Abstract
Treatment of patients with a burn injury is a complex process involving multicomponent multidirectional intensive therapy of the majority of organs and systems damaged by thermal effects on the skin, alternating with repeated surgical interventions aimed at removing nonviable tissues with subsequent plastic closure of wound defects. After the recovery from the burn shock, local infectious complications are considered to be the leading problem that decelerates the process of recovery and is the main cause of lethal outcomes. Since the skin integrity is broken, microorganisms penetrate readily into the internal environment of the human organism resulting in a septic state with multiple organ failure. A widespread and often uncontrollable use of antibacterial drugs in medical practice has led to the emergence of multiple drug resistance (MDR) in microorganisms.Introduction of drugs made on the basis of bacteriophages into practice is presently becoming increasingly important. This is confirmed by the growing interest in this field of pharmacology, the development of special programs aimed at studying the processes of phage and bacterial cell interaction.This review presents the main types of bacteria pertaining to MDR pathogens, principles of their classification, and the risk factors for infecting patients. The mechanisms of the selective action of phage particles on a bacterial cell and the possibility of using phage therapy in the treatment of burn injury (experimental and clinical data) based on the analysis of foreign literature are demonstrated as well as new positive properties of phages related to the changes in the macroorganism immune status caused by the interaction with bacteriophage particles.
Highlights
Antibiotic resistance of microflora in burnsFor the last decades the lethality from burn trauma has been gradually decreasing which is mainly connected with the development of new medical equipment, achievements in the field of intensive therapy, and improvements of surgical techniques such as necrectomy and autodermotransplantation [1,2,3]
A combination of the reduced immune response characterized by the decrease of the T cell function after the trauma [27, 28], the destruction of the skin barrier due to the burn injury [29, 30] enabling pathogens to spread over the entire organism, and long-term hospitalizations with several surgical procedures result in a higher risk of infectious complications in the burn victims
The results indicate that the phage is perspective for the treatment of burn wound infections since its single topical application could reduce lethality in mice caused by K. pneumoniae infection compared to the multiple use of silver nitrate and gentamycin
Summary
For the last decades the lethality from burn trauma has been gradually decreasing which is mainly connected with the development of new medical equipment, achievements in the field of intensive therapy, and improvements of surgical techniques such as necrectomy and autodermotransplantation [1,2,3]. Despite the reduction of the lethality in the acute period, the improvement of survival in the remote period remains a difficult and unsolved task mainly due to sepsis and multiple organ dysfunction syndrome [4,5,6]. Sepsis with multiple organ failure (Sepsis-3) which is often preceded by local infectious complications is presently the main cause of death in children and adult patients with burns [7,8,9,10]. Bacteria with multiple drug resistance (MDR) present a serious problem. Resistance to drugs which became known for the first time soon after the penicillin invention turned currently into a serious obstacle in the struggle against infection worldwide. According to foreign statistics, about 25,000 patients die in the European Union annually from infections caused by MRD bacteria [11, 12]
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