Swift Cure of a Chronic Wound Infected With Multiresistant Staphylococcus aureus in an Elderly Patient With Stage 5 Renal Disease

Abstract

We present a case of a 91-year-old female with stage 5 renal disease, diabetes type 2, and considerable weakness, suffering from a 2-month-old wound infected by a multiresistant Staphylococcus aureus. The wound measured 7 cm in length, 5 cm in width, and 1.5 cm in depth, having purulent white edges and exudates exceeding the size of the wound. The systemic antibiotic use was opposing to improve the patient’s clinical condition due to underlying nephrotoxicity that may have deteriorated renal failure and resistance of the infecting pathogen. The halogenated taurine (Tau) derivatives N-chlorotaurine (NCT) and N-bromotaurine (NBrT) with potent anti-inflammatory and antimicrobial efficacy were alternatively employed as combination topical treatment to provide a therapeutic solution. Each agent was applied separately with an interval of 5 minutes as a 1% spray in aqueous solution every 30 minutes during the day for 3 days. This treatment was very well tolerated and led to rapid disappearance of the purulent exudate, rapid epithelialization, and complete healing. To avoid relapse, the application was continued 4 times daily for a further 4 days. No complications occurred in the course of treatment. This case report confirms the therapeutic efficacy of NCT in chronic purulent wounds. NBrT is well tolerated, too, and can be used in combination with NCT in emergency clinical settings. Its potential as a single agent should be investigated in further studies. Advancement of wound closure by these agents proved to be life-saving for this patient. Further molecular research is needed to identify mechanisms that promote wound healing.

Successful treatment of a unique chronic multi-bacterial scalp infection with N-chlorotaurine, N-bromotaurine and bromamine T

“…None of these halogens proved toxic for the patient. This is in agreement with our previous experimental evidence for a low toxicity of halogens against human cells [59] and a remarkable tolerability by human subjects [20,21,61]. No relapse of infection occurred, as the patient remained free of symptoms for many months post-treatment.…”

“…Therefore, antimicrobial treatment at our hospital was considered. As the patient refused further systemic antibiotics, a novel topical application of the taurine derivatives NCT and NBrT was suggested, because of their high tolerability and antiseptic activity including against biofilms without the development of resistance [18][19][20]. As expected, all clinical isolates were rapidly inactivated in time-kill assays in vitro by the active chlorine and bromine compounds used ( Table 2).…”

“…NCT and NBrT solutions at a concentration of 1.0 % (55 mM NCT, 49 mM NBrT) were freshly prepared in distilled water as described previously in 2016 and 2019 [19,20]. The solutions were put into sterile spray bottles, which released approximately 130 µl per single puff.…”

“…1c). On the fourth day, to further increase the therapeutic efficacy noticed with 1 % NCT as seen in herpes zoster and in a crural purulent wound [20,21], it was decided to proceed with a sequential combination of NCT and NBrT at a concentration of 1 % each. The treatment was altered in that for half an hour a gauze soaked with 1 % NCT solution was used, followed by a gauze soaked with 1 % NBrT solution for half an hour.…”

“…Recently, NCT and NBrT have been also combined as an approach to potentiate their properties. This was a favourable therapeutic choice in the case of a herpes zoster infection refractory to common antivirals [19], and truly life-saving in the case of a multiresistant S. aureus chronic wound infection [20]. Moreover, both haloamines inhibit bacterial biofilm formation and inactivate biofilm as proved in vitro [21,22], with NBrT showing superiority in this activity [21].…”