Anti-infective therapy without antimicrobials: Apparent successful treatment of multidrug resistant osteomyelitis with hyperbaric oxygen therapy

Goerger, Elsa; Honnorat, Estelle; Savini, Hélène; Coulange, Mathieu; Bergmann, E.; Simon, Fabrice; Seng, Piseth; Stein, Andréas

doi:10.1016/j.idcr.2016.09.008

Cited by 15 publications

(14 citation statements)

References 10 publications

(11 reference statements)

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“…Hyperbaric oxygen therapy (HBOT) is a treatment method for soft tissue infections. 75 HBOT is a systemic method conducted in a pressurized chamber where the patient inhales 100% O 2 for a specified time in which it is delivered by the lung to the whole body. 76 , 77 HBOT induces the release of ROS and eliminates the optimum conditions required for obligate and facultative anaerobic bacteria that lack antioxidant defense mechanisms.…”

Section: Hyperbaric Oxygen Treatmentmentioning

confidence: 99%

Antimicrobial use of reactive oxygen therapy: current insights

Memar¹,

Ghotaslou²,

Samiei³

et al. 2018

IDR

180

126

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Infections caused by drug-resistant pathogens are a global public health problem. The introduction of a new antimicrobial strategy is an unavoidable option for the management of drug-resistant pathogens. Induction of high levels of reactive oxygen species (ROS) by several procedures has been extensively studied for the treatment of infections. In this article, the general aspects of ROS production and the common procedures that exert their antimicrobial effects due to ROS formation are reviewed. ROS generation is the antimicrobial mechanism of nanoparticles, hyperbaric oxygen therapy, medical honey, and photodynamic therapy. In addition, it is an alternative bactericidal mechanism of clinically traditional antibiotics. The development of ROS delivery methods with a desirable selectivity for pathogens without side effects for the host tissue may be a promising approach for the treatment of infections, especially those caused by drug-resistant organisms.

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Section: Hyperbaric Oxygen Treatmentmentioning

confidence: 99%

Antimicrobial use of reactive oxygen therapy: current insights

Memar¹,

Ghotaslou²,

Samiei³

et al. 2018

IDR

180

126

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“…Ceftazidime-avibactam combined with aztreonam in vitro demonstrated a synergistic effect against MBL-coproducing Enterobacteriaceae in two reports, being particularly effective against K. pneumoniae isolates, again highlighting the need to assess additional mechanisms of carbapenem resistance in OXA-48-carrying strains (68). Lastly, nonantibiotic options have been explored with an OXA-48-type carbapenemase-producing K. pneumoniae diabetic foot osteomyelitis acquired in Tunisia, which was successfully treated with hyperbaric oxygen therapy alone (69). Overall, these observations highlight the variability and unpredictability of appropriate therapeutic options for this type of infection.…”

Section: Treatment Optionsmentioning

confidence: 99%

Treatment of Infections by OXA-48-Producing Enterobacteriaceae

Stewart

Harris

Henderson

et al. 2018

Antimicrob Agents Chemother

118

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Carbapenemase-producing (CPE) contribute significantly to the global public health threat of antimicrobial resistance. OXA-48 and its variants are unique carbapenemases with low-level hydrolytic activity toward carbapenems but no intrinsic activity against expanded-spectrum cephalosporins. is typically located on a plasmid but may also be integrated chromosomally, and this gene has progressively disseminated throughout Europe and the Middle East. Despite the inability of OXA-48-like carbapenemases to hydrolyze expanded-spectrum cephalosporins, pooled isolates demonstrate high variable resistance to ceftazidime and cefepime, likely representing high rates of extended-spectrum beta-lactamase (ESBL) coproduction. data from pooled studies suggest that avibactam is the most potent beta-lactamase inhibitor when combined with ceftazidime, cefepime, aztreonam, meropenem, or imipenem. Resistance to novel avibactam combinations such as imipenem-avibactam or aztreonam-avibactam has not yet been reported in OXA-48 producers, although only a few clinical isolates have been tested. Although combination therapy is thought to improve the chances of clinical cure and survival in CPE infection, successful outcomes were seen in ∼70% of patients with infections caused by OXA-48-producing treated with ceftazidime-avibactam monotherapy. A carbapenem in combination with either amikacin or colistin has achieved treatment success in a few case reports. Uncertainty remains regarding the best treatment options and strategies for managing these infections. Newly available antibiotics such as ceftazidime-avibactam show promise; however, recent reports of resistance are concerning. Newer choices of antimicrobial agents will likely be required to combat this problem.

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“…There is evidence in the literature that HBO may be useful to treat osteomyelitis [30,31], which could somewhat dampen the strength of this first theory, though osteomyelitis is associated with intense infection, which is an altogether different scenario to guided tissue regeneration for implant supported dental rehabilitation. HBO has been reported as an antimicrobial approach even in cases of infected bone [32], which demonstrates its positive impact on hard tissue, though secondary to resolution of a pre-existing infectious process, as opposed to a direct impact on germ-free bone neoformation. The second theory suggested by the authors was that HBO had no effect on bone neoformation because it was associated with BMAC, which is already known to promote a significant increase in neovascularization, an aspect that might not be further enhanced by HBO.…”

Section: Discussionmentioning

confidence: 99%

Use of Bone Marrow Aspirate Concentrate (BMAC) Associated with Hyperbaric Oxygenation Therapy in Maxillary Appositional Bone Reconstruction. A Randomized Clinical Trial

Aloise

Pasquali²,

Sperandio

et al. 2018

Symmetry

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Objectives: The objective of this study was to evaluate bone reconstruction using xenograft alone and associated with bone marrow aspirate concentrate (BMAC) and hyperbaric oxygen therapy. Material and Methods: Twenty-four maxillary edentulous patients were randomly assigned into three groups: Control group (CG)—xenograft bone alone (n = 8); Group 1 (G1)—xenogeneic bone block combined with BMAC (n = 8), and Group 2 (G2)—xenogeneic bone block combined with BMAC and hyperbaric oxygenation (n = 8). Bone biopsies were harvested 6 months after grafting. Vital Mineralized Tissue (VMT), Non-vital Mineralized Tissue (NVMT), and Non-Mineralized Tissue (NMT) were measured. Computed tomography was also performed on three occasions T0 (preoperative), T4 (4 months postoperative), and T8 (8 months postoperative). The difference between T4 and T8 values with respect to T0 was used to determine the thickness level gain after 4 and 8 months, respectively. Results: The tomographic evaluation did not show significant differences between the groups either at 4 or at the 8 months postoperatively. Regarding the histomorphometric analysis, CG had the lowest percentages of VMT (36.58 ± 9.56%), whereas G1 and G2 had similar results (55.64 ± 2.83% and 55.30 ± 1.41%, respectively). Concerning NMT and NVMT levels, the opposite was observed, with CG levels of 51.21 ± 11.54% and 11.16 ± 2.37%, G1 of 39.76 ± 11.48% and 3.65 ± 0.87%, and G2 of 40.3 ± 11.48% and 4.10 ± 0.87%, respectively. Conclusions: The use of bone block xenograft associated with BMAC resulted in a significant increase of bone neoformation when compared to the xenograft alone, though hyperbaric oxygenation did not enhance the results.

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Anti-infective therapy without antimicrobials: Apparent successful treatment of multidrug resistant osteomyelitis with hyperbaric oxygen therapy

Cited by 15 publications

References 10 publications

Antimicrobial use of reactive oxygen therapy: current insights

Antimicrobial use of reactive oxygen therapy: current insights

Treatment of Infections by OXA-48-Producing Enterobacteriaceae

Use of Bone Marrow Aspirate Concentrate (BMAC) Associated with Hyperbaric Oxygenation Therapy in Maxillary Appositional Bone Reconstruction. A Randomized Clinical Trial

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