18 isolates of P.aeruginosa were obtained. Antimicrobial susceptibility to 8 antibiotics was determined by disk diffusion method. PCR was performed for detection of exoS and exoT genes. Data was analyzed in SPSS V21 applying Chi-square. The significance level was considered at P<0.05. Results: A total of 18 isolates was investigated from which 15 (83.5%) had exoT gene and 14 isolates (77.8%) had exoS gene. Simultaneous presence of these genes was seen in 13 (72.5%) isolates. Statically, resistance against Ampicillin, Cephalexin, Co-trimoxazol, and Cefazolin was significantly correlated with the presence of exoS and exoT genes (P = 0.0184, P =0.0047, respectively). In addition, resistance against Imipenem was significantly correlated with the presence of exoT (P=0.0489). Conclusion: High prevalence of exoS and exoT among Pseudomonas aeruginosa isolates (72.5%) and the significant differences between presence of these genes and antibiotic resistance indicate the importance of these two genes in burn infections. [ABSTRACT FROM AUTHOR]

Curcumin is an effective wound healing agent in burn therapy, but due to its low bioavailability, it is required to be formulated for topical therapy. Liposomal nanocarriers are developed as stable and efficient dermal delivery systems. In this study, we prepared curcumin-propylene glycol liposomes (Cur-PgL) to treat animals subjected to second degree burns. The characterization tests confirmed the production of monodisperse nanoliposomes of average size of about 145 nm with high entrapment efficiency percentage and a sustained release behavior. TEM analysis of nanocarriers showed no aggregation in long time storage up to 60 days. The biocompatibility of the Cur-PgL formulation was evaluated by ISO standards. We found that Cur-PgL 0.3% was the effective dose in injured rats without any side effects on intact skin. The cytotoxicity of the Cur-PgL 0.3% nanovesicles was also assessed on human dermal fibroblast (HDF) cells. The results showed no detectable cytotoxicity, but considerable cytotoxicity was observed in higher concentration of 1.5 and 3 mg/ml of free and PgL forms of curcumin. Eight days of application of Cur-PgL on burned rats resulted in a significant ( P<0.001) recovery of wound repair parameters, and after 18 days, wound contraction occurred significantly ( P < 0.001) compared to the other groups. The antibacterial activity of the Cur-PgL formulation was found to be similar to the silver sulfadiazine (SSD) cream 1% regarding the inhibition of the bacterial growth. In conclusion, the low dose of curcumin nanoliposomal formulation efficiently improved injuries and infections of burn wounds and it can be considered in burn therapy. [ABSTRACT FROM AUTHOR]

Objective: As the number of commercially available wound dressings is increasing rapidly, it is important for clinicians to understand the strengths and limitations of each and to recognise relationships between wound type and dressing properties to obtain optimal healing results. Our aim is to test the antimicrobial activity of two dressings. Method: A hydroconductive (HC) dressing and a silver-impregnated foam (SIF) dressing were compared for their potential to reduce the levels meticillin-resistant Staphylococcus aureus (MRSA). We also assessed MRSA-derived biologically active components in liquid or agar matrices, simplified models for heavily exuding or dry wounds respectively, and in an in vivo animal model with MRSA infected wounds. Results: In the agar model (dry wounds) both dressings showed a strong reduction in MRSA activities within 24 hours post-application. The antibacterial effects of the SIF dressing were more pronounced in the liquid model, however, at an increasing cytotoxic cost. In agreement with these in vitro results, assessment of dressings using an MRSA-infected wound in an rat model showed a decrease in MRSA which was significant 7 days post-burn and inoculation, with more compromised viability of MRSA. Dressings showed a similar capability to reduced and eliminate toxic shock syndrome toxin (TSST-1) at day 7 post-burn in the animal model but not at day 4, where the SIF dressing was more potent Conclusion: These results confirm the advantages of using silver in reducing bacterial load in wound treatment, except for conditions of highly exuding wounds where the cytotoxic properties of silver may offset these advantages and HC dressing use is more suitable Declaration of interest: This work was funded in part by SteadMed. Medical. [ABSTRACT FROM AUTHOR]

Burn injuries are one of the major global health problems. Despite aggressive local and systemic treatment to minimize infection, severe burn wounds continue to become infected with environmental and nosocomial pathogens at relatively high rates. We developed an ultrasound assisted sol–gel technique to prepare treated cotton fibers by coating fabric surface with NiO/organic polymer/enzyme matrix forin vitroevaluation of antibacterial activity. The surface modification was performed to bond more efficiently NiO nanoparticles using cellulase enzyme, to reduce initial bacterial attachment on the hydrophilic surface using poly(ethylene glycol), and to promote ultrasonic generation and to overcome agglomeration of the nanoparticles, respectively. Disk diffusion method was used to quantify the efficacy of NiO-based cottons againstPseudomonas aeruginosaandStaphylococcus aureusas two most burn wound pathogens isolated from burn wound swabs and tissue biopsies of hospitalized burn patients.Almost bacterial isolates showed high resistance to the commonly used antibiotics for burn infection treatment.In vitroantibacterial evaluation showed that the modified cottons exhibited excellent biocidal action against both high-resistant isolated Gram-positive and Gram-negative bacteria. [ABSTRACT FROM AUTHOR]

Infection is a major cause of mortality and morbidity among burn patients. An effective measure to reduce infection is routine monitoring of bacterial infection and antimicrobial susceptibility patterns at the burn unit. This will help to create a burn centre-specific empirical antibiotic therapy protocol. A retrospective, descriptive study was conducted at the Cipto Mangunkusumo Hospital (RSCM) Burn Unit between September-November 2016. Data regarding bacterial culture isolates, antimicrobial susceptibility spectrum, and the number of burn patients diagnosed with sepsis were collected. There were 36 patients with positive bacterial cultures, with the isolates changing continuously between Klebsiella pneumonia (17%), Pseudomonas Aeruginosa (12%) and Acinetobacter baumannii (11%). High resistance was found for 10 antimicrobials, particularly cephalosporins. The three bacteria were only sensitive to carbapenem, aminoglycosides and tigecycline. Fourteen patients were diagnosed with sepsis (38.9%), 10 died. Two major sepsis-causing bacteria were P. aeruginosa (33.3%) and K. pneumoniae (28.9%). Bacterial isolates in our setting changed every month. Almost all bacterial isolates are multi-drug resistant, highly resistant to the empirical therapy given (ceftriaxone), leading to outbreaks of sepsis and increased mortality rates. Carbapenem (imipenem, meropenem and doripenem) and aminoglycosides (amikacin) combination was the selected empirical therapy. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa is most common cause of nosocomial infections in burn centers. This opportunistic and multidrug resistant bacterium causes severe problems for hospitalized burn patients. Samples were collected from patients attending Burn& Plastic Surgery Hospital in Duhok / Iraq, between September 2011 and March 2012, for preliminary identification of P. aeroginosa using conventional methods, then confirmed with the use of BD -PhoenixTM Automated Microbiology System. Isolates were considered Multi Drug Resistant Pseudomonas aeroginosa (MDRPa) if they showed resistance to the three or more classes of antipseudomonal agents. Accordingly thirty isolates were found MDRPa. The pattern of resistance revealed that the highest resistance was for Gentamicin 96.7%, Cefepime 96.7%, Ceftazidime 90% and Aztreonam 83.3%,while lowest resistance was detected against Amikacin 36.7% and Colistin 3.3% .The results of disc diffusion assay demonstrated that antibacterial activities of black seed oil acetone extract at 1:1,1:10,1:25 concentrations were found effective against all tested MDRPa isolates, which were statistically significant (P < 0.05),while at highest dilution 1:75 . All MDRPa isolates showed lowest activity of oil extract . The antimicrobial effects of water extract showed lowest and poor activity against all tested bacteria.

Introduction Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. (1) The main purpose of this study was to determine the prevalence of bacterial wound infection in critically ill burn patients in surgical intensive care unit in Egypt. Objectives The aim of this study was to determine the bacterial isolates in sever burn wound infection, suitability to antibiotics and there are mortalities. Methods We conducted a one year retrospective study in the surgical ICU. Wound swab Culture and sensitivity reports of admitted patients. All the patients of all age groups suffering with flame burnt and both sexes having complete Culture and sensitivity reports were included. Results The main finding of the current study described herein was the percent of isolates from burn wound (60%). The most common organism was pseudomonas (49%). Multidrug resistant gram negative organisms represent about 60% of the isolates. Pattern of antibiotic sensitivity was 84% for colistin, 39% for amikacin and 35% for imipenem. The mortalities in our study were 80%. [ABSTRACT FROM AUTHOR]

Burn wound infection is the leading cause of mortality among burn wound patients. One of the most commonly isolated bacterial burn wound pathogens is Pseudomonas aeruginosa , a notorious nosocomial multidrug-resistant pathogen. As a consequence of its recalcitrance to frontline antibiotic therapy, there is an urgent need to develop alternative treatment avenues to tackle this pathogen. One potential alternative infection prevention measure is to seed the wound bed with probiotic bacteria. Several species of Lactobacillus, a common commensal bacterium, have been previously reported to display growth inhibition activity against wound pathogens. Various species of this genus have also been shown to augment the wound healing process, which makes it a promising potential therapeutic agent. Due to the complexity of the burn wound trauma and burn wound infection, an in vivo model is required for the development of novel therapeutics. There are multiple in vivo models that are currently available, the most common among them being the murine model. However, mammalian burn wound infection models are logistically challenging, do not lend themselves to screening approaches and come with significant concerns around ethics and animal welfare. Recently, an invertebrate burn wound and infection model using G. mellonella has been established. This model addresses several of the challenges of more advanced animal models, such as affordability, maintenance and reduced ethical concerns. This study validates the capacity of this model to screen for potential wound probiotics by demonstrating that a variety of Lactobacillus spp . can limit P. aeruginosa burn wound infection and improve survival.

The postburn infections especially antibiotic-resistant bacterial infections have been recognized as a significant and major public health problem. Staphylococcus aureus, Escherichia coli, Acinetobacter, Klebsiella pneumoniae, and Pseudomonas aeruginosa are among very important bacterial pathogens isolated from postburn infections. The present study has evaluated the antimicrobial activity of some plant extracts ( Melissa officinalis and Lawsonia inermis) against some bacterial pathogens causing burn wound infection. The minimal inhibitory concentration (MIC) and the minimal bactericidal concentration (MBC) of the extracts were determined using the microdilution method. Aqueous and alcoholic extracts of L. inermis leaves or powder and hydro-alcoholic extract of M. officinalis were studied. All extracts had the highest antibacterial activity against S. aureus. Although there was no significant difference between antibacterial activity of L. inermis leaves and powder extracts, significant difference was observed between alcoholic and aqueous extracts of this plant. In addition, the results showed that alcoholic extract of L. inermis powder and M. officinalis extracts showed synergistic effect. Overall, these findings support the potential benefits of M. officinalis and L. inermis extracts in the treatment of burn infections. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pseudomonas aeruginosa is the most common organism, which is separated from the burn infections. Due to increased antibiotic resistance, there are many problems to deal with the infections caused by Pseudomonas aeruginosa. This study aimed to determine the resistance to antibiotics against clinical isolates of Pseudomonas using phenotype methods. Material and Methods: 100 strains of Pseudomonas aeruginosa were collected from the burn patients in Taleghani hospital in Ahwaz, Iran, during a six-month period. After phenotypically initial identification, antibiotic sensitivity of isolated strains to conventional antibiotics against Pseudomonas aeruginosa was determined using a disk diffusion technique, and Phenotypic screening for MBLs production was performed. Results: the maximum percentage was related to wound infection and the frequencies of the resistance to imipenem, meropenem, piperacillin, piperacillin-tazobactam, ceftazidime, gentamicin, amikacin, and ciprofloxacin, doripenem, ertapenem and colistin sulphate, were 70%, 53%, 83%, 67%, 91%, 88%, 84%, 84%, 33%, 90%, and 0%, respectively. The use of CD Test methods was approved for determining resistance to Carbapenems. Conclusion: antibiotic resistance to Pseudomonas aeruginosa is increasing and colistin sulphate is the most effective antibiotic. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas aeruginosa is an opportunistic bacterium in burned and immunocompromised patients causing nosocomial infections. Multiple drug resistance in the bacteria cannot occur only by mutation. Integrons' role in the transfer of multi-drug resistance gene has been approved. Due to the increasing drug resistance of Pseudomonas aeruginosa strains, we decided to examine Pseudomonas aeruginosa strains causing infection in burned patients in terms of class 1 integron. Materials and Methods: In this study, Pseudomonas aeruginosa strains were isolated from burned patients. A simple boiling method was used to extract DNA from bacteria. PCR reactions was used for the amplification of extracted DNA and PCR products were investigated by agarose gel electrophoresis using 1/5% in TBE buffer. Gels were colored with ethidium bromide, and PCR products were detected under UV light. Results: It was found that 19 strains (15/83 %) out of 120 samples were in class 1 integron. Conclusion: Pseudomonas aeruginosa which has a class 1 integron carries drug resistance genes such as MBL-producing genes that may cause cure-resistant infections in hospitals. [ABSTRACT FROM AUTHOR]

Background and Objectives: Infection is known as a major challenge for a burn team to deal with; meanwhile, it's responsible for almost 75% of the burn death. The main underlying cause of this problem is because of this fact that the environment at the site of the wound is ideal for the proliferation of infecting organisms. The aim of this study was to investigate the causative microorganisms and antimicrobial resistance profiles of the isolated microorganisms in patients hospitalized at the burn ICU of Zareh hospital, Sari, Iran. Materials and Methods: All of the 100 patients who were hospitalized at the burn unit were enrolled in this prospective cross sectional study. Demographic, clinical data, including sex, age, total burned surface area were collected for each patient. Laboratory specimens included wound discharge, tissue debridements, tracheal tube and Centeral Venus Presher (CVP). Environmental specimens were also collected from patient's room including medical instatements located in the room. Conventional microbiologic tests were performed for isolation and identification of burn infections causative organisms and to detect antibiotic sensitivity by disc agar diffusion method. Results: Two hundred and twenty six different microorganisms isolated were collected from the 615 samples including 280 swabs, 35 tissue biopsies, 100 urine samples, 100 bloods, 50 CVP samples and 50 endotracheal specimens. Acintobacter baumannii was the most prevalent bacterium isolated. 550 samples of patients' environment were also studied. Regarding antibiotic sensitivity of the isolated bacteria over 90% of Acintobacter baumannii isolates were resistant to amikacin, gentamicin, piperacillin/ tazobactam, ceftazidime and cefepime. The highest susceptibility was observed for tobramycin (58.2 %) and imipenem (41.9 %). The most common type of burn was flash injury. Nearly 60% of participants were aged from 21 to 40 years . Conclusions: Acintobacter baumannii was the most prevalent bacterium causing infection. Detection of high levels of antibiotic resistance in our Acintobacter baumannii and other medically important isolated bacteria underlines need for continuous surveillance of burn infections and developing strategies for antimicrobial resistance control. [ABSTRACT FROM AUTHOR]

• GEN&aPDT continuously inhibited the growth and reproduction of planktonic S. aureus and MDR S. aureus for 15 h. • The cell envelope and biofilms of the hospital-acquired multidrug were effectively destroyed by GEN&aPDT. • GEN&aPDT led to changes in the expression of oxidative stress- and Agr system related genes in S. aureus and MDR S. aureus , in which ROS played a regulatory role. • In the burn infection model, GEN&aPDT cotreatment can effectively promote wound healing. Multi-resistant bacteria, partially a result of the abuse of antibiotics, have greatly diminished the effectiveness of antibiotics. The combination of antibiotics with other therapies like antimicrobial photodynamic therapy (aPDT) may provide a useful strategy for fighting resistant bacteria. Here, the synergistic bactericidal effects of toluidine blue (TB)-aPDT and gentamicin (GEN) were evaluated in vitro and in vivo. The Post-antibacterial effects were measured at 600 nm (OD600) by a microplate reader. The bacterial envelope and biofilm were observed by a field emission scanning electron microscope. The expression of oxidative stress and Agr system-related genes was analyzed by qRT-PCR after GEN combined with TB-aPDT (GEN&aPDT). Besides, the burn infection model was established to investigate the cloning efficiency of immobilized bacteria, wound healing and inflammatory factors in the lesions. GEN&aPDT could inhibit the growth of Staphylococcus aureus (S. aureus) and multidrug-resistant S. aureus (MDR S. aureus) for up to 15 h, and destroyed the cell envelope and biofilm structure of S. aureus and MDR S. aureus. During the process, ROS played an important role, inducing oxidative stress and downregulating the expression of AgrA, AgrB and PSM in the Agr system, resulting in decreased bacterial virulence and infectivity. In addition, GEN&aPDT cotreatment could effectively promoted wound healing in burn-infected mice by reducing the numbers of bacterial colonization in the wound, decreasing the content of inflammatory factors, and increasing the expression of growth factors. The present study confirmed a bactericidal synergy between GEN and aPDT in vitro and in vivo , therein, the oxidative stress exhibited an important role in decreasing bacterial virulence and infectivity, which may bring new ideas for the treatment of bacterial resistance. [ABSTRACT FROM AUTHOR]

Abstract: Background: In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed. Methods: In total 32 adult Wistar rats (body weight 200–220g) 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 108 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. Results: While there were significant differences between Acticoat™® group (4±10×104) and control group (5±6×106), and between Nystatin group (4±4×104) and control group (P =0.01, P =0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2±3×104) 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. Conclusions: 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. [Copyright &y& Elsevier]

Abstract: Purpose: 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. Methods: 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. Results: 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. Conclusions: The described assay is a practical and reproducible approach to identify topical antibiotics most effective in eliminating biofilms produced by burn wound isolates. [Copyright &y& Elsevier]

Abstract: In this animal study, three topical antibacterial dressings, Acticoat™, chlorhexidine acetate 0.5% and silver sulfadiazine 1%, were compared in the treatment of Acinetobacter baumannii contamination of burns. All treatments were effective and prevented the organism invading the muscle and causing systemic infection, so there were significant differences between the results of the treatment groups and the control group. Mean eschar concentrations did not differ significantly between the silver sulfadiazine and chlorhexidine acetate groups, but there were significant differences between these and the Acticoat™ group, indicating that Acticoat™ eliminated A. baumannii from the tissues more effectively. [Copyright &y& Elsevier]