Conservative multimodal management of osteosynthesis material in surgical wounds with polymicrobial superinfection, including methicillin-resistant Staphylococcus aureus. Clinical case

Clinical and histological safety assessment of repeated intra-articular sevoflurane injections into knee joints of Sprague-Dawley rats

“…Concerning the eventual effects of sevoflurane specifically on joints, three clinical cases describing infections affecting the elbow, 38 ankle, 23 and knee 25 need to be addressed. Osteosynthesis material was involved in all three infections, but all of them were successfully resolved with sevoflurane in addition to systemic antibiotics.…”

“…Topical sevoflurane has been repeatedly applied for the successful treatment of infected ulcers and infected surgical wounds. [19][20][21][23][24][25][26][27] This study has several limitations Sample size was not calculated and, considering the final small sample size, it could be argued that the histological results were underpowered. However, as stated below, our aim was not to detect any kind of histological damage.…”

“…In addition to the analgesic effect, an antimicrobial effect has been reported in infected wounds. [19][20][21][22][23][24][25][26][27] Interestingly, some of the infections successfully treated with topical sevoflurane were caused by bacteria resistant to conventional antibiotics, such as methicillin resistant Staphylococcus aureus [21][22][23]25,26 and multi-drug-resistant Pseudomonas aeruginosa. 19,27 In addition to open wounds applications, the liquid formulation allows sevoflurane to be injected into open infected cavities through the fistulous tract which connects the cavity with the skin.…”

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

“…Antibiotic resistance in bacteria even multidrug-resistant (MDR) bacteria is now a worldwide challenge [ 91 ]. Antibiotic-resistant infections were frequently reported all over the world, including in both developing and developed countries ( Table 4 ) [ 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. During an infection, Staphylococcus aureus ( S. aureus ) often forms biofilms on implantable devices, which dramatically increases the ability of the species to acquire resistance via horizontal plasmid transfer [ 111 ].…”

“…This is why S. aureus has high rates of resistance. As shown by the typical cases reported in recent years ( Table 4 ), MRSA has become the most common strain causing infections of various implantable medical devices, including cardiac devices [ 93 , 95 , 99 , 103 , 106 ], orthopedic prosthetics [ 96 , 97 ], cochlear implants [ 98 ], breast implants [ 100 ], laryngeal implants [ 101 ], and stent grafts [ 109 ]. In addition, there is an alarming increase in antibiotic resistance in other strains, such as Acinetobacter baumannii [ 92 ], Mycobacterium chelonae [ 94 ], Enterobacter cloacae complex [ 102 ], S. epidermidis [ 104 , 110 ], Klebsiella pneumoniae [ 105 ], Staphylococcus haemolyticus [ 107 ], and Staphylococcal endophthalmitis [ 108 ], are also involved in various resistant DAIs.…”