Severe Wound Infection Research Articles

Subduing the Inflammatory Cytokine Storm

The inflammatory cytokine response is essential for protective immunity, yet bacterial and viral pathogens often elicit an exaggerated response (“cytokine storm”) harmful to the host that can cause multi-organ damage and lethality. Much has been published recently on the cytokine storm within the context of the coronavirus pandemic, yet bacterial sepsis, severe wound infections and toxic shock provide other prominent examples. The problem of the cytokine storm is compounded by the increasing incidence of multidrug-resistant bacterial strains. We created an incisive molecular tool for analyzing the role of the B7/CD28 costimulatory axis in the human inflammatory response. To attenuate the cytokine storm underlying infection pathology, yet preserve host defenses, we uniquely targeted the engagement of CD28 with its B7 co-ligands by means of short peptide mimetics of the human CD28 and B7 receptor homodimer interfaces. These peptides are not only effective tools for dissecting mechanism but also serve to attenuate the inflammatory response as a broad host-oriented therapeutic strategy against the cytokine storm. Indeed, such peptides protect mice from lethal Gram-positive bacterial superantigen-induced toxic shock even when dosed in molar amounts well below that of the superantigen and show promise in protecting humans from the severe inflammatory disease necrotizing soft tissue infections (‘flesh-eating’ bacterial sepsis) following traumatic wound injuries.

Plerixafor for pathogen-agnostic treatment in murine thigh infection and zebrafish sepsis.

Plerixafor is a CXCR4 antagonist approved in 2008 by the FDA for hematopoietic stem cell collection. Subsequently, plerixafor has shown promise as a potential pathogen-agnostic immunomodulator in a variety of preclinical animal models. Additionally, investigator-led studies demonstrated plerixafor prevents viral and bacterial infections in patients with WHIM syndrome, a rare immunodeficiency with aberrant CXCR4 signaling. Here, we investigated whether plerixafor could be repurposed to treat sepsis or severe wound infections, either alone or as an adjunct therapy. In a Pseudomonas aeruginosa lipopolysaccharide (LPS)-induced zebrafish sepsis model, plerixafor reduced sepsis mortality and morbidity assessed by tail edema. There was a U-shaped response curve with the greatest effect seen at 0.1 μM concentration. We used Acinetobacter baumannii infection in a neutropenic murine thigh infection model. Plerixafor did not show reduced bacterial growth at 24 h in the mouse thigh model, nor did it amplify the effects of a rifampin antibiotic therapy, in varying regimens. While plerixafor did not mitigate or treat bacterial wound infections in mice, it did reduce sepsis mortality in zebra fish. The observed mortality reduction in our LPS model of zebrafish was consistent with prior research demonstrating a mortality benefit in a murine model of sepsis. However, based on our results, plerixafor is unlikely to be successful as an adjunct therapy for wound infections. Further research is needed to better define the scope of plerixafor as a pathogen-agnostic therapy. Future directions may include the use of longer acting CXCR4 antagonists, biased CXCR4 signaling, and optimization of animal models.

Bullet-related bacterial wound infections among injured personnel at emergency site hospitals in Bahir Dar: prevalence, antimicrobial susceptibility and associated factors.

Bullet-related bacterial wound infection can be caused by high-velocity bullets and shrapnel injuries. In Ethiopia, significant injuries were reported that may cause severe wound infections, persistent systemic infections and may lead to amputation and mortality. The magnitude, antimicrobial susceptibility profiles, and factors associated with bacterial wound infections among patients with bullet-related injuries are not yet studied particularly at health facilities in Bahir Dar, Northwest Ethiopia. Therefore, this study was aimed to determine the prevalence, bacterial profiles, antimicrobial susceptibility profiles, and factors associated with bacterial infections among patients with bullet-related injuries at referral health facilities in Bahir Dar, Northwest Ethiopia. A Hospital-based cross-sectional study was conducted among patients with bullet-related injuries at three referral health facilities in Bahir Dar from May 25 to July 27, 2022. A total of 384 patients with bullet-related injuries were included in the study. Sociodemographic and clinical data were collected using a structured questionnaire. Wound swabs were collected aseptically and cultured on Blood and MacConkey agar following bacteriological standards. Biochemical tests were performed to differentiate bacteria for positive cultivation and antimicrobial susceptibility profiles of the isolates were done on Muller Hinton agar using the Kirby-Bauer disk diffusion technique according to the 2021 Clinical Laboratory Standard Institute (CLSI) guideline. The data were entered using Epi-Info version 7.3 and analyzed using SPSS version 25. Descriptive data were presented using frequency, percentages, figures, and charts. Logistic regression was carried out to identify factors associated with bacterial wound infections. P-value < 0.05 was considered statistically significant. The prevalence of bullet-related bacterial wound infection among three referral hospitals in Bahir Dar city was 54.7%. The most commonly isolated Gram-negative organism was Klebsiella spps 49 (23.3%) while among Gram-positive organism, Staphylococcus aureus 58 (27.6%) and coagulase-negative staphylococci (CONS) 18 (8.6%). Contamination, hospitalization and smoking habit were significantly associated with the presence of bullet-related bacterial wound infections. Over 97% multidrug resistant (MDR) bacterial isolates were identified and of theses, E. coli, Proteus species, Citrobactor, and Staphylococcus aureus were highly drug resistant. Increased prevalence of bullet-related bacterial wound infection was noticed in this study. S. aureus followed by Klebsiella species were most commonly isolated bacteria. High frequency of resistance to Ampicillin, Oxacillin, Cefepime, Ceftriaxone, Ceftazidime, Vancomycin, and Norfloxacin was observed. Therefore, proper handling of bullet injuries, prompt investigation of bacterial infections, monitoring of drug sensitivity patterns and antibiotic usage are critical.

Lipase and Protease Production Ability of Multi-drug Resistant Bacteria Worsens the Outcomes of Wound Infections.

Surgical site infections are one of the major clinical problems in surgical departments that cost hundreds of millions of dollars to healthcare systems around the world. The study aimed to address the pressing issue of surgical site infections, which pose significant clinical and financial burdens on healthcare systems globally. Recognizing the substantial costs incurred due to these infections, the research has focused on understanding the role of lipase and protease production by multi-drug resistant bacteria isolated from surgical wounds in the development of post-surgical wound infections. For these purposes, 153 pus specimens were collected from patients with severe post-surgical wound infections having prolonged hospital stays. The specimens were inoculated on appropriate culture media. Gram staining and biochemical tests were used for the identification of bacterial growth on suitable culture media after 24 hours of incubation. The isolated pathogens were then applied for lipase and protease, key enzymes that could contribute to wound development, on tributyrin and skimmed milk agar, respectively. Following the CSLI guidelines, the Kirby-Bauer disc diffusion method was used to assess antibiotic susceptibility patterns. The results revealed that a significant proportion of the samples (127 out of 153) showed bacterial growth of Gram-negative (n = 66) and Gram-positive (n = 61) bacteria. In total, isolated 37 subjects were declared MDR due to their resistance to three or more than three antimicrobial agents. The most prevalent bacteria were Staphylococcus aureus (29.13%), followed by S. epidermidis (18.89%), Klebsiella pneumoniae (18.89%), Escherichia coli (14.96%), Pseudomonas aeruginosa (10.23%), and Proteus mirabilis (7.87%). Moreover, a considerable number of these bacteria exhibited lipase and protease activity with 70 bacterial strains as lipase positive on tributyrin agar, whereas 74 bacteria showed protease activity on skimmed milk agar with P. aeruginosa as the highest lipase (69.23%) and protease (76.92%) producer, followed by S. aureus (lipase 62.16% and protease 70.27%). The antimicrobial resistance was evaluated among enzyme producers and non-producers and it was found that the lipase and protease-producing bacteria revealed higher resistance to selected antibiotics than non-producers. Notably, fosfomycin and carbapenem were identified as effective antibiotics against the isolated bacterial strains. However, gram-positive bacteria displayed high resistance to lincomycin and clindamycin, while gram-negative bacteria were more resistant to cefuroxime and gentamicin. In conclusion, the findings suggest that lipases and proteases produced by bacteria could contribute to drug resistance and act as virulence factors in the development of surgical site infections. Understanding the role of these enzymes may inform strategies for preventing and managing post-surgical wound infections more effectively.

Safety and Effectiveness of Meatal Mobilization (MEMO) Technique for Glandular, Coronal, and Subcoronal Hypospadias Repair in Children: A 5-Year Single-Center Study with 105 Hypospadias.

This study aims to compare outcomes of treatment, in terms of early and late complications, between the Snodgrass and meatal mobilization (MEMO) techniques in children operated on because of distal hypospadias. The medical records of 127 children who underwent glandular, coronal, or subcoronal hypospadias repair between 1 January 2019 and 31 December 2023 were retrospectively reviewed. A total of 105 children met the inclusion criteria and were included in further analysis. The inclusion criteria were pediatric patients who underwent glandular, coronal, or subcoronal hypospadias repair using MEMO (n = 49) or the Snodgrass technique (n = 56) as a comparative group. The primary outcome of this study was the incidence of early and late complications with two different surgical techniques. Secondary outcomes were the duration of surgery, the length of hospital stay, the number of readmissions or unplanned returns to the operating room, and repeat surgeries between groups. The median age of all patients was 17 (interquartile range, IQR 13, 29) months, with a median follow-up of 26 (IQR 17, 34) months. Regarding the type of hypospadias, the majority of patients in both groups were categorized as coronal and subroronal hypospadias. Regarding the incidence of postoperative complications, a significantly lower incidence of postoperative complications was found in the MEMO group compared to the Snodgrass group (n = 4; 8.2% vs. n = 14; 25%; p = 0.037). An urethrocutaneous fistula was the most common complication in the Snodgrass group (n = 8; 14.3%), while in the MEMO group, only one patient (2%) developed a fistula (p = 0.034). The incidence of meatal stenosis (p = 0.621) and wound infections (p > 0.999) was low in both groups. No further complications were recorded during the follow-up period. Duration of surgery (41 min (IQR 38, 47) vs. 51 min (IQR 45.5, 61); p < 0.001), duration of hospitalization (1 day (IQR 1, 2) vs. 3 days (IQR 2, 6); p < 0.001), and time to catheter removal (3 days (IQR 2.5, 5) vs. 6 days (IQR 6, 8); p < 0.001) were significantly lower in patients operated on with MEMO compared to the Snodgrass technique. Only one case of readmission due to severe wound infection which led to suturing line dehiscence was recorded in the Snodgrass group. The incidence of redo surgery was significantly lower in the MEMO group than in the Snodgrass group (n = 3; 6.1% vs. n = 11; 19.6%; p = 0.048). MEMO is a safe and effective technique that can be used for the treatment of distal hypospadias. It showed excellent outcomes, cosmetic results, and a low incidence of complications as well as a significantly shorter duration of surgery compared to the Snodgrass technique.

Non-O1/non-O139 Vibrio cholerae bacteraemia and cholangitis: An unusual case in an oncological patient in Lecco Hospital, Italy

Vibrio species are curved, motile, aerobic and facultative anaerobic, Gram-negative bacilli that are widely distributed in aquatic environments, especially marine and estuarine waters. Vibrios of primary concern in human pathology are essentially represented by the species Vibrio cholerae. Classification of Vibrio cholerae is based on the O-antigen polysaccharide type, with over 200 serogroups described. Historically, only toxigenic serogroups O1 and O139 have been associated with widespread cholera epidemics. Other serogroups can cause small outbreaks that spread via contaminated raw seafood (primarily shellfish and molluscs) and seawater exposure, and they are collectively termed Non-O1/Non-O139 Vibrio Cholerae (NOVC). NOVC, occasionally detected also in the Mediterranean Sea, most often causes sporadic gastrointestinal manifestations requiring supportive therapy. However, rarely the V. cholerae non-O1/ non-O139 serotype can result in extraintestinal manifestations such as severe wound infections, soft tissue infections and sepsis in immunocompromised patients that represent a therapeutic challenge. In particular, NOVC bacteraemia is a rare event but has the highest mortality rates among NOVC infections (almost 33%) and usually occurs in certain immunosuppressed populations, such as patients with haematologic and solid malignancies, and those with underlying liver disease.

Effective local treatment of necrotizing fasciitis using a chlorine solution obtained by electrolysis

Introduction. Severe surgical wound infection as necrotizing fasciitis is one of the leading causes of death in the postoperative period. Large wounds affecting the skin and soft tissues are a particular problem, as such wounds are difficult to heal, especially in immunocompromised patients. Local treatment is important, and different antiseptics are in clinical use. Case outline. A 45-year-old woman with terminal kidney failure, with hypothyroidism and iodine allergy was admitted to the hospital with multiple abscess formation in abdominal wall. After first surgery necrotic fasciitis and sepsis were diagnosed. Complete parenteral therapy, including antibiotics, other supportive therapy and hemodialysis was performed. Successive debridement and local treatment with chlorine solution obtained by electrolysis as irrigation solution and wet wound dressing used daily lead to complete healing. Delayed wound closure was performed. She was discharged in good general condition, and the wound was healed completely. Conclusion. The application of a chlorine solution obtained by electrolysis (Aqualor H 200, Serbia) in a concentration of 0.2 mg/l is effective for local treatment of wounds by washing and applying wet dressing in the wound on skin and soft tissue, especially necrotizing fasciitis as wound with mixed bacterial infection.

GATR-3, a Peptide That Eradicates Preformed Biofilms of Multidrug-Resistant Acinetobacter baumannii.

Acinetobacter baumannii is a gram-negative bacterium that causes hospital-acquired and opportunistic infections, resulting in pneumonia, sepsis, and severe wound infections that can be difficult to treat due to antimicrobial resistance and the formation of biofilms. There is an urgent need to develop novel antimicrobials to tackle the rapid increase in antimicrobial resistance, and antimicrobial peptides (AMPs) represent an additional class of potential agents with direct antimicrobial and/or host-defense activating activities. In this study, we present GATR-3, a synthetic, designed AMP that was modified from a cryptic peptide discovered in American alligator, as our lead peptide to target multidrug-resistant (MDR) A. baumannii. Antimicrobial susceptibility testing and antibiofilm assays were performed to assess GATR-3 against a panel of 8 MDR A. baumannii strains, including AB5075 and some clinical strains. The GATR-3 mechanism of action was determined to be via loss of membrane integrity as measured by DiSC3(5) and ethidium bromide assays. GATR-3 exhibited potent antimicrobial activity against all tested multidrug-resistant A. baumannii strains with rapid killing. Biofilms are difficult to treat and eradicate. Excitingly, GATR-3 inhibited biofilm formation and, more importantly, eradicated preformed biofilms of MDR A. baumannii AB5075, as evidenced by MBEC assays and scanning electron micrographs. GATR3 did not induce resistance in MDR A. baumannii, unlike colistin. Additionally, the toxicity of GATR-3 was evaluated using human red blood cells, HepG2 cells, and waxworms using hemolysis and MTT assays. GATR-3 demonstrated little to no cytotoxicity against HepG2 and red blood cells, even at 100 μg/mL. GATR-3 injection showed little toxicity in the waxworm model, resulting in a 90% survival rate. The therapeutic index of GATR-3 was estimated (based on the HC50/MIC against human RBCs) to be 1250. Overall, GATR-3 is a promising candidate to advance to preclinical testing to potentially treat MDR A. baumannii infections.

Shape-adapted self-gelation hydrogel powder for high-performance hemostasis and wound healing

In the battlefield, accidents, first aid, and hospital environments, uncontrollable bleeding caused by severe wound infections pose a serious risk of death and high costs. However, performing ultrafast hemostasis without any external conditions remains challenging. In this paper, polyacrylic acid, polyacrylamide, tea polyphenols, and Yunnan Baiyao (PAA/PAAm/T/YNBY, PPTY) are used to prepare self-gelling powder with shape adaptability. When the mass fraction of PAA and PAAm is 10 wt% and 8 wt%, the hydrogel can form the most intermolecular hydrogen bonds, exhibiting the best adhesion ability and mechanical strength. When the amount of YNBY was 0.1 wt%, the hydrogel had the most suitable cellular compatibility and hemostatic ability. At this time, the hydrogel powder can achieve the fastest self-gelling (< 3 s), the strongest adhesion (interface adhesion > 499.4 N m − 1), and the fastest hemostatic speed (< 30 s). With the addition of a small amount of YNBY (0.1 wt%), the hemostatic efficiency of the hydrogel can be greatly improved. The combination of hydrogel and YNBY not only prolongs the duration of YNBY ingredient efficacy but also enhances its biocompatibility. This easy-to-use but effective hydrogel can stop bleeding, promote wound healing in emergencies, and has opportunities in functional materials, tissue engineering, biomedical engineering, and clinical medicine.

Improper Use of Traditional Medicine “Anbar Nesara” for Wound Infection: A Case Report

In Iranian traditional medicine, donkey dung, known as "Anbar-Nesara" is used for its antimicrobial and antiallergic properties. Incorrect medical beliefs can lead to the incorrect use of complementary medicine and the creation of unnecessary harmful effects. Although there have been many reports about the traditional medical benefits and the use of Anbar-Nesara, we describe a woman with severe wound infection following surgical and administration of Anbar-Nesara smoke.

Antimicrobial polymer-loaded hydrogels for the topical treatment of multidrug-resistant wound biofilm infections

Integration of antimicrobial polymeric nanoparticles into hydrogel materials presents a promising strategy to address multidrug-resistant biofilm infections. Here we report an injectable hydrogel loaded with engineered cationic antimicrobial polymeric nanoparticles (PNPs) for the effective topical treatment of severe wound biofilm infections. The PNPs demonstrated biofilm penetration and disruption, resulting in the eradication of resistant and persister cells that reside within the biofilm. Significantly, PNPs did not elicit resistance development even after multiple exposures to sub-therapeutic doses. In vitro studies showed PNPs significantly reduced prolonged inflammation due to infection and promoted fibroblast migration. These PNPs were then incorporated into Poloxamer 407 (P407) hydrogels and utilized as an inert carrier for PNPs to provide a controlled and sustained topical release of the antimicrobial nanoparticles at the wound area. In vivo studies using a mature (4-day) wound biofilm infection in a murine model mimicking severe human wound infections demonstrated provided 99% bacterial biofilm clearance and significantly enhanced wound healing. Overall, this work demonstrated the efficacy and selectivity of the antimicrobial polymer-loaded hydrogel platform as a topical treatment for difficult-to-treat wound biofilm infections.

Clinical Outcomes of Patients With Cholesterol Crystal Embolism Accompanied by Lower Extremity Wound.

Cholesterol crystal embolism (CCE) accompanied by a lower extremity wound is occasionally difficult to differentiate from chronic limb-threatening ischemia (CLTI) and treat. The present multi-center retrospective observational study investigated the clinical characteristics and prognosis of CCE with lower extremity wounds. Consecutive patients (n = 58) clinically diagnosed as CCE with lower extremity wounds between April 2010 and December 2019 were studied. CCE was diagnosed using histological findings, foot condition, renal impairment, and eosinophilia. The primary outcome was 1-year wound healing rate. Patients with CCE were compared with 1309 patients diagnosed with CLTI with tissue loss during the same study period. The CCE group had a significantly more severe Wound, Ischemia, and foot Infection (WIfI) classification compared with the CLTI group. After Kaplan-Meier analysis, the CCE group had a similar 1-year wound healing (55.1 vs 58.3%, P = .096) as the CLTI group. In multivariate stratified Cox regression analysis by WIfI stages, CCE was significantly associated with poor wound healing compared with CLTI [hazard ratio .36 (95% confidence interval .21-.62)]. In conclusion, among the similar WIfI clinical stages, wound healing was significantly worse in the CCE group than in the CLTI group.

Arterial leg ulcers-Bacterial patterns, antimicrobial resistance and clinical characteristics, a retrospective single-centre cohort, 2012-2021.

Severe wound infections in patients with peripheral artery disease (PAD) are common, potentially life- and limb-threatening, and difficult to treat. Evidence on patients with infected leg ulcers in PAD is scarce. This study aims to provide insight into the microbiological patterns and antimicrobial resistance (AMR) of specific pathogens in patients with arterial leg ulcers. In this retrospective, consecutive, single-centre study 16,553 patients underwent an endovascular revascularization procedure between 2012 and 2021. Of these, 1,142 patients had PAD Rutherford category 5 or 6 with infected leg ulcers. Logistic regression was used to identify risk factors for Staphylococcus aureus-associated infections. A total of 3,431 bacterial isolates were detected, of which 2,335 (68.1%) bacterial isolates were gram-positive and 1,096 (31.9%) were gram-negative species. The most prevalent bacteria were S. aureus (18.6%), Enterococcus faecalis (9.1%) and S. epidermidis (7.8%). Pseudomonas aeruginosa (5.6%), Proteus mirabilis (3.7%) and Escherichia coli (3.4%). The resistance of S. aureus isolates to clindamycin was 11.0%. Resistance to oxacillin was rare (1.5%). P. aeruginosa is frequently resistant to ciprofloxacin (14.4%) whilst intrinsically resistant to trimethoprim/sulfamethoxazole. P. mirabilis and E. coli were frequently resistant to both ciprofloxacin (7.3; 20.7%) and trimethoprim/sulfamethoxazole (24.6; 22.6%), respectively. Resistance to amoxicillin/clavulanic acid was high among E. coli isolates (36.8%). Multi-drug resistance (MDR) was rare among S. aureus and P. aeruginosa isolates. In contrast, the proportion of MDR was high in E. coli isolates. End-stage renal disease was independently positively associated with S. aureus identification (p = .042). S. aureus was the most common pathogen in arterial leg ulcers with end-stage renal disease being an independent risk factor. Clindamycin resistance was common, making empirical therapy likely to fail. Isolated E. coli species had a high proportion of MDR.

Study of the influence of individual components in the cultivation environment on P. aeruginosa and A. baumannii biofilm-forming activity

Annotation. P. aeruginosa, A. baumannii are the causative agents of severe wound infections, ventilator-associated pneumonia, catheter-associated septic conditions and other severe pathological processes. The ability of bacteria to form biofilms in affected tissues plays an important role in the pathogenesis of these diseases. Therefore, the purpose of our work is to study the influence of certain external factors on the ability of bacteria to form biofilms. The ability of bacteria to form biofilms in affected tissues plays an important role in the pathogenesis of these diseases. 5 clinical strains of P. aeruginosa and 5 strains of A. baumannii were used in this research. The ability to form biofilms was studied in 96-well polystyrene plates by the spectrophotometric method, which is based on the ability of the crystal violet dye to bind to the cells and matrix of the biofilm. Statistical processing of the obtained results was carried out using Excel Microsoft Office tables. The effect of the presence of certain sugars and nitrogen-containing compounds in the cultivation medium on the processes of biofilm formation by pseudomonads and acinetobacteria was investigated. As a result of the research, it was established that acinetobacteria show the ability to form films, unlike pseudomonads, under the condition of their cultivation in sterile distilled water. The introduction of certain carbohydrates or urea into the cultivation medium intensified the biofilm-forming properties of pseudomonads to a much greater extent, compared to acinetobacteria. According to the research results, it was established that the most active process of biofilm formation occurs in both types of non-fermenting Gram-negative bacteria when there are animal blood serum proteins in the culture medium. The formation of biofilms is one of the main strategies that increases the survival of bacteria in the environment, as well as in the human body. The ability of bacteria to form biofilms is, among other things, a factor in the pathogenicity and virulence of bacteria. So, in recent years, special attention has been paid to the ability of microorganisms to form biofilms, and to the study of factors affecting this process.

Severe wound infection by MRCNS following bilateral inguinal herniorrhaphy

BackgroundWound infection after inguinal hernia surgery is not uncommon in the clinical setting. The common microbial aetiology of postoperative inguinal hernia wound infection is Gram-positive bacteria. Staphylococcus aureus is a common pathogen causing wound infection while Staphylococcus epidermidis and Pseudomonas are rare. Staphylococcus epidermidis as a cause of severe wound infection is rarely described in literature. We herein present a case of a 79-year-old man with a rare wound infection after bilateral inguinal herniorrhaphy caused by MRCNS (Methicillin Resistant Coagulase Negative Staphylococcus).Case presentationWe present a case of wound infection accompanied by fever with a temperature of 38.8 °C after bilateral inguinal herniorrhaphy in a 79-year-old man. Bilateral inguinal wounds were marked by redness and swelling, with skin necrosis. In addition, an abscess of approximately 1.5 cm × 1.5 cm was seen on the left wrist. A small amount of gas under the skin in the wound area was observed after pelvic computed tomography (CT) scans. No bacteria were cultured from the inguinal wound discharge, while blood culture detected MRCNS, and Acinetobacter lwoffi was cultured from the pus in the left wrist. We chose appropriate antibiotics based on the results of the bacterial culture and the drug susceptibility results. Vacuum assisted closure (VAC) therapy was used after debridement. The patient was discharged after the wounds improved. He was followed up for ten months and showed no signs of complications. We are sharing our experience along with literature review.ConclusionsWe are presenting a rare case of MRCNS wound infection following open inguinal hernia surgery. Although a rarity, clinicians performing inguinal hernia surgery must consider this entity in an infected wound and follow up the patient for complications of MRCNS.

Hydrogel Formulations of Antibacterial Pyrazoles Using a Synthesized Polystyrene-Based Cationic Resin as a Gelling Agent.

Here, to develop new topical antibacterial formulations to treat staphylococcal infections, two pyrazoles (3c and 4b) previously reported as antibacterial agents, especially against staphylococci, were formulated as hydrogels (R1-HG-3c and R1HG-4b) using a cationic polystyrene-based resin (R1) and here synthetized and characterized as gelling agents. Thanks to the high hydrophilicity, high-level porosity, and excellent swelling capabilities of R1, R1HG-3c and R1HG-4b were achieved with an equilibrium degree of swelling (EDS) of 765% (R1HG-3c) and 675% (R1HG-4b) and equilibrium water content (EWC) of 88% and 87%, respectively. The chemical structure of soaked and dried gels was investigated by PCA-assisted attenuated total reflectance (ATR) Fourier transform infrared (FTIR) spectroscopy, while their morphology was investigated by optical microscopy. Weight loss studies were carried out with R1HG-3c and R1HG-4b to investigate their water release profiles and the related kinetics, while their stability was evaluated over time both by monitoring their inversion properties to detect possible impairments of the 3D network and by PCA-assisted ATR-FTIR spectroscopy to detect possible structural changes. The flow and dynamic rheological characterization of the gels was assessed by determining their viscosity vs. shear rate, applying the Cross rheological equation to achieve the curves of shear stress vs. shear rate, and carrying out amplitude and frequency sweep experiments. Finally, their content in NH3+ groups was determined by potentiometric titrations. Due to their favorable physicochemical characteristic and the antibacterial effects of 3c and 4b possibly improved by the cationic R1, the pyrazole-enriched gels reported here could represent new weapons to treat severe skin and wound infections sustained by MDR bacteria of staphylococcal species.

Successful Use of Amoxicillin-clavulanate Acid in a Patient with Severe Wound Infection with Wound Communication Secondary to Actinomyces

Introduction. Actinomyces is a common genus of bacteria that is typically found in the oral cavity, gastrointestinal tract, and genitourinary tract, as well as on the skin. Gleimia europaea (formerly A europaeus) is a facultative anaerobic gram-positive rod that has been well associated with abscesses of the groin, axilla, and breast, as well as with decubitus ulcer. Infection with this species usually involves multiple abscesses communicating through sinus tracts. Treatment typically requires a prolonged course of penicillin or amoxicillin (up to 12 months). Case Report. A 62-year-old male presented with a PI with fistulous tract and tunneling infected with Actinomyces, which was successfully treated with amoxicillin–clavulanic acid. Conclusions. The outcomes in this case support the use of surgical debridement, meticulous wound care, and appropriate antibiotic coverage to achieve accelerated wound healing of sacral PI with actinomycotic involvement.

Case of Vibrio Vulnificus bacteremia in a patient heterozygous for HFE p.C282Y mutation and alcoholic liver cirrhosis

Vibrio vulnificus is a Gram-negative bacterium, a member of the Vibrionaceae family. V. vulnificus is the main cause of seafood-related deaths in the United States because it can cause severe wound infections or sepsis. This microorganism is highly dependent on iron availability. Therefore, patients with high body iron levels are more susceptible to the infection. Prompt treatment with cephalosporins as well as doxycycline is usually administered. We present a case of V. vulnificus bacteremia in a patient heterozygous for HFE p.C282Y mutation and underlying alcoholic liver cirrhosis.

EFFECT OF LEVOSEMINDAN ON OUTCOME OF CORONARY ARTERY BYPASS GRAFTING SURGERY IN PATIENT WITH IMPAIRED LEFT VENTRICULAR SYSTOLIC FUNCTION

Background: Coronary artery bypass grafting (CABG) is often complicated by hemodynamic instability, especially in cases with decreased left ventricular ejection fraction (LVEF). Levosimendan as inotropic agent can be used in those patients. Objective: To assess morbidity and mortality rates up to 6 months following CABG surgery in patients with LVEF equals 35%, who were given Levosimendan. Patients and methods: 40 patients with preoperative LVEF ≤ 35% underwent elective CABG were retrospectively analyzed between March 2020 and April 2022 at Al-Azhar University Hospitals. Levosemindan was used in continuously-given bolus-free infusion at a range from 0.05 to 0.2 ug/kg/min prior surgery. Hemodynamic and outcome parameters were registered and statistically analyzed. Results: A significant improvement was recorded in EF% from 32.8% to 35.9% then 39.4% after one week and 6 months respectively; it was associated with significant increase in cardiac output from 5.22 liter per minute to 6.3 L/min and 6.1 L/min after one week and 6 months respectively. MAP was also increased from 63.44 mmHg to 80.4 mmHg and 84.6 mmHg after one week and 6 months respectively. 80% of patients showed no complications; on the other hand, 5% of them had low cardiac output syndrome (LCOS), 5% needed IABP, 5% rapid AF, and 5% needed reoperation due to bleeding. On the other hand, postoperative (later) complications included the following: severe sternal wound infection in 2 cases (5%), and chronic AF in one case (2.5%); the overall mortality rate was 10%. Conclusion: levosimendan has a beneficial effect in improving hemodynamic state; in addition, it aids the reduction of hospital and ICU stays, along with the ability to reduce the incidence of LCOS and mortality rate.

A multifunctional PAN/PVP nanofiber sponge wound dressing loaded with ZIF-8-derived carbon nanoparticles with adjustable wetness for rapid wound disinfection and exudate management.

Rapid and safe disinfection and exudate management are two major challenges in infected wound care. Therefore, in this work, we developed a novel wound dressing via encapsulating ZIF-8-derived carbon nanoparticles in a hydrophilic nanofiber sponge to address severe wound infection and heavy exudate problems. The dressing can effectively kill bacteria through chemo-photothermal synergistic therapy. Meanwhile, the hydrophilic nanofiber sponge can quickly absorb wound exudate around the wound and accelerate the evaporation rate of liquid through the photothermal effect and its own structure; therefore, it is possible to remove excess liquid and regulate its wetness. In this way, it prevents the problem of wound overhydration often caused by hydrophilic dressings. In our experiment, the dressing showed good antibacterial performance and biocompatibility in vitro and could effectively control wound infection, absorb wound exudate and promote skin wound healing in vivo. Its good therapeutic effect is not only due to effective infection control and wound exudate management, but also because the structure of nanofibers similar to an extracellular matrix provides basic physical support and structural signals conducive to skin tissue regeneration.