Gentamicin Solution Research Articles

Screening Studies of the Antimicrobial Activity of the Pyrimidine Compound 2,2-[6-Bromo-2,4-Dioxoquinazoline-1,3(2H)diyl]bis(N-Carbamimidoylacetamide)

The aim of this study was to screen the antimicrobial activity of a pyrimidine compound under the laboratory code VMA-21-01. Antimicrobial activity was studied in relation to: Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumonia, and Proteus mirabilis. The antimicrobial activity of 2,2-[6-Bromo-2,4-dioxoquinazoline- 1,3(2H)diyl]bis(N-carbamimidoylacetamide) was carried out in vitro by serial dilution and determination of its minimum inhibitory concentration. The sensitivity of microorganisms to the test substance was determined in a meat-peptone broth (visual assessment), followed by reinoculation on meat-peptone agar and colony count. DMSO tubes were used as a control. A 4% gentamicin solution was used as a comparison drug. In an in vitro experiment, it was found that the pyrimidine compound 2,2-[6-Bromo-2,4-dioxyquinazoline-1,3(2H)diyl]bis(N-carbamimidoylacetamide) under the laboratory cipher VMA21-01 has bactericidal activity against K. pneumonia comparable to the comparison drug gentamicin, as well as bacteriostatic activity against S. aureus, S. pneumoniae, E. coli, and P. mirabilis.

Pharmacokinetics of Locally Applied Antibiotic Prophylaxis for Implant-Based Breast Reconstruction

Antibiotic irrigation of breast implants is widely used internationally, but no clinical study has investigated the pharmacokinetics of antibiotic prophylaxis in the breast implant pocket. To evaluate how long locally applied gentamicin, cefazolin, and vancomycin concentrations in the implant pocket remain above the minimum inhibitory concentration (MIC) for the most common bacterial infections and to measure systemic uptake. This prospective cohort study was performed at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark, between October 25, 2021, and September 22, 2022, among 40 patients undergoing implant-based breast reconstruction who were part of the ongoing BREAST-AB trial (Prophylactic Treatment of Breast Implants With a Solution of Gentamicin, Vancomycin and Cefazolin Antibiotics for Women Undergoing Breast Reconstructive Surgery: a Randomized Controlled Trial). Patients were randomized to receive locally applied gentamicin, cefazolin, and vancomycin or placebo. Samples were obtained from the surgical breast drain and blood up to 10 days postoperatively. The breast implant and the implant pocket were irrigated with 160 μg/mL of gentamicin, 2000 μg/mL of cefazolin, and 2000 μg/mL of vancomycin in a 200-mL saline solution. The primary outcome was the duration of antibiotic concentrations above the MIC breakpoint for Staphylococcus aureus according to the Clinical and Laboratory Standards Institute: gentamicin, 4 μg/mL; cefazolin, 2 μg/mL; and vancomycin, 2 μg/mL. Secondary outcomes included the time above the MIC for Pseudomonas aeruginosa and other relevant bacteria, as well as systemic uptake. The study included 40 patients (median age, 44.6 years [IQR, 38.3-51.4 years]; median body mass index, 23.9 [IQR, 21.7-25.9]) with a median number of 3 drain samples (range, 1-10 drain samples) and 2 blood samples (range, 0-6 blood samples). Vancomycin and cefazolin remained above the MIC for S aureus significantly longer than gentamicin (gentamicin, 0.9 days [95% CI, 0.5-1.2 days] for blood samples vs 6.9 days [95% CI, 2.9 to 10.9 days] for vancomycin [P = .02] vs 3.7 days [95% CI, 2.2-5.2 days] for cefazolin [P = .002]). The gentamicin level remained above the MIC for P aeruginosa for 1.3 days (95% CI, 1.0-1.5 days). Only cefazolin was detectable in blood samples, albeit in very low concentrations (median concentration, 0.04 μg/mL [range, 0.007-0.1 μg/mL]). This study suggests that patients treated with triple-antibiotic implant irrigation during breast reconstruction receive adequate prophylaxis for S aureus and other common implant-associated, gram-positive bacteria. However, the protection against P aeruginosa may be inadequate.

Use of a Porcine Small Intestinal Submucosa Graft to Treat a Degloving Injury in an American Bullfrog (Rana catesbeiana)

Abstract A free-ranging adult female American bullfrog (Rana catesbeiana) presented with a degloving injury to the right manus. Insufficient healthy cutaneous tissue remained on the manus for primary closure. A porcine small intestinal submucosa (SIS) graft was sutured over the wound to promote skin regeneration. Additional treatment included gentamicin solution immersion therapy followed by topical glycerin impregnated with insulin and SilvaSorb® Gel. The initial porcine SIS graft began to fail after five days and was replaced. The second porcine SIS graft began to break down nine days after placement. The graft was allowed to disintegrate after a strong granulation bed had formed and served as a form of mechanical protection. Application of the porcine SIS graft in combination with gentamicin therapy and topical treatment resulted in complete healing of the manus 35 days after the initial placement of the porcine SIS graft and the patient was released.

Intra-soft tissue and intramedullary antibiotic perfusion in combination with negative pressure wound therapy.

Intra-soft tissue and intramedullary antibiotic perfusion (iSAP and iMAP), which combine continuous administration of antibiotic solution to the wound and negative pressure wound therapy (NPWT), have been reported to be a useful management approach for hard-to-heal ulcers in the field of orthopaedic surgery. We report the efficacy of this treatment and discuss the key points. The recipients of this treatment had contaminated fresh severe trauma with a high risk of infection, or hard-to-heal ulcers which were expected to be difficult to manage with conventional NPWT alone. Continuous administration of 1200µg/ml of gentamicin (GM) solution to the wound was performed along with NPWT. The GM solution was administered subcutaneously using a small catheter for iSAP, while intramedullary administration used a bone marrow needle for iMAP. iSAP was employed in all 10 patients who took part, and iMAP in three of these patients. The average treatment time was 13.6 days with iSAP and 9.3 days with iMAP. The mean serum GM level during the therapy was 1.02µg/ml. Moderate GM-induced acute kidney injury was suspected in one case, but resolved spontaneously after GM administration was stopped. Favourable wound bed preparation was achieved in all cases without recurrence of infection. Combination with continuous suction by NPWT is able to keep the local concentration of antibiotic above the minimum inhibitory concentration of biofilm-coated bacteria within the wound. We have referred to this treatment as continuous local antibiotic perfusion. Further investigation of local pharmacodynamics in the wound and side-effects of this treatment are warranted.

Antimicrobial Properties and Substantivity of Gentamicin, Amoxicillin and Metronidazole (GAM) Antibiotic Solution with Chitosan as a Root Canal Irrigant - A Preliminary Study.

The combination of gentamicin, amoxicillin, and metronidazole (GAM) solution with chitosan (GAMC) can be used as an alternative intracanal irrigant as it was found to be a potent antibacterial agent.

Investigation of Antimicrobial Effects of Polydopamine-Based Composite Coatings.

Herein, polydopamine (PDA)-based antimicrobial coatings loaded with silver nanoparticles (Ag NPs) and gentamicin were designed and prepared on glass slides using two different approaches. To our knowledge, this study was performed for the first time with the aim to compare these methods (viz., in situ loading and physical adsorption method) regarding the loading and release behavior of payloads. In one method, gentamicin was in situ loaded on PDA-coated substrates during PDA polymerization followed by Ag NPs immobilization (named as Ag@Gen/PDA); for the second method, Ag NPs and gentamicin were simultaneously loaded onto PDA via physical adsorption by immersing pre-formed PDA coatings into a mixed solution of Ag NPs and gentamicin (named as Ag/Gen@PDA). The loading and release characteristics of these antimicrobial coatings were compared, and both gave variable outcomes. The in situ loading method consequently provided a relatively slow release of loaded antimicrobials, i.e., approx. 46% for Ag@Gen/PDA as compared to 92% from physically adsorbed Ag/GenPDA in an immersion period of 30 days. A similar trend was observed for gentamicin release, i.e., ~0.006 µg/mL from Ag@Gen/PDA and 0.02 µg/mL from Ag/Gen@PDA each day. The slower antimicrobial release from Ag@Gen/PDA coatings would ultimately provide an effective long-term antimicrobial property as compared to Ag/Gen@PDA. Finally, the synergistic antimicrobial activities of these composite coatings were assessed against two microbial species, namely, Staphylococcus aureus and Escherichia coli, hence providing evidence in the prevention of bacterial colonization.

A pilot, masked, randomized controlled trial to evaluate local gentamicin versus saline in open tibial fractures (pGO-Tibia).

Open tibial fractures have a high risk of infection that can lead to severe morbidity. Antibiotics administered locally at the site of the open wound are a potentially effective preventive measure, but there are limited data evaluating aminoglycoside antibiotics. The objective of this study was to assess the feasibility of a clinical trial to test the efficacy of local gentamicin in reducing the risk of fracture-related infection after open tibial fracture. This study is a single-center, pilot, masked, randomized controlled trial conducted at the Muhimbili Orthopaedic Institute. Participants were randomized intraoperatively after wound closure to receive gentamicin solution or normal saline solution injected at the fracture site. Follow-ups were completed at 2 weeks, 6 weeks, 3 months, 6 months, 9 months, and 1 year postoperatively. The primary feasibility outcomes were the rate of enrollment and retention. The primary clinical outcome was the occurrence of fracture-related infection. Of 199 patients screened, 100 eligible patients were successfully enrolled and randomized over 9 months (11.1 patients/month). Complete data were recorded at baseline and follow-up for >95% of cases. The rate of follow-up at 6 weeks, 3 months, 6 months, 9 months, and 1 year were 70%, 68%, 69%, 61%, and 80%, respectively. There was no difference in adverse events or any of the measured primary and secondary outcomes. This pilot study is among the first to evaluate locally administered gentamicin in open tibial fractures. Results indicate a rigorous clinical trial with acceptable rates of enrollment and follow-up to address this topic is possible in this setting.

Effect of Volumes of Solutions on Intraocular Pressure During Intravitreal Injection of Low Dose Gentamicin in Horses With Recurrent Uveitis: A Randomized Controlled Study.

Horses with recurrent uveitis can be treated by intravitreal injection of low dose gentamicin under sedation and after local anesthetic techniques including the retrobulbar nerve block. Since it is reported that retinal degeneration can be secondary to an acute increase of intraocular pressure (IOP), the current randomized controlled study was carried out in order to investigate the changes in IOP following retrobulbar anesthesia, with two different volumes of local anesthetic (lidocaine) solution (10 and 5 mL), and intravitreal injection of 6 mg gentamicin in two different volumes of solution (0.3 and 0.15 mL). Multivariate regression showed that IOP was significantly lower in the pathologic eye at baseline (estimated effect size -6.1 mmHg; P=.0001) and after sedation (estimated effect size -9.4 mmHg; P < .0001). The IOP was significantly higher after a 10 mL block (P .0002) but this effect was very small (+0.5 mmHg). There was no significant difference in IOP after the injection of 0.15 or 0.3 mL solution of gentamicin. There was no significant combined effect of the volume of local anesthetic used for the block and the volume of the gentamicin solution. Since the expected anesthetic effects (desensitization and akinesia) were met in all cases, the smaller volume of 5 mL of lidocaine solution would be preferable for retrobulbar block for intravitreal injections, while intravitreal injections volumes of 0.15 and 0.30 mL can be used indifferently.

Evaluation of effectiveness of combined supportive treatment for paronychia and pyogenic granulomas, associated with targeted anticancer therapy

BACKGROUND: Paronychia and pyogenic granulomas occur in 1050% of patients treated with epidermal growth receptor (EGFR) inhibitors. Supportive therapy for periungual lesions is challenging, since these adverse reactions are prone to torpidity and frequent relapses.&#x0D; AIM: to evaluate the effectiveness of supportive treatment for paronychia and pyogenic granulomas ― dermatologic adverse events of EGFR inhibitors, with a combined cream with betamethasone dipropionate, clotrimazole, gentamicin, and betaxolol solution.&#x0D; MATERIALS AND METHODS: 16 patients with paronychia and pyogenic granulomas associated with EGFR inhibitor therapy were included in a 12-week open-label prospective study. Paronychia and pyogenic granulomas severity assessment was performed with the NCI-CTCAE v. 5.0, a developed 10-point scale. The intensity of pain was assessed with a visual-analogue scale (VAS). The quality of life was assessed with the Dermatology Life Quality Index (DLQI).&#x0D; RESULTS: A significant improvement of all parameters (p 0.05) was evaluated from week 1, indicating the effective reduction of dermatologic adverse event objective and subjective symptoms, improvement of patients quality of life. By the end of the study, 37.5% of patients had complete resolution of lesions, 62.5% of patients had minimal residual erythema. Decrease of pain sensation in the affected periungual folds was observed throughout the study (p 0.05). DLQI score indicated the "small effect" of paronychia and pyogenic granulomas on patients life by the end of the study.&#x0D; CONCLUSIONS: Supportive treatment of paronychia and pyogenic granulomas with a combined cream with betamethasone dipropionate, clotrimazole and gentamicin and a betaxolol 0.25% solution is effective in the management of paronychia and pyogenic granulomas objective and subjective symptoms, has a high tolerability, allows to improve patients quality of life and continue targeted therapy without dose reduction. Long-term maintenance of pain sensation after paronychia and pyogenic granulomas resolution underlines the need for additional treatment options that will improve the effectiveness of pain management.

Prevention of Surgical Site Infection Following Open Spine Surgery: The Efficacy of Intraoperative Wound Irrigation with Normal Saline Containing Gentamicin Versus Dilute Povidone-Iodine

Intraoperative wound irrigation (IOWI) is an important step in preventing surgical site infection (SSI). This study compared the effectiveness of saline with gentamicin versus povidine-iodine (PI) as IOWI solutions in preventing SSI in open spine surgery. It is a prospective comparative study. Patients who had noninstrumented open spine surgery were randomized into 2 groups. Group A and B patients had their surgical wounds irrigated with saline containing gentamicin solution and dilute PI solution, respectively. Both groups were assessed for the occurrence of SSI. A total of 80 patients, divided into 2 groups of 40 each completed the study. Overall, the SSI rate was 17.5% for patients in the normal saline containing gentamicin group (A) and 2.5% for those in the dilute PI group (B), this difference was statistically significant (P= 0.025). The cervical and thoracic spine regions have the same SSI rate (7.1% and 0%, respectively) in both groups. However, in the lumbosacral region, the SSI rate was 31.6% in A and 0% in B, this was statistically significant (P= 0.006). The isolated organisms in patients with SSI were staphylococcus species (42.86% of SSI in A and 0% in B) and pseudomonas species (42.86% of SSI in group A and 100% in group B), and this difference was profound in the lumbosacral spine region (P= 0.008). IOWI with 3.5% dilute PI solution is more efficacious in preventing SSI and has wider microbial coverage compared to normal saline containing gentamicin solution as IOWI fluid in noninstrumented open spine surgery.

The stability and in vitro antibacterial efficacy of enrofloxacin and gentamicin solutions against Staphylococcus pseudintermedius over 28 days.

Many clinicians prepare compounded otic solutions to treat otitis externa (OE). Research evaluating the stability and antimicrobial efficacy of these solutions is limited. This study determined the chemical stability and in vitro bactericidal efficacy of compounded solutions of enrofloxacin and gentamicin during storage for 28 days. Solutions of enrofloxacin (10mg/mL, 1%) and gentamicin (3mg/mL, 0.3%) were prepared with normal saline and 1mg/mL dexamethasone. Solutions were stored at room temperature (25°C) for 0, 14 and 28 days. The chemical stability of the antibiotics and dexamethasone were determined using liquid chromatography tandem mass spectrometry in triplicate. Efficacy assessment was made with 10 isolates of Staphylococcus pseudintermedius obtained from dogs with OE. Serial 10-fold dilutions of the bacteria with the compounded solutions were prepared and the colony count results were converted into colony-forming units (cfus). The mean cfu/mL and cfu/mL reduction rates were compared between Day (D)0, D14 and D28. All of the antimicrobial testing solutions were performed in triplicate. Chromatography showed that both antibiotics and dexamethasone were stable for 28 days. No significant differences were observed in the antibiotic bactericidal efficacy of stored solutions at D0, D14 or D28. Solutions of 1% enrofloxacin and 0.3% gentamicin in normal saline with 0.1% dexamethasone maintained chemical stability and bactericidal efficacy over 28 days. These solutions can be considered as alternatives to commercial preparations for treatment of canine OE when indicated.

Prophylactic treatment of breast implants with a solution of gentamicin, vancomycin and cefazolin antibiotics for women undergoing breast reconstructive surgery: protocol for a randomised, double-blind, placebo-controlled trial (The BREAST-AB trial)

IntroductionPeriprosthetic infection is one of the most severe complications following implant-based breast reconstruction affecting 5%–10% of the women. Currently, many surgeons apply antibiotics locally on the breast implant to reduce...

Gram-negative bacteria act as a reservoir for aminoglycoside antibiotics that interact with host factors to enhance bacterial killing in a mouse model of pneumonia.

In vitro exposure of multiple Gram-negative bacteria to an aminoglycoside (AG) antibiotic has previously been demonstrated to result in bacterial alterations that interact with host factors to suppress Gram-negative pneumonia. However, the mechanisms resulting in suppression are not known. Here, the hypothesis that Gram-negative bacteria bind and retain AGs, which are introduced into the lung and interact with host defenses to affect bacterial killing, was tested. Following in vitro exposure of one of several, pathogenic Gram-negative bacteria to the AG antibiotics kanamycin or gentamicin, AGs were detected in bacterial cell pellets (up to 208 μg/mL). Using inhibitors of AG binding and internalization, the bacterial outer membrane was implicated as the predominant kanamycin and gentamicin reservoir. Following intranasal administration of gentamicin-bound bacteria or gentamicin solution at the time of infection with live, AG-naïve bacteria, gentamicin was detected in the lungs of infected mice (up to 8 μg/g). Co-inoculation with gentamicin-bound bacteria resulted in killing of AG-naïve bacteria by up to 3-log10, mirroring the effects of intranasal gentamicin treatment. In vitro killing of AG-naïve bacteria mediated by kanamycin-bound bacteria required the presence of detergents or pulmonary surfactant, suggesting that increased bacterial killing inside the murine lung is facilitated by the detergent component of pulmonary surfactant. These findings demonstrate that Gram-negative bacteria bind and retain AGs that can interact with host-derived pulmonary surfactant to enhance bacterial killing in the lung. This may help explain why AGs appear to have unique efficacy in the lung and might expand their clinical utility.

Effect of a Novel Soaking Solution Used in Patients With Hand-Foot Syndrome as a Result of Capecitabine Treatment: A Randomized and Self-Controlled Trial

BackgroundHand-foot syndrome (HFS) is a common adverse event in patients receiving capecitabine therapy for breast cancer, and the symptoms of HFS significantly impair patient quality of life. However, currently there are no effective drugs or measures to prevent and alleviate the occurrence of HFS. AimTo assess the effectiveness of a novel soaking solution, a mixture solution of dexamethasone, gentamicin and vitamin B12, in patients with grade 2-3 HFS after capecitabine treatment for breast cancer. Materials and MethodsPatients with grade 2-3 HFS according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) were enrolled in this randomized, single-center, self-controlled trial. Each patient's right and left hands or feet were individually randomized to soak in either a novel soaking solution (treated hands or feet) or a placebo liquid (control hands or feet) for three times a day, each time for 15 minutes and for four weeks. Effectiveness was evaluated according to CTCAE grades, defined as a reduction of 1 or more CTCAE grades. ResultsA total of 60 patients were enrolled. The HFS CTCAE grade of the treated hands and feet at 4 weeks of HFS treatment was significantly decreased compared to that of the control hands and feet (P = .005). Significant differences were also observed between the treatment conditions in terms of the HFS effectiveness rate: treated group 80% and placebo group 51.7% (P = .001). No adverse or unexpected events were observed during the whole trial. ConclusionSoaking affected hands or feet in a novel soaking solution safely and effectively reduced the severity of HFS following treatment with capecitabine for breast cancer.

A Preliminary Exploration of the Efficacy of Gentamicin Sponges in the Prevention and Treatment of Wound Infections.

PurposeThis study aimed to construct drug-loading and drug-releasing quantitative equations for gentamicin sponges in addition to realizing a gentamicin sponge for wound infection prevention and treatment.MethodsSterile sponges were cut into pieces of 1×1 × 0.5 cm and immersed in 40, 16, 8, 4, 1.6, 0.8, or 0 mg/mL of gentamicin solution for 12, 24, 48, 96, or 120 h to evaluate their gentamicin loading. The sponges were subsequently immersed in the gentamicin solution of different concentrations for 48 h, air-dried, and then immersed in 10 mL of 0.9% physiological saline to evaluate the gentamicin release. Methicillin-sensitive Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa were used to explore the sponges’ infection prevention scheme. In addition, a rat femur fracture with wound infection model was used to assess the infection treatment scheme.ResultsThe antibacterial zone sizes of the sponges immersed in 40, 16, 8, 4, 1.6, and 0.8 mg/mL of the gentamicin solution were larger than those of the 0 mg/mL air-dried sponge, and the difference was statistically significant (p < 0.01, p < 0.01, p < 0.01, p < 0.01, p < 0.01, and p < 0.01, respectively). The rats in the 40, 16, and 8 mg/mL air-dried sponge groups had no wound suppuration in either the MSSA or P. aeruginosa rat infection models.ConclusionA quantified equation for the sponges’ gentamicin loading and release was achieved with high accuracy. Furthermore, we recommend the 40, 16, or 8 mg/mL air-dried sponge for the treatment of wounds with antibiotic-sensitive bacterial infections.

Effect of Amh in Patients with Polycystic Ovarian Syndrome on Pregnancy Rate in Icsi Cycle

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy &amp; safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution (1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them. Postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, in obese women undergoing elective CS, wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy &amp; safety.

Subcutaneous Antibiotic Irrigation to Prevent Wound Infection in Obese Patients Undergoing Cesarean Section

Background: Surgical site infections (SSIs) pose considerable morbidity and account for up to 20% of all nosocomial infections in surgical patients Aim of the Work: to determine the efficacy &amp; safety of irrigation of subcutaneous tissue by Gentamicin for caesarean section Incision in reducing the risk of post-caesarean wound complications among obese women compared with placebo. Patients and Methods: This prospective randomized clinical trial study was conducted on total 132 obese patients who underwent elective cesarean section at Ain Shams University Maternity hospitals. This study was conducted on obese women undergoing caesarean section at Ain Shams University Maternity Hospital with the following inclusion and exclusion criteria. Patients were distributed randomly into 2 groups using a computer based program: Group (A) N = 66: CS with Irrigation of subcutaneous tissue by placebo (200 ml of saline 0.9 %). Group (B) N = 66: CS with irrigation of subcutaneous tissue by Gentamicin solution ( 1mg/kg gentamicin in 200 ml of saline 0.9%). Results: The results of this study revealed that the rate of SSI was less in gentamycin (3%) (n=2/66) than control group (4.5%) (n=3/66) with no statistical significance between them . postoperative hospital stay and readmission rate due to SSI for the gentamycin group were also shorter but not statistically different in compared to the control group. Applying local gentamycin antibiotic irrigation during wound closure after cesarean section in obese patients is not recommended. NO role of local gentamycin irrigation in subcutaneous tissue in prevention of wound surgical site infection. Conclusion: as evident from the current study, In obese women undergoing elective CS , wound irrigation with Gentamicin is not superior to wound irrigation with placebo (saline 0.9) regarding efficacy &amp; safety.

Comparison of Povidone-Iodine and Gentamicin Soak as Scleral Buckle Infection Prophylaxis.

ObjectiveTo determine the best method of antimicrobial prophylaxis against implanted material-associated infections in the setting of scleral buckle surgery.DesignExperimental study.ParticipantsScleral buckle elements were soaked in either gram-positive or polymicrobial broth, while control buckle elements were soaked in PBS only.MethodsSolid silicone and sponge scleral buckle elements were inoculated with common pathogens of the ocular surface, and then soaked in either 1% or 5% povidone-iodine, 1 mg/mL gentamicin solution, or sterile saline for 1, 5, 10, or 15 minutes. Bacteria were then isolated from the buckle elements and cultured for 24 hours.ResultsIn all gram-positive bacterial conditions, gentamicin solution decreased the bacterial load from 451,666.67 colony-forming units (CFU)/mL to 171,611.11 CFU/mL (p=0.0004). The fractional bacterial survival after soaking in gentamicin was higher for the silicone sponge than band (0.357 vs 0.079, p=0.038). Both 1% and 5% povidone-iodine were able to completely eradicate all gram-positive bacteria of both buckle elements. Only 5% povidone-iodine was able to completely sterilize all microbes on the buckle after soaking in a polymicrobial solution consisting of gram-positive, gram-negative bacteria, and fungi.ConclusionPovidone-iodine solution was significantly more effective at bacterial eradication compared to gentamicin solution. For all scleral buckle procedures, we recommend soaking the buckle element in 2–3% povidone-iodine solution before placement and rinsing the ocular surface with the same solution after placement.

Development of thermoresponsive poloxamer in situ gel loaded with gentamicin sulfate for cavity wounds

Poloxamer hydrogels are thermoresponsive hydrogels that become fluid when cooled and gel-like when heated. Adding poloxamer 188 to a poloxamer 407 solution increases the overall gelation temperature, thereby allowing adjustments to the window of operating temperatures. The rheological properties of the poloxamer hydrogel, including gelation temperature and gelation time, were investigated, and the biocompatibility, drug release, and antibacterial properties of a gentamicin-loaded hydrogel were determined. An injectable hydrogel was successfully formulated using 20 wt% of poloxamer 407 and 3 wt% of poloxamer 188. This system became fluid at room temperature (25 °C) in the presence of deionized water; at human body temperature (37 °C), it changed to a gel-like state. The gelation time was approximately 95 seconds. The poloxamer hydrogels showed no cytotoxicity to L929 cells after seven days of culturing. A poloxamer hydrogel loaded with gentamicin sulfate, an antibiotic, was studied for its antibacterial properties against E. coli, B. cereus, S. aureus, and MRSA using gentamicin solution as the control. The results showed that the gentamicin-loaded poloxamer hydrogel inhibited bacteria from the first hour of testing. Moreover, the zone of inhibition of the gentamicin-loaded poloxamer hydrogel was larger than that of the gentamicin solution for a similar concentration of gentamicin sulfate. It can be a potent drug carrier for infected cavity wounds.

Abstract 15682: A Novel Antibiotic Delivery Approach Enhances Salvage of Infected Cardiovascular-implantable Electronic Devices

Introduction: Infection of cardiovascular-implantable electronic devices (CIED) is a serious complication. Systemic antibiotic therapy is considered ineffective, justifying the current guidelines proposing total CEID and lead extraction. Objective: To evaluate the safety and efficacy of continuous in-situ-targeted, ultra-high concentration of antibiotics (CITA) in CIED infections limited to the subcutaneous pocket. Methods: Infected CIED were treated with CITA, delivered to the CIED pocket following minimally invasive surgery (MIS). The CIED were submerged in a 10 2 -10 3 minimal inhibition concentration (MIC) solution of vancomycin and/or gentamicin as per daily conventional dosing. Serum antibiotic levels were regulated by adjusting the concentration and flow of pocket irrigation. CIED salvage rate was assessed. Results: A total of 937 and 481serum assays of vancomycin and gentamicin, respectively, from 83 infected CIED was evaluated (Figure). Target antibiotic serum levels were obtained at 12-48 hours. Median treatment was 8 days (IQR 5,12). Parallel intravenous (IV) vancomycin treatment was applied in 6 (7%) infections. Vancomycin serum levels exceeded a trough limit of 20μg/ml in 20 (2.1%) assays, of which 19/20 received parallel IV treatment. No peak gentamicin levels were recorded. Gentamicin exceeded trough serum level reaching 2-3μg/ml in 80 (16.6%), reached potentially toxic levels of 3-5μg/ml in 33 (6.9%), and exceeded 5μg/ml in 10 (2.1%) assays. CITA resulted in a 1-year salvage of 71 (86%) CIED. Treatment failed in 12 infections, resulting in 8 uneventful total CIED extractions. The 30-day mortality rate was 2.4%. Conclusions: CITA provided ultra-high pocket antibiotic levels, with its safety confirmed by systemic level assays. CITA combined with MIS enabled salvage of 86% of infected CIED. The CITA-MIS approach may serve as an initial therapeutic option prior to the extraction of locally infected CIED, especially in high-risk patients.