Antimicrobial stewardship in wound care.

Strategies to tackle the global crisis of antimicrobial resistance include implementing antimicrobial stewardship across the healthcare and agricultural sectors. Many clinical specialities have developed policies to advise practitioners on how to prescribe antibiotics more effectively, but there is still a lack of data on the impact of this change. Overuse and misuse of antibiotics have been commonplace since their introduction 70 years ago, and have contributed to the development of the resistance seen today. There is a dearth of new antibiotics and, if nothing is done to restrict the use of those that remain effective, there is a risk of returning to the pre-antibiotic era where simple infections could result in death. In wound care, it is essential that antibiotic treatment is appropriate to reduce infections. Many medical conditions predispose people to wounds that are difficult to heal and become chronic unless the underlying causes are addressed. Most wound infections are caused by bacteria, which are becoming increasingly resistant to commonly used antibiotics. This necessitates strict regimens for managing infection, which include prescribing antibiotics only when they are essential. Antimicrobial stewardship is undertaken in all UK healthcare facilities, and local advisory committees oversee the prudent use of antibiotics and other antimicrobial agents to try to prevent further increases in resistance. National guidance has been produced but whether full compliance has been followed has yet to be established and the impact of implementation needs to be analysed.

Antimicrobial assessment of a chitosan microfibre dressing: a natural antimicrobial.

OBJECTIVE: Chitosan is a natural biopolymer and is the main structural component of the cuticles of crustaceans, insects and molluscs and the cell walls of certain fungi. It is abundant in nature and is naturally antimicrobial. A natural fibre has been created with chitosan and is being used as a wound dressing, namely Kytocel. It is an absorbent fibre dressing that is claimed to be biodegradable and biocompatible. This study was undertaken to assess the antimicrobial properties of the microfibre wound dressing using a variety of methods commonly used to assess other antimicrobial dressings. METHOD: The zone of inhibition (ZOI) assay, challenge test (log reduction), time-to-kill and an in vitro wound model were all used in this report. Representative Gram-positive and Gram-negative bacteria were used and one yeast, Candida albicans. RESULTS: The ZoI test showed no observable zones around the dressing but killed the organisms underneath the dressing. There was a >3 log reduction of Staphylococcus aureus and Escherichia coli within two hours and >3 log reduction against Pseudomonas aeruginosa and Candida albicans between four and 24 hours in the challenge test. In the wound model, there was a 2 log reduction of Escherichia coli within the wound model and in the sponge and culture medium below the dressing. CONCLUSION: The chitosan microfibre wound dressing gives wound care an additional dressing to use to help prevent and manage bioburden and wound infection.

Investigation of food and environmental exposures relating to the epidemiology of Campylobacter coli in humans in Northwest England.

This study uses multilocus sequence typing (MLST) to investigate the epidemiology of Campylobacter coli in a continuous study of a population in Northwest England. All cases of Campylobacter identified in four Local Authorities (government administrative boundaries) between 2003 and 2006 were identified to species level and then typed, using MLST. Epidemiological information was collected for each of these cases, including food and recreational exposure variables, and the epidemiologies of C. jejuni and C. coli were compared using case-case methodology. Samples of surface water thought to represent possible points of exposure to the populations under study were also sampled, and campylobacters were typed with multilocus sequence typing. Patients with C. coli were more likely to be older and female than patients with C. jejuni. In logistic regression, C. coli infection was positively associated with patients eating undercooked eggs, eating out, and reporting problems with their water supply prior to illness. C. coli was less associated with consuming pork products. Most of the cases of C. coli yielded sequence types described elsewhere in both livestock and poultry, but several new sequence types were also identified in human cases and water samples. There was no overlap between types identified in humans and surface waters, and genetic analysis suggested three distinct clades but with several "intermediate" types from water that were convergent with the human clade. There is little evidence to suggest that epidemiological differences between human cases of C. coli and C. jejuni are a result of different food or behavioral exposures alone.

The role of Acticoat with nanocrystalline silver in the management of burns.

Silver is an effective antimicrobial agent, but older silver-containing formulations are rapidly inactivated by the wound environment, requiring frequent replenishment. These older formulations may also be pro-inflammatory and may delay healing. Acticoat (Smith & Nephew, Hull, UK) is a relatively new form of silver antimicrobial barrier dressing which helps avoid the problems of earlier agents. It has rapid and sustained bactericidal activity, and because of this may reduce inflammation and promote healing. Despite extensive testing and clinical experience, no evidence has emerged of resistance or cytotoxicity to nanocrystalline silver. This article collects together a number of presentations that were given at the 2003 European Burns Association Meeting on the use of Acticoat in the management of burns.