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Ding X, Tang Q, Xu Z, Xu Y, Zhang H, Zheng D, Wang S, Tan Q, Maitz J, Maitz PK, Yin S, Wang Y, Chen J. Challenges and innovations in treating chronic and acute wound infections: from basic science to clinical practice. Burns Trauma 2022; 10:tkac014. [PMID: 35611318 PMCID: PMC9123597 DOI: 10.1093/burnst/tkac014] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/06/2022] [Indexed: 12/30/2022]
Abstract
Acute and chronic wound infection has become a major worldwide healthcare burden leading to significantly high morbidity and mortality. The underlying mechanism of infections has been widely investigated by scientist, while standard wound management is routinely been used in general practice. However, strategies for the diagnosis and treatment of wound infections remain a great challenge due to the occurrence of biofilm colonization, delayed healing and drug resistance. In the present review, we summarize the common microorganisms found in acute and chronic wound infections and discuss the challenges from the aspects of clinical diagnosis, non-surgical methods and surgical methods. Moreover, we highlight emerging innovations in the development of antimicrobial peptides, phages, controlled drug delivery, wound dressing materials and herbal medicine, and find that sensitive diagnostics, combined treatment and skin microbiome regulation could be future directions in the treatment of wound infection.
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Affiliation(s)
- Xiaotong Ding
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Qinghan Tang
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Zeyu Xu
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Ye Xu
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Hao Zhang
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Dongfeng Zheng
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Shuqin Wang
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Qian Tan
- Department of Burns and Plastic Surgery, The affiliated Drum Tow Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, People's Republic of China
| | - Joanneke Maitz
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Sydney, Australia, 2137
| | - Peter K Maitz
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Sydney, Australia, 2137
| | - Shaoping Yin
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Yiwei Wang
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Jun Chen
- School of Pharmacy, Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
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Toro CM, Janvier J, Zhang K, Fonseca K, Gregson D, Church D, Laupland K, Rabin H, Elsayed S, Conly J. Community-associated methicillin-resistant Staphylococcus aureus necrotizing pneumonia without evidence of antecedent viral upper respiratory infection. Can J Infect Dis Med Microbiol 2014; 25:e76-82. [PMID: 25285117 PMCID: PMC4173983 DOI: 10.1155/2014/952603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND USA300 community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains causing necrotizing pneumonia have been reported in association with antecedent viral upper respiratory tract infections (URI). METHODS A case series of necrotizing pneumonia presenting as a primary or coprimary infection, secondary to CA-MRSA without evidence of antecedent viral URI, is presented. Cases were identified through the infectious diseases consultation service records. Clinical and radiographic data were collected by chart review and electronic records. MRSA strains were isolated from sputum, bronchoalveolar lavage, pleural fluid or blood cultures and confirmed using standard laboratory procedures. MRSA strains were characterized by susceptibility testing, pulsed-field gel electrophoresis, spa typing, agr typing and multilocus sequence typing. Testing for respiratory viruses was performed by appropriate serological testing of banked sera, or nucleic acid testing of nasopharyngeal or bronchoalveloar lavage specimens. RESULTS Ten patients who presented or copresented with CA necrotizing pneumonia secondary to CA-MRSA from April 2004 to October 2011 were identified. The median length of stay was 22.5 days. Mortality was 20.0%. Classical risk factors for CA-MRSA were identified in seven of 10 (70.0%) cases. Chest tube placement occurred in seven of 10 patients with empyema. None of the patients had historical evidence of antecedent URI. In eight of 10 patients, serological or nucleic acid testing testing revealed no evidence of acute viral coinfection. Eight strains were CMRSA-10 (USA300). The remaining two strains were a USA300 genetically related strain and a USA1100 strain. CONCLUSION Pneumonia secondary to CA-MRSA can occur in the absence of an antecedent URI. Infections due to CA-MRSA are associated with significant morbidity and mortality. Clinicians need to have an awareness of this clinical entity, particularly in patients who are in risk groups that predispose to exposure to this bacterium.
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Affiliation(s)
| | - Jack Janvier
- Departartments of Medicine, University of Calgary
| | - Kunyan Zhang
- Departartments of Medicine, University of Calgary
| | - Kevin Fonseca
- Microbiology, Immunology and Infectious Diseases, University of Calgary
- Provincial Laboratory of Alberta, Alberta Health Services
| | - Dan Gregson
- Departartments of Medicine, University of Calgary
- Pathology and Laboratory Medicine, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
- Calgary Laboratory Services
| | - Deirdre Church
- Departartments of Medicine, University of Calgary
- Pathology and Laboratory Medicine, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
- Calgary Laboratory Services
| | - Kevin Laupland
- Departartments of Medicine, University of Calgary
- Pathology and Laboratory Medicine, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
- Calgary Laboratory Services
- Departments of Critical Care Medicine, University of Calgary
- Community Health Sciences, University of Calgary
| | - Harvey Rabin
- Departartments of Medicine, University of Calgary
- Microbiology, Immunology and Infectious Diseases, University of Calgary
- The Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Alberta Health Services – Calgary Zone and University of Calgary
| | - Sameer Elsayed
- Departments of Medicine, University of Western Ontario, London, Ontario
- Microbiology and Infectious Diseases, University of Western Ontario, London, Ontario
| | - John Conly
- Departartments of Medicine, University of Calgary
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Abstract
Community-acquired pneumonia (CAP) is a common infectious disease in the United States and the incidence continues to grow as the aging population increases. Overall, in-hospital patient mortality rates have been reported to be as high as 18%. Management of patients with CAP has been challenged by the evolution of resistant pathogens (particularly Streptococcus pneumoniae and Staphylococcus aureus) that have reduced susceptibility to recommended standard antimicrobial agents. Streptococcus pneumoniae continues to be the most frequently identified pathogen in CAP and recently, S. aureus has been found to be the second most often identified pathogen. Data from the SENTRY Antimicrobial Surveillance Program has shown declining susceptibility of pneumococci to penicillin, amoxicillin/clavulanate, and ceftriaxone from 1998 through 2011. In the Assessing Worldwide Resistance Evaluation (AWARE) surveillance program, > 50% of all S. aureus isolates from patient bloodstream infections, skin and skin structure infections, and pneumonia were methicillin-resistant. Stratifying risk factors to identify patients at risk for community-acquired multidrug-resistant pathogens should be considered when selecting therapy. Differences in microbiology and outcomes have been noted in patients presenting from the community with recent exposure to the health care system (eg, nursing home residents, patients with a recent hospital admission). These patients are at an increased risk of an infection caused by a multidrug-resistant pathogen. Understanding a patient's risk for drug-resistant pathogens will allow the physician to choose an appropriate empiric treatment regimen to optimize clinical outcomes.
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Affiliation(s)
- Stefano Aliberti
- Department of Health Science, University of Milan Bicocca, AO San Gerardo, Milan, Italy.
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Zhou W, Scocchera EW, Wright DL, Anderson AC. Antifolates as effective antimicrobial agents: new generations of trimethoprim analogs. Med Chem Commun 2013. [DOI: 10.1039/c3md00104k] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Meticillin-resistant Staphylococcus aureus causes an evolving clinical presentation of pneumonia. Health-care-acquired infection differs from community-associated disease, with important implications for treatment. Current antibiotics are less than ideal, and broader management strategies are crucial to prevent complacency.
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Affiliation(s)
- B Edwards
- Department of Medical Microbiology, Southern General Hospital, Glasgow G51 4TF
| | - IM Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen
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