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1
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Ng MK, Razi AE. Advances in Orthopedic Surgery Irrigation: A Review of Traditional Agents and the Emergence of Citrate-Based Solutions. J Clin Med 2025; 14:3681. [PMID: 40507443 PMCID: PMC12155827 DOI: 10.3390/jcm14113681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2025] [Revised: 05/10/2025] [Accepted: 05/23/2025] [Indexed: 06/16/2025] Open
Abstract
Surgical site infections (SSIs) and prosthetic joint infections (PJIs) remain significant challenges in orthopedic surgery, particularly in joint arthroplasty. Intraoperative irrigation is a widely used strategy for infection prevention, yet traditional solutions such as saline, povidone-iodine, hydrogen peroxide, and sodium hypochlorite are limited by cytotoxicity, short antimicrobial duration, and poor biofilm penetration. This review evaluates commonly used irrigation agents and highlights the growing evidence supporting a novel citrate-based solution as a potentially superior alternative. These agents combine broad-spectrum antimicrobial activity, effective biofilm disruption through ionic chelation, and prolonged postoperative protection with minimal harm to host tissues. Early clinical studies and ongoing randomized trials have demonstrated promising results, including reductions in postoperative swelling, opioid use, and infection rates. As more data become available, citrate-based solutions may emerge as the preferred standard for intraoperative irrigation in orthopedic procedures.
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Affiliation(s)
- Mitchell K. Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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2
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Nagoba BS, Rayate AS, Gavkare AM, Rao A. The efficacy and safety of acids as topical antimicrobial agents: a review. J Wound Care 2025; 34:119-127. [PMID: 39928472 DOI: 10.12968/jowc.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2025]
Abstract
OBJECTIVE Infected wounds, refractory to conventional therapy, are a major burden on the healthcare system. Available data show that many commonly used antiseptic agents may be toxic to the cells involved in the healing process and may affect the normal tissue repair. The topical use of different acids to control wound infections effectively and promote healing is well known. The present review aims to summarise the safety and efficacy of various acids as topical agents for treating wound infections. METHOD A literature search was performed in PubMed and manually from other sources (cross references and journal sites). RESULTS We reviewed 116 articles, from which data from 86 relevant articles were analysed. The studies showed that various organic acids were clinically effective in treating wound infections. CONCLUSION This study found that various organic acids can act as a substitute for antiseptics to control wound infections refractory to conventional antibiotic therapy and local wound care. Various organic acids differ in efficacy, safety and limitations as topical agents to control wound infections and promote healing. Some acids deliver better results than others, particularly in those cases in which antibiotics and routine antiseptic agents yield little lasting success, especially in controlling hospital strains with multiple antibiotic resistance. Among topically used acids, citric acid and acetic acid are associated with better results.
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Affiliation(s)
| | | | - Ajay M Gavkare
- Department of Physiology, MIMSR Medical College, Latur, India
| | - Arunkumar Rao
- Department of Orthopaedics, MIMSR Medical College, Latur, India
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Robinson TE, Clark C, Moakes RJA, Schofield Z, Moiemen N, Geoghegan JA, Grover LM. Simultaneous viscoelasticity and sprayability in antimicrobial acetic acid-alginate fluid gels. BIOMATERIALS ADVANCES 2025; 166:214051. [PMID: 39357110 DOI: 10.1016/j.bioadv.2024.214051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 09/03/2024] [Accepted: 09/19/2024] [Indexed: 10/04/2024]
Abstract
Acetic acid is a promising alternative to antibiotics for topical applications, particularly burn wounds, however its site specificity and retention are impaired by poor material properties. In this study, acetic acid was investigated as both the gelling agent and antimicrobial active in alginate fluid gels. The formed microstructure was found to be directly dependent on acetic acid concentration, leading to highly tuneable material properties. At clinically relevant concentrations of 2.5-5 % acetic acid, the fluid gels were elastically dominated at rest, with viscosities up to 7 orders of magnitude greater than acetic acid alone. These material properties imparted long term surface retention and microparticle barrier function, not seen with either acetic acid or alginate solutions. Most notably, sprayability was enhanced simultaneously with the increased viscosity and elasticity due to the introduction of a discretised microstructure, leading to a remarkable tenfold increase in spray coverage. Formulation was found not to inhibit antimicrobial activity, despite the less acidic pH, with common burn wound pathogens Staphylococcus aureus and Pseudomonas aeruginosa being equally susceptible to the fluid gels as to acetic acid solutions.
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Affiliation(s)
- Thomas E Robinson
- Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, UK.
| | - Callum Clark
- Department of Microbes, Infection & Microbiomes, College of Medicine & Health, University of Birmingham, UK; Institute of Microbiology & Infection, University of Birmingham, UK
| | - Richard J A Moakes
- Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, UK
| | - Zoe Schofield
- Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, UK
| | - Naiem Moiemen
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joan A Geoghegan
- Department of Microbes, Infection & Microbiomes, College of Medicine & Health, University of Birmingham, UK; Institute of Microbiology & Infection, University of Birmingham, UK
| | - Liam M Grover
- Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, UK
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Abid F, Virgo E, Kennewell TL, Khetan R, Haidari H, Kopecki Z, Song Y, Garg S. The Acid-Buffered Engineered Gel Promotes In Vitro Cutaneous Healing and Fights Resistant Bacteria in Wounds. Pharmaceutics 2024; 16:1484. [PMID: 39598606 PMCID: PMC11597482 DOI: 10.3390/pharmaceutics16111484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 11/08/2024] [Accepted: 11/17/2024] [Indexed: 11/29/2024] Open
Abstract
Background: Treatment of cutaneous wound infections is becoming a major clinical challenge due to the growing problem of antimicrobial resistance associated with existing wound treatments. Two prevalent pathogens in wound infections, Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa), continue to present a serious challenge, underscoring the critical need for new therapeutic alternatives. Methods: Novel alginate acid-buffered gels (ABF-1, ABF-2, and ABF-3) were developed using a combination of organic acids in various concentrations and buffered at a pH of 4.5. The acid-buffering capacity of the gels was evaluated against sodium hydroxide solution and simulated wound fluid (SWF) at different wound pHs, mimicking infected and non-infected wound environments. The in vitro antibacterial activity was assessed against resistant bacterial strains (Gram-positive and Gram-negative) using a microdilution method and wound biofilm assay. The rheological properties and cell viability of the gels were evaluated and the gel showing positive cell viability was further investigated for healing ability using an in vitro wound scratch assay. Results: The gels showed promising in vitro antibacterial activity against Staphylococcus epidermidis, S. aureus, and P. aeruginosa. Gels with higher acid concentrations (ABF-1 and ABF-2) were highly effective in reducing the bacterial load in chronic biofilms of S. aureus and P. aeruginosa, while the gel with a lower acid concentration (ABF-3) showed positive effects on the viability of skin cells (over 80% cells viable) and for promoting wound closure. All three gels demonstrated excellent acid-buffering capabilities. Conclusions: The acid-buffered gels demonstrate promising in vitro antibacterial effects, indicating their potential for enhancing wound healing.
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Affiliation(s)
- Fatima Abid
- Centre for Pharmaceutical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (F.A.); (R.K.); (Y.S.)
| | - Emmeline Virgo
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia; (E.V.); (T.L.K.); (H.H.); (Z.K.)
| | - Tahlia Louise Kennewell
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia; (E.V.); (T.L.K.); (H.H.); (Z.K.)
| | - Riya Khetan
- Centre for Pharmaceutical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (F.A.); (R.K.); (Y.S.)
| | - Hanif Haidari
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia; (E.V.); (T.L.K.); (H.H.); (Z.K.)
| | - Zlatko Kopecki
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia; (E.V.); (T.L.K.); (H.H.); (Z.K.)
| | - Yunmei Song
- Centre for Pharmaceutical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (F.A.); (R.K.); (Y.S.)
| | - Sanjay Garg
- Centre for Pharmaceutical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (F.A.); (R.K.); (Y.S.)
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5
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Oropallo A, Rao AS, Del Pin C, Ranire‐Maguire M, Mathew A. An objective comparative study of non-surgical cleansing techniques and cleanser types in bacterial burden management. Int Wound J 2024; 21:e14730. [PMID: 38332560 PMCID: PMC10853581 DOI: 10.1111/iwj.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024] Open
Abstract
Cleansing is a vital component of effective wound hygiene and biofilm management, often accomplished through vigorous mechanical action or through soaking with moistened gauze. In the present study, a quantitative comparison of the effectiveness of different cleansing techniques and solutions in removing bacteria was conducted on 71 chronic wounds using bacterial fluorescence imaging as a real-time diagnostic for moderate to high bacterial loads. Vigorous gauze cleansing for 30 s proved most effective by reducing bacterial fluorescence by 33.99%, surpassing 10-min soaking in bacterial reduction (13.24%). Among different cleansers, no statistically significant differences in effectiveness were observed, but povidone-iodine showed the strongest trend towards bacterial reduction. Sub-analysis highlighted the superiority of antiseptic cleansers over saline and gentle soap (-33.30% vs. -1.80% bacterial reduction respectively). Five percent acetic acid was also shown to be more effective in removing specific bacterial strains (Pseudomonas aeruginosa). Findings from studies like this contribute to refining wound hygiene guidelines and clinical algorithms for bacterial and biofilm management.
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Affiliation(s)
- Alisha Oropallo
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
- Donald and Barbara School of Medicine, Hofstra University/Northwell, Feinstein Institutes for Medical ResearchHempsteadNew YorkUSA
| | - Amit S. Rao
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
| | - Christina Del Pin
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
- Donald and Barbara School of Medicine, Hofstra University/Northwell, Feinstein Institutes for Medical ResearchHempsteadNew YorkUSA
| | - Marisa Ranire‐Maguire
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
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Atasoy M, Álvarez Ordóñez A, Cenian A, Djukić-Vuković A, Lund PA, Ozogul F, Trček J, Ziv C, De Biase D. Exploitation of microbial activities at low pH to enhance planetary health. FEMS Microbiol Rev 2024; 48:fuad062. [PMID: 37985709 PMCID: PMC10963064 DOI: 10.1093/femsre/fuad062] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
Awareness is growing that human health cannot be considered in isolation but is inextricably woven with the health of the environment in which we live. It is, however, under-recognized that the sustainability of human activities strongly relies on preserving the equilibrium of the microbial communities living in/on/around us. Microbial metabolic activities are instrumental for production, functionalization, processing, and preservation of food. For circular economy, microbial metabolism would be exploited to produce building blocks for the chemical industry, to achieve effective crop protection, agri-food waste revalorization, or biofuel production, as well as in bioremediation and bioaugmentation of contaminated areas. Low pH is undoubtedly a key physical-chemical parameter that needs to be considered for exploiting the powerful microbial metabolic arsenal. Deviation from optimal pH conditions has profound effects on shaping the microbial communities responsible for carrying out essential processes. Furthermore, novel strategies to combat contaminations and infections by pathogens rely on microbial-derived acidic molecules that suppress/inhibit their growth. Herein, we present the state-of-the-art of the knowledge on the impact of acidic pH in many applied areas and how this knowledge can guide us to use the immense arsenal of microbial metabolic activities for their more impactful exploitation in a Planetary Health perspective.
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Affiliation(s)
- Merve Atasoy
- UNLOCK, Wageningen University & Research and Technical University Delft, Droevendaalsesteeg 4, 6708 PB,Wageningen, the Netherlands
| | - Avelino Álvarez Ordóñez
- Department of Food Hygiene and Technology and Institute of Food Science and Technology, Universidad de León, Campus de Vegazana s/n, 24071 León, Spain
| | - Adam Cenian
- Institute of Fluid Flow Machinery, Polish Academy of Sciences, Department of Physical Aspects of Ecoenergy, 14 Fiszera St., 80-231 Gdańsk, Poland
| | - Aleksandra Djukić-Vuković
- Department of Biochemical Engineering and Biotechnology, Faculty of Technology and Metallurgy, University of Belgrade, Karnegijeva 4, 11120 Belgrade, Serbia
| | - Peter A Lund
- Institute of Microbiology and Infection,School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Fatih Ozogul
- Department of Seafood Processing and Technology, Faculty of Fisheries, Cukurova University, Balcali, 01330, Adana, Turkey
- Biotechnology Research and Application Center, Cukurova University, Balcali, 01330 Adana, Turkey
| | - Janja Trček
- Department of Biology, Faculty of Natural Sciences and Mathematics, University of Maribor, Koroška cesta 160, 2000 Maribor, Slovenia
| | - Carmit Ziv
- Department of Postharvest Science, Agricultural Research Organization – Volcani Center, 68 HaMaccabim Road , P.O.B 15159 Rishon LeZion 7505101, Israel
| | - Daniela De Biase
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy
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Bagheri M, Zoric A, von Kohout M, Fuchs PC, Schiefer JL, Opländer C. The Antimicrobial Efficacy of Topically Applied Mafenide Acetate, Citric Acid and Wound Irrigation Solutions Lavanox and Prontosan against Pseudomonas aeruginosa. Antibiotics (Basel) 2024; 13:42. [PMID: 38247601 PMCID: PMC10812663 DOI: 10.3390/antibiotics13010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Since burn wound infections caused by Pseudomonas aeruginosa (PA) lead to major complications and sepsis, this study evaluates the antimicrobial efficacy of the wound irrigation solutions Prontosan (PRT), Lavanox (LAV), citric acid (CA) and mafenide acetate (MA) using microbiology assays and an ex vivo skin wound model. In suspension assays, all the solutions showed significant reductions in bacterial number (log10 reduction: CA 5.77; LAV 4.91; PRT 4.74; MA 1.23). The biofilm assay revealed that PRT and LAV reduced biofilm formation by ~25% after a 15 min treatment, while PRT was most effective after a 24 h treatment (~68%). The number of PA in biofilms measured directly after a 15 min treatment was reduced most effectively with CA and LAV (log10 reductions ~2.5), whereas after a 24 h treatment, all solutions achieved only 1.36-1.65 log10 reductions. In the skin wound model, PRT and LAV provided the highest bacterial reduction after a 15 min treatment (log10 reduction 1.8-1.9), while MA was more effective after a 22 h treatment (log10 reduction 3.6). The results demonstrated the antimicrobial efficacy of all solutions against PA. Further investigation is needed to explore the potential clinical applications of a combination or alternating use of these solutions for infection prophylaxis and treatment of wound infections caused by PA.
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Affiliation(s)
- Mahsa Bagheri
- Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Walterhoeferstr. 11, 14165 Berlin, Germany
| | - Andreas Zoric
- Plastic, Reconstructive and Aesthetic Surgery, RKH Hospital Bietigheim-Vaihingen, Riedstr. 12, 74321 Bietigheim-Bissingen, Germany
| | - Maria von Kohout
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Paul C. Fuchs
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Jennifer Lynn. Schiefer
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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8
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Imran R, Hassouna T, Sur G, Casey A, Homer V, Barton D, Brock K, Altarrah K, Moiemen N. Efficacy and optimal dose of acetic acid to treat colonised burns wounds: protocol for a pilot randomised controlled trial. BMJ Open 2023; 13:e058006. [PMID: 37748846 PMCID: PMC10533794 DOI: 10.1136/bmjopen-2021-058006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/26/2022] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Despite of recent advancement in the burns wound management, burn wound infection (BWI) is still one of the major cause of burns mortality. Patients who survive their burns injury still suffers from BWI related complication like delayed wound healing and poor scarring. BWI has been treated by application of topical antimicrobial agents or systemic antibiotics. Due to the global risk of developing systemic antibiotics resistance, medical research focuses on identifying single topical agent which has effective antimicrobial activity, easily available and cost effective. One such agent is acetic acid (AA). AA has been used as a topical antibacterial agent for the treatment of burns wounds for many years and has shown to have activity against gram-negative organisms including Pseudomonas aeruginosa. So far there has been no consensus on optimal concentration that has effective antimicrobial activity, frequency of application, duration of treatment and most importantly good patient's tolerability. A randomised control study is required to answer all these questions. OBJECTIVE To investigate the efficacy and tolerability of 0.5% and 2% of AA when applied to colonised burns wounds for 3 days after admittance to the Queen Elizabeth Hospital Birmingham. METHODS AND ANALYSIS This is a double-blinded, prospective, randomised, controlled, single-centre trial. Patients will be screened for eligibility in the inpatient area and those who are found to be eligible will be randomly assigned to one of two treatment groups: group 1: 0.5% AA (10 patients); group 2: 2% AA (10 patients); total number: 20 patients. OUTCOME MEASURES Primary outcome: Efficacy will be assessed by measuring the bacterial load from microbiology wound swabs for three consecutive days.Secondary outcomes: (1) The assessment of antimicrobial activity of AA and the minimum inhibitory concentrations. (2) Patient's tolerance by assessing Visual Analogue Scale pain score. (3) Time to 95% wound healing of treatment area. (4) Patient's perceived treatment allocation. ETHICS AND DISSEMINATION AceticA trial protocol was approved by the National Research Ethics Service (West Midlands-Edgbaston Research Ethics Committee; 17/WM/0407; IRAS 234132). This article refers to protocol version 5.0 dated 6 July 2020. The analysed results will be presented at national and international conferences related to management of burn patients. The generated articles based on the trial results will be submitted to peer review journals for publication. TRIAL REGISTRATION NUMBER ISRCTN11636684.
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Affiliation(s)
- Rizwana Imran
- Burn Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Scar Free Foundation Burn Research Centre, Birmingham, UK
| | - Tarek Hassouna
- Burn Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Scar Free Foundation Burn Research Centre, Birmingham, UK
| | - Gurneet Sur
- Cancer Research Clinical Trials Unit (CRCTU), Devices, Drugs, Diagnostics and Biomarkers (D3B), University of Birmingham, Birmingham, UK
| | - Anna Casey
- Cancer Research Clinical Trials Unit (CRCTU), Devices, Drugs, Diagnostics and Biomarkers (D3B), University of Birmingham, Birmingham, UK
| | - Victoria Homer
- Cancer Research Clinical Trials Unit (CRCTU), Devices, Drugs, Diagnostics and Biomarkers (D3B), University of Birmingham, Birmingham, UK
| | - Darren Barton
- Cancer Research Clinical Trials Unit (CRCTU), Devices, Drugs, Diagnostics and Biomarkers (D3B), University of Birmingham, Birmingham, UK
| | - Kristian Brock
- Cancer Research Clinical Trials Unit (CRCTU), Devices, Drugs, Diagnostics and Biomarkers (D3B), University of Birmingham, Birmingham, UK
| | - Khaled Altarrah
- Burn Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Scar Free Foundation Burn Research Centre, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Naiem Moiemen
- Burn Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Scar Free Foundation Burn Research Centre, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Cano-Vicent A, Tuñón-Molina A, Bakshi H, Alfagih IM, Tambuwala MM, Serrano-Aroca Á. Biocompatible Alginate Hydrogel Film Containing Acetic Acid Manifests Broad-Spectrum Antiviral and Anticancer Activities. Biomedicines 2023; 11:2549. [PMID: 37760990 PMCID: PMC10526879 DOI: 10.3390/biomedicines11092549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Acetic acid, a colourless liquid organic acid with a characteristic acrid smell, is obtained naturally and has applications in both the food and pharmaceutical industries. It has been reported to have beneficial uses for lifestyle-related diseases, and its efficient disinfectant properties are well known. In this study, an alginate crosslinked with Ca2+ hydrogel film was treated with acetic acid to explore its biological properties for biomedicine. The results showed that the novel calcium alginate/acetic acid film was biocompatible in vitro using human keratinocyte cells and in vivo with Caenorhabditis elegans. It also had antiviral properties against enveloped and non-enveloped viruses and anticancer properties against melanoma and colon cancer cells. This novel film thus showed promise for the biomedical and pharmaceutical industries, with applications for fabricating broad-spectrum antiviral and anticancer materials.
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Affiliation(s)
- Alba Cano-Vicent
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain; (A.C.-V.); (A.T.-M.)
| | - Alberto Tuñón-Molina
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain; (A.C.-V.); (A.T.-M.)
| | - Hamid Bakshi
- Hormel Institute, University of Minnesota, Austin, MN 55912, USA;
| | - Iman M. Alfagih
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 4545, Saudi Arabia;
| | - Murtaza M. Tambuwala
- Brayford Pool Campus, Lincoln Medical School, University of Lincoln, Lincoln LN6 7TS, UK
| | - Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain; (A.C.-V.); (A.T.-M.)
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10
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Feng L, Xu M, Zeng W, Zhang X, Wang S, Yao Z, Zhou T, Shi S, Cao J, Chen L. Evaluation of the antibacterial, antibiofilm, and anti-virulence effects of acetic acid and the related mechanisms on colistin-resistant Pseudomonas aeruginosa. BMC Microbiol 2022; 22:306. [PMID: 36529724 PMCID: PMC9762083 DOI: 10.1186/s12866-022-02716-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (P. aeruginosa) has been majorly implicated in the infection of burns, wounds, skin, and respiratory tract. Colistin is considered the last line of defense against P. aeruginosa infections. However, colistin is becoming increasingly invalid in treating patients infected with colistin-resistant (COL-R) P. aeruginosa. As one of the disinfectants used for wound infections, acetic acid (AA) offers good antibacterial and antibiofilm activities against P. aeruginosa. This study investigated the effects of AA on COL-R P. aeruginosa in terms of its antibacterial, antibiofilm, and anti-virulence properties and the corresponding underlying mechanisms. RESULTS The antimicrobial susceptibility and growth curve data revealed that 0.078% (v/v) AA exhibited good antibacterial activity against COL-R P. aeruginosa. Subinhibitory concentrations of AA were ineffective in inhibiting biofilm formation, but 4 × and 8 × of the minimum inhibitory concentration (MIC) was effective in removing the preformed biofilms in biofilm-eradication assays. The virulence results illustrated that AA inhibited COL-R P. aeruginosa swimming, swarming, twitching, and pyocyanin and elastase production. The analysis of the potential antibacterial mechanisms of AA on COL-R P. aeruginosa revealed that AA acted by increasing the outer and inner membrane permeability, polarizing the membrane potential, and decreasing the reduction potential in a concentration-dependent manner. The qRT-PCR results revealed that AA may inhibit the virulence of COL-R P. aeruginosa by inhibiting the expression of T3SS-related and QS-related genes. CONCLUSIONS AA possesses antibacterial, antibiofilm, and anti-virulence properties that ultimately lead to the alteration of the bacterial membrane permeability, membrane potential, and reduction potential. Our findings indicated that AA is presently one of the effective treatment options for infections. A high concentration of AA (> 0.156% v/v) can be used to sterilize biofilm-prone surgical instruments, for hospital disinfection, and for treating the external wound, whereas a low concentration of AA (0.00975-0.039% v/v) may be used as an anti-virulence agent for adjuvant treatment of COL-R P. aeruginosa, thereby further improving the application value of AA in the treatment of infections.
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Affiliation(s)
- Luozhu Feng
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province China
| | - Mengxin Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
| | - Weiliang Zeng
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
| | - Xiaodong Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
| | - Sipei Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
| | - Zhuocheng Yao
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
| | - Shiyi Shi
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
| | - Jianming Cao
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province China
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province China
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11
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Sauvage S, Gaviard C, Tahrioui A, Coquet L, Le H, Alexandre S, Ben Abdelkrim A, Bouffartigues E, Lesouhaitier O, Chevalier S, Jouenne T, Hardouin J. Impact of Carbon Source Supplementations on Pseudomonas aeruginosa Physiology. J Proteome Res 2022; 21:1392-1407. [PMID: 35482949 DOI: 10.1021/acs.jproteome.1c00936] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pseudomonas aeruginosa is an opportunistic pathogen highly resistant to a wide range of antimicrobial agents, making its infections very difficult to treat. Since microorganisms need to perpetually adapt to their surrounding environment, understanding the effect of carbon sources on P. aeruginosa physiology is therefore essential to avoid increasing drug-resistance and better fight this pathogen. By a global proteomic approach and phenotypic assays, we investigated the impact of various carbon source supplementations (glucose, glutamate, succinate, and citrate) on the physiology of the P. aeruginosa PA14 strain. A total of 581 proteins were identified as differentially expressed in the 4 conditions. Most of them were more abundant in citrate supplementation and were involved in virulence, motility, biofilm development, and antibiotic resistance. Phenotypic assays were performed to check these hypotheses. By coupling all this data, we highlight the importance of the environment in which the bacterium evolves on its metabolism, and thus the necessity to better understand the metabolic pathways implied in its adaptative response according to the nutrient availability.
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Affiliation(s)
- Salomé Sauvage
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France.,PISSARO Proteomic Facility, IRIB, 76820 Mont-Saint-Aignan, France
| | - Charlotte Gaviard
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France.,PISSARO Proteomic Facility, IRIB, 76820 Mont-Saint-Aignan, France
| | - Ali Tahrioui
- Laboratoire de microbiologie signaux et microenvironnement, LMSM EA4312, 55 rue Saint-Germain, 27000 Evreux, France
| | - Laurent Coquet
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France.,PISSARO Proteomic Facility, IRIB, 76820 Mont-Saint-Aignan, France
| | - Hung Le
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France
| | - Stéphane Alexandre
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France
| | - Ahmed Ben Abdelkrim
- Lactanet, Valacta, 555 Boul des Anciens-Combattants, Sainte-Anne-de-Bellevue, Québec H9X 3R4, Canada
| | - Emeline Bouffartigues
- Laboratoire de microbiologie signaux et microenvironnement, LMSM EA4312, 55 rue Saint-Germain, 27000 Evreux, France
| | - Olivier Lesouhaitier
- Laboratoire de microbiologie signaux et microenvironnement, LMSM EA4312, 55 rue Saint-Germain, 27000 Evreux, France
| | - Sylvie Chevalier
- Laboratoire de microbiologie signaux et microenvironnement, LMSM EA4312, 55 rue Saint-Germain, 27000 Evreux, France
| | - Thierry Jouenne
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France.,PISSARO Proteomic Facility, IRIB, 76820 Mont-Saint-Aignan, France
| | - Julie Hardouin
- Normandie Université, UNIROUEN, INSA, CNRS Polymers, Biopolymers, Surface Laboratory, 76821 Mont-Saint-Aignan cedex, France.,PISSARO Proteomic Facility, IRIB, 76820 Mont-Saint-Aignan, France
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12
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Klubthawee N, Bovone G, Marco‐Dufort B, Guzzi EA, Aunpad R, Tibbitt MW. Biopolymer Nano-Network for Antimicrobial Peptide Protection and Local Delivery. Adv Healthc Mater 2022; 11:e2101426. [PMID: 34936732 PMCID: PMC11468357 DOI: 10.1002/adhm.202101426] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/03/2021] [Indexed: 12/12/2022]
Abstract
Antimicrobial resistance (AMR) develops when bacteria no longer respond to conventional antimicrobial treatment. The limited treatment options for resistant infections result in a significantly increased medical burden. Antimicrobial peptides offer advantages for treatment of resistant infections, including broad-spectrum activity and lower risk of resistance development. However, sensitivity to proteolytic cleavage often limits their clinical application. Here, a moldable and biodegradable colloidal nano-network is presented that protects bioactive peptides from enzymatic degradation and delivers them locally. An antimicrobial peptide, PA-13, is encapsulated electrostatically into positively and negatively charged nanoparticles made of chitosan and dextran sulfate without requiring chemical modification. Mixing and concentration of oppositely charged particles form a nano-network with the rheological properties of a cream or injectable hydrogel. After exposure to proteolytic enzymes, the formed nano-network loaded with PA-13 eliminates Pseudomonas aeruginosa during in vitro culture and in an ex vivo porcine skin model while the unencapsulated PA-13 shows no antibacterial effect. This demonstrates the ability of the nano-network to protect the antimicrobial peptide in an enzyme-challenged environment, such as a wound bed. Overall, the nano-network presents a useful platform for antimicrobial peptide protection and delivery without impacting peptide bioactivity.
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Affiliation(s)
- Natthaporn Klubthawee
- Graduate Program in Biomedical SciencesFaculty of Allied Health SciencesThammasat UniversityPathum Thani12120Thailand
| | - Giovanni Bovone
- Macromolecular Engineering LaboratoryDepartment of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
| | - Bruno Marco‐Dufort
- Macromolecular Engineering LaboratoryDepartment of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
| | - Elia A. Guzzi
- Macromolecular Engineering LaboratoryDepartment of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
| | - Ratchaneewan Aunpad
- Graduate Program in Biomedical SciencesFaculty of Allied Health SciencesThammasat UniversityPathum Thani12120Thailand
| | - Mark W. Tibbitt
- Macromolecular Engineering LaboratoryDepartment of Mechanical and Process EngineeringETH ZurichZurich8092Switzerland
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13
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Innovative Approach to the Management of Pseudomonas aeruginosa Infections on Paracorporeal Cannulas. Pediatr Infect Dis J 2022; 41:e106-e107. [PMID: 35144271 DOI: 10.1097/inf.0000000000003386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Ozhathil DK, Wolf SE. Prevention and treatment of burn wound infections: the role of topical antimicrobials. Expert Rev Anti Infect Ther 2022; 20:881-896. [PMID: 35188850 DOI: 10.1080/14787210.2022.2044795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infections related to the skin are the principal drivers of morbidity and mortality following severe burn, therefore a diverse armamentarium of topical antimicrobial agents were developed over the history of burn care. The last 30 years witnessed dramatic changes in the application of surgical intervention and utilization of topical therapies. AREAS COVERED We explore well-known topical antimicrobial products used in burn care. First, we investigate how fundamental changes in the practice of burn surgery influenced the choice of topical therapies used. Then, we examine antimicrobial creams and ointments commonly recognized due to their long record of use in burn care. Next, we dive into antimicrobial solutions commonly used as adjuncts to surgical intervention. Finally, we explore representative antimicrobial dressings, an ever-advancing roster of products opening the door to the next era in burn care. We also describe how these new agents relate to already established tools in present-day burn care. EXPERT OPINION In the current day, though the wisdom of early excision and wound closure remains valid, we continue to strive to minimize aggressive wound excision and disfiguring donor tissue collection while securing rapid wound closure. To this end, antimicrobial therapies are titrated to optimize operative outcomes and provide non-operative wound care when appropriate. Antimicrobial agents bridge the gap with the next generation of skin substitute and skin replacement therapies.
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Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas
| | - Steven E Wolf
- Division Chief, Burns, Trauma & Acute Care surgery, Department of Surgery, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, Texas 77555-1220
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15
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Vyas T, Rapalli VK, Chellappan DK, Dua K, Dubey SK, Singhvi G. Bacterial biofilms associated skin disorders: Pathogenesis, advanced pharmacotherapy and nanotechnology-based drug delivery systems as a treatment approach. Life Sci 2021; 287:120148. [PMID: 34785190 DOI: 10.1016/j.lfs.2021.120148] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Biofilms are microcolonies of microbes that form communities with a variety of microbes, exhibit the same gene composition but differ in gene expression. Biofilm-associated infections have been in existence for a long, however, biofilm-associated skin disorders have not been investigated much. OBJECTIVES Biofilms, which are made mostly of the matrix can be thought of as communities of microbes that are more virulent and more difficult to eradicate as compared to their planktonic counterparts. Currently, several formulations are available in the market which have the potential to treat biofilm-assisted skin disorders. However, the existing pharmacotherapies are not competent enough to cure them effectively and entirely, in several cases. KEY FINDINGS Especially with the rising resistance towards antibiotics, it has become particularly challenging to ameliorate these disorders completely. The new approaches are being used to combat biofilm-associated skin disorders, some of them being photodynamic therapy, nanotherapies, and the use of novel drug delivery systems. The focus of attention, however, is nanotherapy. Micelles, solid lipid nanoparticles, quatsomes, and many others are being considered to find a better solution for the biofilm-associated skin disorders. SIGNIFICANCE This review is an attempt to give a perspective on these new approaches for treating bacterial biofilms associated with skin disorders.
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Affiliation(s)
- Taraj Vyas
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani 333031, India
| | | | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney (UTS), Ultimo, NSW 2007, Australia; Centre for Inflammation, Centenary Institute, Sydney, NSW 2050, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, 2007 New South Wales, Australia
| | - Sunil Kumar Dubey
- Medical Research, R&D Healthcare Division, Emami Ltd, Kolkata 700056, India
| | - Gautam Singhvi
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani 333031, India.
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16
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Siddiqi A, Abdo ZE, Rossman SR, Kelly MA, Piuzzi NS, Higuera CA, Schwarzkopf R, Springer BD, Chen AF, Parvizi J. What Is the Optimal Irrigation Solution in the Management of Periprosthetic Hip and Knee Joint Infections? J Arthroplasty 2021; 36:3570-3583. [PMID: 34127346 DOI: 10.1016/j.arth.2021.05.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Thorough irrigation and debridement using an irrigation solution is a well-established treatment for both acute and chronic periprosthetic joint infections (PJIs). In the absence of concrete data, identifying the optimal irrigation agent and protocol remains challenging. METHODS A thorough review of the current literature on the various forms of irrigations and their additives was performed to evaluate the efficacy and limitations of each solution as pertaining to pathogen eradication in the treatment of PJI. As there is an overall paucity of high-quality literature comparing irrigation additives to each other and to any control, no meta-analyses could be performed. The literature was therefore summarized in this review article to give readers concise information on current irrigation options and their known risks and benefits. RESULTS Antiseptic solutions include povidone-iodine, chlorhexidine gluconate, acetic acid, hydrogen peroxide, sodium hypochlorite, hypochlorous acid, and preformulated commercially available combination solutions. The current literature suggests that intraoperative use of antiseptic irrigants may play a role in treating PJI, but definitive clinical studies comparing antiseptic to no antiseptic irrigation are lacking. Furthermore, no clinical head-to-head comparisons of different antiseptic irrigants have identified an optimal irrigation solution. CONCLUSION Further high-quality studies on the optimal irrigation additive and protocol for the management of PJI are warranted to guide future evidence-based decisions.
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Affiliation(s)
- Ahmed Siddiqi
- A Division of Ortho Alliance NJ, Orthopaedic Institute of Central Jersey, Manasquan, NJ; Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ; Department of Orthopedic Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Zuhdi E Abdo
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ
| | - Stephen R Rossman
- Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Michael A Kelly
- Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Ran Schwarzkopf
- Department of Orthopedics, New York University Langone Medical Center, New York, NY
| | - Bryan D Springer
- Department of Orthopedics, Atrium Musculoskeletal Institute, OrthoCarolina Hip and Knee Center, Charlotte, NC
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Javad Parvizi
- Department of Orthopedics, Rothman Orthopedics, Philadelphia, PA
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17
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Nagoba B, Gavkare A, Rayate A, Mumbre S, Rao A, Warad B, Nanaware N, Jamadar N. Role of an acidic environment in the treatment of diabetic foot infections: A review. World J Diabetes 2021; 12:1539-1549. [PMID: 34630906 PMCID: PMC8472499 DOI: 10.4239/wjd.v12.i9.1539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/21/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Management of diabetic foot ulcers is the biggest challenge to the clinician, as conventional antibiotic therapies and local wound care have their own limitations. They are not effective for control of infections and promotion of healing because of cytotoxic effects. In view of cytotoxicity of routinely used topical antiseptic agents, this article focuses on the search of an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and also in promoting the healing process. This review focuses on the use of various acids such as citric, acetic, hyaluronic, and hypochlorous acids as topical agents in diabetic foot infections. This article also focuses on the different roles of acids in the treatment of diabetic foot infections.
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Affiliation(s)
- Basavraj Nagoba
- Department of Microbiology, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Ajay Gavkare
- Department of Physiology, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Abhijit Rayate
- Department of Surgery, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Sachin Mumbre
- Department of Community Medicine, Ashwini Rural Medical College, Solapur 413001, Maharashtra, India
| | - Arunkumar Rao
- Department of Orthopedics, MIMSR Medical College, Latur 413512, India
| | - Basavraj Warad
- Department of Surgery, MIMSR Medical College, Latur 413512, Maharashtra, India
| | - Neeta Nanaware
- Department of Physiology, Government Medical College, Latur 413512, Maharashtra, India
| | - Nawab Jamadar
- Department of Anesthesiology, MIMSR Medical College, Latur 413512, Maharashtra, India
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18
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Elhage KG, St Claire K, Daveluy S. Acetic acid and the skin: a review of vinegar in dermatology. Int J Dermatol 2021; 61:804-811. [PMID: 34350993 DOI: 10.1111/ijd.15804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
Vinegar is commonly used as a home remedy for many skin problems. It is important for dermatologists to understand the evidence supporting its use in skin disease, as well as potential adverse effects, so they can properly counsel patients on the safe use of this widely available treatment. Vinegar possesses antimicrobial and antioxidant properties that provide utility in wound care as well as bacterial and fungal infections. There is also evidence to support its use in pruritus, head lice removal, and treatment of striae gravidarum. While generally safe, inappropriate use can result in damage to the skin. In this review, we discuss the evidence supporting vinegar as a treatment for skin disease, as well as adverse events reported from misuse, to provide dermatologists the knowledge to counsel patients on the safe and appropriate use of vinegar.
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Affiliation(s)
| | - Kayla St Claire
- Wayne State University School of Medicine, Detroit, MI, USA.,Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven Daveluy
- Wayne State University School of Medicine, Detroit, MI, USA.,Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
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19
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Hassan KS. A novel method for treatment of pseudomonas pyogenic hepatic abscess complicating an echinococcal cyst by irrigation with acetic acid. A case report and literature review. IDCases 2021; 25:e01186. [PMID: 34189036 PMCID: PMC8217704 DOI: 10.1016/j.idcr.2021.e01186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
Hepatic hydatid cysts can be complicated by pyogenic abscesses. We report a case of hepatic hydatid cysts presenting to Sultan Qaboos University Hospital (SQUH) on 29 June 2010 complicated by secondary infection with fully sensitive Pseudomonas aeruginosa. The infection persisted despite standard treatment (drainage and systemic antibiotics) and was eventually cured with a novel method using acetic acid. Methods Instillation of acetic acid (in the form of white vinegar) into the hepatic abscess through the pig tail drainage tube. Results The administration of acetic acid (6%) in the form of white vinegar was well tolerated and safe to the patient and resulted in complete clinical and radiographic resolution of the hepatic abscess. Conclusion Acetic acid (vinegar) irrigation can be used to clear a refractory pyogenic hepatic abscess due toP aeruginosa infection.
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20
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Tawre MS, Kamble EE, Kumkar SN, Mulani MS, Pardesi KR. Antibiofilm and antipersister activity of acetic acid against extensively drug resistant Pseudomonas aeruginosa PAW1. PLoS One 2021; 16:e0246020. [PMID: 33529248 PMCID: PMC7853517 DOI: 10.1371/journal.pone.0246020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
Pseudomonas aeruginosa is an ESKAPE pathogen associated with difficult-to-treat burn wound and surgical-site infections. This study aimed to characterise an extensively drug resistant (XDR) P. aeruginosa isolate (designated PAW1) and to investigate the antibiofilm and antipersister effect of acetic acid on PAW1. PAW1 was identified using biotypic (VITEK) and genotypic (16S rDNA) analysis. Minimum inhibitory concentration (MIC) and disc susceptibility testing showed high level resistance against all antibiotics from classes including beta lactams, cephems, carbapenems and fluoroquinolones. It was therefore identified as extensively drug resistant (XDR), showing resistance to all antibiotics except for, aminoglycoside (gentamicin and netilmicin) and lipopeptides (polymyxin B). Time kill assays showed antibiotic tolerant, persister cell formation in presence of 100X MICs of gentamicin and polymyxin B. Other virulence traits such as ability to produce lipase, protease, haemolysin, and siderophores and to form biofilms were additional factors which may contribute to its pathogenicity. PAW1 showed promising susceptibility against acetic acid with MIC and minimum biofilm inhibitory concentration of 0.156% (v/v). Percent viability of PAW1 was dependent on dose and treatment time of acetic acid. 0.625% acetic acid treatment of 5 minutes was effective in killing >90% planktonic cells showing lesser toxicity to L929 cells (IC50 = 0.625%). Biofilm disruption caused due to acetic acid was also dose dependent, showing 40.57% disruption after treatment with 0.625% acetic acid for 5 minutes. FESEM imaging and live dead staining of planktonic and biofilm forms of PAW1 confirmed that acetic acid treatment caused 19.04% of cell shrinkage and disruption of extracellular matrix resulting in killing of cells. Antipersister activity of acetic acid was demonstrated by showing complete killing of PAW1 at 4X MIC. Overall, this study characterised an XDR isolate P. aeruginosa showing resistance and tolerance to various antibiotics. Antipersister and antibiofilm effect of acetic acid demonstrates the importance of forgotten topical agents as an effective strategy to treat XDR pathogens.
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Affiliation(s)
- Madhumita S. Tawre
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ekta E. Kamble
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Shital N. Kumkar
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Mansura S. Mulani
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Karishma R. Pardesi
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, India
- * E-mail:
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21
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Santos-Carballal D, Roldan A, de Leeuw NH. CO 2 reduction to acetic acid on the greigite Fe 3S 4{111} surface. Faraday Discuss 2021; 229:35-49. [PMID: 34075915 DOI: 10.1039/c9fd00141g] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Acetic acid (CH3-COOH) is an important commodity chemical widely used in a myriad of industrial processes, whose production still largely depends on homogeneous catalysts based on expensive rare metals. Here, we report a computational study on the formation of CH3-COOH from carbon dioxide (CO2) as an alternative chemical feedstock on the {111} surface of the low-cost greigite Fe3S4 catalyst. We have used density functional theory calculations with a Hubbard Hamiltonian approach and long-range dispersion corrections (DFT+U-D2) to simulate the various stages of the direct combination of C1 species of different composition to produce glyoxylic acid (CHO-COOH) as a key intermediate in the formation of CH3-COOH. Three reaction mechanisms are considered: (i) the main pathway where the direct formation of the C-C bond takes place spontaneously, followed by a step-wise reduction of CHO-CHOO to CH3-COOH; and the competitive pathways for the non-promoted and H-promoted elimination of hydroxy groups (OH) and water (H2O), respectively from (ii) the carboxyl; and (iii) the carbonyl end of the glyoxylate intermediates. The thermodynamic and kinetic profiles show that the energies for the intermediates on the main pathway are very similar for the two catalytic sites considered, although the activation energies are somewhat larger for the exposed tetrahedral iron (FeA) ion. In most cases, the intermediates for the deoxygenation of the carboxylic acid are less stable than the intermediates on the main pathway, which suggests that the molecule prefers to lose the carbonylic oxygen. The suitable surface properties of the Fe3S4{111} surface show that this material could be a promising sustainable catalyst in future technologies for the conversion of CO2 into organic acid molecules of commercial interest.
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Affiliation(s)
- David Santos-Carballal
- School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, UK.
| | - Alberto Roldan
- School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, UK.
| | - Nora H de Leeuw
- School of Chemistry, Cardiff University, Main Building, Park Place, Cardiff CF10 3AT, UK. and Department of Earth Sciences, Utrecht University, Princetonplein 8A, 3584 CD Utrecht, The Netherlands
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22
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Shebitz DJ, Agnew LP, Oviedo A, Monga G, Ramanathan D. Introducing the Potential Medicinal and Ecological Value of a Pioneer Tree Species as a Justification to Conserve and Sustainably Manage Tropical Secondary Forests: Vismia macrophylla as a Case Study. J ETHNOBIOL 2020. [DOI: 10.2993/0278-0771-40.1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniela Joy Shebitz
- School of Environmental and Sustainability Sciences, Kean University, 1000 Morris Ave., Union, NJ 07083 USA
| | - Lindsey Page Agnew
- School of Environmental and Sustainability Sciences, Kean University, 1000 Morris Ave., Union, NJ 07083 USA
| | - Angela Oviedo
- School of Environmental and Sustainability Sciences, Kean University, 1000 Morris Ave., Union, NJ 07083 USA
| | - Gaganpreet Monga
- Center for Science, Technology, and Math Education, Kean University
| | - Dil Ramanathan
- Center for Science, Technology, and Math Education, Kean University
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23
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Kavolus JJ, Schwarzkopf R, Rajaee SS, Chen AF. Irrigation Fluids Used for the Prevention and Treatment of Orthopaedic Infections. J Bone Joint Surg Am 2020; 102:76-84. [PMID: 31596810 DOI: 10.2106/jbjs.19.00566] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph J Kavolus
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Sean S Rajaee
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kirsner RS, Amaya R, Bass K, Boyar V, Ciprandi G, Glat PM, Percival SL, Romanelli M, Pittinger TP. Effects of a surfactant-based gel on acute and chronic paediatric wounds: a panel discussion and case series. J Wound Care 2019; 28:398-408. [PMID: 31166855 DOI: 10.12968/jowc.2019.28.6.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
On 20 November 2018, following the International Society for Paediatric Wound Care conference, a closed panel meeting took place in which the use of a surfactant-based gel (PluroGel (PMM), Medline Industries, Illinois, US) in paediatric wound care was discussed. The authors shared their experiences, thoughts, experimental data and clinical results. The panel identified the need for a product that can gently cleanse paediatric wounds and remove devitalised tissue without causing discomfort or skin reactions, as well as potentially promote healing. In adults, PMM has been shown to assist healing by hydrating the wound, controlling exudate and debriding non-viable tissue. Islands of neo-epithelium have also been reported to appear rapidly in different parts of the wound bed. No adverse effects on these proliferating cells have been observed. In vitro data suggest that PMM can remove biofilm, as well as potentially promote healing through cell salvage. The panel, therefore, set out to discuss their experiences of using PMM in the paediatric patients and to establish a consensus on the indications for its use and application in this population. This article will describe the main outcomes of that discussion and present case studies from paediatric patients with a variety of wound types, who were treated with PMM by members of the panel.
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Affiliation(s)
- Robert S Kirsner
- Chairman and Harvey Blank Professor, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, US
| | - Rene Amaya
- Director, Pediatric Wound Care and Laser Specialist, Houston, Texas, US
| | - Kathryn Bass
- Associate Professor of Surgery, Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, New York, US
| | - Vita Boyar
- Director of Neonatal Wound Services, Neonatal-Perinatal Medicine, Alexandra and Steven Cohen Children's Medical Center of New York, Northwell Health, Zucker School of Medicine at Hofstra, Northwell, US
| | - Guido Ciprandi
- Paediatric and Plastic Surgeon, Bambino Gesù Children's Hospital, Department of Surgery, Division of Plastic and Maxillofacial Surgery, Head Wound Care Surgical Unit, Rome, Italy
| | - Paul M Glat
- Professor of Surgery and Pediatrics, Drexel University College of Medicine and Chief of Plastic Surgery, St. Christopher's Hospital for Children, Philadelphia, US
| | - Steven L Percival
- CEO of 5D Heath Protection Group Ltd, 5D Health Protection Group Ltd, Liverpool, UK
| | - Marco Romanelli
- Professor and Chairman, Department of Dermatology, University of Pisa, Italy
| | - Timothy P Pittinger
- Paediatric Surgeon, Department of Surgery & Regional Burn Center, Akron Children's Hospital, Akron, Ohio, US
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A Novel Approach to Treating Moderate to Severe Incontinence-Associated Dermatitis and Intertriginous Dermatitis. J Wound Ostomy Continence Nurs 2019; 46:446-452. [DOI: 10.1097/won.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Agrawal KS, Sarda AV, Shrotriya R, Bachhav M, Puri V, Nataraj G. Acetic acid dressings: Finding the Holy Grail for infected wound management. Indian J Plast Surg 2019; 50:273-280. [PMID: 29618862 PMCID: PMC5868106 DOI: 10.4103/ijps.ijps_245_16] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Wounds have since long, contributed majorly to the health-care burden. Infected long-standing non-healing wounds place many demands on the treating surgeon and are devastating for the patients physically, nutritionally, vocationally, financially, psychologically and socially. Acetic acid has long been included among agents used in the treatment of infected wounds. In this study, we have evaluated the use of acetic acid for topical application in the treatment of infected wounds. Materials and Methods A total of 100 patients with infected wounds were treated with topical application of 1% acetic acid as dressing material after appropriate cleaning. A specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done similarly. Minimum inhibitory concentration (MIC) of acetic acid against various organisms isolated was determined. Results The patients treated ranged between 9 and 60 years, with the mean age 33 years. Nearly 70% of patients were male. Aetiologies of wounds: infective 35, diabetic 25, trauma 20, burns 10, venous ulcers 5 and infected graft donor site 5. Various microorganisms isolated include Pseudomonas aeruginosa (40%), Staphylococcus aureus (2%), Acinetobacter (12%), Escherichia Coli (5%), Proteus mirabilis (3%), Klebsiella (18%), methicillin-resistant S. aureus (10%), Streptococcus (2%) and Enterococcus (1%), Citrobacter (1%). Few wounds (6%) also isolated fungi. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolated organisms was ≤0.5%. Conclusion pH of the wound environment plays a pivotal role in wound healing. Acetic acid with concentration of 1% has shown to be efficacious against wide range of bacteria as well as fungi, simultaneously accelerating wound healing. Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of wound infections caused due to multi-drug resistant, large variety of bacteria and fungus.
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Affiliation(s)
- Kapil S Agrawal
- Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anup Vidyadhar Sarda
- Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Raghav Shrotriya
- Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Manoj Bachhav
- Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vinita Puri
- Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Gita Nataraj
- Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Rozenblat M, Last O, Fisher S, Ziv M. Acetic acid treatment for toe web infection caused by Pseudomonas Aeruginosa combined with fungal infection: A case series of ten patients. Dermatol Ther 2019; 32:e12883. [DOI: 10.1111/dth.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/22/2019] [Accepted: 03/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mati Rozenblat
- Department of Dermatology"Emek" medical center Afula Israel
| | - Omer Last
- Department of DermatologySoroka medical center Beer‐Sheva Israel
| | - Shani Fisher
- Department of Dermatology"Emek" medical center Afula Israel
| | - Michael Ziv
- Department of Dermatology"Emek" medical center Afula Israel
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Bushell FML, Tonner PD, Jabbari S, Schmid AK, Lund PA. Synergistic Impacts of Organic Acids and pH on Growth of Pseudomonas aeruginosa: A Comparison of Parametric and Bayesian Non-parametric Methods to Model Growth. Front Microbiol 2019; 9:3196. [PMID: 30671033 PMCID: PMC6331447 DOI: 10.3389/fmicb.2018.03196] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/10/2018] [Indexed: 01/05/2023] Open
Abstract
Different weak organic acids have significant potential as topical treatments for wounds infected by opportunistic pathogens that are recalcitrant to standard treatments. These acids have long been used as bacteriostatic compounds in the food industry, and in some cases are already being used in the clinic. The effects of different organic acids vary with pH, concentration, and the specific organic acid used, but no studies to date on any opportunistic pathogens have examined the detailed interactions between these key variables in a controlled and systematic way. We have therefore comprehensively evaluated the effects of several different weak organic acids on growth of the opportunistic pathogen Pseudomonas aeruginosa. We used a semi-automated plate reader to generate growth profiles for two different strains (model laboratory strain PAO1 and clinical isolate PA1054 from a hospital burns unit) in a range of organic acids at different concentrations and pH, with a high level of replication for a total of 162,960 data points. We then compared two different modeling approaches for the interpretation of this time-resolved dataset: parametric logistic regression (with or without a component to include lag phase) vs. non-parametric Gaussian process (GP) regression. Because GP makes no prior assumptions about the nature of the growth, this method proved to be superior in cases where growth did not follow a standard sigmoid functional form, as is common when bacteria grow under stress. Acetic, propionic and butyric acids were all more detrimental to growth than the other acids tested, and although PA1054 grew better than PAO1 under non-stress conditions, this difference largely disappeared as the levels of stress increased. As expected from knowledge of how organic acids behave, their effect was significantly enhanced in combination with low pH, with this interaction being greatest in the case of propionic acid. Our approach lends itself to the characterization of combinatorial interactions between stressors, especially in cases where their impacts on growth render logistic growth models unsuitable.
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Affiliation(s)
- Francesca M. L. Bushell
- School of Biosciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Peter D. Tonner
- Department of Biology, Duke University, Durham, NC, United States
- Statistical Engineering Division, National Institute of Standards and Technology, Gaithersburg, MD, United States
| | - Sara Jabbari
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
- School of Mathematics, University of Birmingham, Birmingham, United Kingdom
| | - Amy K. Schmid
- Department of Biology, Duke University, Durham, NC, United States
- Center for Genomics and Computational Biology, Duke University, Durham, NC, United States
| | - Peter A. Lund
- School of Biosciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
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Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, Tuchmann F, Assadian O. Consensus on Wound Antisepsis: Update 2018. Skin Pharmacol Physiol 2017; 31:28-58. [PMID: 29262416 DOI: 10.1159/000481545] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/15/2017] [Indexed: 02/03/2023]
Abstract
Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Contardi M, Heredia-Guerrero JA, Perotto G, Valentini P, Pompa PP, Spanò R, Goldoni L, Bertorelli R, Athanassiou A, Bayer IS. Transparent ciprofloxacin-povidone antibiotic films and nanofiber mats as potential skin and wound care dressings. Eur J Pharm Sci 2017; 104:133-144. [PMID: 28366652 DOI: 10.1016/j.ejps.2017.03.044] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Marco Contardi
- Smart Materials, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | | | - Giovanni Perotto
- Smart Materials, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | - Paola Valentini
- Nanobiointeractions and Nanodiagnostics, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | - Pier Paolo Pompa
- Nanobiointeractions and Nanodiagnostics, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | - Raffaele Spanò
- Department of Drug Discovery and Development, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | - Luca Goldoni
- Department of Drug Discovery and Development, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | - Rosalia Bertorelli
- Department of Drug Discovery and Development, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy
| | | | - Ilker S Bayer
- Smart Materials, Istituto Italiano di Tecnologia, Via Morego, 30, Genova 16163, Italy.
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Nishad DK, Bhalla S, Khanna K, Sharma BG, Rawat HS, Mittal G, Bhatnagar A. Decontamination of rat and human skin experimentally contaminated with 99mTc, 201Tl and 131I radionuclides using “Dermadecon” – a skin decontamination kit: an efficacy study. Cutan Ocul Toxicol 2017; 37:1-8. [DOI: 10.1080/15569527.2017.1315127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Dhruv Kumar Nishad
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
| | - Supriya Bhalla
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
| | - Kushagra Khanna
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
| | - Braj Gaurav Sharma
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
| | - Harish Singh Rawat
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
| | - Gaurav Mittal
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
| | - Aseem Bhatnagar
- Ministry of Defence, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organization, Delhi, India
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32
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Hughes G, Webber MA. Novel approaches to the treatment of bacterial biofilm infections. Br J Pharmacol 2017; 174:2237-2246. [PMID: 28063237 DOI: 10.1111/bph.13706] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/15/2016] [Accepted: 12/10/2016] [Indexed: 12/31/2022] Open
Abstract
Bacterial infection remains a major challenge to healthcare and is responsible for significant morbidity and mortality. This situation is becoming complicated by an increasingly ageing and susceptible population and large numbers of bacterial isolates, which have developed resistance to antibiotics. Bacteria that form biofilms and colonize or infect medical devices or wounds are particularly hard to treat as biofilms are inherently highly antibiotic resistant. Most infections have a component where bacteria exist as a biofilm and as a result, prevention or treatment of biofilm-associated infections is highly important. A number of novel strategies to kill biofilms have been in development; these include the use of weak organic acids, photo irradiation and the application of bacteriophage. All have promise and are able to effectively kill biofilms in model systems, but for each there are still unanswered questions. This review summarizes the main features of biofilm infections, each of these novel approaches and the evidence that is still lacking before these potential treatments can be incorporated into clinical usage. LINKED ARTICLES This article is part of a themed section on Drug Metabolism and Antibiotic Resistance in Micro-organisms. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.14/issuetoc.
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Affiliation(s)
- Gareth Hughes
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Mark A Webber
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Institute of Food Research, Norwich, UK
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Nagoba BS, Suryawanshi NM, Selkar SP. Harmful misuse of white vinegar in a wrong combination. Int Wound J 2016; 13:1044. [PMID: 25292291 PMCID: PMC7950042 DOI: 10.1111/iwj.12380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Basavraj S Nagoba
- Department of Microbiology, Maharashtra Institute of Medical Sciences & Research, Latur, India.
| | - Namdev M Suryawanshi
- Department of Microbiology, Maharashtra Institute of Medical Sciences & Research, Latur, India
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Meybodi F, Sedaghat N, French J, Keighley C, Mitchell D, Elder E. Implant salvage in breast reconstruction with severe peri-prosthetic infection. ANZ J Surg 2015; 87:E293-E299. [PMID: 26572237 DOI: 10.1111/ans.13379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although treatment of mild peri-prosthetic infection in implant-based breast reconstruction results in high rates of resolution, successful management of severe peri-prosthetic infection remains a significant challenge. METHODS In this case series, a protocol utilizing a novel dressing - negative pressure wound therapy with instillation (NPWTi) - for the management of severe peri-prosthetic infection in breast reconstruction patients is described. This is an operative technique involving: (i) explantation of the breast prosthesis and application of the NPWTi dressing to the implant pocket; (ii) change of the NPWTi dressing; (iii) intraoperative fluid/tissue cultures; and (iv) reimplantation of the breast prosthesis when cultures yield no growth. RESULTS This protocol was utilized in six cases of severe peri-prosthetic infection in five patients with immediate breast reconstruction for breast cancer or risk-reducing surgery. Cultures of fluid/tissue grew typical and/or unusual organisms. Only one case did not yield an organism. The hospital length of stay upon completion of the protocol ranged from 7-16 days (mean, 12 days). Successful implant salvage was achieved in five of six cases. The protocol was aborted in one case to allow for completion of adjuvant chemotherapy. CONCLUSIONS Early findings from this case series suggest that in cases of severe peri-prosthetic infection this novel operative protocol may result in successful implant salvage for breast reconstruction patients. Further studies are needed to more fully elaborate the role of NPWTi to achieve implant salvage in challenging cases of peri-prosthetic infection.
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Affiliation(s)
- Farid Meybodi
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Negin Sedaghat
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - David Mitchell
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
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Halstead FD, Rauf M, Moiemen NS, Bamford A, Wearn CM, Fraise AP, Lund PA, Oppenheim BA, Webber MA. The Antibacterial Activity of Acetic Acid against Biofilm-Producing Pathogens of Relevance to Burns Patients. PLoS One 2015; 10:e0136190. [PMID: 26352256 PMCID: PMC4566994 DOI: 10.1371/journal.pone.0136190] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/31/2015] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Localised infections, and burn wound sepsis are key concerns in the treatment of burns patients, and prevention of colonisation largely relies on biocides. Acetic acid has been shown to have good antibacterial activity against various planktonic organisms, however data is limited on efficacy, and few studies have been performed on biofilms. OBJECTIVES We sought to investigate the antibacterial activity of acetic acid against important burn wound colonising organisms growing planktonically and as biofilms. METHODS Laboratory experiments were performed to test the ability of acetic acid to inhibit growth of pathogens, inhibit the formation of biofilms, and eradicate pre-formed biofilms. RESULTS Twenty-nine isolates of common wound-infecting pathogens were tested. Acetic acid was antibacterial against planktonic growth, with an minimum inhibitory concentration of 0.16-0.31% for all isolates, and was also able to prevent formation of biofilms (at 0.31%). Eradication of mature biofilms was observed for all isolates after three hours of exposure. CONCLUSIONS This study provides evidence that acetic acid can inhibit growth of key burn wound pathogens when used at very dilute concentrations. Owing to current concerns of the reducing efficacy of systemic antibiotics, this novel biocide application offers great promise as a cheap and effective measure to treat infections in burns patients.
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Affiliation(s)
- Fenella D. Halstead
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Microbiology and Infection, School of Biosciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Maryam Rauf
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Microbiology and Infection, School of Biosciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Naiem S. Moiemen
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham, United Kingdom
- The Healing Foundation Burns Research Centre, Birmingham, United Kingdom
| | - Amy Bamford
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- The Healing Foundation Burns Research Centre, Birmingham, United Kingdom
| | - Christopher M. Wearn
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- The Healing Foundation Burns Research Centre, Birmingham, United Kingdom
| | - Adam P. Fraise
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Peter A. Lund
- Institute of Microbiology and Infection, School of Biosciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Beryl A. Oppenheim
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Mark A. Webber
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Microbiology and Infection, School of Biosciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Bjarnsholt T, Alhede M, Jensen PØ, Nielsen AK, Johansen HK, Homøe P, Høiby N, Givskov M, Kirketerp-Møller K. Antibiofilm Properties of Acetic Acid. Adv Wound Care (New Rochelle) 2015; 4:363-372. [PMID: 26155378 DOI: 10.1089/wound.2014.0554] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/07/2014] [Indexed: 01/10/2023] Open
Abstract
Bacterial biofilms are known to be extremely tolerant toward antibiotics and other antimicrobial agents. These biofilms cause the persistence of chronic infections. Since antibiotics rarely resolve these infections, the only effective treatment of chronic infections is surgical removal of the infected implant, tissue, or organ and thereby the biofilm. Acetic acid is known for its antimicrobial effect on bacteria in general, but has never been thoroughly tested for its efficacy against bacterial biofilms. In this article, we describe complete eradication of both Gram-positive and Gram-negative biofilms using acetic acid both as a liquid and as a dry salt. In addition, we present our clinical experience of acetic acid treatment of chronic wounds. In conclusion, we here present the first comprehensive in vitro and in vivo testing of acetic acid against bacterial biofilms.
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Affiliation(s)
- Thomas Bjarnsholt
- Department of International Health, Immunology, and Microbiology, Faculty of Health Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Alhede
- Department of International Health, Immunology, and Microbiology, Faculty of Health Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Østrup Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne K. Nielsen
- Department of International Health, Immunology, and Microbiology, Faculty of Health Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Helle Krogh Johansen
- Department of International Health, Immunology, and Microbiology, Faculty of Health Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Hørsholm, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Køge, Denmark
| | - Niels Høiby
- Department of International Health, Immunology, and Microbiology, Faculty of Health Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Givskov
- Department of International Health, Immunology, and Microbiology, Faculty of Health Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
- Singapore Centre on Environmental Life Sciences Engineering, School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
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Pisano MB, Fadda ME, Melis R, Ciusa ML, Viale S, Deplano M, Cosentino S. Molecular identification of bacteriocins produced by Lactococcus lactis dairy strains and their technological and genotypic characterization. Food Control 2015. [DOI: 10.1016/j.foodcont.2014.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kumara D, Fernando S, Kottahachchi J, Dissanayake D, Athukorala G, Chandrasiri N, Damayanthi K, Hemarathne M, Pathirana A. Evaluation of bactericidal effect of three antiseptics on bacteria isolated from wounds. J Wound Care 2015; 24:5-10. [DOI: 10.12968/jowc.2015.24.1.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D.U.A Kumara
- Diploma in nursing, nursing officer, Professor in Surgery, Professorial Surgical Unit, Colombo South Teaching Hospital, Sri Lanka
| | - S.S.N. Fernando
- Professor in Microbiology, MD in Medical Microbiology, Senior lecturer and Consultant Microbiologist, Advanced Certificate Course of Laboratory Technology, Technical Officer, Intern House Officer, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - J. Kottahachchi
- Professor in Microbiology, MD in Medical Microbiology, Senior lecturer and Consultant Microbiologist, Advanced Certificate Course of Laboratory Technology, Technical Officer, Intern House Officer, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - D.M.B.T. Dissanayake
- Professor in Microbiology, MD in Medical Microbiology, Senior lecturer and Consultant Microbiologist, Advanced Certificate Course of Laboratory Technology, Technical Officer, Intern House Officer, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - G.I.D.D.A.D. Athukorala
- Professor in Microbiology, MD in Medical Microbiology, Senior lecturer and Consultant Microbiologist, Advanced Certificate Course of Laboratory Technology, Technical Officer, Intern House Officer, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - N.S. Chandrasiri
- MD in Medical Microbiology, Consultant Microbiologist, Department of Microbiology, Colombo South Teaching Hospital, Sri Lanka
| | - K.W.N. Damayanthi
- Professor in Microbiology, MD in Medical Microbiology, Senior lecturer and Consultant Microbiologist, Advanced Certificate Course of Laboratory Technology, Technical Officer, Intern House Officer, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - M.H.S.L. Hemarathne
- Professor in Microbiology, MD in Medical Microbiology, Senior lecturer and Consultant Microbiologist, Advanced Certificate Course of Laboratory Technology, Technical Officer, Intern House Officer, Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - A.A. Pathirana
- Diploma in nursing, nursing officer, Professor in Surgery, Professorial Surgical Unit, Colombo South Teaching Hospital, Sri Lanka
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Beier R, Foley S, Davidson M, White D, McDermott P, Bodeis-Jones S, Zhao S, Andrews K, Crippen T, Sheffield C, Poole T, Anderson R, Nisbet D. Characterization of antibiotic and disinfectant susceptibility profiles among Pseudomonas aeruginosa
veterinary isolates recovered during 1994-2003. J Appl Microbiol 2014; 118:326-42. [DOI: 10.1111/jam.12707] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/06/2014] [Accepted: 11/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R.C. Beier
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
| | - S.L. Foley
- Division of Microbiology, National Center for Toxicological Research; U.S. Food and Drug Administration; Jefferson AR USA
| | - M.K. Davidson
- Office of Research; Center for Veterinary Medicine; U.S. Food and Drug Administration; Laurel MD USA
| | - D.G. White
- Office of Research; Center for Veterinary Medicine; U.S. Food and Drug Administration; Laurel MD USA
| | - P.F. McDermott
- Office of Research; Center for Veterinary Medicine; U.S. Food and Drug Administration; Laurel MD USA
| | - S. Bodeis-Jones
- Office of Research; Center for Veterinary Medicine; U.S. Food and Drug Administration; Laurel MD USA
| | - S. Zhao
- Office of Research; Center for Veterinary Medicine; U.S. Food and Drug Administration; Laurel MD USA
| | - K. Andrews
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
| | - T.L. Crippen
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
| | - C.L. Sheffield
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
| | - T.L. Poole
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
| | - R.C. Anderson
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
| | - D.J. Nisbet
- Southern Plains Agricultural Research Center; Agricultural Research Service; U.S. Department of Agriculture; College Station TX USA
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Tan P, Peh K, Gan C, Liong M. Bioactive dairy ingredients for food and non-food applications. ACTA ALIMENTARIA 2014. [DOI: 10.1556/aalim.43.2014.1.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nagoba BS, Selkar SP, Wadher BJ, Gandhi RC. Acetic acid treatment of pseudomonal wound infections--a review. J Infect Public Health 2013; 6:410-415. [PMID: 23999348 DOI: 10.1016/j.jiph.2013.05.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 05/07/2013] [Accepted: 05/12/2013] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Pseudomonas aeruginosa is a significant cause of burn wound infections and, skin and soft tissue infections. The antiseptic management is an integral part of the management of wound infections and is essential to control wound infection. Although commonly used, concerns have been raised. RESULTS Available experimental data suggest that many commonly used antiseptic agents may be toxic to the cells involved in wound healing process and may affect the process of normal tissue repair. In view of this, the present review summarized the various organic acids commonly used as a substitute for antiseptics to control pseudomonal wound infections with special reference to acetic acid and their role in the process of wound healing. CONCLUSION Acetic acid is to be kept in mind as one of the alternatives when infection is caused by multiple antibiotic resistant strains of P. aeruginosa. At a time when bacterial resistance to antibiotics is a matter of increasing concern, the value of topical agents such as acetic acid should not be forgotten.
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Nagoba B, Gandhi R, Wadher B, Rao A, Selkar S. Simple and effective approach for the treatment of traumatic wounds in non-diabetic patients: a prospective open study. Int Wound J 2013; 10:585-589. [PMID: 22781002 PMCID: PMC7950341 DOI: 10.1111/j.1742-481x.2012.01026.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Infection is one of the most important obstacles in the wound-healing process. Conventional methods used for the treatment of wound infections have their own limitations and hence, are difficult to control. If infection is not addressed well in time, it will further increase morbidity and cost of treatment. An attempt was made to develop a simple and effective treatment modality by using citric acid as the sole antimicrobial agent to control bacterial infections of traumatic wounds. A total of 259 cases of traumatic wounds infected with a variety of bacteria were investigated for culture and susceptibility, and susceptibility to citric acid. Citric acid ointment (3%) was applied to traumatic wounds to determine its efficacy in their treatment of traumatic wounds. In a culture and susceptibility study, a total of 369 aerobic bacteria and 7 fungi were isolated, with Staphylococcus aureus (30.31%) being the most common isolate and ciprofloxacin (61.43%) being the most effective agent. All the isolates were found to be inhibited by citric acid in in vitro studies (minimum inhibitory concentration--500-2500 µg/ml). Citric acid ointment was found effective in controlling infections. Out of 259 cases, 244 (around 95%) were healed completely in 5-25 applications of 3% citric acid. As citric acid has antibacterial activity and wound-healing property; hence it is the best alternative for the treatment of traumatic wounds. Besides these properties, citric acid has no adverse effects and it is a good dressing agent.
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Affiliation(s)
- Basavraj Nagoba
- Department of Microbiology, MIMSR Medical College, Latur, Maharashtra, India Department of Surgery, MIMSR Medical College, Latur, Maharashtra, India Department of Microbiology, Medical Microbiology Research Laboratory, Nagpur University, Nagpur, Maharashtra, India Department of Orthopaedics, MIMSR Medical College, Latur, Maharashtra, India Department of Physiotherapy, MIMSR Medical College, Latur, Maharashtra, India
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Lew LC, Liong MT. Bioactives from probiotics for dermal health: functions and benefits. J Appl Microbiol 2013; 114:1241-53. [PMID: 23311666 DOI: 10.1111/jam.12137] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 11/27/2022]
Abstract
Probiotics have been extensively reviewed for decades, emphasizing on improving general gut health. Recently, more studies showed that probiotics may exert other health-promoting effects beyond gut well-being, attributed to the rise of the gut-brain axis correlations. Some of these new benefits include skin health such as improving atopic eczema, atopic dermatitis, healing of burn and scars, skin-rejuvenating properties and improving skin innate immunity. Increasing evidence has also showed that bacterial compounds such as cell wall fragments, their metabolites and dead bacteria can elicit certain immune responses on the skin and improve skin barrier functions. This review aimed to underline the mechanisms or the exact compounds underlying the benefits of bacterial extract on the skin based on evidences from in vivo and in vitro studies. This review could be of help in screening of probiotic strains with potential dermal enhancing properties for topical applications.
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Affiliation(s)
- L-C Lew
- School of Industrial Technology, Universiti Sains Malaysia, Penang, Malaysia
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45
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Scimeca CL, Bharara M, Fisher TK, Kimbriel H, Mills JL, Armstrong DG. An update on pharmacological interventions for diabetic foot ulcers. Foot Ankle Spec 2010; 3:285-302. [PMID: 20685955 DOI: 10.1177/1938640010376994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetic foot ulcers are the most common lower extremity complications of diabetes. Peripheral neuropathy and peripheral vascular disease are the underlying risk factors for diabetic foot ulcers, subsequently leading to infections and requiring antimicrobial therapy for the management of the disease. Each risk factor is a target for clinical intervention, with the intent to delay or prevent disease progression to amputation. The effective therapy includes interdisciplinary care, which involves optimized pharmacological interventions in concert with other treatments such as debridement strategies and specialized wound dressings. The pharmacological therapy alone cannot lead to successful therapy, and therefore, these supplementary techniques/modalities should not be overlooked. It is therefore the aim of this report to review various pharmacological interventions, specific to the diabetic foot and wound healing, along with incorporation of advanced therapies required to achieve a multifaceted treatment of diabetic foot ulcers and provide basis for superior drugs as well as drug delivery systems.
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Affiliation(s)
- Christy L Scimeca
- Southern Arizona Limb Salvage Alliance, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Effect of Lactobacillus plantarum and Pseudomonas aeruginosa culture supernatants on polymorphonuclear damage and inflammatory response. Int Immunopharmacol 2010; 10:247-51. [DOI: 10.1016/j.intimp.2009.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 11/04/2009] [Accepted: 11/05/2009] [Indexed: 11/24/2022]
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Ryssel H, Kloeters O, Germann G, Schäfer T, Wiedemann G, Oehlbauer M. The antimicrobial effect of acetic acid--an alternative to common local antiseptics? Burns 2009; 35:695-700. [PMID: 19286325 DOI: 10.1016/j.burns.2008.11.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
Acetic acid has been commonly used in medicine for more than 6000 years for the disinfection of wounds and especially as an antiseptic agent in the treatment and prophylaxis of the plague. The main goal of this study was to prove the suitability of acetic acid, in low concentration of 3%, as a local antiseptic agent, especially for use in salvage procedures in problematic infections caused by organisms such as Proteus vulgaris, Acinetobacter baumannii or Pseudomonas aeruginosa. This study was designed to compare the in vitro antimicrobial effect of acetic acid with those of common local antiseptics such as povidone-iodine 11% (Betaisodona), polyhexanide 0.04% (Lavasept), mafenide 5% and chlohexidine gluconate 1.5% cetrimide 15% (Hibicet). Former studies suggest the bactericidal effect of acetic acid, but these data are very heterogeneous; therefore, a standardised in vitro study was conducted. To cover the typical bacterial spectrum of a burn unit, the following Gram-negative and Gram-positive bacterial strains were tested: Escherichia coli, P. vulgaris, P. aeruginosa, A. baumannii, Enterococcus faecalis, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA) and beta-haemolytic Streptococcus group A and B. The tests showed excellent bactericidal effect of acetic acid, particularly with problematic Gram-negative bacteria such as P. vulgaris, P. aeruginosa and A. baumannii. The microbiological spectrum of acetic acid is wide, even when tested at a low concentration of 3%. In comparison to our currently used antiseptic solutions, it showed similar - in some bacteria, even better - bactericidal properties. An evaluation of the clinical value of topical application of acetic acid is currently underway. It can be concluded that acetic acid in a concentration of 3% has excellent bactericidal effect and, therefore, seems to be suitable as a local antiseptic agent, but further clinical studies are necessary.
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Affiliation(s)
- H Ryssel
- Department of Hand, Plastic and Reconstructive Surgery and Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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Nagoba BS, Wadher BJ, Rao AK, Kore GD, Gomashe AV, Ingle AB. A simple and effective approach for the treatment of chronic wound infections caused by multiple antibiotic resistant Escherichia coli. J Hosp Infect 2008; 69:177-180. [PMID: 18485531 DOI: 10.1016/j.jhin.2008.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 03/26/2008] [Indexed: 01/27/2023]
Abstract
Antimicrobial resistance is a major problem in present-day therapy. Despite the advent of newer antimicrobial agents with a broad spectrum of activity, multiple antibiotic resistant pathogens are difficult to eliminate from infected sites. The present study was carried out to develop an approach, using citric acid as a sole antimicrobial agent, for the treatment of chronic wound infections caused by multiresistant Escherichia coli (MAREC). A total of 34 cases of chronic wound infections yielding MAREC isolates on culture were studied. The antibacterial effect of citric acid against MAREC was evaluated in vitro by broth dilution method. Three percent citric acid gel was applied to each wound once daily until it healed completely. All 34 isolates were inhibited by citric acid with minimum inhibitory concentrations in the range of 1500-2000 microg/ml. Topical application of 3% citric acid to wounds 7-42 times resulted in elimination of MAREC from infected sites and successful healing of wounds in all 34 patients. This treatment modality was simple, reliable, non-toxic and effective. Hence, the use of citric acid for the cost-effective treatment of wound infections caused by MAREC is recommended.
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Affiliation(s)
- B S Nagoba
- Department of Microbiology, MIMSR Medical College, Latur, India.
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Nagoba B, Wadher B, Kulkarni P, Kolhe S. ACETIC ACID TREATMENT OF PSEUDOMONAL WOUND INFECTIONS. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2008; 5:104-106. [DOI: 10.29333/ejgm/82586] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
AIMS To compare the ability of an amorphous first aid topical gel containing vinegar, citric acid and EDTA (RescuDerm(TM); RESC) and various derivative formulations to eradicate Pseudomonas aeruginosa (PSEUD) and Staphylococcus epidermidis (STAPH) biofilms. METHODS AND RESULTS 24-h biofilms prepared using the Minimum Biofilm Elimination Concentration (MBEC) Assay System were exposed for 4 or 24 h to the different gel formulations. Citric acid-free, acetic acid-free or acetic acid-free/sodium acetate-supplemented RESC gels reduced PSEUD and STAPH biofilm formation as effectively as RESC. Substituting the weak organic acids with equivalent concentrations of glacial acetic acid reduced the effectiveness of gel against PSEUD and STAPH biofilms by half, but viable bacterial counts still remained below 4 log(10) CFU/peg. Removal of gelling agent and/or EDTA enhanced efficacy against PSEUD but not STAPH biofilms. An acidified placebo gel formulation generated an only marginal bactericidal effect compared to that of RESC. CONCLUSIONS RESC is a promising new antimicrobial agent. Its weak organic acid content, rather than merely acidic pH, mediates its considerable in vitro bactericidal efficacy against bacterial biofilms. SIGNIFICANCE AND IMPACT OF THE STUDY These data, taken together with the observation that RescuDerm possesses broad in vitro bactericidal activity against other pathogen species, suggest the potential usefulness of this product for controlling biofilm formation on a variety of cutaneous traumatic and surgical wounds.
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Affiliation(s)
- L Martineau
- Defence Research & Development Canada-Toronto (DRDC Toronto), Toronto, ON, Canada.
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