N Patel1, D Hatch1, C M Wells2, D Ahn3, M Harris3, J A Jennings4, W Haggard4, D G Armstrong5. 1. Tucson Medical Center/Midwestern University Podiatry Residency, 5301 E. Grant Road, Tucson Arizona, 85733, US. 2. MS student, The University of Memphis, Department of Biomedical Engineering, 330 Engineering Technology, 3796 Norriswood Avenue, Memphis, TN, 38152, US. 3. Undergraduate Student, The University of Memphis, Department of Biomedical Engineering, 330 Engineering Technology, 3796 Norriswood Avenue, Memphis, TN, 38152, US. 4. The University of Memphis, Department of Biomedical Engineering, 330 Engineering Technology, 3796 Norriswood Avenue, Memphis, TN, 38152, US. 5. University of Arizona Southern Arizona Limb Salvage Alliance (SALSA), 1501 N. Campbell Ave, PO box 245018, Tucson, AZ, 85724, US.
Abstract
OBJECTIVE: The local delivery of antimicrobials is attractive for a number of reasons. Chitosan, a biodegradable polysaccharide sponge material, has been proposed as medium to deliver antibiotics directly to wounds. In this report we evaluate the safety and practicality of antimicrobial delivery via chitosan sponge. METHOD: We present the clinical course and systemic absorption characteristics of three cases of people with diabetic foot wounds treated with antibiotic soaked chitosan sponge (Sentrex BioSponge, Bionova Medical, Germantown, TN). The antibiotic sponge was made by reconstituting 1.2g tobramycin or 100mg doxycycline in 10-15ml saline and saturating the sponge with the solution. The sponge was then applied to the wounds. Serum levels of each respective antibiotic were evaluated after application. Additional in vitro studies were conducted evaluating elution of antibiotics from the chitosan sponge at established minimum inhibitory concentrations (MIC) for Staphylococcus aureus over 28 days. RESULTS: No patient experienced adverse local or systemic effects due to the sponge treatment. The measured serum levels applied antibiotics remained far less than established minimums after intravenous therapy. Each patient required further treatment, however local infection or contamination resolved during the course of their hospital stay after the chitosan/antibiotic application. CONCLUSION: The use of antibiotic-impregnated chitosan sponges appears a safe and effective mechanism of local delivery of antimicrobials in wounds. Future studies and clinical trials are ongoing to confirm these results and to guide clinical applications.
OBJECTIVE: The local delivery of antimicrobials is attractive for a number of reasons. Chitosan, a biodegradable polysaccharide sponge material, has been proposed as medium to deliver antibiotics directly to wounds. In this report we evaluate the safety and practicality of antimicrobial delivery via chitosan sponge. METHOD: We present the clinical course and systemic absorption characteristics of three cases of people with diabetic foot wounds treated with antibiotic soaked chitosan sponge (Sentrex BioSponge, Bionova Medical, Germantown, TN). The antibiotic sponge was made by reconstituting 1.2g tobramycin or 100mg doxycycline in 10-15ml saline and saturating the sponge with the solution. The sponge was then applied to the wounds. Serum levels of each respective antibiotic were evaluated after application. Additional in vitro studies were conducted evaluating elution of antibiotics from the chitosan sponge at established minimum inhibitory concentrations (MIC) for Staphylococcus aureus over 28 days. RESULTS: No patient experienced adverse local or systemic effects due to the sponge treatment. The measured serum levels applied antibiotics remained far less than established minimums after intravenous therapy. Each patient required further treatment, however local infection or contamination resolved during the course of their hospital stay after the chitosan/antibiotic application. CONCLUSION: The use of antibiotic-impregnated chitosan sponges appears a safe and effective mechanism of local delivery of antimicrobials in wounds. Future studies and clinical trials are ongoing to confirm these results and to guide clinical applications.
Authors: Ilker Uçkay; Benjamin Kressmann; Sarah Malacarne; Anna Toumanova; Jaafar Jaafar; Daniel Lew; Benjamin A Lipsky Journal: BMC Infect Dis Date: 2018-08-02 Impact factor: 3.090