Acetic acid treatment of pseudomonal wound infections--a review.

PURPOSE: Pseudomonas aeruginosa is a significant cause of burn wound infections and, skin and soft tissue infections. The antiseptic management is an integral part of the management of wound infections and is essential to control wound infection. Although commonly used, concerns have been raised. RESULTS: Available experimental data suggest that many commonly used antiseptic agents may be toxic to the cells involved in wound healing process and may affect the process of normal tissue repair. In view of this, the present review summarized the various organic acids commonly used as a substitute for antiseptics to control pseudomonal wound infections with special reference to acetic acid and their role in the process of wound healing. CONCLUSION: Acetic acid is to be kept in mind as one of the alternatives when infection is caused by multiple antibiotic resistant strains of P. aeruginosa. At a time when bacterial resistance to antibiotics is a matter of increasing concern, the value of topical agents such as acetic acid should not be forgotten.

A simple and effective approach for the treatment of chronic wound infections caused by multiple antibiotic resistant Escherichia coli.

Antimicrobial resistance is a major problem in present-day therapy. Despite the advent of newer antimicrobial agents with a broad spectrum of activity, multiple antibiotic resistant pathogens are difficult to eliminate from infected sites. The present study was carried out to develop an approach, using citric acid as a sole antimicrobial agent, for the treatment of chronic wound infections caused by multiresistant Escherichia coli (MAREC). A total of 34 cases of chronic wound infections yielding MAREC isolates on culture were studied. The antibacterial effect of citric acid against MAREC was evaluated in vitro by broth dilution method. Three percent citric acid gel was applied to each wound once daily until it healed completely. All 34 isolates were inhibited by citric acid with minimum inhibitory concentrations in the range of 1500-2000 microg/ml. Topical application of 3% citric acid to wounds 7-42 times resulted in elimination of MAREC from infected sites and successful healing of wounds in all 34 patients. This treatment modality was simple, reliable, non-toxic and effective. Hence, the use of citric acid for the cost-effective treatment of wound infections caused by MAREC is recommended.

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%).