Laboratory Research
Prevalence of candida and dermatophyte infections is increasing.1,2 Trichophyton rubrum is one of the most prominent human pathogenic dermatophytes, and accounts for almost approximately 70% of chronic dermatophytosis in humans. Candidiasis is mostly caused by Candida albicans and produce major complications in burn wounds.3. Candida and dermatophyte species cannot be overlooked as an infectious entity in chronic wounds and clinicians should be focused as well as bacteria biofilms. Burn wound infections remain the most important factor limiting survival in burn intensive care units. Large wounds, impaired immune systems and broad-spectrum antibiotic therapy contribute to the growth of opportunistic fungal species.4
Methods:
The aim of this study was examine the effects of a novel debridement method to remove necrotic tissue and dermatophytes using a porcine model.5,6 Deep partial-thickness wounds (63) were created and inoculated with either Trichophyton rubrum ATCC28188(TR), Trichophyton interdigitale ATCC9533(TI) or Candida albicans ATCC64550(CA). Colonization was allowed by 72 hours then baseline wounds (3) were assessed prior apply treatments: 1)Desiccant Shock Technology [DST*], 2)Clotrimazole 1% Positive ControlÉ, or 3)Gauze with sterile saline. Wounds were treated (30seconds) and then rinsed with 5ml of saline. Sterile gauze was used to remove slough. Biopsies (6mm) were taken 20minutes and 24hours for microbiology assessments.
Results: DST treated wounds showed the lowest CA64550, TI9533 and TR28188 counts at 20 minutes and 24 hours as compared to positive and untreated controls. When challenging wounds treated with CA64550, both DST and Clotrimazole 1% exhibited large fungal differences after 24 hours at 99.85% and 99.78%, respectively. Only those wounds treated with DST showed a large fungal difference when compared to baseline wounds, having 96.22% and 94.88% reductions against TI9533 or TR28188, respectively. At 24 hours when comparing DST to untreated control there was a 2.5 LogCFU/g, 2.3 LogCFU/g and 3.5 Log CFU/g reduction with CA, TI and TR, respectively
Discussion:
Overall, wounds treated with DST showed lower fungal counts against the three microorganisms at both 20minutes and 24hours. Comparing the Clotrimazole 1% to untreated, we observed a good reduction in fungal counts when treating wounds infected with Candida albicans ATCC64550. However, Clotrimazole 1% did not appear as effective in wounds infected with either TI9533 or TR28188. Additional animals are currently planned to substantiate these findings which may have important clinical implications in the acute and chronic wound care therapies. *REVITY – Epien Medical, St. Paul, MN . ÉLOTRIMINÒAF Bayer HealthcareLLC, NJ, 07981. Acknowledgement: This study was supported by Epien Medical.
Trademarked Items: REVITY®
References: 1. Palackic A, Popp D, Tapking C, Houschyar KS, Branski LK. Fungal infection in Burn Patients. Surg Infect, 2021, 22(1):83-87.
2. Gnat S, Lagowski D, Nowakiewicz. Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections. J Appl Microbiol, 2020 129(2):212-232
3. Ha JF, Italiano CM, Heath CH, Shih S, Rea S, Wood FM. Candiemia and invasive candidiasis: a review of the literature for the burns surgeon. Burns 2011;37(2)”181-95
4. Ballard J, Edelman L, Saffle J, et al. Positive fungal cultures in burn patients: a multicenter review. J Burn Care Res. 2008;29:213–21.
5. Gil J, Solis M, Higa A, Davis SC. Candida albicans Infections: a novel porcine wound model to evaluate treatment efficacy. BMC Microbiol. 2022 Feb 4;22(1):45. doi: 10.1186/s12866-022-02460.
6. Davis SC, Gil J, Solis M, Higa A, Mills A, Simms C, Valencia-Pena P, Li J, Raut V Antimicrobial Effectiveness of Wound Matrices containing Native Extra Cellular Matrix (ECM) with Polyhexamethylene Biguanide (PHMB), Int Wound J. 2021;1-14. DOI: 10.1111/iwj.13600.