Treatment Of Burn Wound Infection Research Articles

Bacteriophage therapy reduces Staphylococcus aureus in a porcine and human ex vivo burn wound infection model.

Burn wounds are a major burden, with high mortality rates due to infections. Staphylococcus aureus is a major causative agent of burn wound infections, which can be difficult to treat because of antibiotic resistance and biofilm formation. An alternative to antibiotics is the use of bacteriophages, viruses that infect and kill bacteria. We investigated the efficacy of bacteriophage therapy for burn wound infections, in both a porcine and a newly developed human ex vivo skin model. In both models, the efficacy of a reference antibiotic treatment (fusidic acid) and bacteriophage treatment was determined for a single treatment, successive treatment, and prophylaxis. Both models showed a reduction in bacterial load after a single bacteriophage treatment. Increasing the frequency of bacteriophage treatments increased bacteriophage efficacy in the human ex vivo skin model, but not in the porcine model. In both models, prophylaxis with bacteriophages increased treatment efficacy. In all cases, bacteriophage treatment outperformed fusidic acid treatment. Both models allowed investigation of bacteriophage-bacteria dynamics in burn wounds. Overall, bacteriophage treatment outperformed antibiotic control underlining the potential of bacteriophage therapy for the treatment of burn wound infections, especially when used prophylactically.

Prospects for the application of cell therapy in combustiology

Currently, one of the urgent problems in the field of surgery and traumatology is burn injury. A significant part of the victims has deep and extensive burns, the treatment of which is the most difficult problem of modern combustiology. In this aspect, one of the main problems faced by surgeons in combustiology is the lack of donor material and an increased risk of complications of burn wounds. In this regard, the most promising direction in kombustiology is the application of cell engineering methods, including the use of fibroblasts and stem cells. Fibroblasts have a number of advantages, such as efficiency, safety and accessibility. Stem cells are also a common method of cell therapy, they have great potential in regenerative processes. Mesenchymal stem cells (MSCs), which have a pronounced regenerative and immunosuppressive effect, are also used in kombustiology. In the treatment of infected burn wounds, phage therapy, which provides lysis of infectious pathogens, showed a positive result. In addition to fighting pathogens, bacteriophages, like MSCs, have an immunosuppressive effect, thereby reducing the risk of transplant rejection.

Local Phage Therapy During Surgical Treatment of Burn Wounds Reduces the Risk of Colonization of the Skin of the Periwound Area by Pathogens of the ESKAPE Group

Aim of study To study the effect of local phage therapy alone and in combination with systemic antibiotic therapy on the dynamics of microflora colonizing the skin of the periwound area during surgical treatment of infected burn wounds.Material and methods Scientific hypothesis: the use of local phage therapy in monotherapy in the treatment of burn wound infections reduces the risk of colonization of the skin of the periwound area by bacteria of the ESKAPE group. The experimental study analyzed the results of microbiological studies of washings from the skin surface of 40 animals with infected burn wounds, in the course of phage therapy in monotherapy and in combination with systemic antibiotic therapy.Results In the group of animals receiving phage therapy alone, the proportion of ESKAPE group bacteria colonizing the skin of the periwound area at the time of completion of the course of antimicrobial therapy was 9%, while in the group receiving phage therapy in combination with systemic antibiotic therapy it was 43% (p=0.011).Conclusion The use of local phage therapy in single mode during the surgical treatment of infected burn wounds reduces the risk of colonization of the skin of the peri-wound area by pathogens of the ESKAPE group. At the same time, systemic antibiotic therapy causes an imbalance of resident and transient skin microbiota in the periwound area and an increase in the frequency of its colonization by pathogens of the ESKAPE group.

Immobilization of Bacteriophages in Ex Tempore Hydrogel for the Treatment of Burn Wound Infection.

The resistance of bacteria to antibiotics is a major problem for anti-bacterial therapy. This problem may be solved by using bacteriophages-viruses that can attack and destroy bacteria, including antibiotic-resistant ones. In this article, the authors compared the efficacy of topical bacteriophage therapy and systemic antibiotic therapy in the treatment of wound infections caused by ESKAPE pathogens in patients with limited (less than 5% of the body surface) full-thickness burns. Patients in the study group (n = 30) were treated with PVA-based hydrogel dressings saturated ex tempore with a bacteriophage suspension characterized by its lytic activity against the bacteria colonizing the wound. Patients in the control group (n = 30) were treated using etiotropic systemic antibiotic therapy, and the wounds were covered with gauze bandages soaked in an aqueous solution of povidone-iodine. An assessment of the decrease in the level of bacterial contamination of the recipient wounds in both groups was conducted after 7 days, and after that, free skin grafting was performed. On day 14 after free skin grafting, patients in both groups underwent incisional biopsy. The study group demonstrated an increase in the indices of proliferative activity (Ki-67), and angiogenesis (CD-31, VEGF) in the area of engraftment of the split-thickness skin grafts. The results indicate that PVA-based hydrogel wound dressings can be used as bacteriophage carriers for local antimicrobial therapy ahead of free skin grafting.

3D Printed Chitosan/Alginate Hydrogels for the Controlled Release of Silver Sulfadiazine in Wound Healing Applications: Design, Characterization and Antimicrobial Activity.

The growing demand for personalized medicine requires innovation in drug manufacturing to combine versatility with automation. Here, three-dimensional (3D) printing was explored for the production of chitosan (CH)/alginate (ALG)-based hydrogels intended as active dressings for wound healing. ALG hydrogels were loaded with 0.75% w/v silver sulfadiazine (SSD), selected as a drug model commonly used for the therapeutic treatment of infected burn wounds, and four different 3D CH/ALG architectures were designed to modulate the release of this active compound. CH/ALG constructs were characterized by their water content, elasticity and porosity. ALG hydrogels (Young's modulus 0.582 ± 0.019 Mpa) were statistically different in terms of elasticity compared to CH (Young's modulus 0.365 ± 0.015 Mpa) but very similar in terms of swelling properties (water content in ALG: 93.18 ± 0.88% and in CH: 92.76 ± 1.17%). In vitro SSD release tests were performed by using vertical diffusion Franz cells, and statistically significant different behaviors in terms of the amount and kinetics of drugs released were observed as a function of the construct. Moreover, strong antimicrobial potency (100% of growth inhibition) against Staphylococcus aureus and Pseudomonas aeruginosa was demonstrated depending on the type of construct, offering a proof of concept that 3D printing techniques could be efficiently applied to the production of hydrogels for controlled drug delivery.

ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES

Background. Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns. Objective. The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics. Methods. The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007. Results. The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant. Conclusions. Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.

Conventional Treatment of Burn Wound Infections versus Phage Therapy

Conventional Treatment of Burn Wound Infections versus Phage Therapy

Topical Antimicrobial Agents for Burn Wound Care: History and Current Status.

Background: Infection is the leading cause of death after thermal injury. Optimal prevention and treatment of burn wound infection is enabled by an in-depth understanding of burn wound treatment modalities not only from a technical standpoint, but also from the standpoint of the clinical context in which these modalities were originally developed. Methods: A review of the historical literature on the topical antimicrobial care of burn wounds was performed. Results: As our understanding of post-burn infection evolved, and as new products were developed for the prevention of post-burn wound infection, major advances in post-burn survival occurred. Ultimately, improvements in anesthetic, surgical, and critical care management have permitted early excision and grafting of the burn wound, decreasing but not eliminating the importance of topical antimicrobial care, and shifting much of the burden of wound infection prevention to the post-operative period. Conclusions: The development of effective topical antimicrobial agents for wound care was, arguably, the single most important advance in the care of the burn patient. Still, many gaps in our ability to treat complicated burn wounds remain. Fungal infection is an unusual but daunting challenge. Patients with impaired wound healing and those with advanced age or medical comorbidities may not benefit from early excision, and the benefits of early excision may not be available in austere or remote locations. For these reasons, research on optimal topical treatment continues.

Biosynthesis of Zinc oxide nanoparticles and their application for antimicrobial treatment of burn wound infections

The current study demonstrated the green fabrication of Zinc oxide nanoparticles (ZnO NPs) using the leaf extract of Coleus amboinicus (C. amboinicus) by an environment-friendly method. The leaf extract of C. amboinicus acts as capping and reducing agent during the fabrication of ZnO NPs. The prepared ZnO NPs were characterized by utilizing analytical techniques such as photoluminescence spectroscopy (PL), Transmission Electron microscopy (TEM), Energy dispersive spectroscopy (EDS), Fourier transform infrared spectroscopy (FTIR), UV–visible spectroscopy (UV–vis) and x-ray diffraction spectroscopy (XRD). The XRD pattern confirmed the formation of polydisperse ZnO NPs having crystalline nature. The FTIR spectrum demonstrated the biomolecular capping on the surface of zinc oxide nanoparticles. The prepared ZnO NPs displayed excellent antimicrobial activities over several gram positive and gram-negative microbial pathogens. Further, wound healing studies in rats revealed that wound closure rate was greater in the ZnO NPs treated rats at all doses when related with the untreated group (negative control group), therefore, this indicates the effective wound healing ability of prepared ZnO NPs.

Potentiation effects of antimicrobial photodynamic therapy on quorum sensing genes expression: A promising treatment for multi-species bacterial biofilms in burn wound infections.

As the increase in the prevalence of antimicrobial resistant bacterial strains, development of adjuvant antimicrobial approach for the treatment of burn wound infection is important. Therefore, the aim of this study was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) using indocyanine green (ICG) in reducing the bacterial load and expression profiling of the quorum sensing (QS) system associated with the biofilm formation in multi-species bacterial biofilms. Multi-species bacterial suspension including Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus were photosensitized with ICG, which was excited at a wavelength of 810 nm. After evaluating the dose of ICG-aPDT contributing to the sub-significant reduction of colony forming unit (CFU)/mL, the gene expression levels of abaI, agrA, and lasI were assessed using real-time quantitative reverse transcription polymerase chain reaction. As well as, lipid peroxidation, superoxide radicals and reactive oxygen species (ROS) were measured and the morphological changes of multi-species bacteria were evaluated by scanning electron microscopy (SEM). According to the results, maximal sub-significant reduction dose of aPDT against CFUs/mL of multi-species bacterial cells was found with a combination of 31.2 μg/mL of ICG and irradiation by the diode laser for 1 min, with an estimated average output light energy 31.2 J/cm2. The expression levels of abaI, agrA, and lasI in A. baumannii, P. aeruginosa, and S. aureus were down-regulated to approximately 1.9-, 3.7-, and 4.9-fold, respectively. The amount of lipid peroxidation, superoxide radical production, and ROS generation significantly increased (P < 0.05). Also, the cell morphology under SEM showed that ICG-aPDT is a stressful condition for multi-species bacterial cells. ICG-aPDT with antimicrobial, anti-biofilm, and gene expression inhibitor characteristics, as well as, ROS generation can be used for the treatment of burn wound infections in vivo.

New Nanotechnologies for the Treatment and Repair of Skin Burns Infections.

Burn wounds are highly debilitating injuries, with significant morbidity and mortality rates worldwide. In association with the damage of the skin integrity, the risk of infection is increased, posing an obstacle to healing and potentially leading to sepsis. Another limitation against healing is associated with antibiotic resistance mainly due to the use of systemic antibiotics for the treatment of localized infections. Nanotechnology has been successful in finding strategies to incorporate antibiotics in nanoparticles for the treatment of local wounds, thereby avoiding the systemic exposure to the drug. This review focuses on the most recent advances on the use of nanoparticles in wound dressing formulations and in tissue engineering for the treatment of burn wound infections.

A novel wound dressing consisting of PVA-SA hybrid hydrogel membrane for topical delivery of bacteriophages and antibiotics.

The emergence of antibiotic-resistant pathogens has made the treatment of infected burn wounds even more problematical than the pre-antibiotic era. Phage therapy is now being considered a promising treatment options to fight against antibiotic resistant pathogens. Hence, we introduce a novel PVA-SA hydrogel based wound dressing system for topical delivery of bacteriophages and antibiotic to treat infected burn injuries. Hydrogel membrane provides wound healing environment while surface absorbed bacteriophages/antibiotic takes care of the local infection. Different blends of PVA and SA were crosslinked by boric acid and calcium ions to form the hydrogel membrane and assessed for ideal wound dressing properties. 1:2 blended PVA: SA membrane displayed highest swelling index, gel fraction, protein adsorption, hemocompatibility and best mechanical properties among the 3 blends studied in this study. The selected membrane was further characterised by FTIR, FESEM and TGA. Overall, self-adherent, antibacterial and biocompatible membrane was obtained as revealed by the in-vitro antibacterial assays, elution assays and cell cytotoxicity assays. The in-vivo potential was evaluated using MRSA-infected murine burn wound model revealing significant bacterial reduction, wound contraction and reduced inflammation in membrane treated groups in comparison to control group. The dual coated hydrogel membrane delivering both MR10 phage and minocycline proved to be better treatment strategy to treat the resistant burn wound infection rather than phage and antibiotic alone.

Delivery of silver sulfadiazine and adipose derived stem cells using fibrin hydrogel improves infected burn wound regeneration.

Infection control is necessary for improved burn wound regeneration. In this study contact burn wounds were induced on the dorsum of the rats and were infected with Pseudomonas aeruginosa (107cfu/ml of saline) and left overnight (12–14 hours) to establish the infection. After 12 hours, the wounds were treated with PEGylated fibrin hydrogel containing 50 mgs of silver sulfadiazine (SSD) loaded chitosan microsphere (SSD-CSM-FPEG). On day 9, SSD-CSM-FPEG treated burn wounds further received adipose derived stem cell (5×104 ASCs cells/ml) embedded in PEGylated fibrin hydrogel. Wounds were assessed for the healing outcomes such as neovascularization, granulation tissue formation, wound closure and collagen maturation. Analysis of bacterial load in the burn wound biopsies, demonstrated that SSD–CSM-FPEG significantly reduced bacterial infection, while overt infection was still observed in the untreated groups on day 14. Sequential treatment of infected wounds with SSD–CSM-FPEG followed by ASC-FPEGs (SSD-CSM-ASC-FPEG) significantly reduced bacterial colonization (9 log reduction) and pro-inflammatory cytokine (TNF-α) expression. A significant increase in neovascularization markers; NG2 and vWF was also observed. Histological analysis indicated the wounds treated with SSD-CSM-ASC-FPEG increased amount of dermal collagen matrix deposition, a thicker granulation tissue on day 21 and more mature collagen on day 28. This work demonstrates that the sequential treatment of infected burn wounds with SSD-CSM-FPEG followed by ASC-FPEG reduces bacterial infection as well as promotes neo-vascularization with improved matrix remodeling.

The protective effect of Lactobacillus plantarum against meticillin-resistant Staphylococcus aureus infections: an experimental animal model.

To determine and quantitatively measure the protective and/or therapeutic effect of Lactobacillus plantarum (LP) application on a burn wound before and after the onset of meticillin-resistant Staphylococcus aureus (MRSA) infection. Third-degree scald burns affecting 10% of body surface area were formed on the back of five groups of rats. Group 1 was designated as the control group. In Group 2, LP was applied immediately after the burn and then MRSA inoculated. In Group 3, MRSA was applied immediately after the burn and then LP inoculated. Groups 4 and 5 were designated as controls of LP and MRSA. On the fifth and tenth days, bacterial loads and compositions were assessed by tissue biopsies. Each group contained seven rats (n=35). In Group 2, MRSA colony counts were found to be significantly lower compared with the other groups (p<0.05). In Group 3, MRSA colony counts were not found to be significantly different compared with control groups (p>0.05). LP was shown to have a protective role in non-infected, burn wounds when applied before MRSA infection but a therapeutic effect of LP was not demonstrated. LP is thought to have a promising role in the prevention and treatment of burn wound infections.

Fabrication of antibacterial electrospun cellulose acetate/ silver-sulfadiazine nanofibers composites for wound dressings applications

Metals and their nanoparticles, sodium alginate, honey and bacterial cellulose were widely used in the fabrication of scaffolds and wound dressings due to their biocompatibility, but silver sulfadiazine (SSD) is a leading topical antibacterial agent especially for the treatment of burn wound infections. In this novel research study, first time SSD was embedded with nanofibers. The objective of this study was to fabricate the wound dressings by blending of SSD with cellulose acetate (CA) for high profiled antibacterial properties. The resultant electrospun CA/SSD nanofibers revealed the appreciable morphology with uniform blending of SSD in the CA/SSD nanofibers. SEM images showed that the average diameter distribution of CA/SSD nanofibers was uniform with 292 ± 2, 287 ± 4, 293 ± 3 and 286 ± 6 nm. FT-IR spectra revealed that CA/SSD nanofibers having strong chemical interactions between SSD and CA. The XRD spectra and water contact angle test also showed that CA/SSD nanofibers revealed the suitable water absorbency as required for scaffoldings. The resultant CA/SSD nanofibers exhibited the appreciable antimicrobial activity against Gram-negative Escherichia Coli and Gram-positive Bacillus Subtilis bacteria with considerable sustainability for repetitive use. So, CA/SSD nanofibers can be used as a promising & distinguish product for wound dressings applications.

Evaluation of bactericidal and anti-biofilm activities of silver nanoparticles against multidrug-resistant Gram-negative bacilli isolated from burn wound infections

Background: The emergence and spread of multidrug-resistant Gram-negative bacilliin burn wound infections related to biofilm formation, which lend to challenge in treatment with conventional antibiotics andprompting to search for novel antimicrobial agents to control the infections.Silver nanoparticles (AgNPs) have wide spectrum biological properties with different mechanisms of action and less toxicity towards human cells.&#x0D; Objective:The goal of this study was to evaluated the anti-bacterial and anti-biofilm activities of AgNPs alone and in combination with aminoglycoside (Amikacin) and β-lactam (Ampicillin) antibiotics against multidrug resistant Gram-negative bacilli (Pseudomonas aeruginosa, Escherichia coli, klebsiellapneumoniae) isolated from burn wound infections. Type of the study: Cross –sectional study.&#x0D; Methods: 70 clinical isolates of GNBtested for susceptibility tests by disk diffusion method against 10 antibiotics. The minimum inhibitory concentrations (MICs) of AgNPs and antibiotics were carried out according to the standard broth microdilution method, while synergistic interactions were evaluated by time kill-kinetic assays. Calgary method was applied for anti-biofilm activity.&#x0D; Results:Pseudomonas aeruginosa represented the majority of GNBisolated from burn wound infections 34 (48.5 %)followed by Klebsiella pneumonia 21 (30 %) and Escherichia coli 15 (21.5 %). Silver nanoparticles showed remarkable antibacterial activity against GNB that isolated from burn wound infections with the MICs between 25- 75 µg/ml. Aztreonam, amikacin and cefepime were the most effective antimicrobial drugagainst GNB isolates.Synergistic bactericidal effects were observed in two-drug combinations of AgNPswith broad-spectrum aminoglycoside (Amikacin) and β-lactam (Ampicillin) antibiotics against multidrug resistant GNB. In addition,AgNPsalone or in combination with ampicillin inhibited biofilm activity about 60 % – 75 % ofGNB,while combination of AgNPs withamikacin exhibited a powerful anti-biofilm activity and inhibition biofilm formation by 75% to 80%.&#x0D; Conclusion: The results confirmed a synergistic bactericidal effects and significant enhancing of anti-biofilm activity of AgNPs in combination with antibiotics (amikacin and ampicillin) against multidrug resistant GNB isolated from burn wound infections. These data suggest that AgNPs could beapplied as nanodrug for treatment of burn wound infections

Role of Daptomycin on Burn Wound Healing in an Animal Methicillin-Resistant Staphylococcus aureus Infection Model.

Prolonged hospitalization and antibiotic therapy are risk factors for the development of methicillin-resistant Staphylococcus aureus (MRSA) infections in thermal burn patients. We used a rat model to study the in vivo efficacy of daptomycin in the treatment of burn wound infections by S. aureus, and we evaluated the wound healing process through morphological and immunohistochemical analysis. A copper bar heated in boiling water was applied on a paraspinal site of each rat, resulting in two full-thickness burns. A small gauze was placed over each burn and inoculated with 5 × 107 CFU of S. aureus ATCC 43300. The study included two uninfected control groups with and without daptomycin treatment, an infected control group that did not receive any treatment, and two infected groups treated, respectively, with intraperitoneal daptomycin and teicoplanin. The main outcome measures were quantitative culture, histological evaluation of tissue repair, and immunohistochemical expression of wound healing markers: epidermal growth factor receptor (EGFR) and fibroblast growth factor 2 (FGF-2). The highest inhibition of infection was achieved in the group that received daptomycin, which reduced the bacterial load from 107 CFU/ml to about 103 CFU/g (P < 0.01). The groups treated with daptomycin showed better overall healing with epithelialization and significantly higher collagen scores than the other groups, and these findings were also confirmed by immunohistochemical data. In conclusion, our results support the hypothesis that daptomycin is an important modulator of wound repair by possibly reducing hypertrophic burn scar formation.

Stability of bacteriophages in burn wound care products.

Bacteriophages could be used along with burn wound care products to enhance antimicrobial pressure during treatment. However, some of the components of the topical antimicrobials that are traditionally used for the prevention and treatment of burn wound infection might affect the activity of phages. Therefore, it is imperative to determine the counteraction of therapeutic phage preparations by burn wound care products before application in patients. Five phages, representatives of two morphological families (Myoviridae and Podoviridae) and active against 3 common bacterial burn wound pathogens (Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus) were tested against 13 different products commonly used in the treatment of burn wounds. The inactivation of the phages was quite variable for different phages and different products. Majority of the anti-infective products affected phage activity negatively either immediately or in the course of time, although impact was not always significant. Products with high acidity had the most adverse effect on phages. Our findings demonstrate that during combined treatment the choice of phages and wound care products must be carefully defined in advance.

Liposome loaded phage cocktail: Enhanced therapeutic potential in resolving Klebsiella pneumoniae mediated burn wound infections

BackgroundKlebsiella pneumoniae is one of the predominant pathogens in burn wound infections, and prevalence of multidrug resistant strains has further complicated the situation. An increased interest in phage therapy as a means of combating infection has been accruing in recent years. In order to overcome the drawbacks associated with phage therapy, the present study was conducted to evaluate the potential of liposomes as a delivery vehicle for phage in the treatment of burn wound infection. MethodsBurn wound infection with Klebsiella pneumoniae B5055 was established in BALB/c mice. The therapeutic efficacy of free phage cocktail in comparison to liposome entrapped phage cocktail in resolving the course of burn wound infection in mice was evaluated. ResultsThe results depicted that mice treated with liposomal entrapped phage cocktail showed higher reduction in bacterial load in blood and major organs. This was accompanied with faster resolution of the entire infection process as compared to non-liposomal free phage cocktail. The liposomes increased phage retention time in vivo thus potentiating efficacy. Liposomal phage preparation was able to protect all the test animals from death even when there was a delay of 24h in instituting the therapy. ConclusionThe results showed the potential of liposome entrapped phage cocktail for treating Klebsiella pneumoniae mediated infections. Thus, this strategy can serve as an effective approach for treating Klebsiella mediated burn wound infections in individuals who do not respond to conventional antibiotic therapy.

Burn wound healing: present concepts, treatment strategies and future directions.

Burns are the most extensive forms of soft tissue injuries occasionally resulting in extensive and deep wounds and death. Burns can lead to severe mental and emotional distress, because of excessive scarring and skin contractures. Treatment of burns has always been a difficult medical problem and many different methods have been used to treat such injuries, locally. Biofilms are a collection of microorganisms that delay wound healing. One of the new methods of prevention and treatment of burn wound infections is application of antimicrobials, which act on biofilms and prevent the wound infection. Biofilm initiates a persistent, low-grade, inflammatory response, impairing both the epithelialisation and granulation tissue formation. Skin grafts have been shown to dramatically reduce deaths from infection. However, grafting has considerable limitations. Such injuries are long-lasting and many patients suffer from chronic pain for a long time. Tissue engineering is a new approach in reducing the limitations of conventional treatments and producing a supply of immunologically tolerant artificial tissue, leading to a permanent solution for damaged tissues; such criteria make it a cost-effective and reliable treatment modality. To overcome the present limitations of burn wound healing, knowledge about the latest findings regarding healing mechanisms is important. Here the authors discuss the most important events regarding burn wound healing and review the latest treatment strategies that have been used for burn wounds from in vitro to clinical levels. Finally, we discuss the role of tissue engineering and regenerative medicine in the future of burn wound healing, modelling and remodelling.