A New Challenge in the Treatment of Thermal Injury

Curreri, P. William; Bruck, H; Lindberg, Robert B.; Mason, Arthur D.; Pruitt, Basil A.

doi:10.1097/00000658-197302000-00001

Cited by 44 publications

(16 citation statements)

References 4 publications

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“…added to > >dd5 ftC NBC of CZ 500 >500 >500 500 >500 >500 >500 >500 500 NBC of CF 500 500 500 500 500 >500 >500 >500 >500 lAg/all Cq/0If N(BCo/f CZl 500 >500 >500 >500 >500 >500 >250 >500 >500 18C /of >500 500 >500 *500 >500 >250 >500 500 VOL. 5,1974 (11). Our findings confirm their results and further define the bacteriostatic and bactericidal activity of this combination.…”

supporting

confidence: 88%

“…The minimal bactericidal concentration of aminoglycoside for one-third of the strains was reduced by fourfold or more in the presence of one-fourth of the minimal bactericidal concentration of either cephalosporin. This effect was achieved by clinically attainable concentrations of cephalothin or cefazolin.Although Providencia has been an uncommon cause of clinical infections, recent epidemics have been described in hospitalized patients, particularly in burn units (5,14,15). We have noted a gradually increasing incidence of clinical isolates of Providencia in our hospital, although serious infections have remained rare.…”

mentioning

confidence: 99%

“…Although Providencia has been an uncommon cause of clinical infections, recent epidemics have been described in hospitalized patients, particularly in burn units (5,14,15). We have noted a gradually increasing incidence of clinical isolates of Providencia in our hospital, although serious infections have remained rare.…”

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confidence: 99%

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Synergy Between Cephalosporin and Aminoglycoside Antibiotics Against Providencia and Proteus

Hyams

Rahal

1974

Antimicrob Agents Chemother

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Clinical isolates of Providencia and Proteus with relative aminoglycoside resistance were tested for susceptibility to combinations of gentamicin or tobramycin with cephalothin or cefazolin. The minimal bactericidal concentration of aminoglycoside for one-third of the strains was reduced by fourfold or more in the presence of one-fourth of the minimal bactericidal concentration of either cephalosporin. This effect was achieved by clinically attainable concentrations of cephalothin or cefazolin.Although Providencia has been an uncommon cause of clinical infections, recent epidemics have been described in hospitalized patients, particularly in burn units (5,14,15). We have noted a gradually increasing incidence of clinical isolates of Providencia in our hospital, although serious infections have remained rare. In vitro studies on these strains have indicated relative resistance to all aminoglycoside antibiotics. Most strains have required minimal inhibitory and bactericidal concentrations of 12.5 to 50 gg of gentamicin per ml. A synergistic effect of penicillins or cephalosporins with aminoglycosides has previously been demonstrated against Enterobacteriaceae (3, 4, 10) and Pseudomonas (6,12,17). We have therefore studied nine strains of Providencia and seven strains of the related genus, Proteus, which were moderately or highly resistant to gentamicin. Our purpose was to evaluate two cephalosporins, cephalothin and cefazolin, in crossover combination with two aminoglycosides, gentamicin and tobramycin, for possible in vitro synergy against these organisms.MATERIALS AND METHODS Providencia and Proteus strains were collected from the clinical microbiology laboratory on the basis of gentamicin resistance by routine disk sensitivity testing. Tube dilution assays were done in MuellerHinton broth as previously described (9). Grid studies were performed so that double dilutions of cephalothin, and cefazolin were combined with double dilutions of gentamicin or tobramycin. This resulted in duplicate minimal inhibitory and bactericidal concentration values for each drug against each strain. Of the 144 such duplications, four differed by two tube dilutions and the remainder differed by one dilution or less. Synergy was defined as a fourfold decline in minimal inhibitory concentrations (MIC) or minimal bactericidal concentration (MBC) of gentamicin or tobramycin after the addition of one-fourth of the MIC or MBC of a cephalosporin antibiotic to each tube. RESULTSThe MIC and MBC values of each drug against the nine strains of Providencia and seven strains of Proteus tested are shown in Fig. 1

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confidence: 88%

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Synergy Between Cephalosporin and Aminoglycoside Antibiotics Against Providencia and Proteus

Hyams

Rahal

1974

Antimicrob Agents Chemother

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“…In the past decades, Gram-negative organisms have emerged as the most common etiologic agents of invasive infections, and antibiotic-resistant organisms have increasingly been isolated in burn units (10). However, very few studies have reported endemic or epidemic situations due to P. stuartii in these wards (11,41,53). Most patients of this study suffered from severe burn injury (mean TBSA, greater than 40%) and thus exhibited risk factors for acquiring multidrug-resistant bacteria, i.e., antibiotic receipt, extended duration of hospitalization, and invasive procedures, together with immunosuppression induced by the burn injury (10,50).…”

Section: Discussionmentioning

confidence: 99%

“…Staphylococcus aureus is the main bacterial species involved, followed by Pseudomonas aeruginosa. Providencia stuartii, a member of the Enterobacteriaceae occasionally found in the human digestive flora and in the environment, is a rare etiological agent of burn wound infections (10,11). Indeed, this opportunistic pathogen is essentially responsible for urinary tract infections, particularly in long-term care populations (33).…”

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Evolution of an Incompatibility Group IncA/C Plasmid Harboring bla _CMY-16 and qnrA6 Genes and Its Transfer through Three Clones of Providencia stuartii during a Two-Year Outbreak in a Tunisian Burn Unit

Arpin

Thabet²,

Yassine

et al. 2012

Antimicrob Agents Chemother

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During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmidmediated CMY-16 ␤-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6=)-Ib= enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C 2 of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C 2 , unusual antibiotic resistance genes (e.g., aphA-6), and their genetic environments. Further investigation suggested that deletions, acquisition of the ISCR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C 2 plasmid which underwent a remarkable evolution during the epidemic period.

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Mechanisms of In Vitro Sensitivity to Sulfadiazine Silver

McManus¹,

Denton²,

Mason³

1983

Arch Surg

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a $ulfonamlde-realstant organisms have been reported as a Despite several reports of in vitro assays of the antifrequent consequence of the clinical use of sulfaelazine silver, microbial activity of sulfadiazine silver, the specific role of At this bum center, sultfnmide resistance occurred in more sulfadiazine in the antibacterial activity of this salt has not than 80% of gram-negative Isolates. We tested the requirement been defined.' The question of whether sulfadiazine plays a for the Individual antimicrobial activities of sulfadlatine and direct antibacterial role as a sulfonamide, behaves as a sllver tor In vitro activity of sulfsdiazine sliver. The sulfadlazine chemical coordinator of silver ion, or has both functions in component Is not necessary for In vitro sensitivity. In vitro sensitivity to sulfadlazlne sliver does not consistently predict vitro has not been answered. We have used a bacteriologthe presence of therapeutic activity In Pseudomonas aeruglnically inactive analogue of sulfadiazine, 2-benzenesulosa-inected rats with burns. We describe an example of a fonamidopyrimidine (ISR-44), as a control molecule to test tranoferable multiple-antiblotic resistance plasmid that con-the specific silver and sulfonamide activities of sulfadiazine tains selectable sulfonamide resistance. The use of sulftdla-silver in vitro.' The analogue ISR-44 has been shown to have zine slilver cn, therefore, lead to the selection of organisms silver-coordinating properties similar to sulfadiazine.' that are resistant not only to sulfonamides but to antiblotlcs of Sulfadiazine and ISR-44 were examined in vitro as both clinical consequence, and this possible risk must be considsodium and silver salts and also in vivo, using rats with swed in electing to use the agent.burns that were infected with sulfonamide-sensitive and a (Arch Surg 1983;118:161-166) sulfonamide-resistant strain of Pseudomonas aeruginosa.We report our findings, define the sulfonamide requirehe silver salt of sulfadiazine is the chemotherapeutic ment for in vitro activity of sulfadiazine silver, and address T agent most commonly used in the topical treatment of the significance of in vitro sensitivity to sulfadiazine silver hospitalized patients with burns. Shortly after first using in therapeutic activity against experimental P aeruginosa this agent, Lowbury et al' observed increased sulfonamide burn wound sepsis. Additionally, we present an example of resistance among gram-negative organisms isolated from the potential risk inherent in maintaining sulfonamide burns. We have noted a similar phenomenon. At our burn resistant plasmids in the clinical burn environment. center, sulfadiazine (in sulfadiazine silver salt) is the only bacteriologically active para-aminobenzoic acid antagonist MATERIALS AND METHODS iThe analogue ISR-44 was synthesized by condensation in pyridine of benzene sulfonyl chloride and 2-aminopyrimidine. The

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A New Challenge in the Treatment of Thermal Injury

Cited by 44 publications

References 4 publications

Synergy Between Cephalosporin and Aminoglycoside Antibiotics Against Providencia and Proteus

Synergy Between Cephalosporin and Aminoglycoside Antibiotics Against Providencia and Proteus

Evolution of an Incompatibility Group IncA/C Plasmid Harboring bla _CMY-16 and qnrA6 Genes and Its Transfer through Three Clones of Providencia stuartii during a Two-Year Outbreak in a Tunisian Burn Unit

Mechanisms of In Vitro Sensitivity to Sulfadiazine Silver

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A New Challenge in the Treatment of Thermal Injury

Cited by 44 publications

References 4 publications

Synergy Between Cephalosporin and Aminoglycoside Antibiotics Against Providencia and Proteus

Synergy Between Cephalosporin and Aminoglycoside Antibiotics Against Providencia and Proteus

Evolution of an Incompatibility Group IncA/C Plasmid Harboring bla CMY-16 and qnrA6 Genes and Its Transfer through Three Clones of Providencia stuartii during a Two-Year Outbreak in a Tunisian Burn Unit

Mechanisms of In Vitro Sensitivity to Sulfadiazine Silver

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Product

Resources

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Evolution of an Incompatibility Group IncA/C Plasmid Harboring bla _CMY-16 and qnrA6 Genes and Its Transfer through Three Clones of Providencia stuartii during a Two-Year Outbreak in a Tunisian Burn Unit