S1 Guideline onychomycosis.

Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.

Abdominal Symptoms Assessed With the CFAbd-Score are Associated With Intestinal Inflammation in Patients With Cystic Fibrosis.

OBJECTIVES: This prospective study evaluated the relationship between fecal markers of intestinal inflammation and cystic fibrosis (CF)-associated abdominal symptoms. These were assessed using the CFAbd-Score, a CF-specific patient-related outcome measure developed and validated, following FDA guidelines. METHODS: In feces from patients with CF (n = 41) and healthy volunteers (n = 27), concentrations of fecal calprotectin (FC), M2-pyruvate kinase (M2-PK), interleukins IL-1ß, IL-6, IL-8, and neutrophilic elastase (NE) were measured. Abdominal symptoms during the 2 preceding weeks were recorded using the CFAbd-Score. This patient-reported outcome measure (PROM) for assessment of the multi-organic abdominal involvement in CF includes 28 items in five domains. RESULTS: Inflammatory parameters FC, IL-1ß, M2-PK, and NE in feces, as well as CFAbd-Scores resulted significantly higher in CF patients than in healthy controls (all P < 0.01). Furthermore, significant differences between both groups were found for pain-symptoms, disorders of bowel movement, impaired quality of life, as well as disorders of eating and appetite. With 83% sensitivity and 74% specificity, FC was the most reliable measure for CF-related intestinal inflammation, which, in the CFAbd-Score, was associated to significantly higher rates of abdominal pain, as well as to general quality of life items such as gastrointestinal-related impaired sleep and frustration. CONCLUSION: Using the CFAbd-Score as a CF-specific PROM for identification and quantification of abdominal symptoms revealed that abdominal pain and impaired quality of life are associated with intestinal inflammation in CF.

Point mutations in the squalene epoxidase erg1 and sterol 14-α demethylase erg11 gene of T indotineae isolates indicate that the resistant mutant strains evolved independently.

BACKGROUND: The T indotineae population shows a high amount of terbinafine resistant isolates based on different point mutations of squalene epoxidase erg1 (ergosterol) gene. A significant proportion of these isolates also show azole resistance. OBJECTIVES: Elucidation of the molecular mechanism for azole resistance, especially the identification of mutations in the sterol 14-α demethylase Erg11 genes, which encode for enzymes interacting with azoles. METHODS: Sequencing of putative Erg11 genes and analysis of phenotypic resistance pattern using a microplate-laser-nephelometry-based growth assay. RESULTS: Four different types of Erg11B mutants were detected; two double mutants with Ala230Thr/Asp441Gly, respectively, Ala230/Tyr444His and single mutants with Gly443Glu, Tyr444Cys and Tyr444His. All isolates featured the wild type genotype of Erg11A. All strains demonstrated different combinations of Erg1 and Erg11 genotypes. CONCLUSION: Resistance against terbinafine and azoles developed several times independently within the T indotineae population. The challenge for fungal treatment is, therefore, that species identification is not enough for prediction of therapeutic efficacy of antifungals. In the future, it will also become important to analyse genes involved in resistance mechanisms.

Dermatophyte infections in children compared to adults in Germany: a retrospective multicenter study in Germany.

BACKGROUND AND OBJECTIVE: Dermatophyte infections of the skin and nails are common worldwide and vary between geographical areas and over time. The aim of this study was to determine the epidemiological profile of dermatophytes in Germany with a focus on comparing children with adults. PATIENTS AND METHODS: In this retrospective multicenter study, mycological dermatophyte culture results in the period 01/2014 to 12/2016 were analyzed according to identified pathogen, age and gender of patients, and type of disease. RESULTS: Of 1,136 infections (children: n = 88, adults: n = 1,048), 50.8 % were clinically classified as onychomycosis, followed by tinea pedis (34.6 %), tinea corporis (16.2 %), tinea manus (16.2 %), tinea capitis (2.5 %), and tinea faciei (1.2 %). The most frequent pathogen was Trichophyton (T.) rubrum (78.6 %), followed by T. interdigitale (14.3 %), T. benhamiae (3.2 %), T. mentagrophytes (2.1 %), and Microsporum canis (1.7 %). The fungal spectrum differed particularly in tinea corporis and tinea capitis between children and adults with a more diverse pathogen spectrum in children. Trichophyton tonsurans was rarely identified as cause for tinea corporis (2.7 %) or tinea capitis (3.3 %). CONCLUSIONS: Differences in pathogens and frequency of fungal infections between age groups should be considered for optimal selection of the appropriate therapeutic regimen.

Superficial fungal infections in the department of dermatology, University Hospital Jena: A 7-year retrospective study on 4556 samples from 2007 to 2013.

BACKGROUND: Superficial fungal infections are often seen in day-to-day clinical practice, and their prevalence continues to rise worldwide. Over the years, a change in the pattern of dermatophytoses has been noted. OBJECTIVES: This study aimed to determine the epidemiologic profile of dermatophytes at the Department of Dermatology, University Hospital Jena, from 2007 to 2013. METHODS: The retrospective study was carried out with a total of 4556 samples collected from 3607 patients suspected of superficial fungal infections during the 7-year study period. RESULTS: Among the 3607 suspected patients, 1951 (54.09%) were men and 1656 (45.91%) were women. Of 4556 samples, 703 (15.43%) samples were positive for fungal culture, which included 585 (83.21%) dermatophytes and 118 (16.79%) non-dermatophytes. Trichophyton (T.) rubrum was the most common isolated pathogen in 73.33% of the dermatophyte cases. Among dermatophyte-infected patients, men were most likely to be affected (63.48%) as well as those of higher age (61 to 80). The most commonly affected areas were nails (33.16%) and feet (33%). T rubrum was recurrently isolated in several regions with exception of the scalp where M canis (58.33%) was the most frequently isolated pathogen. About 16.04% of cases had a history of treatment taken prior to sampling. The majority of the affected individuals did not have any prior animal contact (77.26%). T benhamiae was exclusively associated with contact to guinea pigs. CONCLUSION: Trichophyton rubrum was the most frequently isolated pathogen in several regions except the scalp. New dermatophyte species emerged with time especially T benhamiae.

Indian Trichophyton mentagrophytes squalene epoxidase erg1 double mutants show high proportion of combined fluconazole and terbinafine resistance.

BACKGROUND: The Indian ITS genotype VIII Trichophyton mentagrophytes population shows a high amount of different erg1 (ergosterol) mutants encoding for squalene epoxidase, which catalyses the first step of ergosterol biosynthesis. OBJECTIVES: Illumination of the implication of point mutations at position Ala448Thr in single and double erg1 T mentagrophytes mutants because mutants of this type were abundantly found within the Indian fungal population. METHODS: Growth in fluconazole or terbinafine containing medium was analysed using a microplate-laser-nephelometry (MLN)-based growth assay. RESULTS: Ala 448 Thr erg1 single mutants were terbinafine sensitive, but about 50% of isolates showed an increased fluconazole resistance, whereas 95% of the double mutants (Phe 397 Leu, Ala 448Thr) demonstrated combined terbinafine and increased fluconazole resistance. CONCLUSION: The new Indian T mentagrophytes populations show several point mutations in erg1. Point mutations at position 397 were previously described and cause terbinafine resistance. A large part of the double mutants exhibit resistance to terbinafine and fluconazole, demonstrating a selective advantage of the combination of both mutations.

Alarming India-wide phenomenon of antifungal resistance in dermatophytes: A multicentre study.

BACKGROUND: An alarming increase in recalcitrant dermatophytosis has been witnessed in India over the past decade. Drug resistance may play a major role in this scenario. OBJECTIVES: The aim of the present study was to determine the prevalence of in vitro resistance to terbinafine, itraconazole and voriconazole in dermatophytes, and to identify underlying mutations in the fungal squalene epoxidase (SQLE) gene. PATIENTS/METHODS: We analysed skin samples from 402 patients originating from eight locations in India. Fungi were identified by microbiological and molecular methods, tested for antifungal susceptibility (terbinafine, itraconazole, voriconazole), and investigated for missense mutations in SQLE. RESULTS: Trichophyton (T.) mentagrophytes internal transcribed spacer (ITS) Type VIII was found in 314 (78%) samples. Eighteen (5%) samples harboured species identified up to the T interdigitale/mentagrophytes complex, and T rubrum was detected in 19 (5%) samples. 71% of isolates were resistant to terbinafine. The amino acid substitution Phe397Leu in the squalene epoxidase of resistant T mentagrophytes was highly prevalent (91%). Two novel substitutions in resistant Trichophyton strains, Ser395Pro and Ser443Pro, were discovered. The substitution Ala448Thr was found in terbinafine-sensitive and terbinafine-resistant isolates but was associated with increased MICs of itraconazole and voriconazole. CONCLUSIONS: The high frequencies of terbinafine resistance in dermatophytes are worrisome and demand monitoring and further research. Squalene epoxidase substitutions between Leu393 and Ser443 could serve as markers of resistance in the future.

[Occupational Trichophyton verrucosum infection in a cattle farmer]. / Berufliche Infektion mit Trichophyton verrucosum bei einem Rinderzüchter.

Ringworm in cattle may cause an occupational skin disease in humans. Trichophyton verrucosum lead to a highly inflammatory fungal skin infection that is often misdiagnosed as bacterial disease and consequently mistreated with antibiotics. To establish the correct diagnosis, it is necessary to collect skin scales; in addition, a skin biopsy can be helpful. Deep dermatophyte infections by Trichophyton verrucosum can be treated effectively with oral terbinafine. In addition, it is necessary to pay careful attention to use suitable hygiene measures in the stables to protect against reinfection.

S1 guidelines: Tinea capitis.

Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.

The current Indian epidemic of superficial dermatophytosis due to Trichophyton mentagrophytes-A molecular study.

The disease burden of chronic-relapsing and therapy-refractory superficial dermatophytosis dramatically increased in India within the past 5-6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and a PCR-ELISA directly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)-1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte-positive culture result. Out of this, 138 (92.62%) samples were identified as Trichophyton (T.) mentagrophytes and 11 (7.38%) as Trichophyton rubrum. The PCR-ELISA revealed similar results: 162 out of 201 (80.56%) samples were dermatophyte-positive showing 151 (93.21%) T mentagrophytes- and 11 (6.79%) T rubrum-positive samples. In this study, we show for the first time a dramatic Indian-wide switch from T rubrum to T mentagrophytes. Additionally, sequencing revealed a solely occurring T mentagrophytes "Indian ITS genotype" that might be disseminated Indian-wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents.

The application of UV resonance Raman spectroscopy for the differentiation of clinically relevant Candida species.

Candida-related infections have become a major problem in hospitals. The species identification of yeast is the prerequisite for the initiation of adequate antifungal therapy. In the present study, the connection between inherent UV resonance Raman (RR) spectral profiles of Candida species and taxonomic differences was investigated for the first time. UV RR in combination with statistical modeling was applied to extract taxonomic information from the spectral fingerprints for subsequent differentiation. The identification accuracies of independent batch cultures were determined by applying a leave-one-batch-out cross validation. The quality of differentiation can be divided into three levels. Within a defined taxonomic group comprising the species C. glabrata, C. guilliermondii, and C. haemulonii, the identification accuracy was low. On the next level, the identification results of C. albicans and C. tropicalis were characterized by high sensitivities of 98 and 95% but simultaneously challenged by false-positive predictions due to the misallocation of C. spherica (as C. albicans) and C. viswanathii (as C. tropicalis). The highest level of identification accuracies was reached for the species C. dubliniensis, C. krusei, C. africana, C. novergica, and C. parapsilosis. Reliable identification results were observed with accuracies ranging from 93 up to 100%. The species allocation based on the UV RR spectral profiles could be reproduced by the identification of independent batch cultures. We conclude that the introduced spectroscopic approach is capable of transforming the high-dimensional UV RR data of Candida species into clinically useful decision parameters. Graphical abstract.

Deep facial mycosis due to Trichophyton verrucosum-molecular genetic identification of the dermatophyte in paraffin-embedded tissue-case report and review of the literature.

Deep trichophytosis is relatively uncommon. The infection of the bearded area is also known as sycosis barbae or tinea barbae and can be caused by various fungal species, most often zoophilic fungi. We report on an 80-year-old male patient with severe sycosis barbae who had no animal contact and was treated with systemic antibiosis without improvement. Microbial and mycological investigations using swabs from oozing lesions revealed Staphylococcus haemolyticus and Candida parapsilosis. Histology demonstrated fungal elements in hair follicles. Paraffin-embedded material was subjected to further mycological analysis. For molecular diagnostics DNA was prepared from paraffin sections for real-time polymerase chain reaction (RT-PCR). For sequencing, DNA was isolated from paraffin-embedded skin tissue and the ITS region of the rDNA was selected. Sequencing of the ITS2 region of rRNA revealed a 100% accordance with Trichophyton (T.) verrucosum. Treatment with oral terbinafine achieved a complete remission. Sycosis barbae is an important differential diagnosis for infections of the bearded area. Nucleic acid amplification techniques (NAAT) are more and more used for direct examination of dermatophytes in clinical samples, eg T. verrucosum. NAAT are also used as culture confirmation tests for identification of rare dermatophytes like T. verrucosum. Today, singleplex and multiplex quantitative real-time PCR (qRT-PCR) assays for the detection of the most common dermatophytes including T. verrucosum in clinical specimens are available. Recently, an ITS2 PCR assay has been successfully used for direct detection of T. verrucosum in paraffin-embedded formalin-fixed skin tissue. The PCR is fast and highly specific. The sensitivity of direct molecular detection of the dermatophytes both in native clinical material, and in paraffin-embedded skin tissue can been increased.

Identification of the causative dermatophyte of tinea capitis in children attending Mbarara Regional Referral Hospital in Uganda by PCR-ELISA and comparison with conventional mycological diagnostic methods.

Tinea capitis is a dermatophyte infection common among prepubertal children in sub-Saharan Africa and mainly caused by Trichophyton and Microsporum species. Accurate identification is challenging as conventional methods like culture and microscopy are slow and mostly based on morphological characteristics, which make them less sensitive and specific. Modern molecular methods, like polymerase chain reaction (PCR) assays, are gaining acceptance and are quick as well as accurate. The aim of this study was to investigate the clinical patterns of tinea capitis and to accurately identify the most common causative dermatophytes affecting the scalps of children aged 1 to 16 years attending the Skin Clinic at Mbarara University of Science and Technology (MUST), Mbarara, Uganda, East Africa, using both conventional mycological methods and PCR-ELISA for detection of dermatophyte DNA. One hundred fifteen clinical samples from children from Western Uganda attending the MUST Skin Clinic with a clinical diagnosis of tinea capitis were analyzed. T. violaceum was identified as the most common causative agent, followed by M. audouinii, T. soudanense, and T. rubrum. The early identification of the causative agent of tinea capitis is a prerequisite for the effective management of the disease, the identification of probable source and the prevention of spreading. Children with tinea capitis in Western Uganda should be treated by systemic therapy rather than topical preparations to ensure high cure rates as the most common causative dermatophytes T. violaceum exhibits an endothrix rather than ectothrix invasion of the hair follicle.

Raman and infrared spectroscopy differentiate senescent from proliferating cells in a human dermal fibroblast 3D skin model.

Senescent cells contribute to tissue aging and dysfunction. Therefore, detecting senescent cells in skin is of interest for skin tumor diagnostics and therapy. Here, we studied the transition into senescence of human dermal fibroblasts (HDFs) in a three-dimensional (3D) human fibroblast-derived matrix (FDM). Senescent and proliferating cells were imaged by Raman spectroscopy (RS) and Fourier transform infrared (FTIR) spectroscopy. The obtained averaged spectra were analyzed using PLS-LDA. For these 3D cultured cells, RS and FTIR could clearly distinguish senescent from proliferating cells. For both techniques, we detected senescence-associated alterations in almost all cellular macromolecules. Furthermore, we identified different biochemical properties of 3D compared to two-dimensional (2D) cultured cells, indicating that cells in their natural, skin-like 3D environment act differently than in (2D) cell cultivations in vitro. Compared to 2D cultured cells, cells grown in 3D models displayed a sharper contrast between the proliferating and senescent state, also affecting the abundance of biomolecules including nucleic acids. The training accuracies of both vibrational spectroscopic techniques were >96%, demonstrating the suitability of these label-free measurements for detecting these cellular states in 3D skin models.

Diagnostische Präzision der komponentenbasierten vs. der extraktbasierten In-vitro-Diagnostik von Insektengift-Allergien: Auswirkungen auf das klinische Management.

HINTERGRUND: Die Bestimmung von spezifischen IgE-Antikörpern spielt eine zentrale Bedeutung bei der Diagnostik von Bienen- und Wespengiftallergien. In den letzten Jahren wurden die komponentenbasierte Diagnostik (CRD) eingeführt, die die Bestimmung spezifischer IgE-Antikörper gegen die Allergene Api m 1, Ves v 1, Ves v 5 und Pol d 5 sowie kreuzreaktive Kohlenhydratdeterminanten (CCDs) erlaubt. Hierdurch soll vor allem bei Probanden mit Doppelsensibilisierungen die klinische Relevanz der einzelnen Sensibilisierungen besser beurteilt werden können. PROBANDEN UND METHODIK: Die spezifischen IgE-Antikörper-Bestimmungen an 143 Probanden mit Bienen- und/oder Wespengiftallergie erfolgten mit den extraktbasierten ImmunoCAP®-Allergenen i1 und i3 sowie den ImmunoCAP®-Allergenkomponenten i208-211 und o214 (Api m 1, Ves v 1, Ves v 5, Pol d 5, CCD). Bei Doppelsensibilisierten wurde zusätzlich ein Inhibitionstest durchgeführt. An einem Teilkollektiv der Studienpopulation erfolgten sIgE-Bestimmungen gegen Api m 1, Api m 4, Pol d 5 und Ves v 5 mittels Allergiechip (ISAC®, n  =  44). ERGEBNISSE: Die Sensitivität von Ves v 5 bei isolierten Wespengiftallergikern betrug 78,5 %, gemeinsam mit Ves v 1 stieg diese auf 92,3 %. Die Sensitivität von Api m 1 bei isolierten Bienengiftallergikern betrug 25 %. Die komponentenbasierte Diagnostik und Inhibitionstests bei Doppelsensibilisierten lieferten divergente Ergebnisse. Die CRD mittels ISAC®-Allergiechip erbrachte deutliche Unterschiede vor allem im Hinblick auf die Diagnostik von Api m 1 und CCDs. SCHLUSSFOLGERUNGEN: Die CRD bereichert das diagnostische Spektrum, sofern sie nicht allein sondern zusätzlich zu den etablierten Verfahren eingesetzt wird. Sie sollte neben Ves v 5 stets die Bestimmung der IgE-Antikörper gegen Ves v 1 umfassen.

Diagnostic precision of component-resolved vs. extract-based in vitro diagnosis of hymenoptera venom allergy: effects on clinical management.

BACKGROUND: The measurement of specific IgE (sIgE) antibodies plays a key role in the diagnosis of honeybee and wasp venom allergy. In recent years, component-resolved diagnosis (CRD) has been introduced, which allows for the measurement of sIgE antibodies against Api m 1, Ves v 1, Ves v 5, and Pol d 5, as well as cross-reactive carbohydrate determinants (CCDs). These tests are intended to help determine the clinical relevance of any given sensitization, especially in patients with dual sensitization. PATIENTS AND METHODS: Specific IgE antibody levels were measured in 143 patients with bee and/or wasp venom allergy using the extract-based ImmunoCAP® allergens i1 and i3 as well as the ImmunoCAP® allergen components i208-211 and O214 (Api m 1, Ves v 1, Ves v 5, Pol d 5, CCDs). In patients with dual sensitization, inhibition testing was also performed. In a subgroup of the study population, sIgE to Api m 1, Api m 4, Pol d 5, and Ves v 5 were determined using the ISAC® allergy microarray (n = 44). RESULTS: The sensitivity of Ves v 5 in patients with isolated wasp venom allergy was 78.5 %; in combination with Ves v 1, that figure increased to 92.3 %. The sensitivity of Api m 1 in individuals with isolated bee venom allergy was 25 %. CRD and inhibition testing in individuals with dual sensitization showed divergent results. CRD using the ISAC® allergy microarray showed marked differences, especially with regard to Api m 1 and CCDs. CONCLUSION: Component-resolved tests are a valuable addition to the diagnostic spectrum as long as they are used in combination with established procedures. Apart from Ves v 5, measuring IgE antibodies to Ves v 1 should always be included in the diagnostic workup.

Colonization of CF patients' upper airways with S. aureus contributes more decisively to upper airway inflammation than P. aeruginosa.

In cystic fibrosis (CF) patients' airways, inflammatory processes decisively contribute to remodeling and pulmonary destruction. The aims of this study were to compare upper airway (UAW) inflammation in the context of Staphylococcus aureus and Pseudomonas aeruginosa colonization in a longitudinal setting, and to examine further factors influencing UAW inflammation. Therefore, we analyzed soluble inflammatory mediators in noninvasively obtained nasal lavage (NL) of CF patients together with microbiology, medication, and relevant clinical parameters. NL, applying 10 mL of isotonic saline per nostril, was serially performed in 74 CF patients (326 samples). Concentrations of the inflammatory mediators' interleukin (IL)-1ß, IL-6, IL-8, matrix metalloproteinase (MMP)-9, and its anti-protease TIMP-1 were quantified by bead-based multiplexed assay, neutrophil elastase (NE) via ELISA. Culture-based microbiology of the upper and lower airways (LAW), as well as serological and clinical findings, were compiled. Our results indicate that UAW colonization with S. aureus significantly impacts the concentration of all measured inflammatory mediators in NL fluid except TIMP-1, whereas these effects were not significant for P. aeruginosa. Patients with S. aureus colonization of both the UAW and LAW showed significantly increased concentrations of IL-1ß, IL-6, IL-8, MMP-9, and slightly elevated concentrations of NE in NL fluid compared to non-colonized patients. This work elaborates a survey on S. aureus' virulence factors that may contribute to this underestimated pathology. Serial assessment of epithelial lining fluid by NL reveals that colonization of the UAW with S. aureus contributes more to CF airway inflammatory processes than hitherto expected.

Cytocompatibility testing of cyclodextrin-functionalized antimicrobial textiles-a comprehensive approach.

Functionalized textiles can be used in wound management to reduce the microbial burden in the wound area, to prevent wound infections, and to avoid cross-contamination between patients. In the present study, a comprehensive in vitro approach to enable the assessment of antibacterial activity of functionalized textiles and cytotoxicity of cyclodextrin (CD)-complexes with chlorhexidine diacetate (CHX), iodine (IOD), and polihexanide (PHMB) is suggested to evaluate their properties for supporting optimal conditions for wound healing. For all ß-CD-antiseptic functionalized cotton samples a strong antibacterial effect on the Gram-positive bacteria Staphylococcus aureus and Staphylococcus epidermidis as well as on the Gram-negative bacteria Klebsiella pneumoniae and Escherichia coli was proven. In addition, ß-CD-CHX and ß-CD-PHMB were effective against the yeast Candida albicans. The growth of Pseudomonas aeruginosa could be reduced significantly by ß-CD-IOD and ß-CD-PHMB. The established comprehensive testing system for determination of biocompatibility on human HaCaT keratinocytes is suitable for obtaining robust data on cell viability, cytotoxicity and mode of cell death of the ß-CD-antiseptic-complexes. The promising results of the high antimicrobial activity of these functionalized textiles show the high potential of such materials in medical applications.