The role of phage therapy in burn wound infection management: advantages and pitfalls

Multi-resistant organisms in burn patients: an end or a new beginning

Infections are a major cause of morbidity and mortality in burn patients, and the rise of multidrug-resistant organisms (MDROs) has made it more challenging to manage and prevent infections. This review examines the available treatment options for MDROs in burn patients and anticipates the future challenges posed by their increasing prevalence. The review covers new antibiotics, such as Eravacycline and Plazomicin, as well as non-antibiotic therapies, such as bacteriophages and nanoparticles. Future research should focus on examining the long-term efficacy, cost-effectiveness, and in vivo efficacy of different treatment modalities. The potential of alternative therapies, such as probiotics and low-frequency magnetic fields, should also be explored. Accurate and rapid diagnostic and monitoring tools for detecting MDROs in burn patients should be developed. The emergence of MDROs in burn care is a challenge and a new beginning in infection innovation and novel treatments.

Sepsis in surgical patients: Burn sepsis

Patients with large burn injuries remain a challenge. The loss of skin barrier integrity and induced immunosuppression after injury increases their vulnerability to infection. Sepsis remains the primary cause of death for burn-injured patients who survive their acute injury and resuscitation. The objective of this work is to describe the current understanding and management of sepsis in the burn-injured patient and newer strategies to approach its management. Current understanding of the systemic inflammatory response to burn injury and sepsis, preventative strategies, and novel research will be discussed. Understanding the origin of burn sepsis from wounds themselves is key to understanding current paradigms. Infection control and management begins from the time of injury and continues throughout the patient's hospital course. The use of personal protective equipment, burn unit design considerations, and optimization of prevention protocols and catheter care all play a role in burn sepsis prevention and management. The emergence of drug-resistant pathogens poses a particular challenge for burn patients due to the chronicity with which their wounds are sometimes open. The difficulty of systemic antibiotics to reach wounds has underscored the need to anticipate resistant organisms moving forward. Antibiotic strategies and newer approaches, such as phage therapy, will be discussed. Multi-omics approaches to understanding burn sepsis have developed in hopes of identifying patients more susceptible or at risk of developing burn sepsis. As with many aspects of burn care, a multidisciplinary, proactive approach to the management of burn sepsis is key to minimizing the morbidity and mortality associated with this complication.

Bacterial Swarm-Mediated Phage Transportation Disrupts a Biofilm Inherently Protected from Phage Penetration

Physical forces that arise due to bacterial motility and growth play a significant role in shaping the biogeography of the human oral microbiota. Bacteria of the genus Capnocytophaga are abundant in the human oral microbiota and yet very little is known about their physiology. The human oral isolate Capnocytophaga gingivalis exhibits robust gilding motility that is driven by the rotary type 9 secretion system (T9SS), and cells of C. gingivalis transport nonmotile oral microbes as cargo. Phages, i.e., viruses that infect bacteria, are found in abundance within the microbiota. By tracking fluorescently labeled lambda phages that do not infect C. gingivalis, we report active phage transportation by C. gingivalis swarms. Lambda phage-carrying C. gingivalis swarms were propagated near an Escherichia coli colony. The rate of disruption of the E. coli colony increased 10 times compared with a control where phages simply diffused to the E. coli colony. This finding suggests a mechanism where fluid flows produced by motile bacteria increase the rate of transport of phages to their host bacterium. Additionally, C. gingivalis swarms formed tunnel-like structures within a curli fiber-containing E. coli biofilm that increased the efficiency of phage penetration. Our data suggest that invasion by a C. gingivalis swarm changes the spatial structure of the prey biofilm and further increases the penetration of phages. IMPORTANCE Dysbiosis of the human oral microbiota is associated with several diseases, but the factors that shape the biogeography of the oral microbiota are mostly opaque. Biofilms that form in the human supragingival and subgingival regions have a diverse microbial community where some microbes form well-defined polymicrobial structures. C. gingivalis, a bacterium abundant in human gingival regions, has robust gliding motility that is powered by the type 9 secretion system. We demonstrate that swarms of C. gingivalis can transport phages through a complex biofilm which increases the death rate of the prey biofilm. These findings suggest that C. gingivalis could be used as a vehicle for the transportation of antimicrobials and that active phage transportation could shape the spatial structure of a microbial community.

Bioprospecting the Skin Microbiome: Advances in Therapeutics and Personal Care Products

Bioprospecting is the discovery and exploration of biological diversity found within organisms, genetic elements or produced compounds with prospective commercial or therapeutic applications. The human skin is an ecological niche which harbours a rich and compositional diversity microbiome stemming from the multifactorial interactions between the host and microbiota facilitated by exploitable effector compounds. Advances in the understanding of microbial colonisation mechanisms alongside species and strain interactions have revealed a novel chemical and biological understanding which displays applicative potential. Studies elucidating the organismal interfaces and concomitant understanding of the central processes of skin biology have begun to unravel a potential wealth of molecules which can exploited for their proposed functions. A variety of skin-microbiome-derived compounds display prospective therapeutic applications, ranging from antioncogenic agents relevant in skin cancer therapy to treatment strategies for antimicrobial-resistant bacterial and fungal infections. Considerable opportunities have emerged for the translation to personal care products, such as topical agents to mitigate various skin conditions such as acne and eczema. Adjacent compound developments have focused on cosmetic applications such as reducing skin ageing and its associated changes to skin properties and the microbiome. The skin microbiome contains a wealth of prospective compounds with therapeutic and commercial applications; however, considerable work is required for the translation of in vitro findings to relevant in vivo models to ensure translatability.

A Narrative Review of the Potential Roles of Lipid-Based Vesicles (Vesiculosomes) in Burn Management

Burn injuries can have a lasting effect on people’s quality of life, as they negatively impact their physical and mental health. Then, they are likely to suffer psychological problems as a result. A serious problem is that deep burns are more challenging to treat due to their slow healing rate and susceptibility to microbial infection. Conventional topical medications used for burn treatment are sometimes ineffective because they cannot optimize their ability of transcutaneous absorption at the targeted site and accelerate healing. However, nanotechnology offers excellent prospects for developing current medical wound therapies and is capable of addressing issues such as low drug stability, water solubility, permeability, and bioavailability. The current review focuses on lipid-based vesicles (vesiculosomes) as an example of advanced delivery systems, showing their potential clinical applications in burn wound management. Vesiculosomes may help overcome impediments including the low bioavailability of active agents, offering the controlled release of drugs, increased drug stability, fewer side effects, and reduced dosing frequency, which will ultimately improve therapeutic efficacy and patient compliance. We discuss the application of various types of vesiculosomes such as liposomes, niosomes, ethosomes, cubosomes, transfersomes, and phytosomes in burn healing therapy, as these demonstrate superior skin penetration compared to conventional burn topical treatment. We also highlight their noteworthy uses in the formulation of natural products and discuss the current status as well as future perspectives of these carriers in burn management. Furthermore, the burn treatment options currently available in the market are also summarized.