Search Results (160)

This review explores the biofilm architecture and drug resistance of Enterococcus faecalis in clinical and environmental settings. The biofilm in E. faecalis is a heterogeneous, three-dimensional, mushroom-like or multilayered structure, characteristically forming diplococci or short chains interspersed with water channels for nutrient exchange and waste removal. Exopolysaccharides, proteins, lipids, and extracellular DNA create a protective matrix. Persister cells within the biofilm contribute to antibiotic resistance and survival. The heterogeneous architecture of the E. faecalis biofilm contains both dense clusters and loosely packed regions that vary in thickness, ranging from 10 to 100 µm, depending on the environmental conditions. The pathogenicity of the E. faecalis biofilm is mediated through complex interactions between genes and virulence factors such as DNA release, cytolysin, pili, secreted antigen A, and microbial surface components that recognize adhesive matrix molecules, often involving a key protein called enterococcal surface protein (Esp). Clinically, it is implicated in a range of nosocomial infections, including urinary tract infections, endocarditis, and surgical wound infections. The biofilm serves as a nidus for bacterial dissemination and as a reservoir for antimicrobial resistance. The effectiveness of first-line antibiotics (ampicillin, vancomycin, and aminoglycosides) is diminished due to reduced penetration, altered metabolism, increased tolerance, and intrinsic and acquired resistance. Alternative strategies for biofilm disruption, such as combination therapy (ampicillin with aminoglycosides), as well as newer approaches, including antimicrobial peptides, quorum-sensing inhibitors, and biofilm-disrupting agents (DNase or dispersin B), are also being explored to improve treatment outcomes. Environmentally, E. faecalis biofilms contribute to contamination in water systems, food production facilities, and healthcare environments. They persist in harsh conditions, facilitating the spread of multidrug-resistant strains and increasing the risk of transmission to humans and animals. Therefore, understanding the biofilm architecture and drug resistance is essential for developing effective strategies to mitigate their clinical and environmental impact. Full article

Wound care in military and combat environments poses distinct challenges that set it apart from conventional medical practice in civilian settings. The nature of injuries sustained on the battlefield—often complex, contaminated, and involving extensive tissue damage—combined with limited access to immediate medical intervention, significantly increases the risk of infection, delayed healing, and adverse outcomes. Traditional wound dressings frequently prove inadequate under such extreme conditions, as they have not been designed to address the specific physiological and logistical constraints present during armed conflicts. This review provides a comprehensive overview of recent progress in the development of advanced wound dressings tailored for use in military scenarios. Special attention has been given to multifunctional dressings that go beyond basic wound coverage by incorporating biologically active macromolecules such as collagen, chitosan, thrombin, alginate, therapeutic peptides, and growth factors. These compounds contribute to properties including moisture balance control, exudate absorption, microbial entrapment, and protection against secondary infection. This review highlights the critical role of advanced wound dressings in improving medical outcomes for injured military personnel. The potential of these technologies to reduce complications, enhance healing rates, and ultimately save lives underscores their growing importance in modern battlefield medicine. Full article

Developing innovative, low-cost halochromic materials for diagnosing microbial contamination in wounds and burns can effectively facilitate tissue regeneration. Here, we combine the pH-sensing capability of highly colorful red cabbage anthocyanins (RCAs) with their healing potential within a unique cellulose polymer film that mimics the skin matrix. Biological activities of RCA extract in bacterial cellulose (BC) showed no cytotoxicity and skin-sensitizing potential to human cells at concentrations of RCAs similar to those released from BC/RCA dressings (4.0–40.0 µg/mL). A decrease in cell viability and apoptosis was observed in human cancer cells with RCAs. The invisible eye detection of the early color change signal from RCAs in response to pH alteration by bacteria was recorded with a smartphone application. The incorporation of RCAs into BC polymer has altered the morphology of its matrix, resulting in a denser cellulose microfibril network. The complete coincidence of the vibrational modes detected in the absorption spectra of the cellulose/RCA composite with the modes in RCAs most likely indicates that RCAs retain their structure in the BC matrix. Affordable, sensitive halochromic BC/RCA hydrogels can be recommended for online monitoring of microbial contamination, making them accessible to patients. Full article

Background and Objectives: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no liver-focused quantitative synthesis exists. We aimed to evaluate the effectiveness and safety of prophylactic ciNPWT after hepatopancreatobiliary (HPB) surgery. Methods: MEDLINE, Embase, and PubMed were searched from inception to 30 April 2025. Randomized and comparative observational studies that compared ciNPWT with conventional dressings after elective liver transplantation, hepatectomy, pancreatoduodenectomy, and liver resections were eligible. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB-2/ROBINS-I). A random-effects Mantel–Haenszel model generated pooled risk ratios (RRs) for superficial SSI; secondary outcomes were reported descriptively. Results: Twelve studies (seven RCTs, five cohorts) encompassing 15,212 patients (3561 ciNPWT; 11,651 control) met the inclusion criteria. Device application lasted three to seven days in all trials. The pooled analysis demonstrated a 29% relative reduction in superficial SSI with ciNPWT (RR 0.71, 95% CI 0.63–0.79; p < 0.001) with negligible heterogeneity (I² 0%). Absolute risk reduction ranged from 0% to 13%, correlating positively with the baseline control-group SSI rate. Deep/organ-space SSI (RR 0.93, 95% CI 0.79–1.09) and 90-day mortality (RR 0.94, 95% CI 0.69–1.28) were unaffected. Seven studies documented a 1- to 3-day shorter median length of stay; only two reached statistical significance. Device-related adverse events were rare (one seroma, no skin necrosis). Conclusions: Prophylactic ciNPWT safely reduces superficial SSI after high-risk HPB surgery, with the greatest absolute benefit when baseline SSI risk exceeds ≈10%. Its influence on deep infection and mortality is negligible. Full article

Hospital-acquired infections in operating rooms are contributing factors to the increasing presence of pathogens, with surgical site infections being the most frequent among them. Surgical antimicrobial prophylaxis is administered to minimize the risk of developing surgical site infection. Surgeons are responsible for weighing the benefit of surgical site infection-risk reduction for the individual patient afforded by prophylactic antimicrobial administration against the broader societal risk from such use. The aim of this study was to analyze the data on surgical antimicrobial prophylaxis related to patient status, surgery duration, wound classification and the occurrence of surgical site infection in two operating rooms of the Veterinary Teaching Hospital of Naples from January 2023 to January 2024. Two hundred seventy-seven surgical procedures met the inclusion criteria. For soft tissue clean-contaminated procedures and clean orthopedic surgeries not involving implants, no statistically significant difference was observed between the various antibiotic protocols used and surgical site infection; this finding supports the possibility of avoiding antibiotic use for these procedures. In contrast to previous reports, this study identified a statistically significant association between ASA status and surgical site infection; no correlation was found between surgical duration and the occurrence of infection. Further research on antibiotic use and risk factors associated with surgical site infection will be crucial to strengthen clinical guidelines. Full article

Autochthonous Chagas disease remains a health risk for humans in Latin American countries but is rarely found among residents of the United States (US), despite the presence of competent insect vectors and small mammal reservoirs of Trypanosoma cruzi in the lower two-thirds of the US. This report discusses the differences in the rates of autochthonous Chagas disease in Latin America and the US. The key to the differences may lie in the mode (or means) of transmission of parasites to humans. In both Latin America and the US, the so-called vectorial transmission of Chagas disease to humans is the mode of acquisition accepted by most authorities. This mode involves the improbable combination of an infected kissing bug defecating near the mouth or eyes or the site of the bite, followed by the bite victim rubbing infected feces into the wound site or mucous membranes. Outbreaks of Chagas disease due to fecal–oral contamination, known as oral Chagas, have been recorded in Latin America for decades, and at present, oral Chagas is the predominant mode of infection recognized in Brazil. It is perhaps time to consider fecal–oral transmission in its many manifestations as a risk factor for Chagas disease in the US rather than reflexively invoking vectorial transmission. Fecal–oral transmission includes contamination of food and drink by triatomine feces and infection via contaminated fomites and surfaces at home and at worksites, as well as transmission from infected small mammals and other routes discussed in this report. Full article

Climate change and ocean warming have a huge impact on microbial communities, leading to an increased prevalence of Vibrio parahaemolyticus infections in northern America. V. parahaemolyticus is an inhabitant of aquatic environments and is associated with fishes and shellfishes, particularly with oysters. It causes gastrointestinal infection through consumption of contaminated seafood, as well as wound infections or septicemia. Temperature is known to affect virulence and persistence factors in V. parahaemolyticus. In this study, twenty clinical strains isolated form sick patients in Quebec, Canada, were characterized for persistence and virulence factor production at different temperatures to assess the impact of a switch from sea water to the human body on them. Their capacity to produce biofilm, hemolysins, and membrane vesicles as well as their motility and antibiotic resistance at 20 °C and 37 °C were assessed. Our results revealed that while temperature had little effect on vesicle production, it significantly influenced their growth, antimicrobial resistance, biofilm formation, and motility. Additionally, all V. parahaemolyticus strains produced hemolysins at 37 °C but not under environmental conditions. Full article

Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative Pressure Wound Therapy (NPWT), advanced dressings, irrigation techniques, antibiotic regimens, and innovative therapies, in improving wound healing outcomes and reducing infection rates. Materials and Methods: An exhaustive literature search focused on the use of NPWT, dressings, and antibiotics in the care of chronic wounds was conducted following PRISMA guidelines in the PubMed, Scopus, Web of Science, and CINAHL databases. Eligible studies included randomized controlled trials and prospective cohorts assessing interventions for wound care in trauma, surgical, and chronic wound settings. The risk of bias was assessed using the ROB2 tool. Subgroup analyses were performed to evaluate the relative risk (RR) of infections based on the intervention type. Results: The analysis included 17 studies spanning diverse geographical and clinical settings. NPWT demonstrated significant benefits in reducing infection rates compared to control groups (RR: 0.590, 95% CI: 0.458–0.760, and p < 0.001). Although advanced dressings demonstrated clinically relevant benefits as reported across the included studies, the meta-analysis did not reveal statistically significant differences (RR: 0.516, 95% CI: 0.242–1.100, and p = 0.087). Antibiotic therapies significantly reduced infections when administered within 24 h of injury, while low-pressure irrigation techniques effectively minimized bacterial contamination without causing tissue damage. Growth factors and honey-based treatments exhibited promising results in accelerating wound healing and reducing infection risks in chronic wounds. Conclusions: NPWT emerges as a highly effective intervention for infection prevention and wound healing, supported by robust evidence. Advanced dressings and innovative therapies show potential but require further research for conclusive evidence. These findings underscore the importance of tailoring wound care strategies to the clinical context and patient needs. Future research should focus on long-term outcomes and cost-effectiveness analyses to enhance the integration of these therapies into clinical practice. Full article

The discontinuation of commercially available saline and hypertonic saline wound dressings for the veterinary market has restricted options available to veterinary practitioners treating contaminated and infected wounds. Clinicians may manufacture their own homemade solutions in clinics or field settings to treat equine or livestock species; however, information is limited on whether autoclave sterilization is necessary or sufficient to eliminate bacterial growth in isotonic and concentrated salt solutions and how long they may subsequently be stored prior to use. The purpose of this study was to assess sterility of saline (0.9%) and hypertonic saline (20%) solutions manufactured three ways (1—autoclaved glass bottle that was autoclaved again following solution preparation; 2—autoclaved glass bottle, not autoclaved again following preparation; 3—non-autoclaved plastic bottle, not autoclaved following preparation). Solutions were stored two different ways (1—solution in sealed bottle or 2—soaked gauze in vacuum-sealed plastic packets). Products were assessed for bacterial growth at four time points (baseline, one week, one month, six months). At each time point, samples of each solution were plated on Luria–Bertani (LB) agar plates and assessed for bacterial growth at 24 h. Vacuum-sealed soaked gauze was placed in antibiotic-free growth media for 24 h, and then media were plated on LB agar plates and assessed for bacterial growth at 24 h. If bacterial growth was detected, qualitative culture with sensitivity was performed to identify bacterial isolates. No bacterial growth was detected in stored solutions for any preparation method, concentration or time point assessed. Bacterial growth was detected from 0.9% saline-soaked gauze at 1 week, 1 month and 6 months in all container types for at least one time point. Bacterial culture revealed Ralstonia, Bacillus, Sphingomonas and Staphylococcus species. Environmental controls (water, containers, salt, biosafety cabinet and benchtop) were submitted for culture to identify the source of contamination, yielding light mixed growth from tap water and no growth from any other locations. These findings provide clinicians with practical information to guide preparation and storage of homemade saline-based products for wound care. Full article

Bacterial contamination of the surgical site in horses is a major risk factor for the development of surgical site infections (SSIs), which increase morbidity, mortality, the hospitalisation period, antibiotic use, and management costs. While contamination is a prerequisite for infection, its progression to clinical infection depends on additional factors that compromise host defences. The present study, conducted at the Veterinary Teaching Hospital of the University of Perugia over an 11-month period, investigated bacterial contamination in 70 surgeries (53 clean and 17 clean-contaminated) at the end of the procedure. To exclude pre-existing contamination, a sterile swab was collected after surgical scrub, and only cases that entered surgery with a sterile operative field were considered. A swab, biopsy, and fine-needle aspiration from the wound margins were then performed at the end of the surgery to conduct a qualitative assessment of the bacterial contamination of the surgical sites. Risk factors for surgical field contamination were analysed separately for clean and clean-contaminated procedures. Specifically, for clean-contaminated surgeries, the presence of emergency conditions, surgery duration, and intra-operative complications were evaluated. For clean surgeries, risk factors included the type of operating room, surgical duration, tissue involved, use of local anaesthetics, and placement of surgical drapes. The results revealed bacterial contamination rates of 49.1% in clean surgeries and 41.2% in clean-contaminated surgeries. Coagulase-negative staphylococci were the most frequently isolated bacteria, followed by Burkholderia cepacia, Bacillus sp., and Stenotrophomonas maltophilia. A statistical analysis showed no significant results on the predictive factors of the contamination evaluated. However, the observed trends suggest the importance of further investigating these risk factors in a larger sample size. These results emphasise the importance of effective prophylactic measures to limit surgical site contamination. Future research will focus on optimising pre-operative and intra-operative prophylaxis strategies to reduce bacterial contamination to sub-pathogenic levels, thereby enhancing post-operative outcomes. Full article

Polysaccharide-based hydrogels have emerged as indispensable materials in tissue engineering and wound healing, offering a unique combination of biocompatibility, biodegradability, and structural versatility. Indeed, their three-dimensional polymeric network and high water content closely resemble the natural extracellular matrix, creating a microenvironment for cell growth, differentiation, and tissue regeneration. Moreover, their intrinsic biodegradability, tunable chemical structure, non-toxicity, and minimal immunogenicity make them optimal candidates for prolonged drug delivery systems. Notwithstanding numerous advantages, these polysaccharide-based hydrogels are confronted with setbacks such as variability in material qualities depending on their source, susceptibility to microbial contamination, unregulated water absorption, inadequate mechanical strength, and unpredictable degradation patterns which limit their efficacy in real-world applications. This review summarizes recent advancements in the application of polysaccharide-based hydrogels, including cellulose, starch, pectin, zein, dextran, pullulan and hyaluronic acid as innovative solutions in wound healing, drug delivery, tissue engineering, and regenerative medicine. Future research should concentrate on optimizing hydrogel formulations to enhance their effectiveness in regenerative medicine and antimicrobial therapy. Full article

Microbial contamination of chronic wounds complicates their treatment. Traditional knowledge systems and the diversity of indigenous medicinal plants create a haven for traditional medicine practices in South Africa (SA). This systematic review aims to present a comprehensive ethnobotanical report of traditional medicines used in the documented empirical wound healing studies in SA. Google Scholar, PubMed, Medline EBSCOhost, Science Direct, and Scopus were sourced using the keywords/terminologies “South Africa”, “medicinal plants”, “traditional medicine” “indigenous”, “skin”, “wound”, “ethnobotany”, “survey”, “interview”, and “treatment” in different combinations. Relevant and unpublished records were retrieved from the Global Electronic Thesis Database. The searching process identified 32,419 records, of which 4005 studies were screened. Following the removal of 1795 duplicates, the remaining 2210 sources were screened by title and abstract, and 133 full-text reports were accessed and evaluated. Plants traditionally used for wound-healing purposes comprised 222 species belonging to 71 families, namely Asteraceae (predominantly the Helichrysum species), Asphodelaceae, Fabaceae, Solanaceae, and Euphorbiaceae. Plant organs used for medicinal remedies included leaves, roots, and bark prepared as poultices, infusions, decoctions, gel/ointments/lotions, and pastes. This review provides a valuable reference for future phytochemical and pharmacological studies and highlights the need for further ethnobotanical research to treat wounds in SA. Full article

Injuries to the distal limb are common in horses. The clinical aspect of the lesions is variable based on the structures that are involved. Synovial structures as well as tendons and/or ligaments may be involved in such injuries, affecting treatment modalities and costs, and prognosis. This retrospective study compares wounds involving synovial structures to wounds without such involvement in terms of treatment duration and costs, and prognosis. Synovial wounds were much more expensive to treat and carried a lower prognosis. Involvement of tendons and/or ligaments in the wounds resulted in more expensive and prolonged treatment courses compared to cases without such involvement, even without synovial contamination. The prognosis for discharge was good overall for both groups. Full article

Although caesarean section (CS) is a common surgery, the bacteria contaminating the abdominal incision during this operation are not documented. This study aimed to enhance perioperative antibiotic therapy and reduce post-operative surgical site infections by describing the bacteria contaminating the abdominal incision during CS. Bacterial culture was performed on swabs sampled from the abdominal incision (muscular layers) of 23 cows during the realisation of CS. Bacteriology was positive in 6/22 samples. while 16/22 were negative (p = 0.03), and one sample was contaminated. All identified bacteria were aerobic, and 8/14 isolates were Gram-positive and 6/14 were Gram-negative (p = 0.7). The most encountered species were Acinetobacter spp., Aerococcus viridans, Neisseria spp. and Streptococcus spp.; other species were isolated only once. The abdominal incision of elective CS can be contaminated by ubiquitous aerobic Gram-positive and Gram-negative species coming from the environment. This contamination might be avoided by using a better aseptic protocol and by improving the conditions in which CSs are performed. However, more samples are required, and antibiotic susceptibility determination is needed to identify the adequate pre-operative antibiotic. Full article

Vibrio vulnificus (V. vulnificus) is a Gram-negative, halophilic bacillus known for causing severe infections such as gastroenteritis, necrotizing fasciitis, and septic shock, with mortality rates exceeding 50% in high-risk individuals. Transmission occurs primarily through the consumption of contaminated seafood, exposure of open wounds to infected water, or, in rare cases, insect bites. The bacterium thrives in warm, brackish waters with high salinity levels, and its prevalence is rising due to the effects of climate change, including warming ocean temperatures and expanding coastal habitats. High-risk populations include individuals with underlying conditions such as chronic liver disease, diabetes, or immunosuppression, which heighten susceptibility to severe outcomes. The pathogenicity of V. vulnificus is mediated by an array of virulence factors, including hemolysins, proteases, and capsular polysaccharides, as well as mechanisms facilitating iron acquisition and immune system evasion. Clinical manifestations range from localized gastrointestinal symptoms to life-threatening systemic infections such as septicemia. Rare but severe complications, including pneumonia and meningitis, have also been reported. Treatment typically involves the use of doxycycline in combination with third-generation cephalosporins, although the emergence of multidrug-resistant strains is an escalating concern. Alternative therapeutic approaches under investigation include natural compounds such as resveratrol and the application of antimicrobial blue light. For necrotizing infections, prompt and aggressive surgical intervention remains essential to improving patient outcomes. As global temperatures continue to rise, understanding the epidemiology of V. vulnificus and developing innovative therapeutic strategies are critical to mitigating its growing public health impact. Full article