Jalali Omid, Best Molly, Wong Alison, Schaeffer Brett, Bauer Brendon, Johnson Lanny
Keck School of Medicine of USC, Los Angeles, California.
Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California.
JB JS Open Access. 2020 Jun 26;5(3). doi: 10.2106/JBJS.OA.19.00079. eCollection 2020 Jul-Sep.
There is a need for novel skin antiseptic agents to combat the health-care burdens associated with surgical site infection (SSI) and bacterial resistance. The purpose of this proof-of-principle pilot study was to investigate the potential of the phenolic compound protocatechuic acid (PCA) as a topical antimicrobial for surgical skin antisepsis.
The Kirby-Bauer method of disc diffusion was used to investigate the in vitro antimicrobial activity and comparative effectiveness of PCA and 7 related compounds against SSI pathogens. To explore the in vivo efficacy of topical PCA for providing deep, penetrating skin antisepsis, living was intradermally injected into the skin of female BALB/c mice. Mice were assigned to treatment with daily applications of topical PCA at 3 doses (78, 39, and 19.5 mM) or no treatment (n = 2 mice per group). After 96 hours, infected skin samples were harvested to compare mean counts by treatment.
Compared with other polyphenols, PCA demonstrated the broadest spectrum of antimicrobial activity against tested SSI pathogens, including drug-resistant organisms. At 96 hours following infection, the mean burden in untreated mice was 6.65 log colony-forming units (CFUs) per gram of skin. Compared with the untreated group, daily topical application of 78 mM of PCA was associated with a significantly lower CFU burden in mice skin (mean, 5.51 log CFUs per gram of skin; p = 0.0295). Both lower dosages of topical PCA failed to show an effect.
PCA demonstrated laboratory efficacy against pathogens implicated in SSI, including drug-resistant organisms. In vivo, topical PCA demonstrated dose-dependent skin penetration and antimicrobial activity against mouse skin loads. Human clinical studies exploring the antimicrobial efficacy of topical PCA for preoperative shoulder skin antisepsis are warranted.
Topical PCA may have the potential to improve current shoulder SSI treatment and prevention protocols.
需要新型皮肤抗菌剂来应对与手术部位感染（SSI）和细菌耐药性相关的医疗负担。本原理验证性初步研究的目的是调查酚类化合物原儿茶酸（PCA）作为手术皮肤消毒局部抗菌剂的潜力。
采用 Kirby-Bauer 纸片扩散法研究 PCA 及 7 种相关化合物对 SSI 病原体的体外抗菌活性和比较有效性。为探究局部 PCA 提供深层、穿透性皮肤消毒的体内疗效，将活的[此处原文可能有误，推测为某种细菌名称]皮内注射到雌性 BALB/c 小鼠皮肤中。将小鼠分为三组，分别每日局部应用 3 种剂量（78、39 和 19.5 mM）的 PCA 进行治疗或不治疗（每组 n = 2 只小鼠）。96 小时后，采集感染的皮肤样本以比较各治疗组的平均[此处原文可能有误，推测为细菌计数]计数。
与其他多酚相比，PCA 对测试的 SSI 病原体（包括耐药菌）表现出最广泛的抗菌活性谱。感染后 96 小时，未治疗小鼠的平均[此处原文可能有误，推测为细菌]负荷为每克皮肤 6.65 log 菌落形成单位（CFU）。与未治疗组相比，每日局部应用 78 mM 的 PCA 使小鼠皮肤中的[此处原文可能有误，推测为细菌]CFU 负荷显著降低（平均每克皮肤 5.51 log CFUs；p = 0.0295）。两种较低剂量的局部 PCA 均未显示出效果。
PCA 在实验室中对涉及 SSI 的病原体（包括耐药菌）显示出疗效。在体内，局部 PCA 对小鼠皮肤[此处原文可能有误，推测为细菌]负荷表现出剂量依赖性的皮肤渗透和抗菌活性。有必要进行人体临床研究以探索局部 PCA 用于术前肩部皮肤消毒的抗菌疗效。
局部 PCA 可能有潜力改善当前肩部 SSI 的治疗和预防方案。
