A simple and effective approach for the treatment of chronic wound infections caused by multiple antibiotic resistant Escherichia coli

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Summary

Antimicrobial resistance is a major problem in present-day therapy. Despite the advent of newer antimicrobial agents with a broad spectrum of activity, multiple antibiotic resistant pathogens are difficult to eliminate from infected sites. The present study was carried out to develop an approach, using citric acid as a sole antimicrobial agent, for the treatment of chronic wound infections caused by multiresistant Escherichia coli (MAREC). A total of 34 cases of chronic wound infections yielding MAREC isolates on culture were studied. The antibacterial effect of citric acid against MAREC was evaluated in vitro by broth dilution method. Three percent citric acid gel was applied to each wound once daily until it healed completely. All 34 isolates were inhibited by citric acid with minimum inhibitory concentrations in the range of 1500–2000 μg/ml. Topical application of 3% citric acid to wounds 7–42 times resulted in elimination of MAREC from infected sites and successful healing of wounds in all 34 patients. This treatment modality was simple, reliable, non-toxic and effective. Hence, the use of citric acid for the cost-effective treatment of wound infections caused by MAREC is recommended.

Introduction

Antimicrobial resistance is a major problem and is continuously increasing all over the world, especially in nosocomial infections. The topical use of acetic acid and citric acid for the treatment of nosocomial wound infections caused by P. aeruginosa has been reported previously.1, 2, 3, 4 Considering multiple antibiotic resistance E. coli (MAREC) in association with chronic wound infections, an attempt was made to treat such infections with citric acid.

Section snippets

Methods

A total of 34 cases of chronic wound infections (21 non-healing traumatic ulcers, seven diabetic foot ulcers, four postoperative wound infections and two leprosy ulcers) caused by MAREC not responding to routine wound care were selected for the study. The severity of the local infection for each patient was documented before starting treatment, the diagnosis being made on the basis of local signs of infection. These included presence of slough, discharge from wound, presence of granulation

Results

In-vitro antimicrobial susceptibilities showed that amikacin (47.1%) was the most active agent followed by ceftazidime (35.3%) against the E. coli isolates (Table I). Out of 34 isolates, 32.3% of isolates showed resistance to six drugs, 26.5% to five drugs, 23.5% showed resistance to all seven drugs and the remaining 17.6% isolates showed resistance to four drugs (Table II). All E. coli isolates were found to be inhibited by citric acid. The MIC to citric acid ranged from 1500–2000 μg/ml. Based

Discussion

Wound healing is a process that occurs naturally when the host–bacteria equilibrium is in balance and can be enhanced by reducing the bacterial bioburden.8

In this study, topical application of 3% citric acid gel in all 34 patients was effective in the successful elimination of MAREC from infected sites, resulting in enhanced healing. All the wounds, including severe infected diabetic foot ulcers and lepromatous ulcers, granulated rapidly and healed completely within 7–42 applications. Ulcers

Acknowledgements

We thank Drs. V.D. Karad, H.T. Karad, R.K. Karad, N.S. Arvikar, C.D. Shirole, M.K. Mashalkar, R.G. Malu, N. Jamadar, A. Jagtap, M. Unni, D. Ladda and S. Gaulkar for their support and cooperation. We thank S.S. Gutte, N. Surwase, S.P. Mane, D.L. Ghante, and Mr. M.J. Kaule and Mr. S.S. Kadam for technical assistance.

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