Direct application of Amikacin in pressure sores - A prospective cohort study

The largest organ in the body, the skin, serves multiple purposes. Every year, the expense of treating its wounds, such as all types of pressure sores, ulcers, burn wounds, and other abrasive and traumatic wounds, is very significant. As a result, many studies on wound dressings have been performed to develop an effective strategy for wound healing [1,2]. One of the major obstacles to wound healing is the infection caused by bacteria and other microorganisms in the wounded area of the skin [3]. Further problems, such as delayed skin recovery, may occur as a result of this infection. Burn wounds, acute surgical wounds, traumatic wounds such as those that arise as a result of an accident, and chronic wounds such as diabetic foot, leg, and pressure ulcers are just a few examples of the various types of wounds that patients may present within a range of different settings. Patients may also have acute wounds after surgery, traumatic wounds such as those that arise as a result of an accident, and burn wounds. All wounds contain microorganisms that are a part of the saprophytic microflora of the skin, which might help the wound heal [20]. Skin is the most exposed part of the body to the environment, and it is easily contaminated with bacteria in wounds. S. aureus, beta-hemolytic streptococci, and coryneform bacteria are the three skin pathogens that are found most frequently in open environments. In open wounds, it is very difficult to avoid forming such bacteria. Most people use antibiotic cream and ointments for local use. In most cases, standard systemic antibiotics are sufficient for treating simple postoperative infections. These antibiotics are safe and effective in simple infections due to their strong bacterial sensitivity, good penetration into well-vascularized tissues, and low host toxicity. However, failures of systemic antibiotic therapy occasionally occur and are linked to high costs and morbidity [1]. Amikacin (AM), a potent commercially available antibiotic medication, is frequently given because it is effective in eliminating a wide range of gram-positive and gram-negative bacteria [2]. The therapeutic local drug concentrations of a slow-release antibiotic formulation administered directly to the infection sites may be maintained, preventing systemic exposure to potentially harmful substances. Selection of resistant organisms at distant locales might possibly be prevented as well [3]. Pressure sores (decubitus ulcers) develop because of tissue death due to ischemia and are one of the most common problems encountered following Meningomyelocele , cerebral palsy , traumatic spinal myelopathy (15) and . These lesions are frequently multiple and can vary in severity from mild erythema of the skin to huge necrotic excavations with extensive destruction of underlying connective tissue and bone. Pressure sores im-pede rehabilitation and have major socioeconomic conse-quences (7, 5). They are recurrent and often serve as foci of local and systemic sepsis. The devitalized, ischemic tissue adjoining pressure sores invites the growth of micro-organisms, and the gram-negative infections which fre-quently complicate these wounds are often caused by organisms susceptible to aminoglycoside antibiotics (13).Bacteremia can be anticipated to accompany debridement of pressure sores, and the septicemia or cellulitis associated with pressure sores is a significant cause of morbidity and mortality in many patients affected with Myelomeningocele , Cerebral palsy , Diabetes and spinal cord injuries (SCI) (5, 13).Most bacterial infections are localized in tissue. The interstitial fluid (IF) in tissue contiguous with a pressure sore serves as a medium for propagation of infection and is also the primary path by which antibiotics are transported to a site of infection. Hence, a major determinant of the efficacy of antimicrobial therapy is thought to be the amount of antibiotic available in the IF (2, 6). The concentration of a drug in the IF that is free (unbound to proteins) andgenerally considered to be biologically active is ofgreater therapeutic significance than the corresponding total concentration. Although penetration of antibiotics into living tissue has been extensively studied (3, 4, 14), measurement of antibi-otic concentrations in viable tissue surrounding pressure sores in patients with SCI has not been described. Never-theless, strategies for the use of antimicrobial agents in preoperative prophylaxis or in the treatment of infected pressure sores have evolved in the absence of information about the concentrations in tissue and pharmacokinetic behavior of antibiotics at the precise location where infection originates and is propagated. A dearth of information concerning the concentration and disposition of antibiotics in tissue adjoining pressure sores led us to implement a study of amikacin, an aminoglycoside antibiotic of proven efficacy in the treatment of gram-negative infections, in a population of patients whoare highly susceptible to both pressure sores and gram-negative bacterial sepsis.