A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics.

AIMS: Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. MATERIALS AND METHODS: Databases were searched to identify eligible studies and 13 were identified for inclusion. RESULTS: Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. CONCLUSION: There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409-15.

Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection: a systematic review and meta-analysis.

Aims: The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems that may be used to diagnose prosthetic joint infection (PJI). Materials and Methods: Studies using alpha-defensin or Synovasure (Zimmer Biomet, Warsaw, Indiana) to diagnose PJI were identified from systematic searches of electronic databases. The quality of the studies was evaluated using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) tool. Meta-analysis was completed using a bivariate model. Results: A total of 11 eligible studies were included. The median QUADAS score was 13 (interquartile range 13 to 13) out of 14. Significant conflicts of interest were identified in five studies. The pooled sensitivity for the laboratory alpha-defensin test was 0.95 (95% confidence interval (CI) 0.91 to 0.98) and the pooled specificity was 0.97 (95% CI 0.95 to 0.98) for four studies with a threshold level of 5.2 mgl-1 The pooled sensitivity for the lateral flow cassette test was 0.85 (95% CI 0.74 to 0.92) and the pooled specificity was 0.90 (95% CI 0.91 to 0.98). There was a statistically significant difference in sensitivity (p = 0.019), but not specificity (p = 0.47). Conclusion: Laboratory-based alpha-defensin testing remains a promising tool for diagnosing PJI. The lateral flow cassette has a significantly lower performance and pooled results are comparable to the leucocyte esterase test. Further studies are required before the widespread adoption of the lateral flow cassette alpha-defensin test. Cite this article: Bone Joint J 2018;100-B:703-11.

Bacteriological analysis of burn sepsis.

A total of 114 opportunistic bacteria were isolated from 65 swabs from burn sepsis. P. aeruginosa (53.8%) was the most common agent followed by S. aureus (38.4%), Klebsiella Spp. (27.6%), Proteus (18.4%), E. coil (10.7%) and others. The infection was monobacterial in 25 cases (38.4%) and polybacterial in 49 cases (61.5%). P. aeruginosa was predominated in both monobacterial and polybacterial infections. Ciprofloxacin (42.9%) was found to be the most effective antibacterial agent. Results indicate that resistance in burn isolates is higher and increasing day by day.

Citric acid treatment of severe electric burns complicated by multiple antibiotic resistant Pseudomonas aeruginosa.

A case of severe electric burns complicated by multiple antibiotic resistant Pseudomonas aeruginosa not responding to various antibiotics administered systemically is presented. Citric acid (3%) was used successfully to eliminate Pseudomonas aeruginosa from burn wounds and infection was completely controlled in 14 days. Citric acid treatment is evidently of value in the clinical control of burn wound colonization caused by difficult strains of Pseudomonas aeruginosa.

Bacteriological analysis of various environmental sources in a rural hospital.

Two hundred and five specimens from various sources of hospital ecosystem were processed for isolation of bacteria. 51.7% specimens were found positive and a total of 146 isolates were obtained. Isolation was monobacterial in 35.6% and polybacterial in 16.0%. Bacteria were recovered from discarding jar fluid (84.6%), air (73%), basin swabs (70.5%) hand wash bowl solution (64.2%), cheatle forceps (64%) and thermometer fluid (53.8%) etc. The most common bacteria isolated were P. aeruginosa, B. subtilis, Klebsiella Spp. and E. col and ciprofloxacin (72.88%) was found to be the most effective antibacterial agent.

Norfloxacin induced resistance to fluoroquinolones & structurally unrelated antimicrobial agents in coagulase negative staphylococci.

Nine clinical isolates of coagulase negative staphylococci (CONS) susceptible to norfloxacin (MIC 1.8-2 micrograms/ml) were manipulated in vitro to induce norfloxacin resistance by means of serial passage in brain heart infusion broth containing increasing concentrations of norfloxacin. Exposure of CONS to norfloxacin resulted in 18 to 20 times increase in MIC of norfloxacin and change in in vitro susceptibility to ciprofloxacin, pefloxacin, ofloxacin, kanamycin, neomycin and tobramycin, indicating development of cross resistance to fluoroquinolones and aminoglycosides. These results show that exposure to increasing concentrations of norfloxacin can induce the development of resistance to various antimicrobial agents, suggesting its mutagenic role.

A comparison of sputum examination for acid fast bacilli by modified Schaeffer & Fulton stain, Ziehl-Neelsen stain & cold stain.

A comparative study of Ziehl-Neelsen stain, cold stain and modified Schaeffer and Fulton stain was carried out to evaluate the efficiency of modified Schaeffer and Fulton method in sputum examination for acid fast bacilli (AFB). Of 187 sputum samples studied, 67 (35.82%) were reported positive by Ziehl-Neelsen stain and cold stain method while 66 (35.29%) were reported positive by modified Schaeffer and Fulton method. In comparison with Ziehl-Neelsen staining, 98.58 per cent positivity was reported by modified Schaeffer and Fulton method. Modified Schaeffer and Fulton method is found to be simple, reliable, less expensive and as efficient as Ziehl-Neelsen stain and cold stain for demonstration of acid fast bacilli in sputum.

Serotyping and transferability of drug resistance in clinical isolates of E. coli.

Forty nine multiple drug resistant strains of E. coli isolated from UTI were serotyped. The pattern was found to be 057 (eight strains); 0109 (four strains); 020, 038, 068, 0106, 0148. Rough (three each). 012, 054, 0101, 0160 (two each) and 02, 032, 046, 053, 060, 065, 090, 091, 0117, 0118, untypable (one each). The resistance pattern of all E. coli were identified and matted with recepient strain in penassay broth and in human urine. In a penassay broth transfer of resistance was demonstrated in 38 strains (77.5%) while in human urine transfer was demonstrated only in 14 strains (28.57%).