Prevention and Treatment of Frostbite Infection With Antimicrobial Pharmacokinetic Analysis

Summary

This study will compare the effectiveness of two different treatments for preventing infection from frostbite injuries. These two treatments are A) aloe vera and B) long-acting silver wound dressings. The investigators will also study the safety and effectiveness of Dalbavancin, an FDA approved antibiotic used for treating people who develop frostbite wound infections, as well as evaluate how frostbite damage to individuals' bodies may affect how fast their kidney clear drugs from their systems.

Timeline

Start

2024-03-01

Primary completion

2026-05

Completion

2026-08

Publications

• Background Mueller SW, Blass B, Molina KC, Gibson C, Krsak M, Kohler AD, Deeter L, Stalilonis J, Wiktor AJ. Augmented Renal Function in Burn Patients: Occurrence and Discordance With Commonly Used Methods to Assess Renal Function. J Burn Care Res. 2023 Nov 2;44(6):1298-1303. doi: 10.1093/jbcr/irad107.
• Background Carmichael H, Michel S, Smith TM, Duffy PS, Wiktor AJ, Lambert Wagner A. Remote Delivery of Thrombolytics Prior to Transfer to a Regional Burn Center for Tissue Salvage in Frostbite: A Single-center Experience of 199 Patients. J Burn Care Res. 2022 Jan 5;43(1):54-60. doi: 10.1093/jbcr/irab041.
• Background Torian SC, Wiktor AJ, Roper SE, Laramie KE, Miller MA, Mueller SW. Burn Injury and Augmented Renal Clearance: A Case for Optimized Piperacillin-Tazobactam Dosing. J Burn Care Res. 2023 Jan 5;44(1):203-206. doi: 10.1093/jbcr/irac138.
• Background Barletta JF, Mangram AJ, Byrne M, Sucher JF, Hollingworth AK, Ali-Osman FR, Shirah GR, Haley M, Dzandu JK. Identifying augmented renal clearance in trauma patients: Validation of the Augmented Renal Clearance in Trauma Intensive Care scoring system. J Trauma Acute Care Surg. 2017 Apr;82(4):665-671. doi: 10.1097/TA.0000000000001387.
• Background Udy AA, Jarrett P, Stuart J, Lassig-Smith M, Starr T, Dunlop R, Wallis SC, Roberts JA, Lipman J. Determining the mechanisms underlying augmented renal drug clearance in the critically ill: use of exogenous marker compounds. Crit Care. 2014 Nov 29;18(6):657. doi: 10.1186/s13054-014-0657-z.
• Background Cook AM, Hatton-Kolpek J. Augmented Renal Clearance. Pharmacotherapy. 2019 Mar;39(3):346-354. doi: 10.1002/phar.2231. Epub 2019 Mar 11.
• Background Dunne MW, Puttagunta S, Giordano P, Krievins D, Zelasky M, Baldassarre J. A Randomized Clinical Trial of Single-Dose Versus Weekly Dalbavancin for Treatment of Acute Bacterial Skin and Skin Structure Infection. Clin Infect Dis. 2016 Mar 1;62(5):545-51. doi: 10.1093/cid/civ982. Epub 2015 Nov 26.
• Background Carrothers TJ, Chittenden JT, Critchley I. Dalbavancin Population Pharmacokinetic Modeling and Target Attainment Analysis. Clin Pharmacol Drug Dev. 2020 Jan;9(1):21-31. doi: 10.1002/cpdd.695. Epub 2019 May 14.
• Background Mangum LC, Garcia GR, Akers KS, Wenke JC. Duration of extremity tourniquet application profoundly impacts soft-tissue antibiotic exposure in a rat model of ischemia-reperfusion injury. Injury. 2019 Dec;50(12):2203-2214. doi: 10.1016/j.injury.2019.09.025. Epub 2019 Sep 20.
• Background Kam PC, Kavanagh R, Yoong FF. The arterial tourniquet: pathophysiological consequences and anaesthetic implications. Anaesthesia. 2001 Jun;56(6):534-45. doi: 10.1046/j.1365-2044.2001.01982.x.
• Background Dunne MW, Puttagunta S, Sprenger CR, Rubino C, Van Wart S, Baldassarre J. Extended-duration dosing and distribution of dalbavancin into bone and articular tissue. Antimicrob Agents Chemother. 2015 Apr;59(4):1849-55. doi: 10.1128/AAC.04550-14. Epub 2015 Jan 5.
• Background Nicolau DP, Sun HK, Seltzer E, Buckwalter M, Dowell JA. Pharmacokinetics of dalbavancin in plasma and skin blister fluid. J Antimicrob Chemother. 2007 Sep;60(3):681-4. doi: 10.1093/jac/dkm263. Epub 2007 Jul 12.
• Background Morrisette T, Miller MA, Montague BT, Barber GR, McQueen RB, Krsak M. On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections. J Antimicrob Chemother. 2019 Aug 1;74(8):2405-2416. doi: 10.1093/jac/dkz162.
• Background Molina KC, Lunowa C, Lebin M, Segerstrom Nunez A, Azimi SF, Krsak M, Mueller SW, Miller MA. Comparison of Sequential Dalbavancin With Standard-of-Care Treatment for Staphylococcus aureus Bloodstream Infections. Open Forum Infect Dis. 2022 Jul 14;9(7):ofac335. doi: 10.1093/ofid/ofac335. eCollection 2022 Jul.
• Background Cain AR, Bremmer DN, Carr DR, Buchanan C, Jacobs M, Walsh TL, Moffa MA, Shively NR, Trienski TL. Effectiveness of Dalbavancin Compared With Standard of Care for the Treatment of Osteomyelitis: A Real-world Analysis. Open Forum Infect Dis. 2021 Dec 18;9(2):ofab589. doi: 10.1093/ofid/ofab589. eCollection 2022 Feb.
• Background Rappo U, Puttagunta S, Shevchenko V, Shevchenko A, Jandourek A, Gonzalez PL, Suen A, Mas Casullo V, Melnick D, Miceli R, Kovacevic M, De Bock G, Dunne MW. Dalbavancin for the Treatment of Osteomyelitis in Adult Patients: A Randomized Clinical Trial of Efficacy and Safety. Open Forum Infect Dis. 2018 Dec 10;6(1):ofy331. doi: 10.1093/ofid/ofy331. eCollection 2019 Jan.
• Background Boucher HW, Wilcox M, Talbot GH, Puttagunta S, Das AF, Dunne MW. Once-weekly dalbavancin versus daily conventional therapy for skin infection. N Engl J Med. 2014 Jun 5;370(23):2169-79. doi: 10.1056/NEJMoa1310480.
• Background Jones RN, Fritsche TR, Sader HS, Goldstein BP. Antimicrobial spectrum and potency of dalbavancin tested against clinical isolates from Europe and North America (2003): initial results from an international surveillance protocol. J Chemother. 2005 Dec;17(6):593-600. doi: 10.1179/joc.2005.17.6.593.
• Background Molina KC, Miller MA, Mueller SW, Van Matre ET, Krsak M, Kiser TH. Clinical Pharmacokinetics and Pharmacodynamics of Dalbavancin. Clin Pharmacokinet. 2022 Mar;61(3):363-374. doi: 10.1007/s40262-021-01088-w. Epub 2021 Dec 21.
• Background Sader HS, Castanheira M, Huband MD, Shortridge D, Carvalhaes CG, Mendes RM. Antimicrobial activity of dalbavancin against Gram-positive bacteria isolated from patients hospitalized with bloodstream infection in United States and European medical centers (2018-2020). Eur J Clin Microbiol Infect Dis. 2022 May;41(5):867-873. doi: 10.1007/s10096-022-04437-0. Epub 2022 Mar 30.
• Background Goldstein EJ, Citron DM, Warren YA, Tyrrell KL, Merriam CV, Fernandez HT. In vitro activities of dalbavancin and 12 other agents against 329 aerobic and anaerobic gram-positive isolates recovered from diabetic foot infections. Antimicrob Agents Chemother. 2006 Aug;50(8):2875-9. doi: 10.1128/AAC.00286-06.
• Background Madry R, Struzyna J, Stachura-Kulach A, Drozdz L, Bugaj M. Effectiveness of Suprathel(R) application in partial thickness burns, frostbites and Lyell syndrome treatment. Pol Przegl Chir. 2011 Oct;83(10):541-8. doi: 10.2478/v10035-011-0086-5.
• Background Heil K, Thomas R, Robertson G, Porter A, Milner R, Wood A. Freezing and non-freezing cold weather injuries: a systematic review. Br Med Bull. 2016 Mar;117(1):79-93. doi: 10.1093/bmb/ldw001. Epub 2016 Feb 12.
• Background Gonzaga T, Jenabzadeh K, Anderson CP, Mohr WJ, Endorf FW, Ahrenholz DH. Use of Intra-arterial Thrombolytic Therapy for Acute Treatment of Frostbite in 62 Patients with Review of Thrombolytic Therapy in Frostbite. J Burn Care Res. 2016 Jul-Aug;37(4):e323-34. doi: 10.1097/BCR.0000000000000245.
• Background Goertz O, Hirsch T, Buschhaus B, Daigeler A, Vogelpohl J, Langer S, Steinau HU, Ring A. Intravital pathophysiologic comparison of frostbite and burn injury in a murine model. J Surg Res. 2011 May 15;167(2):e395-401. doi: 10.1016/j.jss.2011.01.034. Epub 2011 Feb 18.
• Background Cauchy E, Cheguillaume B, Chetaille E. A controlled trial of a prostacyclin and rt-PA in the treatment of severe frostbite. N Engl J Med. 2011 Jan 13;364(2):189-90. doi: 10.1056/NEJMc1000538. No abstract available.
• Background Imray C, Grieve A, Dhillon S; Caudwell Xtreme Everest Research Group. Cold damage to the extremities: frostbite and non-freezing cold injuries. Postgrad Med J. 2009 Sep;85(1007):481-8. doi: 10.1136/pgmj.2008.068635.
• Background Woodmansey EJ, Roberts CD. Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds. Int Wound J. 2018 Dec;15(6):1025-1032. doi: 10.1111/iwj.12969. Epub 2018 Aug 17.
• Background Silverstein P, Heimbach D, Meites H, Latenser B, Mozingo D, Mullins F, Garner W, Turkowski J, Shupp J, Glat P, Purdue G. An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream. J Burn Care Res. 2011 Nov-Dec;32(6):617-26. doi: 10.1097/BCR.0b013e318236fe31.
• Background Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mohapatra DP, Hassan IA, Dumville JC. Antiseptics for burns. Cochrane Database Syst Rev. 2017 Jul 12;7(7):CD011821. doi: 10.1002/14651858.CD011821.pub2.
• Background Dat AD, Poon F, Pham KB, Doust J. Aloe vera for treating acute and chronic wounds. Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD008762. doi: 10.1002/14651858.CD008762.pub2.
• Background Miller MB, Koltai PJ. Treatment of experimental frostbite with pentoxifylline and aloe vera cream. Arch Otolaryngol Head Neck Surg. 1995 Jun;121(6):678-80. doi: 10.1001/archotol.1995.01890060076015.
• Background Klein AD, Penneys NS. Aloe vera. J Am Acad Dermatol. 1988 Apr;18(4 Pt 1):714-20. doi: 10.1016/s0190-9622(88)70095-x.
• Background Heggers JP, Robson MC, Manavalen K, Weingarten MD, Carethers JM, Boertman JA, Smith DJ Jr, Sachs RJ. Experimental and clinical observations on frostbite. Ann Emerg Med. 1987 Sep;16(9):1056-62. doi: 10.1016/s0196-0644(87)80758-8.
• Background Khaira HS, Coddington T, Drew A, Roberts PN, Imray CH. Patellar tendon bearing orthosis--application as adjunctive treatment in healing of lower-limb tissue loss. Eur J Vasc Endovasc Surg. 1998 Dec;16(6):485-8. doi: 10.1016/s1078-5884(98)80238-4.
• Background Imray CH, Oakley EH. Cold still kills: cold-related illnesses in military practice freezing and non-freezing cold injury. J R Army Med Corps. 2005 Dec;151(4):218-22. doi: 10.1136/jramc-151-04-02. No abstract available.
• Background Cauchy E, Chetaille E, Marchand V, Marsigny B. Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme. Wilderness Environ Med. 2001 Winter;12(4):248-55. doi: 10.1580/1080-6032(2001)012[0248:rsocos]2.0.co;2.
• Background Cauchy E, Marsigny B, Allamel G, Verhellen R, Chetaille E. The value of technetium 99 scintigraphy in the prognosis of amputation in severe frostbite injuries of the extremities: A retrospective study of 92 severe frostbite injuries. J Hand Surg Am. 2000 Sep;25(5):969-78. doi: 10.1053/jhsu.2000.16357.
• Background Handford C, Thomas O, Imray CHE. Frostbite. Emerg Med Clin North Am. 2017 May;35(2):281-299. doi: 10.1016/j.emc.2016.12.006.
• Background Zaramo TZ, Green JK, Janis JE. Practical Review of the Current Management of Frostbite Injuries. Plast Reconstr Surg Glob Open. 2022 Oct 24;10(10):e4618. doi: 10.1097/GOX.0000000000004618. eCollection 2022 Oct.
• Background Bruen KJ, Ballard JR, Morris SE, Cochran A, Edelman LS, Saffle JR. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007 Jun;142(6):546-51; discussion 551-3. doi: 10.1001/archsurg.142.6.546.
• Background Bennett BL, Holcomb JB. Battlefield Trauma-Induced Hypothermia: Transitioning the Preferred Method of Casualty Rewarming. Wilderness Environ Med. 2017 Jun;28(2S):S82-S89. doi: 10.1016/j.wem.2017.03.010. Epub 2017 May 5.
• Background DeGroot DW, Rappole CA, McHenry P, Englert RM. Seasonal Trends for Environmental Illness Incidence in the U.S. Army. Mil Med. 2022 May 3;187(5-6):e672-e677. doi: 10.1093/milmed/usab072.

Drugs

Indications

No indication recorded.