Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring

Wang, Yiwei; Beekman, Joanneke; Hew, Jonathan J; Jackson, Stuart; Issler‐Fisher, Andrea C.; Parungao, Roxanne; Lajevardi, Sepehr S.; Li, Zhe; Maitz, Peter

doi:10.1016/j.addr.2017.09.018

Cited by 481 publications

(323 citation statements)

References 275 publications

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“…Although an association between the frequency of systemic antibiotics prescription and development of AMR could not be established due to sparsity of data, the observation is consistent with findings from international studies. 25–27 The observation therefore whilst not conclusive, further highlights the need for rational prescription of antibiotics in order to control the development of AMR.…”

Section: Discussionmentioning

confidence: 94%

“…Post-burn hypermetabolism and systemic inflammatory response syndrome (SIRS) also result in increased in capillary leakage, hypoprotenaemia, decreased protein binding and augmented renal clearance which results in altered pharmacokinetics and pharmacodynamics of drugs including antibiotics. 25,35,36 The effects of these changes are more pronounced with hydrophilic drugs(e.g. Beta-lactams, Aminoglycosides, glycopeptides and lipopeptides) which account for 79.6% of antibiotic prescriptions in this study and are often augmented by administration of intravenous fluids or inotropes.…”

Section: Discussionmentioning

confidence: 99%

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Bacteriology and Antibiotic Prescription Patterns in a Malawian Tertiary Hospital Burns Unit

Kasenda

Mategula

Manda³

et al. 2018

Preprint

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IntroductionInfections are responsible for up to 85% of deaths in patients with burn injuries. Proper management of infections in patients with burns requires knowledge of local microbial landscape and antimicrobial resistance patterns. Most burns units in low to middle income countries lack this data to guide patient management.Methods and resultsWe conducted a retrospective audit of adult (≥17 years) patient records admitted between at 1st June 2007 and May 2017 at Queen Elizabeth Central Hospital Burns unit in Blantyre Malawi with an index complaint of burn injury. Descriptive statistical analysis was performed to determine antibiotic prescription patterns, microbial isolates and antimicrobial resistance patterns on the 500 patient files that met the inclusion criteria. Cephalosporin’s and Penicillin’s constituted 72.3% of the 328 antibiotic prescriptions given to 212 patients and 84% of all prescriptions were potentially inappropriate. A total of 102 bacterial isolates were identified and a majority (30.4%; n=31) were resistant to Aminoglycosides and Aminocyclitols (23.5%; n=24); seconded by Penicillin’s at 19.6% (n=20). Pseudomonas, staphylococcus and streptococcus species constituted 36.1%, 25% and 16.7% of all resistant bacteria that were isolated and they were thus the most common bacterial isolates. Drug resistance was more common among gram negative bacteria (48.8% versus 26.2%) and a greater proportion of patients (74.1%) that had antibiotic sensitivity testing were affected by drug resistant gram negative bacteria which appear on the World Health Organisation list of priority pathogens.ConclusionThe results of our preliminary study point towards nosocomial gram negative bacteria which appear on the World Health Organisations list of priority pathogens as the more common sources of antibiotic resistance. This scenario is potentially driven by inappropriate antibiotic prescriptions as well as clinical and laboratory diagnostic imprecision in addition to the universally recognised post burn pathophysiological changes of hypermetabolism and immunosuppression. Improvements in the areas of antimicrobial stewardship, diagnostic capacity and burns related research are needed in order to achieve optimal therapeutic outcomes and resource utilisation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Bacteriology and Antibiotic Prescription Patterns in a Malawian Tertiary Hospital Burns Unit

Kasenda

Mategula

Manda³

et al. 2018

Preprint

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“…Two distinct phenotypes of MSCs were involved in the wound healing process: the pro-inflammatory M1 and the anti-inflammatory M2 [33]. MSC role in the control of cell migration, cytokine secretion and extracorporeal matrix deposition is the result of the switching between both phenotypes which is mediated by different toll-like receptors (TLRs), specifically, stimulation of TLR3 and TLR4 switches the cell between an anti-inflammatory and pro-inflammatory phenotype, respectively [32]. Down-regulation of inflammatory markers COX2 and IL-1B and up-regulation of anti-inflammatory marker IL-10 in the skin tissues burn of EPOa/MSCs group in the present work might clarify the possible mediating mechanism of these MSCs in burn healing.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of erythropoietin-pretreated mesenchymal stem cells in murine burn wound healing: possible in vivo transdifferentiation into keratinocytes

Imam

Rizk

2019

Folia Morphol

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Background: Stem cells have shown promising potential to treat burn wounds. Erythropoietin was capable of promoting in vitro transdifferentiation of mesenchymal stem cells (MSCs). The aim of the study was to investigate possible role of erythropoietin-pretreated mesenchymal stem cells (EPOa/MSCs) in burn wounds healing and to evaluate its in vivo differentiation into keratinocytes. Materials and methods: Forty rats were utilised in this study divided into four groups (n = 10 for each). Control group (I), burn group (II), burn + MSCs, group (III), burn + EPOa/MSCs. 1 × 10 6 cells were injected locally for each 1 cm 2 of burn areas. Burn areas were followed-up morphologically. After 21 days of the experiment, the rats were euthanised, skin specimens were assessed biochemically, histologically and immunohistochemically. Results: EPOa/MSCs enhanced significantly (p < 0.05) burn wound vimentin gene expression and level of interleukin (IL)-10 while decreased IL-1 and COX2 as compared to the burn group. Histologically, EPOa/MSCs improved epithelialisation despite stem cells' differentiation into keratinocytes was rarely detected by PKH26 red fluorescence. EPOa/MSCs promoted angiogenesis as detected by significant increase in VEGF and PDGF immunoexpression as compared to burn group. Conclusions: EPOa/MSCs may improve burn wound healing, probably through anti-inflammatory, immunomodulatory and angiogenic action. However, in vivo transdifferentiation into keratinocytes was rarely detected. (Folia Morphol 2019; 78, 4: 798-808)

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“…Wound formation is often accompanied by changes in mental status, especially in cases of acute wounds caused in emergency situations . During treatment, stimuli experienced by the patients such as pain during dressing changes, invasive operations, or the environment of the intensive care unit could all contribute to aggravation and persistence of depressive symptoms. Many clinical studies have found that depression is significantly detrimental to the healing of wounds .…”

Section: Discussionmentioning

confidence: 99%

Effects of depression on healing and inflammatory responses of acute wounds in rats

Jian

Huang

Zhu

et al. 2019

Wound Repair Regeneration

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This study aimed to elucidate the effect of depression on the healing of acute wounds in rats. We hypothesized that depression would have negative effects on inflammation and wound healing and that antidepressant therapy would reverse these effects. This study included 100 rats randomly allocated into five groups: control group (CG), depression group (DG), pre-depression group (PDG), antidepressant group (AG), and preantidepressant group (PAG). Acute wounds were created on the rats' backs. The groups were subjected to no interventions (CG), aversive stimuli before (PDG) and after (DG) wound creation, and antidepressant treatment before (PAG) and after (AG) wound creation. On the day of wound creation and on days 3, 6, 9, and 12 after wound creation, observations of the wound area and degree of depression (evaluated using the sucrose preference test, open-field test, and weight change) were recorded. On days 6 and 12 after wound creation, venous serum and wound tissues were collected. Tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 levels were measured using the enzyme-linked immunosorbent assay. Results showed an initial increase followed by a decrease in the degree of depression in all groups except DG (continuous decline). The wound-healing rate was significantly lower in PDG and DG than in CG; it was higher in AG and PAG than in CG. DG and PDG had higher concentrations of inflammatory cytokines than CG, and AG and PAG had lower concentrations than CG. This indicates that the onset of depression delays the healing of acute wounds and aggravates the inflammatory response in rats. Antidepressant treatment counteracts both of these negative effects.

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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring

Cited by 481 publications

References 275 publications

Bacteriology and Antibiotic Prescription Patterns in a Malawian Tertiary Hospital Burns Unit

Bacteriology and Antibiotic Prescription Patterns in a Malawian Tertiary Hospital Burns Unit

Efficacy of erythropoietin-pretreated mesenchymal stem cells in murine burn wound healing: possible in vivo transdifferentiation into keratinocytes

Effects of depression on healing and inflammatory responses of acute wounds in rats

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