In Today' s Path's, Gene S. Graham DPM, AACFAS, FAPWCA, offers his expertise and insight into the ever-prevelant topic of MRSA. Physician Certified in Wound Care by CMET, Dr. Graham is in private practice in Columbus Ohio.
He completed his residency at Ohio State University Hospital East.
He is affiliated with the residency training program at Grant Medical Center and also performs surgery at Ohio State University Hospital East. He is a physician certified in wound care and has been doing clinical studies with wound dressings containing oak extract for the last 5 years.
MRSA: How to Combat the Rising Numbers? |
by Gene S. Graham, DPM, AACFAS, FAPWCA |
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Gene S. Graham, DPM, AACFAS, FAPWCA |
Antibiotic resistance is a growing concern in diabetic foot ulcerations (DFUs). Specifically, Methicillin-Resistant Staphylococcus Aureus (MRSA) pathogens have been isolated with increasing frequency from wound and skin infections in patients with diabetes. The most important pathogen involved in DFUs is Staphylococcus aureus, whether by itself or part of a mixed infection. The prevalence of infections caused by MRSA continues to rise, whether Hospital Acquired (HA-MRSA) or Community Acquired (CA-MRSA).
One recent study from a Pennsylvania Medical Center’s Emergency Department (ED) reported that 65% of all patients whose wounds were cultured grew positive for MRSA. This does not take into consideration those patients who are seen by their primary care provider or podiatrist. CA-MRSA cases are rising at an alarming rate and some public health officials consider it almost an epidemic. There are limited antibiotics and wound dressings for the physician to choose from when treating these patients. For example, when selecting an antimicrobial wound dressing for a DFU that is effective against MRSA, the choices are generally limited to one that contains mupirocin, povidone-iodine, or silver.
Amerx Health Care’s hydrogel, AmeriGel® Wound Dressing, has been proven to have antimicrobial properties due to the tannins found in Oakin®. Minimum Inhibition Concentration (MIC) tests proved Oakin® to be bactericidal against 49 gram negative and gram positive bacteria and fungi. Upon further testing, AmeriGel®’s antimicrobial properties were proven effective against MRSA and Vancomycin-Resistant Enterococcus (VRE). BioScience Laboratories, Bozeman, MT (a third party FDA-approved laboratory) performed an In-vitro Time-Kill study titled: An evaluation of one test product for its antibacterial properties when challenged with two microorganism strains using an In-vitro Time-Kill Method.
All agar plating was performed in duplicate. The Percent Reductions from the initial populations of each challenge species were determined following one (1) hour, six (6) hour, twelve (12) hour, and twenty-four (24) hour exposure to AmeriGel®. (Table 1) The longer exposure times significantly improved the bacterial reductions observed. The Percent Reductions for the Bacterial Viability Control (0.9% Sodium Chloride Irrigation, USP) versus each of the two (2) bacterial species were determined at twenty-four (24) hours. (Table 2)
Table 1. Time-Kill study Results |
Challenge
Microorganism |
Exposure Time
(at Room Temperature) |
Percent
Reduction |
MRSA |
1 hour |
42.9293% |
6 hours |
98.2071% |
12 hours |
98.0556% |
24 hours |
99.2071% |
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VRE |
1 hour |
29.0588% |
6 hours |
72.3529% |
12 hours |
93.0588% |
24 hours |
90.8235% |
Table 2. Bacterial Viability Control
(Sterile 0.9% Sodium Chloride Irrigation, USP) |
Challenge
Microorganism |
Exposure Time
(at Room Temperature) |
Percent
Reduction |
MRSA |
24 hours |
0.0000% |
VRE |
24 hours |
17.6471% |
Case Study – Diabetic Foot Ulcer,
Plantar Surface with MRSA
Patient: 70 year-old Caucasian male |
Click on the images for a full screen view. |
Medical History:
Alcoholic, neuropathic patient with rocker bottom foot presented with plantar abscess. Long history of ulcerations with previous treatment for Osteomyelitis in 2004. Previous treatment with 2 Crow Walker boots and plastic AFO brace, non-compliant. (Fig. 1) |
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Treatment: Abscess drained, cultures performed and wound probed to bone. X-rays inconclusive for Osteo, MRI showed full thickness abscess that had penetration to MPJ capsules, but no bone Osteomyelitis. Wound dressed with AmeriGel® Wound Dressing and patient was instructed to do daily dressing changes. (Fig. 1A) Cultures showed MRSA, Providencia and Anaerobic bacteriodes. Patient put on Coumadin due to Atrial Fib., Clindamycin and Cipro. Patient scheduled to be seen in 2 weeks but presented every 3 - 4 weeks. Patient prescribed custom molded shoes and continued with daily
dressing changes. (Fig. 2) |
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Results:
Patient continued to be non-compliant and was last seen on August 17, 2008 with ulcer closed. (Fig. 3)
Follow this link to see other Case Studies. |
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Amerigel® Skin and Wound Care Products contain Oakin®, a proprietary oak extract proven to treat a variety of skin conditions. The tannins found in the Oakin® enhance the natural healing of wounds, ulcers, burns, sores, cuts, rashes and is recommended for problematic skin conditions caused by diabetes. This unique ingredient has earned AmeriGel® Wound Dressing a #1 rating by podiatrists across the country for use as a topical wound/ulcer and post surgical treatment.
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