Systemic Administration Of Antibiotics Research Articles

Devices to fight catheter-related infections

Healthcare-Associated Infections (HAI) affect ~1.7 M people in the USA and 4.1 M in Europe, contributing to 99,000 and 37,000 deaths/year, respectively. Catheter-related infections are the most frequent cause of HAI, leading to life-threatening complications and colossal medical costs. Current prevention/treatment options – sterilization protocols, lock solutions, systemic antibiotic administration – are inefficient and lead to bacterial resistance, a huge threat to public health. This review addresses the existing solutions in the market – mostly catheter caps –, and emerging alternatives, to fight catheter-related infections. Graphene-based biomaterials arise as interesting weapons against these infections, particularly in combination with light: their photothermal and photodynamic properties boost their own antimicrobial action, allowing them to kill bacteria without contributing to bacterial resistance. Healthcare-Associated Infections (HAI) affect ~1.7 M people in the USA and 4.1 M in Europe, contributing to 99,000 and 37,000 deaths/year, respectively. Catheter-related infections are the most frequent cause of HAI, leading to life-threatening complications and colossal medical costs. Current prevention/treatment options – sterilization protocols, lock solutions, systemic antibiotic administration – are inefficient and lead to bacterial resistance, a huge threat to public health. This review addresses the existing solutions in the market – mostly catheter caps –, and emerging alternatives, to fight catheter-related infections. Graphene-based biomaterials arise as interesting weapons against these infections, particularly in combination with light: their photothermal and photodynamic properties boost their own antimicrobial action, allowing them to kill bacteria without contributing to bacterial resistance.

Challenges to the design and testing of antimicrobial nanostructured surfaces

Nanomaterials, specifically nano-topographies, have been explored for their antimicrobial activity toward bacteria, fungi and even viruses. A decade ago, we discovered that the nanopillar topography of insect wings such as cicadas, dragonflies and damselflies, were not repelling bacteria as previously surmised, but bacteria were attaching and consequently being killed. The nature of the bactericidal effect associated with nanostructured insect wings has been extended to include antimicrobial activity toward both to environmental and pathogenic fungi. Specifically, the antimicrobial nature is associated with the physical disintegration of attached microbes due to a mechanical stress imposed on the cell membrane, which stretches and breaks. This exciting new discovery implies that, if successfully replicated on the surface of biomaterials and implantable devices, systemic or local administration of antibiotics are no longer required to kill bacteria that attach on such surfaces.

β-tricalcium phosphate/gelatin composite scaffolds incorporated with gentamycin-loaded chitosan microspheres for infected bone defect treatment.

The repair of infected bone defects remains a clinical challenge. Staphylococcus aureus is a common pathogenic micro-organism associated with such infections. Gentamycin (GM) is a broad spectrum antibiotic that can kill S. aureus in a dose-dependent manner. However, the systemic administration of antibiotics may lead to drug resistance and gut dysbiosis. In this work, we constructed β-tricalcium phosphate/gelatin composite scaffolds incorporated with gentamycin-loaded chitosan microspheres (CMs(GM)-β-TCP/gelatin composite scaffolds), which helped optimize the local GM release in the infected defect areas and enhance bone regeneration. The cumulative release curves showed that both microspheres and composite scaffolds reached a sustained slow-release phase after the initial rapid release, and the latter further stabilized the initial drug release rate. The release curve of CMs(GM)-β-TCP/gelatin composite scaffolds reached a plateau after 24 h, and the cumulative release reached 41.86% during this period. Moreover, the combination of β-TCP and gelatin mimicked bone composition and were able to provide the requisite mechanical strength (0.82 ± 0.05 MPa) during the first phase of bone generation. The inner structure of the scaffold was arranged in the shape of interconnected pores, and presented a porosity level of 16%. The apertures were uniform in size, which was beneficial for cell proliferation and material transportation. Macroscopic observation and histological analysis showed that CMs(GM)-β-TCP/gelatin composite scaffolds fused with bone tissues, and new tissues were formed in defect areas without any infection. This new composite scaffold may be a promising repair material for treating infected bone defects.

Surface Functionalization of Ti6Al4V-ELI Alloy with Antimicrobial Peptide Nisin.

Implant-associated infections are a severe global concern, especially in the case of orthopedic implants intended for long-term or permanent use. The traditional treatment through systemic antibiotic administration is often inefficient due to biofilm formation, and concerns regarding the development of highly resistant bacteria. Therefore, there is an unfulfilled need for antibiotic-free alternatives that could simultaneously support bone regeneration and prevent bacterial infection. This study aimed to perform, optimize, and characterize the surface functionalization of Ti6Al4V-ELI discs by an FDA-approved antimicrobial peptide, nisin, known to hold a broad antibacterial spectrum. Accordingly, nisin bioactivity was also evaluated by in vitro release tests both in physiological and inflammatory pH conditions. Several methods, such as X-ray photoelectron spectroscopy (XPS), and Kelvin Probe atomic force microscopy confirmed the presence of a physisorbed nisin layer on the alloy surface. The functionalization performed at pH 6-7 was found to be especially effective due to the nisin configuration exposing its hydrophobic tail outwards, which is also responsible for its antimicrobial action. In addition, the first evidence of gradual nisin release both in physiological and inflammatory conditions was obtained: the static contact angle becomes half of the starting one after 7 days of soaking on the functionalized sample, while it becomes 0° on the control samples. Finally, the evaluation of the antibacterial performance toward the pathogen Staphylococcus aureus after 24 h of inoculation showed the ability of nisin adsorbed at pH 6 to prevent bacterial microfouling into biofilm-like aggregates in comparison with the uncoated specimens: viable bacterial colonies showed a reduction of about 40% with respect to the un-functionalized surface and the formation of (microcolonies (biofilm-like aggregates) is strongly affected.

The association of fecal calprotectin and respiratory exacerbation in cystic fibrosis patients

BackgroundCF patients experience several episodes of pulmonary exacerbations and reduction in their lung function progressively. Lung function is not the only diagnostic index by physicians to decide if CF patients require antibiotic therapy following pulmonary exacerbations. Non-invasive fecal indicators are increasingly being used to assess intestinal inflammation. Calprotectin is the most extensively utilized fecal biomarker in recent CF researches.MethodsIn this longitudinal study, 30 CF patients (1–18 years) without current infectious gastroenteritis were recruited from Mofid Children's Hospital and Masih Daneshvari Hospital, Tehran, Iran. Then, fecal calprotectin levels were evaluated before treatment, two weeks after systemic antibiotic administration, as well as recurrence of pulmonary exacerbation after first post-hospital discharge.ResultsThe initial fecal calprotectin level in CF patients receiving antibiotics was 651.13 ± 671.04, significantly decreasing two weeks after antibiotic therapy and following recurrence (171.81 ± 224.40, 607.93 ± 549.89, respectively; P < 0.01). Following systemic antibiotic treatment, the patient's respiratory and GI symptoms improved (P < 0.01).ConclusionOur findings revealed that fecal calprotectin modifications are associated with CF pulmonary exacerbations and antibiotic treatment could reduce calprotectin levels. Therefore, the fecal calprotectin level could be considered as a diagnostic tool and an index to follow the response to treatment in CF pulmonary exacerbations.

Insight in Superiority of the Hydrophobized Gentamycin in Terms of Antibiotics Delivery to Bone Tissue.

Bone infections are a serious problem to cure, as systemic administration of antibiotics is not very effective due to poor bone vascularization. Therefore, many drug delivery systems are investigated to solve this problem. One of the potential solutions is the delivery of antibiotics from poly(L-actide-co-glycolide) (PLGA) nanoparticles suspended in the gellan gum injectable hydrogel. However, the loading capacity and release kinetics of the system based on hydrophilic drugs (e.g., gentamycin) and hydrophobic polymers (e.g., PLGA) may not always be satisfying. To solve this problem, we decided to use hydrophobized gentamycin obtained by ion-pairing with dioctyl sulfosuccinate sodium salt (AOT). Herein, we present a comparison of the PLGA nanoparticles loaded with hydrophobic or hydrophilic gentamycin and suspended in the hydrogel in terms of physicochemical properties, drug loading capacity, release profiles, cytocompatibility, and antibacterial properties. The results showed that hydrophobic gentamycin may be combined in different formulations with the hydrophilic one and is superior in terms of encapsulation efficiency, drug loading, release, and antibacterial efficacy with no negative effect on the NPs morphology or hydrogel features. However, the cytocompatibility of hydrophobic gentamycin might be lower, consequently more extensive study on its biological properties should be provided to evaluate a safe dose.

Globe Rupture – A Case Report and Review of Emergency Department Diagnosis and Management

Globe ruptures, while uncommon, must be promptly recognized to optimize the possibility of preserving vision. Differentiating open globe injuries from corneal abrasions, hyphema, and other ocular injuries is critical. When a globe rupture is identified, prompt ophthalmology consultation, placement of a rigid eye shield, administration of prophylactic systemic antibiotics (and antifungals with an appropriate history), and a tetanus vaccine update (if needed) are key to a successful outcome, so long as the visual prognosis is not dismal. We describe a case of ocular trauma presenting as a blood blister adherent to the cornea, which was initially assessed (by the triage nurse) to be a blood clot but later identified as a globe rupture. We include a discussion of globe rupture recognition and its management by the emergency department.

The association between oral antibiotics with the decreased severity index of acne vulgaris in the medical cosmetics division dermatovenereology outpatient clinic of Dr. Soetomo General Teaching Hospital Surabaya from 2017- 2019

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit. AV therapy is given based on the severity of AV. Oral antibiotic therapy is routinely prescribed to treat moderate to severe inflammatory acne. The purpose of this study is to determine the relationship between systemic antibiotic administration and the decrease in the severity of acne vulgaris.&#x0D; Methods: This was a retrospective study with an analytical design, carried out on 49 medical records that met the inclusion criteria for acceptance of the sample; new AV patients come with grades 2, 3, and 4 to the Medical Cosmetics division Dermatovenereology Outpatient Clinic of Dr. Soetomo General Teaching Hospital Surabaya in the period January 2017 - December 2019.&#x0D; Results: This study was conducted on 49 patients with acne vulgaris grade 2,3,4 who came to follow-up in a week 2,4,8 treatment. Data from the first follow-up group, 26 subjects (53.1%) experienced a decrease in grade; from the second follow-up group, 25 subjects (51.0%) experienced a decrease in grade; from the third follow-up group, 38 subjects (77, 6%) experienced a decrease in the group comparing with condition patient before treatment. Analytic comparative showed that the condition of the first visit compared to the first, second and third follow-up groups were 0,180, 0,000, and 0,000, respectively. The significance test results showed a value of 0.000 (p ≤ 0.05) in the second and third follow-up groups, which is statistically significant.&#x0D; Conclusion: An oral antibiotic can effectively reduce the severity degree of acne vulgaris in four to eight weeks after treatment with an oral antibiotic.

Development of an antibiotics delivery system for topical treatment of the neglected tropical disease Buruli ulcer

Skin infection by Mycobacterium ulcerans causes Buruli ulcer (BU) disease, a serious condition that significantly impact patient’ health and quality of life and can be very difficult to treat. Treatment of BU is based on daily systemic administration of antibiotics for at least 8 weeks and presents drawbacks associated with the mode and duration of drug administration and potential side effects. Thus, new therapeutic strategies are needed to improve the efficacy and modality of BU therapeutics, resulting in a more convenient and safer antibiotic regimen. Hence, we developed a dual delivery system based on poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) microparticles and a gellan gum (GG) hydrogel for delivery of rifampicin (RIF) and streptomycin (STR), two antibiotics used for BU treatment. RIF was successfully loaded into PHBV microparticles, with an encapsulation efficiency of 43%, that also revealed a mean size of 10 µm, spherical form and rough topography. These microparticles were further embedded in a GG hydrogel containing STR. The resultant hydrogel showed a porous microstructure that conferred a high water retention capability (superior to 2000%) and a controlled release of both antibiotics. Also, biological studies revealed antibacterial activity against M. ulcerans, and a good cytocompatibility in a fibroblast cell line. Thus, the proposed drug delivery system can constitute a potential topical approach for treatment of skin ulcers caused by BU disease.

Antibiotics at replantation of avulsed permanent teeth? A systematic review.

At present there is no clear consensus whether systemic antibiotics should be administered at replantation of an avulsed permanent tooth. This systematic review and meta-analysis assessed the evidence on effectiveness and harms of the administration of systemic antibiotics at replantation of avulsed permanent teeth. In August 2020 a systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for systematic reviews, randomized controlled trials (RCT) and observational controlled studies in MEDLINE, PreMedline, Embase, and the Cochrane databases. The population of interest were medically fit patients with a replanted avulsed tooth. Main outcomes were tooth survival, periodontal healing, pulpal revascularization as well as (severe) adverse events. These outcomes were compared in patients who did and who did not receive systemic antibiotics. The GRADE methodology was used to assess the quality of evidence. The search yielded no RCTs, and none of the 7 included observational studies had the prime intent to investigate the effectiveness or harms of antibiotics. According to GRADE, the overall level of evidence was very low. The meta-analyses showed non-significant associations between the administration of systemic antibiotics on the one hand and tooth survival (1 study, RR = 3.70, 95% CI: 0.63-21.69), periodontal healing (meta-analysis of 6 studies RR: 1.07; 95% CI: 0.80-1.45), and pulpal revascularization (meta-analysis of 2 studies, RR: 0.36; 95% CI: 0.05-2.41) on the other hand. Currently there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth. Hence, their routine use cannot be recommended in medically fit patients. Well-designed RCTs should be a priority on the research agenda.

A Systematic Review and Meta-Analysis of Systemic Antibiotic Therapy in the Treatment of Peri-Implantitis.

Research has been conducted into the advantages of the systemic administration of antibiotics. The aim of this systematic review and meta-analysis was to assess the efficacy of systemic antibiotic administration in the treatment of peri-implantitis in terms of bleeding on probing (BoP) and probing pocket depth (PPD). Literature searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials and observational clinical studies. After peri-implantitis treatment, PPD was reduced by 0.1 mm (p = 0.58; IC 95% [−0.24, 0.47]), indicating a non-significant effect of antibiotic administration on PPD. The BoP odds ratio value was 1.15 (p = 0.5; IC 95% [0.75, 1.75]), indicating that the likelihood of bleeding is almost similar between the test and control groups. Secondary outcomes were found, such as reduced clinical attachment level, lower suppuration and recession, less bone loss, and a reduction in total bacterial counts. In the treatment of peri-implantitis, the systemic antibiotic application reduces neither PPD nor BoP. Therefore, the systemic administration of antibiotics, in the case of peri-implantitis, should be rethought in light of the present results, contributing to address the problem of increasing antibiotic resistance.

Bilateral hip septic arthritis caused by nontyphoidal Salmonella group D in a 16-year-old girl with COVID-19: A case report.

Introduction and importanceNontyphoidal Salmonella infection can lead to gastroenteritis, enteric fever, and bacteremia. However, joint infections due to this bacterium are rare, and usually associated with immunosuppressive disorders.Case presentationA 16-year-old girl, with a recent history of acute lymphocytic leukemia (ALL) presented with bacteremia, and bilateral hip pain after COVID-19 symptoms. Clinical presentation, laboratory features and imaging showed bilateral nontyphoidal Salmonella septic arthritis. We administered antibiotics, based on antibiotics susceptibility pattern of the isolated Salmonella.Clinical discussionThe case is presented because reports of bilateral hip joint infection due to nontyphoidal Salmonella are rare especially after COVID-19. When the patient presents with joint discomfort, the clinician should think infection especially in immunocompromised hosts.ConclusionIt illustrates successful management of septic arthritis requires prompt clinical diagnosis, microorganism identification, administration of appropriate systemic antibiotics and hip joint surgery.

Analysis of Swelling Capability and Efficacy of Gelatin‐Based Antibiotic Eluting Hemostatic Agents

During surgical procedures, hemostatic agents are applied within incisions to accelerate the clotting process and mitigate excessive blood loss. These hemostats are typically gelatin based and remain within the surgical site after the incision is closed, which can serve as an ideal environment for microbial growth. Therefore, we developed a gelatin‐based hemostatic agent capable of sustained release of antibiotics to serve as a prophylactic measure against surgical site infections, while avoiding the disadvantages associated with systemic antibiotic administration. Gelatin matrices containing trapped/covalently bonded antibiotics were generated using type B gelatin, the cross‐linking agent 1‐ethyl‐3‐(‐3‐dimethylaminopropyl)carbodiimide, and either vancomycin, ciprofloxacin, or ceftazidime. Gelatin matrices were allowed to elute antibiotics over time in phosphate‐buffered saline solution to simulate release under native conditions, and elution samples were analyzed via infrared spectroscopy, Kirby‐Bauer, microdilution, and cell viability assays. Temporal swelling assays were also performed to assess the swelling capacity of the antibiotic‐eluting matrices. Eluted antibiotics retained structural integrity as demonstrated with infrared spectroscopy. Vancomycin and ciprofloxacin‐containing matrices inhibited microbial growth, while ceftazidime matrices exhibited no significant difference in inhibition when compared to controls. The antibiotic‐eluting matrices maintained their biocompatibility, as evaluated by cell viability assays. In addition, temporal swelling assays affirmed the ability of the matrices to perform as viable hemostats. Thus, adoption of these antibiotic‐eluting hemostatic agents in surgical practice could result in a novel method of combating surgical site infections while avoiding drawbacks associated with systemic antibiotic administration.

Prescription Pattern of Antibiotics among General Dental Practitioners in Karnataka—A Cross-Sectional Survey

Abstract Introduction There is a lack of clear guidelines for the use of antibiotics and analgesics in medically healthy patients as well as endodontic pain management strategies. Diseases of the dental pulp and periapical tissue are mainly caused by microorganisms; however, not all cases of dental infections require the administration of systemic antibiotics. The purpose of the present survey was to evaluate the prescription pattern of antibiotics among general practitioners and specialists practicing in Karnataka. Methods This descriptive cross-sectional survey was based on a structured questionnaire in Google Form with 17 questions, including the demographic characteristics and the knowledge and practice of the dentists on the antibiotic prescription. Completed questionnaires were analyzed using the SPSS software to determine relationships between factors affecting the prescription patterns and educational qualification. Results Of the 200 participants surveyed, 169 (84.9%) felt that the overuse of antibiotics can lead to resistance of bacteria. Amoxicillin 500 mg was the most prescribed antibiotic (97%) and cephalexin by only 3% of the participants. Majority of the dentists prescribed antibiotics on a weekly basis (51.8%) during their practice and the preferred duration was for 5 days (62.8%). Conclusion The results of the present study indicated a lack of knowledge and uncertain diagnosis on prescribing antibiotics leading to overprescription and further antibiotic resistance. The majority of the dentist feels there is an overuse of antibiotics, but at the same time prescribes it on a daily basis.

Changes to Gut Microbiota Following Systemic Antibiotic Administration in Infants.

Long-term antibiotic use can have consequences on systemic diseases, such as obesity, allergy, and depression, implicating the causal role of gut microbiome imbalance. However, the evaluation of the effect of antibiotics in early infancy on alterations to the gut microbiome remains poorly understood. This study aimed to evaluate the gut microbiome state in infancy following systemic antibiotic treatment. Twenty infants under 3 months of age who had received antibiotics for at least 3 days were enrolled, and their fecal samples were collected 4 weeks after antibiotic administration finished. Thirty-four age-matched healthy controls without prior exposure to antibiotics were also assessed. The relative bacterial abundance in feces was obtained via sequencing of 16 S rRNA genes, and alpha and beta diversities were evaluated. At the genus level, the relative abundance of Escherichia/Shigella and Bifidobacterium increased (p = 0.03 and p = 0.017, respectively) but that of Bacteroides decreased (p = 0.02) in the antibiotic treatment group. The microbiome of the antibiotic treatment group exhibited an alpha diversity lower than that of the control group. Thus, systemic antibiotic administration in early infancy affects the gut microbiome composition even after a month has passed; long-term studies are needed to further evaluate this.

A human bone infection organ model for biomaterial research

The aim of this work was to establish an organ model for staphylococcal infection of human bone samples and to investigate the influence and efficacy of a microporous β-tricalcium phosphate ceramic (β-TCP, RMS Foundation) loaded with hydrogels (alginate, alginate-di-aldehyde (ADA)-gelatin) and clindamycin on infected human bone tissue over a period of 28 days. For this purpose, human tibia plateaus, collected during total knee replacement surgery, were used as a source of bone material. Samples were infected with S. aureus ATCC29213 and treated with differently loaded β-TCP composites (alginate +/- clindamycin, ADA-gelatin +/- clindamycin, unloaded). The loading of the composites was carried out by means of a flow chamber. The infection was observed for 28 days, quantifying bacteria in the medium and the osseus material on day 1, 7, 14, 21 and 28. All samples were histologically processed for bone vitality evaluation. Bone infection could be consistently performed within the organ model. In addition, a strong reduction in bacterial counts was recorded in the groups treated with ADA-gelatin + clindamycin and alginate + clindamycin, while the bacterial count in the control groups remained constant. No significant differences between groups could be observed in the number of lacunae filled with osteocytes suggesting no differences in bone vitality among groups. In an ex-vivo human bone infection model, over a period of 28 days bacterial growth could be reduced by treatment with ADA-Gel + CLI and ALG + CLI -releasing β-TCP composites. This could be relevant for its clinical use. Further work will be necessary to improve the loading of β-TCP and the bone infection organ model itself. Statement of SignificanceThe common treatment of bone infections is debridement and systemic administration of antibiotics. In some cases, antibiotic-containing carriers are already used, but these must be removed again. Our work is intended to show another treatment option. The scaffold we have developed, made of a calcium phosphate ceramic and a hydrogel as the active substance carrier, can, in addition to releasing the active substance, also assume a load-bearing function of the bone and is biodegradable. In addition, the model we developed can also be used for the analysis and treatment of bone infections other than those of the musculoskeletal system. More importantly, it can also serve as a substitute for previously used animal experiments.

Systemic quinolones and risk of retinal detachment III: a nested case–control study using a US electronic health records database

BackgroundQuinolones are popular antibiotics that are known for their potency, broad coverage, and reasonable safety. Concerns have been raised about a possible association between quinolones and retinal detachment (RD).MethodsWe conducted a nested case–control study using electronic health records (EHR) from the Health Facts® Database. The initial cohort included all patients who were admitted between 2000 and 2016, with no history of eye disease, and had a minimum medical history of one year. Eligible cases comprised inpatients who were first admitted with a primary diagnosis of RD between 2010 and 2015. Each eligible case was matched without replacement to five unique controls by sex, race, age, and period-at-risk. We used conditional logistic regression to calculate RD risk, adjusting for exposure to other medications, and major risk factors.ResultsWe identified 772 cases and 3860 controls. Whereas our primary analysis of all subjects revealed no quinolone-associated RD risk, elevated but non-significant risks were noted in African Americans (ciprofloxacin and levofloxacin), those aged 56–70 years old (moxifloxacin), and women (ciprofloxacin).ConclusionOur study did not identify an elevated RD risk within 30 days following systemic administration of quinolone antibiotics. Suggestions of increased risk observed in some population subgroups warrant further investigation.

The Current Consensus on the Management of Post-traumatic Blisters Among Orthopaedic Surgeons.

Post-traumatic blister is often encountered in high-energy injuries and following major limb surgeries. Currently, there is very limited evidence concerning blister management resulting in a lack of comprehensive guidelines for their management. The current survey-based study aims to appraise the current consensus in post-traumatic management among the practising orthopaedic surgeons and compare the same with the evidence in the literature. We conducted an online questionnaire-based survey of orthopaedic surgeons concerning post-traumatic blister management practices. The questionnaire mainly focused on antibiotic prophylaxis, local invasive procedures, antiseptics dressings and additional treatment options regarding blister management. A high prevalence (~ 78%) of systemic antibiotics administration was noticed for post-traumatic blister management. Similarly, large section of respondents (66.4%) advocated for either de-roofing or aspiration of blisters. Approximately 42% of respondents preferred sending blister fluid for cultures. More than half of the respondents used some form of local dressing to cover the blister bed to provide a healing environment. Additional opinions mostly included anti-inflammatory and swelling reducing measures. Few respondents also advocated for oral steroids for inflammation control. The limited evidence available in literature could be the potential contributing factor for varying clinical practices for post-traumatic blister management. The general measures to reduce soft-tissue oedema have been supported by the literature. However, the use of systemic antibiotics and steroids has not been supported by the literature and should be avoided unless indicated due to other reasons. Further evidence is required to strengthen the recommendations for post-traumatic blister management.

Piezo-Augmented Sonosensitizer with Strong Ultrasound-Propelling Ability for Efficient Treatment of Osteomyelitis.

The successful treatment of osteomyelitis remains a great challenge in the field of orthopedics. The clinical method for treating refractory bone infection requires a combination therapy of long-term systemic antibiotics administration and surgical debridement. It is highly desirable to develop an antibiotic-free, noninvasive, rapid strategy to eradicate osteomyelitis. Herein, we fabricate a piezoelectric-enhanced sonosensitizer that consists of a porphyrin-based hollow metal-organic framework (HNTM), MoS2 nanosheets, and a red cell (RBC) membrane. We find that the ultrasound (US)-induced piezoelectric polarization of MoS2 can improve the charge transfer of HNTM at the heterointerface of HNTM-MoS2, increasing the production of reactive oxygen species (ROS). Besides, MoS2 increases the asymmetric shape of HNTM, leading to the strong US-propelling ability of HNTM-MoS2. The produced ROS and strong mechanical force can kill methicillin-resistant Staphylococcus aureus (MRSA) with an antibacterial efficiency of 98.5% under 15 min of US treatment, resulting in intracellular DNA damage and increased oxidative stress and disturbance of purine metabolism, tryptophan metabolism, and pantothenate and CoA biosynthesis of MRSA. Together with the toxin neutralization ability, the RBC-HNTM-MoS2 successfully eliminates the bone infection and suppresses inflammation and bone loss. This work provides another strategy for developing an efficient sonosensitizer through piezoelectric-assisted sonocatalysis and enhancing US-propelling ability.

Tracheobronchitis in children with tracheostomy tubes: Overview of a challenging problem.

Tracheobronchitis is common in children with tracheostomy tubes. These children are predisposed to respiratory infections due to the bypassing of normal upper airway defense mechanisms by the tracheostomy, bacterial colonization of the tracheostomy tube itself, and underlying medical conditions. Diagnosis of bacterial tracheobronchitis is challenging due to the difficulty in differentiating between bacterial colonization and infection, as well as between viral and bacterial etiologies. Difficulty in diagnosis complicates management decisions, and there are currently no consensus guidelines to assist clinicians in the treatment of these patients. Frequent administration of systemic antibiotics causes adverse effects and leads to the emergence of resistant organisms. Topical administration of antibiotics via nebulization or direct instillation may lead to a significantly higher concentration of drug in the upper and lower airways without causing systemic side effects, although therapeutic trials in children with tracheostomy tubes are lacking. Several preventative measures such as regular airway clearance and the use of a speaking valve may mitigate the risk of developing respiratory infections.