Topical Antimicrobials Research Articles

Chlorhexidine gluconate for antisepsis in preterm neonates: A review of safety and efficacy.

Sepsis is a leading cause of death in preterm neonates. The increased susceptibility to sepsis is due to prolonged hospitalization, the need for invasive procedures, and immaturity of innate and adaptive immunity. Chlorhexidine gluconate is a popular topical disinfectant that was not recommended for use in preterm neonates until 2012. Thus, there are few studies assessing the role of chlorhexidine gluconate in antisepsis for preterm neonates. A better understanding of the safety and efficacy of chlorhexidine gluconate as an antiseptic agent for preterm neonates is the first step in establishing best practice guidelines for this population.

A Review of Diabetic Foot Osteomyelitis: Focus on Diagnosis, Clinical Presentation, Management and Outcomes

Diabetic foot osteomyelitis (DFO) affects around 38.5 lakh patients in India. It is diagnosed using clinical and radiologicalapproaches. Polymicrobial etiology, peripheral artery disease (PAD) and peripheral neuropathy are commonly observed. Ahigh degree of clinical vigil is required to avoid underestimation of the extent of damage due to speed and spread of infectionand prevent chances of lower extremity amputation. ‘Time is Tissue’ (time taken to access multidisciplinary care) aptlyrepresents one of the critical factors affecting outcomes, along with anatomical location and presence of gangrenous tissues.Traditionally, DFO treatment is the most complex and controversial aspect of managing diabetic foot infections (DFIs). Thetherapeutic paradigm has evolved from high-level surgical resection of all necrotic and infected bone to the more refined andindividualized surgical interventions along with appropriate antibiotics and topical antimicrobials. It is necessary to have asurgeon available with diabetic foot expertise. The surgical outcome is facilitated with strict off-loading, wound management,agitation (freshening and scrapping of wound edges), biofilm disruption and negative pressure wound therapy (NPWT) toaccelerate healing. Formal protocol-driven treatment can be provided by a multidisciplinary team involving surgical, medicaland podiatric specialties to reduce hospital stay and the need for repeat debridement.This review aims to present a completeoverview of the diagnosis, clinical presentation, management and outcomes of DFO according to scientific recommendationsand our experience, along with few illustrative case reports.

Pattern of prescriptions and prudent use of antimicrobial in horse practice at a Veterinary Teaching Hospital

Antimicrobial prescriptions of the University of Pisa and their compliance with prudent use recommendations were investigated over 11 years (2011−2021). At least one antimicrobial was always prescribed in surgical prophylaxis for the suture of wounds and in 33% of horses with signs of disease of a body system. Antimicrobials were administered in monotherapy (48%) in fixed dose combinations (21%) and empirical combinations (31%). Antimicrobials were mostly (63%) administered by parenteral route, while oral and topical antimicrobials accounted for 14% and 23% of prescriptions, respectively. Gentamicin, benzylpenicillin and ceftiofur were the most prescribed antimicrobials; aminoglycosides, penicillins and cephalosporins were the most common class of antimicrobial prescribed. Protected antimicrobials (WHO HPCIA and rifampicin) represented 24% of antimicrobial dispensations. The pattern of classes of antimicrobial used by body system was broad and included up to eight different pharmaceutical classes. The heterogeneity of antimicrobial use was confirmed by the estimate of the prescription diversity index. Antimicrobial prescriptions were in compliance with prudent use recommendations in terms of availability of diagnosis, respect of the dose range and duration of treatment On the contrary, principles of appropriate antimicrobial use have only been partially observed in relation to off-label use, use of antimicrobials in empirical combination, use of antimicrobial susceptibility tests and use of protected antimicrobials, suggesting that additional interventions are required to improve the responsible use of antimicrobials use in our equine practice.

BrSPR-20-P1 peptide isolated from Brevibacillus sp. developed into liposomal hydrogel as a potential topical antimicrobial agent.

A novel BrSPR-20-P1 antimicrobial peptide (P1-AMP; NH2-VVVNVLVKVLPPPVV-COOH) isolated from Brevibacillus sp. SPR-20 was encapsulated in a liposome containing varying proportions of l-α-phosphatidylcholine (PC) and cholesterol (CH). P1-AMP liposomes were incorporated into a chitosan hydrogel to achieve a peptide concentration of 0.02%. P1-AMP has been tested for its antibacterial and in vitro wound healing activities. The physicochemical characteristics of liposomes and hydrogel were investigated, including in vitro drug release, permeability, cell toxicity, antimicrobial activities, and stability studies. P1-AMP showed higher antimicrobial and wound-healing activities than the negative control. A toxicity test of P1-AMP in keratinocyte cell lines revealed cell viability of 100% at a concentration range of 1.96-1000 μg mL-1. The empty liposomes exhibited an average particle size ranging from 324.5 ± 8.6 to 1823.7 ± 288.2 nm. The size range of P1-AMP liposomes was 378.6 ± 14.0 to 2363.0 ± 255.6 nm. The zeta potential of the blank liposome ranged from -40.43 ± 2.51 to -60.17 ± 0.93 mV and it decreased to -57.33 ± 0.72 to -70.33 ± 0.15 mV of the liposome loaded with peptide. SEM images showed liposomes were ovoid spheres with smooth surfaces. The chosen formulation, composed of PC to CH in an 18 : 1 ratio (formulation F3), had the highest entrapment effectiveness with small particle size and possessed an acceptable zeta potential. The developed P1-AMP liposome-loaded hydrogels exhibited a yellowish-clear appearance with a viscosity of 758.0 ± 149.8 cPs. The P1-AMP was rapidly released from the P1-AMP-loaded liposome hydrogel formulation. The P1-AMP-loaded liposome showed high permeability compared to P1-AMP alone or P1-AMP in hydrogel without the incorporation of liposomes. The minimum inhibitory concentration (MIC) against Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) of P1-AMP-loaded liposome hydrogel was 2 μg mL-1, equivalent to P1-AMP. It completely killed S. aureus at 10× and 5× MIC after 6 and 12 h of incubation, respectively. The formulation did not induce cytotoxicity to the tested keratinocyte cell and remained stable for at least 6 months under the studied conditions.

MODIFICATION OF MUKHADOOSHIKARI LEPA INTO GEL

Facial expressions are crucial in interpreting emotions on first encounters, and everyone desires an attractive face to fit into society. Youvana Pidika/Mukhadooshika (Acne Vulgaris) is a skin disorder that can significantly impact young people's beauty and confidence. Cosmetology is a science focusing on beautification, with various treatment options, including topical therapies, antimicrobials, hormones, surgery, and UV radiation, each with its limitations. Ayurveda's unique beauty concept, characterized by effective, affordable, and long-lasting treatments, is highly sought after in cosmetology, mainly through shodhana and shamana chikitsa. External applications of Ayurveda's lepa, like Vachadi and Manjisthadi lepa, significantly impact youvana Pidaka's features but have disadvantages like patient acceptability, portability, and time consumption. The current research aims to modify the traditional lepa into a gel form for treating youvana pidika/mukhadooshika (Acne Vulgaris). Kashaya was prepared using drugs Usheera, Dhanyaka, Chanaka, Pushkara Mula, Vacha, Lodhra, and Manjishta and modified into the gel using additives like gelling agents. i.e. carbopol and preservatives i.e. parabens. On preliminary analysis, it was observed that the gel has a dark brown colour, 3.78 pH, 20.5% spreadability and 16 total suspended solids. Overall, this research project aims to improve the treatment experience for individuals with youvana pidika/mukhadooshika by developing a modified gel formulation that offers advantages such as lightweight, quick absorbability, non-greasy texture, and hydration.

Knowledge Regarding Surgical Site Infection Among Post-Operative Bariatric Surgical Patients in Al Ahsa City

Patient knowledge of surgical site infection (SSI) is essential for their safety and reduced complications. This study aimed to assess the knowledge and awareness of post-surgical site infections among post-bariatric surgical patients in Al Ahsa City. The research, conducted with 90 participants, revealed that Patient knowledge of surgical site infection is a fair level of knowledge (55.6%), while the remaining 44.4% exhibited a poor level of knowledge. Descriptive analysis provided insights into participants' personal data, education, work, previous surgery, and post- surgical infection. Notably, 65.6% of participants were not employed, and 44 (48.9%) had a history of previous operations, with 13 (14.4%) reporting experiences of post-surgery infections. Participants' knowledge and awareness of SSIs were also evaluated, with a majority demonstrating awareness of various SSI symptoms and preventive measures. Overall, 55.6% of participants exhibited a good level of knowledge and awareness about SSIs. Furthermore, the study highlighted healthcare professionals as the most commonly reported sources of information about post-surgical site infections. These findings emphasize the importance of tailored educational interventions to increase the level of knowledge and enhance patient understanding of SSI symptoms and preventive measures among post-bariatric surgical patients. The study underscores the significance of considering demographic and experiential factors in developing targeted patient education strategies to improve post-surgery infection awareness and promote patient safety and decreased the rate of readmission following bariatric surgery. Future research can explore the educational interventions such as the use of virtual clinic. Background Patient knowledge of surgical site infection (SSI) is essential for their safety and reduced complications. Literature Review An infection at the surgical site in a deep or superficial wound within 30 days of the surgery is called a surgical site infection. Emergency surgeries (p=0.0001), American Society of Anesthesiologists high index (47.4%), long duration of surgical procedures, stay in the hospital before surgery for more than 24 hours and age from 18 to 81 years were found to be important contributing factors for SSI in this article by [1]. Surgical site infection is the third most commonest infection in the hospital, found in up to 38% of surgical patients. The rate of mortality is 77%. About 93% of patients have severe infections at the site of operation [2]. Surgical site infections reported by a national survey conducted in England hospitals was 1807 cases among various specialties and procedures [3]. Moreover, 1.7% of 120 patients' surgical site infections in the last 5 years were reported by researchers in Riyadh (Alotaibi et al., 2020). A previous study found that surgical site infection is more common among obese patients undergoing abdominal surgery (p<0.001) [4]. Pseudomonas aeruginosa, Staphylococcus aureus, and coagulase-negative staphylococci were the most frequently isolated organisms in surgical sites (Julius et al., 2018). Surgical site infection is a life-threatening if not managed well. It can lead to various complications such as reoperation (36.2%) and readmission (49.7%). Moreover, SSI correlates with delayed discharge from the hospital by 34.1% [3]. A study done on the economic burden caused by SSI found that the median additional cost attributable to SSI was to the tune of 5,239 GBP in a 2-year study done in an NHS trust hospital [5]. Based on relevant practical guidelines, antimicrobial prophylaxis should be administered before surgical procedures and patients should take complete bath with or without antimicrobial soap. Before making a skin incision, clean the skin with an antiseptic solution. Avoid topical antimicrobial agents at the surgical incision after surgery [6]. Surgical site infection is one of the most commonly acquired infections at hospitals. Determination of knowledge of patients on SSI and symptoms may be useful in improving their awareness and safety after discharge. Therefore, in this study, we will evaluate patients' knowledge of SSI and its symptoms.

Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study.

We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13-month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true-positive results for bacteremia, and 324 (59.1%) patients showed true-negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone-iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7-22.6; p < 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3-31.9, p < 0.001 and 41.1%, 95% CI 22.2-59.9, p < 0.001, respectively). Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant.

External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment algorithm

BackgroundExternal peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. MethodsA retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone. ResultsA total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. ConclusionNon-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.

Review of the role of biofilms in equine wounds: Clinical indications and treatment strategies

SummaryRecognition of the role that biofilms play in the persistence of wounds and lack of response to therapy in horses is increasing. Prevention of biofilm development in the early stages of wound care involves three primary strategies: wound debridement and cleansing to reduce bacterial counts in the wound bed, appropriate use of advanced wound dressings and implementation of topical antimicrobial agents. Once formed, eradication of biofilms requires elimination to improve the wound environment for contraction and epithelialisation while not further harming the native cells integral to the healing process, which is achieved predominantly through repeated lavage and debridement combined with topical antimicrobial therapy. Pseudomonas, Enterococcus and Staphylococcus bacterial species have been most commonly identified in equine wounds with delayed healing. This review will establish why and how biofilms form, how to recognise clinical indications that biofilms have formed in equine wounds and review current diagnostic options and biofilm‐based wound care strategies to eradicate biofilms. Clinical scenarios for cases in which biofilms developed and were successfully treated will be presented. This review will advance practitioners' understanding of the presence and role of biofilms in equine wounds and provide an updated summary of recommended treatment strategies.

Population-based outpatient antimicrobial use in Newfoundland and Labrador: a retrospective descriptive study.

Data that have been reported on antimicrobial use in Newfoundland and Labrador (NL) do not appear to be representative of use at the population level. We sought to use pharmacy network data on prescriptions to describe outpatient antimicrobial use in NL. We analyzed all outpatient antimicrobial prescriptions dispensed between June 1, 2017, and June 8, 2021, from the provincial pharmacy network database and translated deidentified data into SPSS. We excluded prescriptions for parenteral and topical antimicrobials, antivirals and antifungals. We described antimicrobial use using the prescription rate and defined daily dose (DDD) rate. Overall, we analyzed 1 586 534 prescriptions dispensed to 394 708 people by 3431 prescribers. The rate of antimicrobial use was 741 prescriptions per 1000 population per year (7161 DDD/1000 population/yr). The median duration of prescriptions was 7 (interquartile range 7-10) days. The prescription rate decreased from 867 to 546 per 1000 population per year (-37%) over the study period, and the mean DDD rate decreased from 8387 to 5356 DDD per 1000 population per year (-36.1%). Antimicrobials with the highest DDD rate were amoxicillin (1568 DDD/1000/yr), doxycycline (864 DDD/1000/yr) and ciprofloxacin (633 DDD/1000/yr). Prescribers wrote a mean of 102 (standard deviation 248) prescriptions per year; 3 prescribers wrote more than 2500 prescriptions per year. Overall, 9203 (2.3%) of the 394 708 people in the study population received 4 or more prescriptions per year. The rate of antimicrobial use in NL is lower than previously described in national surveillance data. Potential targets for stewardship intervention include prolonged duration of prescriptions, high-rate prescribers and high-rate patients, but further research is needed to assess the appropriateness of prescriptions according to diagnosis.

CLINICO-MICROBIOLOGICAL SPECTRUM OF HEMODIALYSIS CATHETER-RELATED BLOOD STREAM INFECTIONS: A CONCISE REVIEW

The disease burden of chronic kidney disease is increasing worldwide, and with the growing population of patients requiring hemodialysis, more patients are placed on central venous catheters (CVCs). Vascular access infections significantly cause hospitalization and mortality among end-stage renal disease (ESRD) patients. As per the data from the United States, Gram-positive organisms account for almost 56% of the total cases of catheter-related bloodstream infection (CRBSI), in stark contrast to Indian studies showing a dominance of Gram-negative organisms. The prolonged use of non-tunnelled catheters, poor hygiene, lack of catheter care protocols, and the tropical climate pose unique challenges to control CRBSIs in resource-poor countries. The most effective strategy to prevent CRBSI is to minimize the duration of dialysis catheters. Other strategies include the introduction of strict catheter care protocols, using tunnelled cuffed catheters, anti-microbial lock solutions, and topical antimicrobials. Eradicating nasal carriage of Staphylococcus aureus also reduced the incidence of CRBSIs.Treatment of suspected CRBSI should be promptly initiated with empirical broad-spectrum antibiotics covering Gram-positive and Gram-negative organisms. Catheter removal is indicated only if the patient is clinically unstable, has metastatic infections, and those who do not respond to antibiotic therapy.

The effects of topical mafenide acetate application on skin graft survival in bacterial contaminated wounds

BackgroundInfection related skin graft loss still remains as a common problem even with the use of systemic antibiotics. Mafenide acetate (Sulfamylon) is a topical antimicrobial agent with a wide spectrum of antimicrobial activity. Since mafenide acetate has the ability to penetrate the burn eschar, it was preferred in the treatment of infected full-thickness skin grafts. We investigated the effects of topical Mafenide acetate application on graft survival in an experimental model of contaminated wound beds in rats. Materials and methodsTwenty-eight male Wistar albino rats were included in the study. A full-thickness skin graft (FTSG) was harvested from the back region and the wound bed was inoculated with Pseudomonas aeruginosa. The same FTSG was sutured in place. Rats were divided into 4 groups. In groups 1 and 2, wound care was performed with gauze and hydrofiber dressings respectively. In groups 3 and 4, Mafenide acetate soaked hydrofiber and Mafenide acetate soaked gauze dressings were used respectively. The dressings were closed for 4 days in all groups. The rats in groups 1 and 2 received dressing changes every day. The dressing of the rats in group 3 was changed once every two days. The dressing of the rats in group 4 was changed twice a day. ResultsIn groups 3 and 4, the graft survival rates decreased significantly from day 7 to day 14 in all groups. Histologically, detachment at the dermoepidermal junction, disorganization of collagen along with increased numbers of fibroblasts and a decrease in graft adhesion to the wound bed were determined in Mafenide acetate-treated groups. ConclusionIn rats treated with Mafenide acetate, graft survival was higher on day 7 and gradually decreased towards day 14. Application of a 2.5% solution of Mafenide acetate longer than 7 days on inoculated skin grafts in a rat model causes significant cytotoxicity and graft loss.

Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study.

To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.

Study of the antimicrobial activity of cationic carbosilane dendrimers against clinical strains of multidrug-resistant bacteria and their biofilms.

Antimicrobial Resistance is a serious public health problem, which is aggravated by the ability of the microorganisms to form biofilms. Therefore, new therapeutic strategies need to be found, one of them being the use of cationic dendritic systems (dendrimers and dendrons). The aim of this study is to analyze the in vitro antimicrobial efficacy of six cationic carbosilane (CBS) dendrimers and one dendron with peripheral ammonium groups against multidrug-resistant bacteria, some of them isolated hospital strains, and their biofilms. For this purpose, minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), minimum biofilm inhibitory concentration (MBIC) and minimum eradication biofilm concentration (MBEC) studies were carried out. In addition, the cytotoxicity on Hela cells of those compounds that proved to be the most effective was analyzed. All the tested compounds showed in vitro activity against the planktonic forms of methicillin-resistant Staphylococcus aureus and only the dendrimers BDSQ017, BDAC-001 and BDLS-001 and the dendron BDEF-130 against their biofilms. On the other hand, only the dendrimers BDAC 001, BDLS-001 and BDJS-049 and the dendron BDEF-130 were antibacterial in vitro against the planktonic forms of multidrug-resistant Pseudomonas aeruginosa, but they lacked activity against their preformed biofilms. In addition, the dendrimers BDAC-001, BDLS-001 and BDSQ-017 and the dendron BDEF-130 exhibited a good profile of cytotoxicity in vitro. Our study demonstrates the possibility of using the four compounds mentioned above as possible topical antimicrobials against the clinical and reference strains of multidrug-resistant bacteria.

Umbilical Cord Care by Topical Application of Kushta Tail

Newborn health &amp; survival depends on the care given to the newborn, although care is a very essential element in reducing child mortality, it often receives less than the optimum attention. The World Health Organization (WHO) estimates that ~ 4 million children die during the neonatal period each year, with most deaths occurring in developing countries. About 25% of global neonatal death / year occur in India alone &amp; amongst them bacterial infections count for about 36%, of which umbilical cord infections are an important precursor. Application of topical antimicrobials having ample of side effects like local irritation, allergic &amp; contact dermatitis and local tissue destruction. Topical medications being one amongst the routes of drug administration have also been appreciated in our ayurvedic classics also. The importance and necessity of nabhinalparicharaya are very clearly understood by Acharyas and are vividly stated in the samhitas. The present study was undertaken to evaluate the role of our classical method to cut the cord at 4 angul (7.5cm) and medication kustha taila local application in protecting umbilical sepsis in healthy new born. This study provide nil discharges, no swelling&amp; redness and minimal microbial growth percentage from the sample of umblical stump culture, till the day 15 of new born.

A case of postoperative sclerotomy site infection secondary to hordeolum externum

Postoperative infective scleritis is a rare entity, often reported following pterygium surgery involving anti-metabolites. Infective scleritis following hordeolum has not been reported before. We report a case of hordeolum externum that developed 3 days post uneventful vitreoretinal surgery that led to sclerotomy site infection. The condition was managed successfully with topical and systemic antimicrobials based on microbiology. This case also highlights the importance of proper examination of the lid, adnexa, and sclerotomy sites in the postoperative period.

A Clinical Trial Design for Evaluating Topical Antimicrobials in Chronic Wounds: The BLEU Trial.

Chronic wound management is a global challenge. Millions of patients suffer from nonhealing ulcers and health systems are overwhelmed by the growing demand for treatment. Despite the prevalence of chronic wounds, the emergence of wound centers and specialized physicians is a recent phenomenon. Likewise, clinical research in wound healing is in its infancy. To date, many of the products in wound care have little or no clinical evidence. The field needs standardized clinical trial design, endpoints recognized by clinicians and payers, and improved overall clinical evidence. Wound healing is impeded by the presence of bacterial biofilms, which exist in most chronic wounds. It is not surprising that biofilm disruption is the focus of wound management and essential to the healing process. Multiple laboratory and preclinical studies demonstrate promising efficacy of several antimicrobials in treating biofilms; however, the field lacks in vivo clinical studies. In addition, a standardized trial design to evaluate efficacy of antimicrobials in chronic wounds does not exist. The advent of new diagnostic technologies, such as fluorescence imaging, has led to clinical trial designs that are reliable, easier to conduct, and cost efficient. The protocol presented here describes a randomized controlled double-blind trial designed to evaluate antiseptics in chronic wounds.

Surgical site infection prophylaxis: what have we learned and are we making progress?

This review aims to discuss the current state of surgical antimicrobial prophylaxis (SAP) evidence for surgical site infection prevention. Despite decades of research, knowledge gaps persist in identifying optimal SAP regimens. Recent randomised controlled trials highlight ongoing heterogeneity in study design. Key new findings support the use of oral preoperative SAP for colorectal surgery and advise against the use of SAP for transperineal prostate biopsy. There is growing evidence for culture-based SAP over empiric use for transrectal prostate biopsy.Contentious issues remain regarding topical antimicrobials for cardiac procedures involving sternotomy, the necessity of SAP for wire lumpectomy and laparoscopic cholecystectomy for both mild or moderate acute cholecystitis. Procedures where SAP is not indicated, yet research is still being conducted on this topic include dental implants and clean orthopaedic procedures. Research efforts continue with numerous trials published and registered to determine optimal SAP regimens. However, many efforts are suboptimal due to poor statistical design and redundant questions already answered by existing literature. To improve practice and influence surgeons prescribing behaviour future RCTs should be well powered, with large sample sizes across multiple sites, focusing on clinically relevant questions.

Efficacy and optimal dose of acetic acid to treat colonised burns wounds: protocol for a pilot randomised controlled trial

IntroductionDespite of recent advancement in the burns wound management, burn wound infection (BWI) is still one of the major cause of burns mortality. Patients who survive their burns injury still...

PH-sensitive bilayer electrospun nanofibers based on ethyl cellulose and Eudragit S-100 as a dual delivery system for treatment of the burn wounds; preparation, characterizations, and in-vitro/in-vivo assessment

A pH-sensitive bilayer electrospun nanofibrous mat containing both antibiotic (gentamicin sulfate, GEN) and non-steroidal anti-inflammatory (diclofenac sodium, DIC) drugs was fabricated for burn wound dressing by electrospinning technique, in which ethyl cellulose (EC) and ethyl cellulose/Eudragit S-100 (EC/ES-100) formed the top and bottom layers, respectively. The fabricated pH-sensitive bilayer electrospun nanofibrous mats were characterized from aspects of both structure and efficiency. Physicochemical properties were investigated via SEM, FTIR, and TGA. The swelling ratio and in vitro drug release of the fabricated nanofibrous mats were studied in different pHs. MTT was applied to assess the safety of the fiber mats. Finally, the in vivo efficiency of the designed pH-sensitive bilayer electrospun nanofibrous mats was examined on the male Wistar rats. Based on the histological analysis and wound healing test (in vivo animal experiments), the (ES100/EC-DIC/GEN)-(EC) pH-sensitive bilayer nanofibrous mat displayed faster wound healing than other bilayer nanofibrous mat. As a result, (ES100/EC-DIC/GEN)-(EC) bilayer nanofibrous mat with pH-responsion could accelerate the burn wound healing process via decreasing the adverse effects of GEN and DIC as topical antimicrobial and anti-inflammatory agents, receptively.