Science.gov

Sample records for wound infection

  1. Surgical wound infection - treatment

    MedlinePlus

    ... there is an infection and what kind of antibiotic medicine would work best Debride the wound by removing dead or infected tissue in the wound Rinse the wound with salt water (saline solution) Drain the pocket of pus (abscess), if present ...

  2. Infection in conflict wounded

    PubMed Central

    Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.

    2011-01-01

    Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base. PMID:21149356

  3. Surgical wound infection surveillance.

    PubMed

    Lee, J T

    2003-12-01

    Measuring the frequency of a defined outcome flaw for a series of patients undergoing operative procedures generates information for performance evaluation. Such data influence decisions to improve care if used responsibly. Wound infection (WI), bacterial invasion of the incision, is the most common infectious complication of surgical care and WI prevention has value because the complication affects economic, patient satisfaction, and patient functional status outcomes. WI frequency, one kind of surgical outcome flaw rate, is traditionally used to judge one aspect of surgical care quality. At the author's institution, global WI surveillance was conducted without interruption for 20 years. Results for 85,260 consecutive inpatient operations performed during the period showed that secular changes in infection rates occurred but were not necessarily caused by surgical care quality decrements. PMID:14750065

  4. Surgical wound infection - treatment

    MedlinePlus

    ... wounds heal, you may have a wound VAC (Vacuum Assisted Closure) dressing. It increases blood flow in ... helps with healing. This is a negative pressure (vacuum) dressing. There is a vacuum pump, a foam ...

  5. Animal models of external traumatic wound infections

    PubMed Central

    Dai, Tianhong; Kharkwal, Gitika B; Tanaka, Masamitsu; Huang, Ying-Ying; Bil de Arce, Vida J

    2011-01-01

    Background: Despite advances in traumatic wound care and management, infections remain a leading cause of mortality, morbidity and economic disruption in millions of wound patients around the world. Animal models have become standard tools for studying a wide array of external traumatic wound infections and testing new antimicrobial strategies. Results: Animal models of external traumatic wound infections reported by different investigators vary in animal species used, microorganism strains, the number of microorganisms applied, the size of the wounds and for burn infections, the length of time the heated object or liquid is in contact with the skin. Methods: This review covers experimental infections in animal models of surgical wounds, skin abrasions, burns, lacerations, excisional wounds and open fractures. Conclusions: As antibiotic resistance continues to increase, more new antimicrobial approaches are urgently needed. These should be tested using standard protocols for infections in external traumatic wounds in animal models. PMID:21701256

  6. Flavimonas oryzihabitans infection of a surgical wound.

    PubMed

    Munro, R; Buckland, G; Neville, S

    1990-10-01

    An unusual case of a post operative wound infection involving Flavimonas oryzihabitans is described. This organism is rarely isolated from human sources. It can cause infections in patients having continuous ambulatory peritoneal dialysis. Our patient developed a wound infection 2 months after femoro-popliteal bypass grafting. The source of the organism was unknown. PMID:2091006

  7. Topical antimicrobial toolkit for wound infection.

    PubMed

    Woo, Kevin Y; Alam, Tarik; Marin, Joseph

    2014-11-01

    Increased bacterial burden and formation of biofilm has been recognized as one of the key factors contributing to delayed wound healing. There is a toolbox of topical antimicrobial wound dressings that incorporate silver, iodine, polyhexamethylene biguanide, methylene blue/gentian violet, and honey. This article reviews a diverse range of evidence to discuss the advantages and disadvantage of topical antimicrobial dressings. Discussion will provide guidance on when and how to use topical antimicrobial dressings to achieve optimal outcomes and cost-effective wound care. Chronic wounds do not follow a predictable and expected healing trajectory, and they may persist for months or years due to underlying disease processes, recurrent injury, and comorbidities.1 With an aging population and increased prevalence of chronic diseases, the majority of wounds are refractory to healing, placing a significant burden on the health system and individual patients. Bacterial burden and biofilm have been recognized as key factors contributing to persistent inflammation, tissue destruction, delayed wound healing, and other serious complications (especially in individuals who are frail and immune-compromised).2 It has been demonstrated that when bacterial growth reaches a critical threshold of 105 bacteria per gram of tissue, bacterial toxins can cause tissue damage in the superficial wound compartment, delaying healing.2 In the literature, this phenomenon is referred to as critical colonization, increased bacterial burden, superficial infection, or localized infection. According to a recent review, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized infection.3. PMID:25433174

  8. Microbiology of Animal Bite Wound Infections

    PubMed Central

    Abrahamian, Fredrick M.; Goldstein, Ellie J. C.

    2011-01-01

    Summary: The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans. PMID:21482724

  9. Microbiology of animal bite wound infections.

    PubMed

    Abrahamian, Fredrick M; Goldstein, Ellie J C

    2011-04-01

    The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans. PMID:21482724

  10. Skin and wound infections: an overview.

    PubMed

    O'Dell, M L

    1998-05-15

    Skin infections are common and may be caused by bacteria, fungi or viruses. Breaks in the skin integrity, particularly those that inoculate pathogens into the dermis, frequently cause or exacerbate skin infections. Bacterial skin infections caused by corynebacteria include erythrasma, trichomycosis axillaris and pitted keratolysis. Staphylococci may cause impetigo, ecthyma and folliculitis. Streptococcal skin infections include impetigo and erysipelas. Human papillomavirus skin infections present as several different types of warts, depending on the surface infected and its relative moisture, and the patterns of pressure. The many dermatomycoses (skin infections caused by fungi or yeasts) include tinea capitis, tinea barbae, tinea cruris, tinea manus, tinea pedis and tinea unguium (onychomycosis). Candidal infections occur in moist areas, such as the vulva, mouth, penis, skinfolds and diaper area. Wounds caused by wood splinters or thorns may result in sporotrichosis. Animal bites may result in complex, serious infections, requiring tetanus and, possibly, rabies prophylaxis in addition to appropriate antibiotic therapy. PMID:9614412

  11. Enhanced susceptibility to infections in a diabetic wound healing model

    PubMed Central

    Hirsch, Tobias; Spielmann, Malte; Zuhaili, Baraa; Koehler, Till; Fossum, Magdalena; Steinau, Hans-Ulrich; Yao, Feng; Steinstraesser, Lars; Onderdonk, Andrew B; Eriksson, Elof

    2008-01-01

    Background Wound infection is a common complication in diabetic patients. The progressive spread of infections and development of drug-resistant strains underline the need for further insights into bacterial behavior in the host in order to develop new therapeutic strategies. The aim of our study was to develop a large animal model suitable for monitoring the development and effect of bacterial infections in diabetic wounds. Methods Fourteen excisional wounds were created on the dorsum of diabetic and non-diabetic Yorkshire pigs and sealed with polyurethane chambers. Wounds were either inoculated with 2 × 108 Colony-Forming Units (CFU) of Staphylococcus aureus or injected with 0.9% sterile saline. Blood glucose was monitored daily, and wound fluid was collected for bacterial quantification and measurement of glucose concentration. Tissue biopsies for microbiological and histological analysis were performed at days 4, 8, and 12. Wounds were assessed for reepithelialization and wound contraction. Results Diabetic wounds showed a sustained significant infection (>105 CFU/g tissue) compared to non-diabetic wounds (p < 0.05) over the whole time course of the experiment. S. aureus-inoculated diabetic wounds showed tissue infection with up to 8 × 107 CFU/g wound tissue. Non-diabetic wounds showed high bacterial counts at day 4 followed by a decrease and no apparent infection at day 12. Epidermal healing in S. aureus-inoculated diabetic wounds showed a significant delay compared with non-inoculated diabetic wounds (59% versus 84%; p < 0.05) and were highly significant compared with healing in non-diabetic wounds (97%; p < 0.001). Conclusion Diabetic wounds developed significantly more sustained infection than non-diabetic wounds. S. aureus inoculation leads to invasive infection and significant wound healing delay and promotes invasive co-infection with endogenous bacteria. This novel wound healing model provides the opportunity to closely assess infections during

  12. Ghee and honey dressing for infected wounds.

    PubMed

    Udwadia, Tehemton E

    2011-08-01

    Ghee and honey has been advocated and used as dressing for infected wounds by Sushruta (600BC) and since 1991 in four Mumbai Hospitals. The gratifying results observed with the dressing have prompted this study which aims to establish its efficacy in five recalcitrant subset of chronic infected wounds over a three year period 2006-2009. A standardized ghee and honey dressing was used to treat: a) Eight cases of fungating malignant lesions. b) Thirteen chronic venous ulcers. c) Twenty nine diabetic foot ulcers. d) Eleven of infected ventral hernia mesh hernioplasty. e) Eleven patient with post-cesarean wound dehiscence. The dressing markedly reduced the foul odour and discharge, significantly improving the quality of life in malignant lesions. The results were equivocal in cases of venous ulcers. The results were uniformly good in the last three groups. In view of our results, as also result of innumerable Randomized Control Trials (RCTs) reported on honey dressing for infected wounds, there is substantial evidence that ghee and honey dressing has at least comparable results to other modes of treatment. The easy availability and low cost of this treatment makes it significant in developing countries. Further trials seem warranted. PMID:22851841

  13. Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section

    ClinicalTrials.gov

    2015-04-20

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  14. Combat-Related Invasive Fungal Wound Infections

    PubMed Central

    Rodriguez, Carlos J.

    2014-01-01

    Combat-related invasive fungal (mold) wound infections (IFIs) have emerged as an important and morbid complication following explosive blast injuries among military personnel. Similar to trauma-associated IFI cases among civilian populations, as in agricultural accidents and natural disasters, these infections occur in the setting of penetrating wounds contaminated by environmental debris. Specific risk factors for combat-related IFI include dismounted (patrolling on foot) blast injuries occurring mostly in southern Afghanistan, resulting in above knee amputations requiring resuscitation with large-volume blood transfusions. Diagnosis of IFI is based upon early identification of a recurrently necrotic wound following serial debridement and tissue-based histopathology examination with special stains to detect invasive disease. Fungal culture of affected tissue also provides supportive information. Aggressive surgical debridement of affected tissue is the primary therapy. Empiric antifungal therapy should be considered when there is a strong suspicion for IFI. Both liposomal amphotericin B and voriconazole should be considered initially for treatment since many of the cases involve not only Mucorales species but also Aspergillus or Fusarium spp., with narrowing of regimen based upon clinical mycology findings. PMID:25530825

  15. Profiling wound healing with wound effluent: Raman spectroscopic indicators of infection

    NASA Astrophysics Data System (ADS)

    Crane, Nicole J.; Elster, Eric A.

    2012-01-01

    The care of modern traumatic war wounds remains a significant challenge for clinicians. Many of the extremity wounds inflicted during Operation Enduring Freedom and Operation Iraqi Freedom are colonized or infected with multi-drug resistant organisms, particularly Acinetobacter baumannii. Biofilm formation and resistance to current treatments can significantly confound the wound healing process. Accurate strain identification and targeted drug administration for the treatment of wound bioburden has become a priority for combat casualty care. In this study, we use vibrational spectroscopy to examine wound exudates for bacterial load. Inherent chemical differences in different bacterial species and strains make possible the high specificity of vibrational spectroscopy.

  16. A deep sternal wound infection caused by Ureaplasma urealyticum.

    PubMed

    Lucke, Katja; Kuster, Stefan P; Bertea, Mihai; Ruef, Christian; Bloemberg, Guido V

    2010-10-01

    Ureaplasma species are usually associated with infection of the urogenital tract. An unusual case of a sternal wound infection caused by Ureaplasma urealyticum in a 41-year-old male after aortic valve replacement is described. PMID:20616189

  17. UVC Light Prophylaxis for Cutaneous Wound Infections in Mice

    PubMed Central

    Dai, Tianhong; Garcia, Barbara; Murray, Clinton K.; Vrahas, Mark S.

    2012-01-01

    UVC light has long been known to be highly germicidal but has not been much developed as a therapy for infections. This study investigated the potential of UVC light for the prophylaxis of infections developing in highly contaminated superficial cutaneous wounds. In vitro studies demonstrated that the pathogenic bacteria Pseudomonas aeruginosa and Staphylococcus aureus were inactivated at UVC light exposures much lower than those needed for a similar effect on mammalian keratinocytes. Mouse models of partial-thickness skin abrasions infected with bioluminescent P. aeruginosa and S. aureus were developed. Approximately 107 bacterial cells were inoculated onto wounds measuring 1.2 by1.2 cm on the dorsal surfaces of mice. UVC light was delivered at 30 min after bacterial inoculation. It was found that for both bacterial infections, UVC light at a single radiant exposure of 2.59 J/cm2 reduced the bacterial burden in the infected mouse wounds by approximately 10-fold in comparison to those in untreated mouse wounds (P < 0.00001). Furthermore, UVC light increased the survival rate of mice infected with P. aeruginosa by 58.3% (P = 0.0023) and increased the wound healing rate in mice infected with S. aureus by 31.2% (P < 0.00001). DNA lesions were observed in the UVC light-treated mouse wounds; however, the lesions were extensively repaired by 48 h after UVC light exposure. These results suggested that UVC light may be used for the prophylaxis of cutaneous wound infections. PMID:22564833

  18. Wound infection: a knowledge deficit that needs addressing.

    PubMed

    Hughes, Maria A

    2016-03-01

    A survey was undertaken at a recent large wound-care exhibition, aimed at generalist nurses, podiatrists and other allied health professionals, to ascertain delegates' understanding of wound infection and its treatment options. The sample comprised 116 delegates, although not all of them answered every question. Results showed good knowledge in some areas, with most (90%) correctly identifying the symptoms of localised wound infection and the characteristics of an infected wound (97%). However, the results did reveal some alarming gaps in knowledge, with 64% unable to identify that it is the inability of the host to mount a robust immune response that can tip the balance between colonisation and infection. Similarly, over a third (38%) incorrectly considered that wounds should always be cleansed, regardless of the wound characteristics, while 5% stated that antimicrobial dressings should be used continuously until epithelialisation occurs. The results suggest that there is still a worrying trend for ritualistic wound care and that more ongoing education is needed on the core aspects of wound management. PMID:27019185

  19. Incidence of postoperative wound infections after open tendo Achilles repairs

    PubMed Central

    Marican, Mohd Mizan; Fook-Chong, Stephanie Man Chung; Rikhraj, Inderjeet Singh

    2015-01-01

    INTRODUCTION Tendo Achilles (TA), which is the confluence of the gastrocnemius and soleus muscles, is one of the most commonly injured tendons. The surgical repair of TA ruptures is associated with a significant risk of infection. This study examined several factors (i.e. gender, age, body mass index, history of diabetes mellitus, steroid use, acute or chronic TA injuries, type of surgical incision and type of sutures used) that may be associated with postoperative wound infection after open TA repair. METHODS This was a retrospective study involving 60 patients who underwent open TA repair over an 18-month period. Patients who had prior TA surgery or open TA injuries, or who needed soft tissues flaps were excluded. RESULTS Among the patients, 7 (11.7%) developed superficial wound infections that were successfully treated with oral antibiotics, while 3 (5.0%) developed deep wound infections that required at least one debridement procedure. No significant association was found between the risk of postoperative wound infection and gender, age, the presence of diabetes mellitus, acute or chronic ruptures, site of surgical incision and type of deep or superficial sutures used. CONCLUSION While diabetes mellitus and age did not appear to be associated with postoperative wound infections after open TA repair, obese patients were found to be two times more likely to develop a wound infection than normal-weight patients. The incidence of superficial wound infections in this study was similar to previously published results (11.7% vs. 8.2%–14.6%), but the incidence of deep infections was higher (5% vs. 1%–2%). PMID:26512146

  20. Development of biofilm-targeted antimicrobial wound dressing for the treatment of chronic wound infections.

    PubMed

    Ng, Shiow-Fern; Leow, Hon-Lunn

    2015-01-01

    It has been established that microbial biofilms are largely responsible for the recalcitrance of many wound infections to conventional antibiotics. It was proposed that the efficacy of antibiotics could be optimized via the inhibition of bacterial biofilm growth in wounds. The combination of antibiofilm agent and antibiotics into a wound dressing may be a plausible strategy in wound infection management. Xylitol is an antibiofilm agent that has been shown to inhibit the biofilm formation. The purpose of this study was to develop an alginate film containing xylitol and gentamicin for the treatment of wound infection. Three films, i.e. blank alginate film (SA), alginate film with xylitol (F5) and alginate film with xylitol and gentamicin (AG), were prepared. The films were studied for their physical properties, swelling ratio, moisture absorption, moisture vapor transmission rate (MVTR), mechanical and rheology properties, drug content uniformity as well as in vitro drug release properties. Antimicrobial and antibiofilm in vitro studies on Staphylococcus aureus and Pseudomonas aeruginosa were also performed. The results showed that AG demonstrates superior mechanical properties, rheological properties and a higher MVTR compared with SA and F5. The drug flux of AG was higher than that of commercial gentamicin cream. Furthermore, antimicrobial studies showed that AG is effective against both S. aureus and P. aeruginosa, and the antibiofilm assays demonstrated that the combination was effective against biofilm bacteria. In summary, alginate films containing xylitol and gentamicin may potentially be used as new dressings for the treatment of wound infection. PMID:25758412

  1. Ultraviolet C light for Acinetobacter baumannii wound infections in mice: Potential use for battlefield wound decontamination?

    PubMed Central

    Dai, Tianhong; Murray, Clinton K.; Vrahas, Mark S.; Baer, David G.; Tegos, George P.; Hamblin, Michael R.

    2012-01-01

    BACKGROUND Since the beginning of the conflicts in the Middle East, US Army physicians have noted a high rate of multidrug-resistant Acinetobacter baumannii infections among US soldiers wounded and initially treated in Iraq. In this study, we investigated the use of ultraviolet C (UVC) light for prevention of multidrug-resistant A. baumannii wound infections using mouse models. METHODS Partial-thickness skin abrasions and full-thickness burns in mice were infected with a multidrug-resistant A. baumannii isolate recovered from a wounded US soldier deployed to Iraq. The luxCDABE operon, which was contained in plasmid pMF 385, was cloned into the A. baumannii strain. This allowed real-time monitoring of the extent of infection in mice using bioluminescence imaging. UVC light was delivered to the mouse wounds at 30 minutes after the inoculation of A. baumannii. Groups of infected mouse wounds without being exposed to UVC served as the controls. RESULTS In vitro studies demonstrated that A. baumannii cells were inactivated at UVC exposures much lower than those needed for a similar effect on mammalian cells. It was observed in animal studies that UVC (3.24 J/cm2 for abrasions and 2.59 J/cm2 for burns) significantly reduced the bacterial burdens in UVC-treated wounds by approximately 10-fold compared with nontreated controls (p = 0.004 for abrasions, p = 0.019 for burns). DNA lesions were observed by immunofluorescence in mouse skin abrasions immediately after a UVC exposure of 3.24 J/cm2; however, the lesions were extensively repaired within 72 hours. CONCLUSION These results suggested that UVC may be useful in preventing combat-related wound infections. PMID:22929495

  2. Negative Pressure Wound Therapy of Chronically Infected Wounds Using 1% Acetic Acid Irrigation

    PubMed Central

    Lee, Byeong Ho; Lee, Hye Kyung; Kim, Hyoung Suk; Moon, Min Seon; Suh, In Suck

    2015-01-01

    Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix. PMID:25606491

  3. Treatment of Sternal Wound Infection Using a Free Myocutaneous Flap.

    PubMed

    Chiang, I-han; Chen, Shyi-Gen; Wang, Chih-Hsin

    2015-11-01

    Deep sternal wound infections are potentially life-threatening complications after cardiac operations because they can spread into the mediastinum and cause postoperative morbidity and mortality. We present a 65-year-old man with a history of coronary artery bypass grafting. A large sternal defect was left after debridement. After brief vacuum-assisted closure (VAC), a free myocutaneous flap of the anterolateral thigh (ALT) was used to fill the dead space. At the 9-month follow-up, the wound had healed completely without tissue loss or complications, and the patient returned to normal life. This was a successful treatment of a deep sternal wound with free flap coverage. PMID:26522542

  4. Application of VitaVallis dressing for infected wounds

    NASA Astrophysics Data System (ADS)

    Kirilova, N. V.; Fomenko, A. N.; Korovin, M. S.

    2015-11-01

    Today there is a growing demand for safe and efficient antimicrobial dressings for infected wound treatment. The antimicrobial sorption material for VitaVallis dressings was produced by one-stage oxidation of aluminum nanopowder in water in the presence of fibrous acetylcellulose matrix. Scanning electron microscopy revealed that the material is made up of fibers of diameter 1.5-3.0 µm with adhered agglomerated alumina nanosheets. An antimicrobial study revealed a high inhibitory effect of VitaVallis against the growth of gram-negative (E.coli, P. aeruginosa) and gram-positive (S. aureus) strains. The antimicrobial activity of the dressing against microbial pathogens on the wound surface was demonstrated in in vivo experiments on male rats. The dressing was also tested on volunteer patients. The testing showed reduction of the wound healing period, accelerated cleaning of the infected wound and enhanced tissue regeneration in the wound. The results demonstrate that the VitaVallis dressing can be used for the treatment of deep infected wounds.

  5. Application of VitaVallis dressing for infected wounds

    SciTech Connect

    Kirilova, N. V. Fomenko, A. N. Korovin, M. S.

    2015-11-17

    Today there is a growing demand for safe and efficient antimicrobial dressings for infected wound treatment. The antimicrobial sorption material for VitaVallis dressings was produced by one-stage oxidation of aluminum nanopowder in water in the presence of fibrous acetylcellulose matrix. Scanning electron microscopy revealed that the material is made up of fibers of diameter 1.5–3.0 µm with adhered agglomerated alumina nanosheets. An antimicrobial study revealed a high inhibitory effect of VitaVallis against the growth of gram-negative (E.coli, P. aeruginosa) and gram-positive (S. aureus) strains. The antimicrobial activity of the dressing against microbial pathogens on the wound surface was demonstrated in in vivo experiments on male rats. The dressing was also tested on volunteer patients. The testing showed reduction of the wound healing period, accelerated cleaning of the infected wound and enhanced tissue regeneration in the wound. The results demonstrate that the VitaVallis dressing can be used for the treatment of deep infected wounds.

  6. Platelet-rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections.

    PubMed

    Serraino, Giuseppe F; Dominijanni, Andrea; Jiritano, Federica; Rossi, Michele; Cuda, Aldo; Caroleo, Santo; Brescia, Adalgisa; Renzulli, Attilio

    2015-06-01

    Despite the large choice of wide-spectrum antibiotic therapy, deep sternal wound infection (DSWI) following cardiac surgery is a life-threatening complication worldwide. This study evaluated that the use of platelet-rich plasma (PRP) applied inside the sternotomy wound would reduce the effect of sternal wound infections, both superficial and deep. Between January 2007 and January 2012, 1093 consecutive patients underwent cardiac surgery through median sternotomy. Patients were divided into two groups. Group B, the study group, included those who received the PRP applied inside the sternotomy wound before closure. Group A, the control group, included patients who received a median sternotomy but without the application of PRP. Antibiotic prophylaxis remained unchanged across the study and between the two groups. Occurrence of DSWI was significantly higher in group A than in group B [10 of 671 (1·5%) versus 1 of 422 (0·20%), P = 0·043]. Also, superficial sternal wound infections (SSWIs) were significantly higher in group A than in group B [19 of 671 (2·8%) versus 2 of 422 (0·5%), P = 0·006]. The use of PRP can significantly reduce the occurrence of DSWI and SSWI in cardiac surgery. PMID:23692143

  7. Development of a diagnostic aid for bacterial infection in wounds

    NASA Astrophysics Data System (ADS)

    Pisanelli, A. M.; Persaud, K. C.; Bailey, A.; Stuczen, M.; Duncan, R.; Dunn, K.

    2009-05-01

    Infection of wounds during hospitalisation often induces morbidity and sometimes mortality. The delay in patient recovery and subsequent increased length of hospital stay also has economic consequences. Standard techniques for microbiological detection are surface swabbing and wound biopsy culture. Surface swabbing is the most commonly used technique mainly because is quite inexpensive and is not invasive but can give only a representation of surface infection and analysis is also time consuming. Infected wounds are often characterised by an offensive odour that can be used as a diagnostic parameter. We report the results obtained by examining swabs and dressings taken from patients using a gas sensor array instrument developed as part of an EU funded project WOUNDMONITOR.

  8. Photodynamic therapy for Staphylococcus aureus infected burn wounds in mice.

    PubMed

    Lambrechts, Saskia A G; Demidova, Tatiana N; Aalders, Maurice C G; Hasan, Tayyaba; Hamblin, Michael R

    2005-07-01

    The rise of multiply antibiotic resistant bacteria has led to searches for novel antimicrobial therapies to treat infections. Photodynamic therapy (PDT) is a potential candidate; it uses the combination of a photosensitizer with visible light to produce reactive oxygen species that lead to cell death. We used PDT mediated by meso-mono-phenyl-tri(N-methyl-4-pyridyl)-porphyrin (PTMPP) to treat burn wounds in mice with established Staphylococcus aureus infections The third degree burn wounds were infected with bioluminescent S. aureus. PDT was applied after one day of bacterial growth by adding a 25% DMSO/500 microM PTMPP solution to the wound followed by illumination with red light and periodic imaging of the mice using a sensitive camera to detect the bioluminescence. More than 98% of the bacteria were eradicated after a light dose of 210 J cm(-2) in the presence of PTMPP. However, bacterial re-growth was observed. Light alone or PDT both delayed the wound healing. These data suggest that PDT has the potential to rapidly reduce the bacterial load in infected burns. The treatment needs to be optimized to reduce wound damage and prevent recurrence. PMID:15986057

  9. Deep wound infection after proximal femoral fracture: consequences and costs.

    PubMed

    Pollard, T C B; Newman, J E; Barlow, N J; Price, J D; Willett, K M

    2006-06-01

    The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group. PMID:16621145

  10. Imaging modalities in wounds and superficial skin infections.

    PubMed

    Blankenship, Robert B; Baker, Todd

    2007-02-01

    Open wounds and lacerations are the most commonly encountered problems in emergency medicine. Detection and removal of a foreign body is essential to avoid the many complications of a retained foreign body, which may include infection, inflammation, allergic reaction, and disability. Currently, there are several imaging modalities that the emergency medicine provider may use to aid in foreign body detection and wound management. Techniques and appropriate use of these imaging modalities for foreign bodies and soft tissue infections are discussed in this article. PMID:17400083

  11. Wound infections on board ship--prevention, pathogens, and treatment.

    PubMed

    Dahl, Eilif

    2011-01-01

    Wounds are common in seafarers and they can easily become infected in the marine environment. Pre-sea tetanus immunization is essential. Without diagnostic facilities and only a limited range of antibiotics onboard, injury prevention and early treatment to reduce the likelihood of infection are important measures. Suturing clean cuts reduces healing time and risk of infection. Fresh, clean cuts, especially on the face or head, can be closed by adhesive tape or sutures, but if infection arises, then one or more sutures should be removed to enable drainage. Most wounds must be considered contaminated and should not be closed, just covered with sterile dressing after cleaning. Antibiotic treatment should be started immediately in seafarers with hand and puncture wounds. The primary treatment for a simple abscess is incision and drainage. Antibiotic treatment is recommended for abscesses if the infection spreads to the surrounding tissue (associated cellulitis), if there is lack of response to incision and drainage alone, or if the abscess is in an area difficult or dangerous to drain (e.g. face, palm, genitalia). Recommended therapy for cellulitis is 5-10 days of dicloxacillin, cephalexin, clindamycin, or erythromycin, but if there is no improvement after 2-3 days, methicillin-resistant Staphylococcus aureus (MRSA) should be suspected. Bites and burn wounds require special attention. Since wound infections can deteriorate rapidly, a telemedicine advice service (TMAS) should be consulted during the early stages, and serial digital photographs of the affected area, transmitted by e-mail to TMAS, are often useful during treatment at sea. PMID:22258845

  12. Case 7: highly infected post-surgical wound.

    PubMed

    von Hallern, Bernd

    2016-03-01

    Following treatment with antibiotics and surgical incision, which resulted in the release of putrid exudate, the wound was rinsed thoroughly with octenisept and covered with an antimicrobial dressing. This regimen successfully eradicated the infection, with full healing occurring in 6 weeks. PMID:26949851

  13. Negative-pressure wound therapy and laparoscopic omentoplasty for deep sternal wound infections after median sternotomy.

    PubMed

    De Brabandere, Kristof; Jacobs-Tulleneers-Thevissen, Daniel; Czapla, Jens; La Meir, Mark; Delvaux, Georges; Wellens, Francis

    2012-01-01

    Deep sternal wound infection remains one of the most serious complications in patients who undergo median sternotomy for coronary artery bypass surgery.We describe our experience in treating 6 consecutive patients with our treatment protocol that combines aggressive débridement, broad-spectrum antibiotics, negative-pressure wound therapy, omentoplasty with laparoscopically harvested omentum, and the use of bilateral pectoral muscle advancement flaps.The number of débridements needed in order to attain clinically clean wounds and negative cultures varied between 1 and 10, with a median of 5. The length of stay after omentoplasty and bilateral pectoral muscle advancement flap placement varied between 11 and 22 days. One of the 6 patients developed a small wound dehiscence that was treated conservatively. No bleeding related to vacuum-assisted closure therapy was identified. Three patients had pneumonia. Two of the 3 patients had an episode of acute renal failure. The 30-day mortality rate was zero, although 1 patient died in the hospital 43 days after the reconstructive surgery, of multiple-organ failure due to pneumonia that was induced by end-stage pulmonary fibrosis. No patient died between hospital discharge and the most recent follow-up date (4-12 mo). Late local follow-up results, both functional and aesthetic, were good.We conclude that negative-pressure wound therapy-in combination with omentoplasty using laparoscopically harvested omentum and with the use of bilateral pectoral advancement flaps-is a valuable technique in the treatment of deep sternal wound infection because it produces good functional and aesthetic results. PMID:22719146

  14. Negative-Pressure Wound Therapy and Laparoscopic Omentoplasty for Deep Sternal Wound Infections after Median Sternotomy

    PubMed Central

    De Brabandere, Kristof; Jacobs-Tulleneers-Thevissen, Daniel; Czapla, Jens; La Meir, Mark; Delvaux, Georges; Wellens, Francis

    2012-01-01

    Deep sternal wound infection remains one of the most serious complications in patients who undergo median sternotomy for coronary artery bypass surgery. We describe our experience in treating 6 consecutive patients with our treatment protocol that combines aggressive débridement, broad-spectrum antibiotics, negative-pressure wound therapy, omentoplasty with laparoscopically harvested omentum, and the use of bilateral pectoral muscle advancement flaps. The number of débridements needed in order to attain clinically clean wounds and negative cultures varied between 1 and 10, with a median of 5. The length of stay after omentoplasty and bilateral pectoral muscle advancement flap placement varied between 11 and 22 days. One of the 6 patients developed a small wound dehiscence that was treated conservatively. No bleeding related to vacuum-assisted closure therapy was identified. Three patients had pneumonia. Two of the 3 patients had an episode of acute renal failure. The 30-day mortality rate was zero, although 1 patient died in the hospital 43 days after the reconstructive surgery, of multiple-organ failure due to pneumonia that was induced by end-stage pulmonary fibrosis. No patient died between hospital discharge and the most recent follow-up date (4–12 mo). Late local follow-up results, both functional and aesthetic, were good. We conclude that negative-pressure wound therapy—in combination with omentoplasty using laparoscopically harvested omentum and with the use of bilateral pectoral advancement flaps—is a valuable technique in the treatment of deep sternal wound infection because it produces good functional and aesthetic results. PMID:22719146

  15. Prevention of orthopaedic wound infections: a quality improvement project.

    PubMed

    Douglas, P; Asimus, M; Swan, J; Spigelman, A

    2001-12-01

    Using clinical practice improvement methodology, a project was undertaken to reduce the incidence of surgical wound infections following elective hip and knee replacement surgery. A team was established, key measures for improvement were identified, strategies for change were developed and an action plan was implemented. Outcomes for this project included a reduction in the rate of clean surgical wound infection for joint replacement surgery from 28% to zero. Average length of stay for total hip replacement surgery was reduced from 13.9 to 9.3 days and from 14.6 to 10.4 days for total knee replacement surgery. Guidelines for patient selection were developed along with a protocol for the management of preparation to prevent urinary tract infections. Post-discharge surveillance and a preoperative rehabilitation and exercise programme have been implemented. There is potential for wider uptake and implementation of the quality principles described herein. PMID:11856413

  16. Topical antimicrobials for burn wound infections.

    PubMed

    Dai, T; Huang, Y Y; Sharma, S K; Hashmi, J T; Kurup, D B; Hamblin, M R

    2010-06-01

    Throughout most of history, serious burns occupying a large percentage of body surface area were an almost certain death sentence because of subsequent infection. A number of factors such as disruption of the skin barrier, ready availability of bacterial nutrients in the burn milieu, destruction of the vascular supply to the burned skin, and systemic disturbances lead to immunosuppression combined together to make burns particularly susceptible to infection. In the 20th century the introduction of antibiotic and antifungal drugs, the use of topical antimicrobials that could be applied to burns, and widespread adoption of early excision and grafting all helped to dramatically increase survival. However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. This review will cover patented strategies that have been issued or filed with regard to new topical agents, preparations, and methods of combating burn infections. Animal models that are used in preclinical studies are discussed. Various silver preparations (nanocrystalline and slow release) are the mainstay of many approaches but antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage therapy and natural products such as honey and essential oils have all been tested. This active area of research will continue to provide new topical antimicrobials for burns that will battle against growing multidrug resistance. PMID:20429870

  17. Topical Antimicrobials for Burn Wound Infections

    PubMed Central

    Dai, Tianhong; Huang, Ying-Ying; Sharma, Sulbha K.; Hashmi, Javad T.; Kurup, Divya B.; Hamblin, Michael R.

    2010-01-01

    Throughout most of history, serious burns occupying a large percentage of body surface area were an almost certain death sentence because of subsequent infection. A number of factors such as disruption of the skin barrier, ready availability of bacterial nutrients in the burn milieu, destruction of the vascular supply to the burned skin, and systemic disturbances lead to immunosuppression combined together to make burns particularly susceptible to infection. In the 20th century the introduction of antibiotic and antifungal drugs, the use of topical antimicrobials that could be applied to burns, and widespread adoption of early excision and grafting all helped to dramatically increase survival. However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. This review will cover patented strategies that have been issued or filed with regard to new topical agents, preparations, and methods of combating burn infections. Animal models that are used in preclinical studies are discussed. Various silver preparations (nanocrystalline and slow release) are the mainstay of many approaches but antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage therapy and natural products such as honey and essential oils have all been tested. This active area of research will continue to provide new topical antimicrobials for burns that will battle against growing multi-drug resistance. PMID:20429870

  18. Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections.

    PubMed

    Warkentien, Tyler E; Shaikh, Faraz; Weintrob, Amy C; Rodriguez, Carlos J; Murray, Clinton K; Lloyd, Bradley A; Ganesan, Anuradha; Aggarwal, Deepak; Carson, M Leigh; Tribble, David R

    2015-07-01

    Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively; P < 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds with Mucorales growth than for wounds with non-Mucorales growth (median, 17 days versus 13 days; P < 0.01). When wounds with Mucorales and Aspergillus spp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: order Mucorales, Aspergillus spp., and Fusarium spp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds with Mucorales growth. PMID:25972413

  19. Postoperative wound infections after a proctectomy—Patient experiences

    PubMed Central

    Andersson, Kristin; Koinberg, Inga-Lill; Wennström, Berith

    2016-01-01

    Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61–87 years, median age 71 years) were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: “Managing postoperative complications,” “Being independent,” “Feeling safe,” and “Accepting the situation.” A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery. PMID:26900139

  20. Postoperative wound infections after a proctectomy--Patient experiences.

    PubMed

    Hassel, Karin; Andersson, Kristin; Koinberg, Inga-Lill; Wennström, Berith

    2016-01-01

    Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61-87 years, median age 71 years) were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: "Managing postoperative complications," "Being independent," "Feeling safe," and "Accepting the situation." A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients' lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery. PMID:26900139

  1. Delayed aortic rupture resulting from postoperative superficial sternal wound infection

    PubMed Central

    Kim, Su Wan; Chang, Jee Won

    2016-01-01

    While deep sternal wound infection (DSWI) after cardiac surgery is a significant contributor to patient morbidity and mortality, superficial sternal wound infection (SSWI) mostly has a benign course. We report a mortality case of aortic rupture resulting from SSWI after cardiac surgery. A 50-year-old male underwent an aortic valve replacement (AVR). Three months after the valve operation, he presented with severe dyspnea, which had never before been observed, and chest computed tomography revealed an ascending aortic rupture with large hematoma compressing the main pulmonary artery. We performed an emergent operation for aortic rupture that possibly originated from the SSWI. Postoperatively, the patient died of hypovolemic shock due to recurrent aortic rupture despite efforts to resuscitate him. PMID:27499988

  2. G-CSF enhances resolution of Staphylococcus aureus wound infection in an age-dependent manner.

    PubMed

    Brubaker, Aleah L; Kovacs, Elizabeth J

    2013-10-01

    This study tested the hypothesis that heightened bacterial colonization and delayed wound closure in aged mice could be attenuated by granulocyte colony-stimulating factor (G-CSF) treatment. Previously, we reported that aged mice had elevated bacterial levels, protracted wound closure, and reduced wound neutrophil accumulation after Staphylococcus aureus wound infection relative to young mice. In aseptic wound models, G-CSF treatment improved wound closure in aged mice to rates observed in young mice. Given these data, our objective was to determine if G-CSF could restore age-associated differences in wound bacterial burden and closure by increasing wound neutrophil recruitment. Young (3- to 4-month) and aged (18- to 20-month) BALB/c mice received three dorsal subcutaneous injections of G-CSF (250 ng/50 μL per injection) or saline control (50 μL per injection) 30 min after wound infection. Mice were killed at days 3 and 7 after wound infection, and bacterial colonization, wound size, wound leukocyte accumulation, and peripheral blood were evaluated. At days 3 and 7 after wound infection, bacterial colonization was significantly reduced in G-CSF-treated aged mice to levels observed in saline-treated young animals. Wound size was reduced in G-CSF-treated aged animals, with no effect on wound size in G-CSF-treated young mice. Local G-CSF treatment significantly enhanced neutrophil wound accumulation in aged mice, whereas there was no G-CSF-induced change in young mice. These data demonstrate that G-CSF enhances bacterial clearance and wound closure in an age-dependent manner. Moreover, G-CSF may be of therapeutic potential in the setting of postoperative wound infection or chronic nonhealing wounds in elderly patients. PMID:23856924

  3. Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection

    PubMed Central

    Kabon, Barbara; Akça, Ozan; Taguchi, Akiko; Nagele, Angelika; Jebadurai, Ratnaraj; Arkilic, Cem F.; Sharma, Neeru; Ahluwalia, Arundhathi; Galandiuk, Susan; Fleshman, James; Sessler, Daniel I.; Kurz, Andrea

    2005-01-01

    Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that supplemental fluid administration during and after elective colon resections decreases the incidence of postoperative wound infections. Patients undergoing open colon resection were randomly assigned to small (n=124, 8 mL·kg-1·h-1) or large volume (n=129, 16-18 mL·kg-1·h-1) fluid management. Our major outcomes were two distinct criteria for diagnosis of surgical wound infections: 1) purulent exudate combined with a culture positive for pathogenic bacteria and 2) Center for Disease Control criteria for diagnosis of surgical wound infections. All wound infections diagnosed using either criterion by a blinded observer in the 15 days following surgery were considered in the analysis. Wound healing was evaluated with the ASEPSIS scoring system. Of the patients given small fluid administration, 14 had surgical wound infections; 11 given large fluid therapy had infections, P=0.46. ASEPSIS wound healing scores were similar in both groups: 7±16 (small volume) vs. 8±14 (large volume), P=0.70. Our results suggest that supplemental hydration in the range tested does not impact wound infection rate. PMID:16244030

  4. Staphylococcal scalded skin syndrome due to burn wound infection

    PubMed Central

    Farroha, A.; Frew, Q.; Jabir, S.; Dziewulski, P.

    2012-01-01

    Summary Introduction. The staphylococcal scalded skin syndrome is an acute exfoliation of the skin caused by exfoliative toxins A and B. Although Staphylococcus aureus is a common cause of burn wound infection, SSSS following burn wound infection is rare. Method. A retrospective review of all SSSS cases admitted to a regional burns service between January 2008 and January 2012 was undertaken. Results. Two cases of SSSS were reported during this time period as occurring following burns injury. The first case was a 17-month-old boy who had been hospitalized for a conservative treatment of 6% total body surface area (TBSA) mixed depth scald burns. On day four he developed exfoliation of 85% TBSA. The second case was a ten-month-old boy who sustained a 1% TBSA scald burn and was managed conservatively in the community by his general practitioner. On day five, he developed exfoliation of 80% TBSA. Staphylococcus aureus was isolated from the burn wounds in both cases. Conclusion: These two cases show that it is vital for burns surgeons and intensive care specialists to be aware of the possibility of SSSS occurring in patients with burn injuries with its potential devastating effects. PMID:23467312

  5. Ceftriaxone versus povidone iodine in preventing wound infections following biliary surgery.

    PubMed

    Kiff, R S; Lomax, J; Fowler, L; Kingston, R D; Hoare, E M; Sykes, P A

    1988-09-01

    The effect of either prophylactic antibiotic or wound antiseptic on bile bacteriology, wound and other postoperative sepsis has been studied in a controlled prospective randomised trial of 243 patients undergoing biliary surgery at a district general hospital. Wound infection rates were significantly less in patients given intravenous ceftriaxone (1%) at induction of anaesthesia when compared to povidone iodine sprayed into the wound at the completion of surgery (9%) (P = 0.02). In all but one patient infected wounds grew organisms identical to those cultured from the bile. There were also fewer chest and urinary infections in the ceftriaxone group but this was not statistically significant. PMID:3056208

  6. Antiseptics for treating infected wounds: Efficacy on biofilms and effect of pH.

    PubMed

    Percival, Steven L; Finnegan, Simon; Donelli, Gianfranco; Vuotto, Claudia; Rimmer, Steve; Lipsky, Benjamin A

    2016-01-01

    Biofilm recalcitrance is a persistent problem when managing difficult to heal and infected chronic wounds. The wound biofilm is a fundamental factor in the re-occurrence and delayed healing commonly observed in non-healing and infected chronic wounds. However, there is presently no single antimicrobial agent that is completely efficacious against both the planktonic and sessile polymicrobial communities evident in at risk or infected wounds. We will review currently available antimicrobials, with particular emphasis on silver and iodine, employed to help suppress biofilms in wounds. In addition, we will also review the effect of pH on antimicrobial efficacy. Available evidence suggests that it is best to take a multifactorial approach towards controlling biofilm in chronic, "at risk" and infected wounds. This highlights the growing importance of avoiding indiscriminate or inappropriate use of antimicrobials in the treatment of chronic wounds. PMID:25159044

  7. Staphylococcus albus in Wound Infection and in Septicemia

    PubMed Central

    Wilson, T. S.; Stuart, R. D.

    1965-01-01

    Coagulase-negative Staphylococcus albus was considered to be the causal agent in 53 (4.4%) of 1200 wound infections investigated in a large general hospital over the eight-year period 1957-1964. There was clinical evidence of morbidity in these patients, with fever, but the infection cleared spontaneously, usually in a week or two, and antibiotics were unnecessary. Of much greater importance was the finding of this organism in blood cultures on repeated occasions, with associated clinical septicemia. Twelve patients were so affected, of whom six died, a mortality rate of 50%. Such data emphasize the tragic mistake of dismissing the report of Staph. albus in a blood culture as “only a contaminant”, and of failure to recognize that the organism can cause serious disease. This is particularly true in poor-risk patients, and in those who have undergone cardiac surgery. PMID:14308909

  8. Deep sternal wound infection after cardiac surgery: Evidences and controversies

    PubMed Central

    Cotogni, Paolo; Barbero, Cristina; Rinaldi, Mauro

    2015-01-01

    Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a “bridge” prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. PMID:26557476

  9. Deep sternal wound infection after cardiac surgery: Evidences and controversies.

    PubMed

    Cotogni, Paolo; Barbero, Cristina; Rinaldi, Mauro

    2015-11-01

    Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. PMID:26557476

  10. Diagnosis and rehabilitation of deep wound infection and internal fixation rejection in elbow: A case report.

    PubMed

    Lu, Huiping; Song, Lin; Lin, Ying

    2016-06-01

    This study aims at diagnosis and rehabilitation of a rare case of deep wound infection and internal fixation rejection in elbow. The patient sustained a distal fracture in the humerus 1 year ago, which was internal fixed. The wound always effused and the elbow had pain and swelling; joint motion was limited. Blood sedimentation rate and C reactive protein level increased, bacterial culture suggested deep wound infection, and ultrasound indicated inflammation. The main diagnoses were deep wound infection and internal fixation rejection. Therapeutics interventions were antibiotic agents, physical therapy, operative debridement, incision, drainage, and exercise and physical therapy. One year later, the internal fixation was taken out. His elbow was fully mobilized and the fracture healed. He got back to his former job. When encountered deep wound infection again and again after internal fixation, rejection should be considered. Except for anti-infection treatment, rehabilitation cannot be neglected, or the healing process may be delayed. PMID:27281079

  11. Diagnosis and rehabilitation of deep wound infection and internal fixation rejection in elbow

    PubMed Central

    Lu, Huiping; Song, Lin; Lin, Ying

    2016-01-01

    Abstract This study aims at diagnosis and rehabilitation of a rare case of deep wound infection and internal fixation rejection in elbow. The patient sustained a distal fracture in the humerus 1 year ago, which was internal fixed. The wound always effused and the elbow had pain and swelling; joint motion was limited. Blood sedimentation rate and C reactive protein level increased, bacterial culture suggested deep wound infection, and ultrasound indicated inflammation. The main diagnoses were deep wound infection and internal fixation rejection. Therapeutics interventions were antibiotic agents, physical therapy, operative debridement, incision, drainage, and exercise and physical therapy. One year later, the internal fixation was taken out. His elbow was fully mobilized and the fracture healed. He got back to his former job. When encountered deep wound infection again and again after internal fixation, rejection should be considered. Except for anti-infection treatment, rehabilitation cannot be neglected, or the healing process may be delayed. PMID:27281079

  12. Long-term prognosis of patients with surgical wound infections.

    PubMed

    Poulsen, K B; Gottschau, A

    1997-10-01

    This study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self-administered questionnaires during 1993-1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self-assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long-term prognosis of general health was unaffected by SWIs. However significantly increased social dependence was found for patients with SWIs compared to uninfected patients. Almost one-fourth of the operations were complicated by an SWI. Most of the infections were recognized only after discharge and were thought to be of minor importance, which may explain why no chronic impairment of the health was found for patients with an SWI. A bias toward no-effect may have been introduced if patients with severe SWIs abstained from participation. The societal cost of care for patients with minor infections seems to be large. The causal relation between outcome and SWI needs to be further investigated. PMID:9327669

  13. Tilapia Piscidin 4 (TP4) Stimulates Cell Proliferation and Wound Closure in MRSA-Infected Wounds in Mice.

    PubMed

    Huang, Hang-Ning; Chan, Yi-Lin; Wu, Chang-Jer; Chen, Jyh-Yih

    2015-05-01

    Antimicrobial peptides (AMPs) are endogenous antibiotics that directly affect microorganisms, and also have a variety of receptor-mediated functions. One such AMP, Tilapia piscidin 4 (TP4), was isolated from Nile tilapia (Oreochromis niloticus); TP4 has antibacterial effects and regulates the innate immune system. The aim of the present study was to characterize the role of TP4 in the regulation of wound closure in mice and proliferation of a keratinocyte cell line (HaCaT) and fibroblast cell line (Hs-68). In vitro, TP4 stimulated cell proliferation and activated collagen I, collagen III, and keratinocyte growth factor (KGF) gene expression in Hs-68 cells, which induces keratin production by HaCaT cells. This effect was detectable at TP4 concentrations of 6.25 µg/mL in both cell lines. In vivo, TP4 was found to be highly effective at combating peritonitis and wound infection caused by MRSA in mouse models, without inducing adverse behavioral effects or liver or kidney toxicity. Taken together, our results indicate that TP4 enhances the survival rate of mice infected with the bacterial pathogen MRSA through both antimicrobial and wound closure activities mediated by epidermal growth factor (EGF), transforming growth factor (TGF), and vascular endothelial growth factor (VEGF). The peptide is likely involved in antibacterial processes and regulation of tissue homeostasis in infected wounds in mice. Overall, these results suggest that TP4 may be suitable for development as a novel topical agent for wound dressing. PMID:25955756

  14. Tilapia Piscidin 4 (TP4) Stimulates Cell Proliferation and Wound Closure in MRSA-Infected Wounds in Mice

    PubMed Central

    Huang, Hang-Ning; Chan, Yi-Lin; Wu, Chang-Jer; Chen, Jyh-Yih

    2015-01-01

    Antimicrobial peptides (AMPs) are endogenous antibiotics that directly affect microorganisms, and also have a variety of receptor-mediated functions. One such AMP, Tilapia piscidin 4 (TP4), was isolated from Nile tilapia (Oreochromis niloticus); TP4 has antibacterial effects and regulates the innate immune system. The aim of the present study was to characterize the role of TP4 in the regulation of wound closure in mice and proliferation of a keratinocyte cell line (HaCaT) and fibroblast cell line (Hs-68). In vitro, TP4 stimulated cell proliferation and activated collagen I, collagen III, and keratinocyte growth factor (KGF) gene expression in Hs-68 cells, which induces keratin production by HaCaT cells. This effect was detectable at TP4 concentrations of 6.25 µg/mL in both cell lines. In vivo, TP4 was found to be highly effective at combating peritonitis and wound infection caused by MRSA in mouse models, without inducing adverse behavioral effects or liver or kidney toxicity. Taken together, our results indicate that TP4 enhances the survival rate of mice infected with the bacterial pathogen MRSA through both antimicrobial and wound closure activities mediated by epidermal growth factor (EGF), transforming growth factor (TGF), and vascular endothelial growth factor (VEGF). The peptide is likely involved in antibacterial processes and regulation of tissue homeostasis in infected wounds in mice. Overall, these results suggest that TP4 may be suitable for development as a novel topical agent for wound dressing. PMID:25955756

  15. Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

    PubMed Central

    Azzopardi, Ernest A.; Azzopardi, Elayne; Camilleri, Liberato; Villapalos, Jorge; Boyce, Dean E.; Dziewulski, Peter; Dickson, William A.; Whitaker, Iain S.

    2014-01-01

    Background Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. Methods Studies investigating adult hospitalised patients (2000–2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. Primary Findings Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens’ incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). Interpretation Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative “target organisms” facilitate clinical practice and target research towards a defined clinical demand. PMID:24751699

  16. Wound infection rate and irrigation pressure of two potential new wound irrigation devices: the port and the cap.

    PubMed

    Morse, J W; Babson, T; Camasso, C; Bush, A C; Blythe, P A

    1998-01-01

    The objectives of this study were to determine the speed of irrigation and the infection rate of two new irrigation devices. In the clinical portion of this two-part study, 208 patients with traumatic wounds were randomized to one of two new irrigation device groups, the cap/bottle or the port/bag, to determine irrigation times and infection/complication rates. Wounds were irrigated in less than 4 minutes in 97% of patients using a mean of 786 mL. The combined infection/complication rates were: port group, 1 of 99 (1%); cap group, 4 of 108 (4%), P = .356. In part II, 9 male and 8 female medical volunteers were timed in the delivery of 250 mL of saline into a graduated cylinder, using four different irrigation set-ups. Mean time for 250 mL and calculated stream pressures (psi) were: (1) cap/bottle, 12.9 seconds, 1.5 psi; (2) port/bag, 11.2 seconds, 2.0 psi; (3) syringe/catheter, 113.2 seconds, 8.2 psi; and (4) syringe/needle, 175.4 seconds, 7.3 psi (time and psi: P < .05 for all pairwise comparisons except cap versus port). Rapid irrigation and infection rates comparable with standard devices used in wound irrigation suggest that the new devices may prove to be valuable tools in emergent wound care. PMID:9451311

  17. Delayed primary closure of deep sternal wound infections.

    PubMed Central

    Zacharias, A; Habib, R H

    1996-01-01

    Deep infections of the sternum and mediastinum, with prevalence of osteomyelitis and tissue necrosis, were documented in 38 of 8,056 patients (0.47%) who underwent open-heart surgery (1975 through 1994) in our service. The incidences of insulin-dependent diabetes, obesity, and emergency surgery in these patients were relatively high at 39%, 47%, and 18%, respectively. Treatment with antibiotics, débridement, open packing, and delayed closure was administered to 33 patients (87%), with 100% healing. There were no deaths in this group. Flap reconstruction was indicated in 5 gravely ill patients (13%) in whom excessively large wound defects did not allow reapproximation. There were 2 deaths in this group, and 4 reoperations were necessary in the surviving patients because of sequelae arising from flap reconstruction. The overall mortality was 5.3% and the median period of hospitalization was 29 days. The length of stay decreased substantially over the period of this study (median = 21 days, year > or = 1987). Accordingly, we believe that treatment of deep sternal infections with delayed primary closure is safe and effective. Also, given the increased potential for complications and long-term sequelae, we believe that flap reconstruction should be used selectively and should be limited to patients with large defects, uncontrolled mediastinal bleeding, or both. PMID:8885104

  18. Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples.

    PubMed

    Benskin, Linda L

    2016-06-01

    Patients with acute wounds often delay seeking medical assistance until an incapacitating infection has developed. When such patients come for help at a remote Christian clinic in northern Ghana, West Africa, the goals of care are to resolve and prevent a return of infection, decrease pain, enable an immediate return to normal activities, and facilitate healing. Because the local protocol of care, Edinburgh University Solution of Lime (EUSOL)-soaked gauze, did not meet these goals, the author tried using a variety of donated wound dressing regimens. Ultimately, polymeric membrane dressings (PMDs) were observed to meet patient care needs while also reducing clinic staff time and resources, and a PMD protocol of care was developed. Three (3) representative patients who presented with acute wounds and infection are described: a 20-year-old man with a hand abscess, a 16-year-old boy with a malleolus wound, and an approximately 20-year-old woman with an injection abscess, all otherwise relatively healthy, albeit undernourished. All 3 patients re- ceived oral antibiotics, their wounds were initially cleansed and debrided, and an appropriate configuration of either regular or silver-containing PMDs was applied to all exposed wound surfaces. Dressing changes were scheduled based upon the personalized plan of care. In all 3 patients, the pain-relieving properties of PMDs allowed resumption of activi- ties within 1 day of initiating treatment, the dressings' continuous wound cleansing system kept the wounds clean and free of infection despite the challenging environment, and the wounds healed steadily. Managing infected acute wounds with PMDs through complete wound closure was time efficient for clinic staff and met all 4 major patient goals of care. Randomized, controlled studies to compare wound and quality of life outcomes in patients whose infected wounds are managed with PMDs compared with those whose wounds are managed with other advanced dressings are warranted. PMID

  19. Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery

    PubMed Central

    Targońska, Sylwia; Stążka, Janusz; Kozioł-Montewka, Maria

    2014-01-01

    The frequency of sternal wound infection (SWI) after cardiac surgery ranges from 0.5% to 8% and is associated with significant morbidity, mortality, and treatment cost. Perioperative antibiotic prophylaxis is not sufficient to fully prevent the contamination of the surgical access site. One of the most effective methods for the prevention of wound infection seems to be the use of gentamicin-impregnated collagen sponge, which is successfully used in abdominal and orthopedic surgery. Surgically implantable topical antibiotics can reduce wound infection in cardiac patients as well, but the efficacy of SWI prevention in cardiac surgery still raises many questions. PMID:26336388

  20. Management of Large Sternal Wound Infections With the Superior Epigastric Artery Perforator Flap.

    PubMed

    Eburdery, H; Grolleau, J L; Berthier, C; Bertheuil, N; Chaput, B

    2016-01-01

    The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the superior epigastric artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails. PMID:26694288

  1. Prevention of post-operative infections after surgical treatment of bite wounds

    PubMed Central

    Kramer, Axel; Assadian, Ojan; Frank, Matthias; Bender, Claudia; Hinz, Peter

    2010-01-01

    After reviewing the literature about the microbial spectrum, the risk factors of post-operative infections, and the results of surgical interventions, the following recommendation can be made for the management of bite wounds: fresh, open wounds: surgical debridement, if appropriate, then an antiseptic lavage with a fluid consisting of povidone iodine and ethanol (e.g., Betaseptic®), no antibiotics, primary wound closure nearly closed fresh wounds (e.g., cat bites): surgical debridement, if appropriate, dressing with an antiseptic-soaked compress for ~60 minutes with repeated soaking (e.g., Betaseptic®), no antibiotics older wounds after ~4 hours: surgical debridement, if appropriate, dressing with an antiseptic-soaked compress or bandage for ~60 minutes with repeated soaking (e.g., Betaseptic®), at the same time intravenous or dose-adapted oral antibiotics (Amoxicillin and/or clavulanic acid) older wounds after ~24 hours: surgical debridement, then antiseptic lavage (Betaseptic®), in case of clinically apparent infection or inflammation surgical revision with opening of wound and treatment with antibiotics according to resistogram (empirical start with Amoxicillin and/or clavulanic acid). For each kind of bite wound, the patient’s tetanus immunization status as well as the risk of exposure to rabies have to be assessed. Similarly, the possibility of other infections, such as lues (Syphilis), hepatitis B (HBV), hepatitis C (HBC), hepatitis D (HDV) and HIV, in the rare case of a human bite wound, has to be taken into account. PMID:20941334

  2. Novel technique for avoidance of pressure competition between a negative pressure wound therapy device and chest drains in the management of deep sternal wound infections.

    PubMed

    Davis, James S; Kourliouros, Antonios; Deshpande, Ranjit; Cavale, Naveen

    2015-02-01

    In recent years, the use of negative pressure wound therapy (NPWT) devices has changed the way sternal wound infections are being managed. It is not uncommon for deep sternal wound infections to occur together with mediastinal or even pleural collections requiring underwater seal drainage. In these patients in whom there is a communication between the pleural and mediastinal cavities, the concomitant use of an NPWT device negates the pressure gradient within the pleural and mediastinal drains, allowing suppurative fluid to stagnate. We present a novel technique to address this limitation of NPWT devices in patients with sternal wound infections that communicate with a pleural collection. PMID:25415315

  3. Postoperative wound infection associated with Vibrio parahaemolyticus in a patient without exposure to seawater.

    PubMed Central

    Ahsan, N; Conter, R L; Appelbaum, P C

    1988-01-01

    This report describes a case of wound infection associated with Vibrio parahaemolyticus. The patient had ingested steamed crabs 7 days before admission for surgical treatment of intestinal obstruction due to colon carcinoma. The Vibrio sp. was isolated from postoperative wound drainage as well as from stool. Recovery was uneventful. PMID:3384932

  4. Pseudomonas aeruginosa wound infection involves activation of its iron acquisition system in response to fascial contact

    PubMed Central

    Kim, M.; Christley, S.; Khodarev, N. N.; Fleming, I.; Huang, Y.; Chang, E.; Zaborina, O.; Alverdy, J.

    2015-01-01

    Background Wound infections are traditionally thought to occur when microbial burden exceeds the innate clearance capacity of host immune system. Here we introduce the idea that the wound environment itself plays a significant contributory role to wound infection. Methods We developed a clinically relevant murine model of soft tissue infection to explore the role of activation of microbial virulence in response to tissue factors as a mechanism by which pathogenic bacteria cause wound infections. Mice underwent abdominal skin incision and light muscle injury with a crushing forceps versus skin incision alone followed by topical inoculation of P. aeruginosa. Mice were sacrificed on postoperative day 6 and abdominal tissues analyzed for clinical signs of wound infection. To determine if specific wound tissues components induce bacterial virulence, P. aeruginosa was exposed to skin, fascia, and muscle. Results Gross wound infection due to P. aeruginosa was observed to be significantly increased in injured tissues vs non-injured (80% vs 10%) tissues (n=20/group, p<0.0001). Exposure of P. aeruginosa to individual tissue components demonstrated that fascia significantly induced bacterial virulence as judged by the production of pyocyanin, a redox-active phenazine compound known to kill immune cells. Whole genome transcriptional profiling of P. aeruginosa exposed to fascia demonstrated activation of multiple genes responsible for the synthesis of the iron scavenging molecule pyochelin. Conclusion We conclude that wound elements, in particular fascia, may play a significant role in enhancing the virulence of P. aeruginosa and may contribute to the pathogenesis of clinical wound infection. PMID:25807409

  5. The Healing Effect of Scrophularia Striata on Experimental Burn Wounds Infected to Pseudomonas Aeruginosa in Rat

    PubMed Central

    Tanideh, Nader; Haddadi, Mohammad Hossein; Rokni-Hosseini, Mohammad Hossein; Hossienzadeh, Masood; Mehrabani, Davood; Sayehmiri, Kourosh; Koohi-Hossienabadi, Omid

    2015-01-01

    BACKGROUND The cause of death in burn patients after 48 hours of hospitalization has been reported to be bacterial infections. Recently, due to the compounds accelerating the healing process and the intense reduction of treatment side effects, medicinal plants are used to cure burn wound infections. This study aims to investigate the medicinal effect of the ethanolic extract of Scrophularia striata on burn wound infection in in-vivo and in-vitro in comparison with silver sulfadiazine (SSD). METHODS One hundred and fifty male Sprague Dawley rats were divided into 3 equal groups. A hot plate of 1×1cm was used to create second degree burn wounds. The ethanolic extract of S. striata was provided through percolation method. Group 1 was treated with SSD, group 2 with S. striata, and group 3 was considered as control group. All animals were infected to Pseudomonas aeruginosa. On days 3, 7, 10, 14, and 21 after burn wound injury, the animals were euthanized and were evaluated histologically. The MIC and MBC were determined using the micro dilution method. RESULTS The rate of wound healing was significantly greater in S. striata group in comparison to SSD and control groups. CONCLUSION S. striata contains was shown to have anti-bacterial and wound healing effects while this effect was significantly more than SSD denoting to its use when needed for burn wounds infected to P. aeruginosa. PMID:25606472

  6. Maggot therapy for repairing serious infective wound in a severely burned patient.

    PubMed

    Wu, Jun-Cheng; Lu, Ren-Rong; Huo, Ran; Fu, Hong-Bin

    2012-01-01

    The larvae of musca domestica were put in use to discard the dead tissue of a case of severe burn. A total of 50 000 aseptic maggots were put onto the infective wound surface, and aseptic dressings overlaid the surface. Three days later, another 20 000 maggots were put onto the wound for the second therapy. After twice maggot debridement, most necrotic muscle tissues of the wound were cleaned up, and eventually fresh granulation tissue grew and later the wound was covered and healed by 3 times of skin grafting. The result demonstrates that maggot therapy is safe and effective with no adverse complications except pain. PMID:22480679

  7. Burn Wound Infections and Antibiotic Susceptibility Patterns at Pakistan Institute of Medical Sciences, Islamabad, Pakistan

    PubMed Central

    Saaiq, Muhammad; Ahmad, Shehzad; Zaib, Muhammad Salman

    2015-01-01

    BACKGROND Burn wound infections carry considerable mortality and morbidity amongst burn injury victims who have been successfully rescued through the initial resuscitation. This study assessed the prevalent microrganisms causing burn wound infections among hospitalized patients; their susceptibility pattern to commonly used antibiotics; and the frequency of infections with respect to the duration of the burn wounds. METHODS This study was carried out at Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan over a period of two years (i.e. from June 2010 to May 2012). The study included all wound-culture-positive patients of either gender and all ages, who had sustained deep burns and underwent definitive management with wound excisions and skin auto-grafting. Patients with negative cultures of the wounds were excluded. Tissue specimens for culture and sensitivity were collected from burn wounds using standard collection techniques and analyzed at microbiological laboratory. RESULTS Out of a total of 95 positive microbial growths, 36 were Pseudomonas aeruginosa (35.29%) as the most frequent isolate found, followed by 21 Klebsiella pneumoniae (20.58%), 19 Staphylococcus aureaus (18.62%), 10 Proteus (9.80%), 7 E. coli (6.86%), 7 Acinetobacter (6.86%), and 4 Candida (3.92%). A variable antibiotic susceptibility pattern was observed among the grown microbes. Positive cultures were significantly more frequent among patients with over two weeks duration of burn wounds. CONCLUSION P. aeruginosa, K. pneumoniae and S. aureus constituted the most common bacterial microbes of burn wounds in our in-patients cases. Positive cultures were more frequent among patients with over two weeks duration of burn wounds. Early excision and skin grafting of deep burns and adherence to infection control measures can help to effectively reduce the burden of these infections. PMID:25606471

  8. Wound infection during the Yom Kippur war: observations concerning antibiotic prophylaxis and therapy.

    PubMed Central

    Klein, R S; Berger, S A; Yekutiel, P

    1975-01-01

    Eighty-eight episodes of wound associated infection were identified among 624 consecutively admitted battlefield casualties. Ninety-one per cent of infections occurred during the administration of antibiotic therapy or prophylaxis and 65% were associated with the use of multiple antibacterial agents. Gram negative bacillary and mixed microbial infection predominated and were found to increase in relative incidence after the second day of hospitalization. Appropriate therapy, based on disc sensitivity testing, was administered in only 33% of infectious episodes. The practice of antibiotic wound prophylaxis may contribute to the incidence and nature of infection in battlefield wounds. Problems unique to the handling of battlefield wounded are discussed in comparing the present data with those of other war associated and civilian studies. PMID:167666

  9. Interactions of Methicillin Resistant Staphylococcus aureus USA300 and Pseudomonas aeruginosa in Polymicrobial Wound Infection

    PubMed Central

    Pastar, Irena; Nusbaum, Aron G.; Gil, Joel; Patel, Shailee B.; Chen, Juan; Valdes, Jose; Stojadinovic, Olivera; Plano, Lisa R.; Tomic-Canic, Marjana; Davis, Stephen C.

    2013-01-01

    Understanding the pathology resulting from Staphylococcus aureus and Pseudomonas aeruginosa polymicrobial wound infections is of great importance due to their ubiquitous nature, increasing prevalence, growing resistance to antimicrobial agents, and ability to delay healing. Methicillin-resistant S. aureus USA300 is the leading cause of community-associated bacterial infections resulting in increased morbidity and mortality. We utilized a well-established porcine partial thickness wound healing model to study the synergistic effects of USA300 and P. aeruginosa on wound healing. Wound re-epithelialization was significantly delayed by mixed-species biofilms through suppression of keratinocyte growth factor 1. Pseudomonas showed an inhibitory effect on USA300 growth in vitro while both species co-existed in cutaneous wounds in vivo. Polymicrobial wound infection in the presence of P. aeruginosa resulted in induced expression of USA300 virulence factors Panton-Valentine leukocidin and α-hemolysin. These results provide evidence for the interaction of bacterial species within mixed-species biofilms in vivo and for the first time, the contribution of virulence factors to the severity of polymicrobial wound infections. PMID:23451098

  10. Protective immunization against Staphylococcus aureus infection in a novel experimental wound model in mice.

    PubMed

    Schennings, Torgny; Farnebo, Filip; Szekely, Laszlo; Flock, Jan-Ingmar

    2012-10-01

    A novel murine experimental wound infection model was used to assess the efficacy of multi-component immunization against Staphylococcus aureus infection. Necrotic lesions were induced in mice with venom from Bothrops asper and infected with a low inoculum, 1 × 10(2) CFU. The wound infection model therefore more resembles a clinical case of S. aureus infection compared with conventional infection models where far more bacteria are required. Before infection, mice were immunized with four recombinant S.aureus proteins expressed from Escherichia coli: (i) domains 1-3 of Extracellular adherence protein (Eap), (ii) Efb - D (fusion protein combining Extracellular fibrinogen binding protein (Efb) and a fibronectin binding domain (D) of the fibronectin binding protein (FnBP) and (iii) clumping factor A (ClfA). In the immunized group, lower bacterial colonization, undisturbed crust formation and significantly faster wound healing were found compared with the unimmunized control group. Efb and Eap have previously been found to impair wound healing and neutralization of these proteins by antibodies restores a more natural wound healing process. This effect is further also enhanced by the proposed opsonic activity of antibodies against ClfA and FnBP. PMID:22958286

  11. Biofilms and persistent wound infections in United States military trauma patients: a case–control analysis

    PubMed Central

    2014-01-01

    Background Complex traumatic injuries sustained by military personnel, particularly when involving extremities, often result in infectious complications and substantial morbidity. One factor that may further impair patient recovery is the persistence of infections. Surface-attached microbial communities, known as biofilms, may play a role in hindering the management of infections; however, clinical data associating biofilm formation with persistent or chronic infections are lacking. Therefore, we evaluated the production of bacterial biofilms as a potential risk factor for persistent infections among wounded military personnel. Methods Bacterial isolates and clinical data from military personnel with deployment-related injuries were collected through the Trauma Infectious Disease Outcomes Study. The study population consisted of patients with diagnosed skin and soft-tissue infections. Cases (wounds with bacterial isolates of the same organism collected 14 days apart) were compared to controls (wounds with non-recurrent bacterial isolates), which were matched by organism and infectious disease syndrome. Potential risk factors for persistent infections, including biofilm formation, were examined in a univariate analysis. Data are expressed as odds ratios (OR; 95% confidence interval [CI]). Results On a per infected wound basis, 35 cases (representing 25 patients) and 69 controls (representing 60 patients) were identified. Eight patients with multiple wounds were utilized as both cases and controls. Overall, 235 bacterial isolates were tested for biofilm formation in the case–control analysis. Biofilm formation was significantly associated with infection persistence (OR: 29.49; CI: 6.24-infinity) in a univariate analysis. Multidrug resistance (OR: 5.62; CI: 1.02-56.92), packed red blood cell transfusion requirements within the first 24 hours (OR: 1.02; CI: 1.01-1.04), operating room visits prior to and on the date of infection diagnosis (OR: 2.05; CI: 1

  12. The Wound Healing and Antibacterial Activity of Five Ethnomedical Calophyllum inophyllum Oils: An Alternative Therapeutic Strategy to Treat Infected Wounds

    PubMed Central

    Léguillier, Teddy; Lecsö-Bornet, Marylin; Lémus, Christelle; Rousseau-Ralliard, Delphine; Lebouvier, Nicolas; Hnawia, Edouard; Nour, Mohammed; Aalbersberg, William; Ghazi, Kamelia; Raharivelomanana, Phila; Rat, Patrice

    2015-01-01

    Background Calophyllum inophyllum L. (Calophyllaceae) is an evergreen tree ethno-medically used along the seashores and islands of the Indian and Pacific Oceans, especially in Polynesia. Oil extracted from the seeds is traditionally used topically to treat a wide range of skin injuries from burn, scar and infected wounds to skin diseases such as dermatosis, urticaria and eczema. However, very few scientific studies reported and quantified the therapeutic properties of Calophyllum inophyllum oil (CIO). In this work, five CIO from Indonesia (CIO1), Tahiti (CIO2, 3), Fiji islands (CIO4) and New Caledonia (CIO5) were studied and their cytotoxic, wound healing, and antibacterial properties were presented in order to provide a scientific support to their traditional use and verify their safety. Methods The safety of the five CIO was ascertained using the Alamar blue assay on human keratinocyte cells. CIO wound healing properties were determined using the scratch test assay on human keratinocyte cells. CIO-stimulated antibacterial innate immune response was evaluated using ELISA by measuring β defensin-2 release in human derivative macrophage cells. CIO antibacterial activity was tested using oilogramme against twenty aerobic Gram- bacteria species, twenty aerobic Gram+ bacteria species, including a multi-drug resistant Staphylococcus aureus strain and two anaerobic Gram+ bacteria species e.g. Propionibacterium acnes and Propionibacterium granulosum. To detect polarity profile of the components responsible of the antibacterial activity, we performed bioautography against a Staphylococcus aureus strain. Results Based on Alamar Blue assay, we showed that CIO can be safely used on keratinocyte cells between 2.7% and 11.2% depending on CIO origin. Concerning the healing activity, all the CIO tested accelerated in vitro wound closure, the healing factor being 1.3 to 2.1 higher compared to control when keratinocytes were incubated after scratch with CIO at 0.1%. Furthermore

  13. Chitosan based substrates for wound infection detection based on increased lysozyme activity.

    PubMed

    Tegl, Gregor; Rollett, Alexandra; Dopplinger, Jasmin; Gamerith, Clemens; Guebitz, Georg M

    2016-10-20

    There is a strong need of point-of-care diagnostics for early detection of wound infection. In this study, substrates based on functionalized chitosan were developed for visual detection of elevated lysozyme activity, an infection biomarker in wound fluids. For efficient hydrolysis by lysozyme, N-acetyl chitosan with a final degree of acetylation of around 50% was synthesized. N-acetylated chitosan and a chitosan-starch composite were labeled with structurally different dyes resulting in lysozyme-responsive biomaterials. Incubation with lysozyme in buffer and artificial wound fluid lead to a release of colored hydrolysis products already after 2h incubation. Tests in human wound fluid from infected wounds indicated a clear visual color change after 2.5h compared to control samples. A higher degree of swelling of the chitosan/starch containing substrate led to faster hydrolysis by lysozyme. This study demonstrates the potential of the lysozyme-responsive materials for diagnosis of wound infection and provides different diagnostic substrates for potential incorporation in point-of-care devices. PMID:27474566

  14. Polypragmasia in the therapy of infected wounds – conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy

    PubMed Central

    Kramer, Axel; Hübner, Nils-Olaf; Weltmann, Klaus-Dieter; Lademann, Jürgen; Ekkernkamp, Axel; Hinz, Peter; Assadian, Ojan

    2008-01-01

    As long as a wound is infected, the healing process cannot begin. The indication for wound antiseptic is dependent on the interaction between the wound, the causative micro-organisms, and the host immune system. An uncritical colonisation is a condition whereby micro-organisms on a wound will proliferate, yet the immune system will not react excessively. Wound antiseptic is most often not necessary unless for epidemiologic reasons like colonisation with multi-resistant organisms. In most instances of a microbial contamination of the wound and colonisation, thorough cleaning will be sufficient. Bacterial counts above 105 to 106 cfu per gram tissue (critical colonisation) might decrease wound healing due to release of toxins, particularly in chronic wounds. Traumatic and heavily contaminated wounds therefore will require anti-infective measures, in particular wound antiseptic. In such situations, even a single application of an antiseptic compound will significantly reduce the number of pathogens, and hence, the risk of infection. If a wound infection is clinically manifest, local antiseptics and systemic antibiotics are therapeutically indicated. The prophylactic and therapeutic techniques for treatment of acute and chronic wounds (chemical antiseptics using xenobiotics or antibiotics, biological antiseptic applying maggots, medical honey or chitosan, physical antiseptic using water-filtered infrared A, UV, or electric current) mostly have been empirically developed without establishing a fundamental working hypothesis for their effectiveness. The most important aspect in controlling a wound infection and achieving healing of a wound is meticulous debridement of necrotic material. This is achieved by surgical, enzymatic or biological means e.g. using maggots. However, none of these methods (with some exception for maggots) is totally gentle to vital tissue and particularly chemical methods possess cytotoxicity effects. Derived from the general principles of

  15. Infected total knee arthroplasty due to postoperative wound contamination with Pasteurella multocida.

    PubMed

    Subramanian, Bala; Holloway, Edward; Townsend, Robert; Sutton, Paul

    2013-01-01

    Pasteurella multocida is a small Gram-negative bacterium comprising part of the normal gastrointestinal and nasopharyngeal flora of domestic pets, such as dogs and cats. It rarely causes infection in humans. Previous reports of P multocida causing prosthetic joint infection have described either haematogenous spread of infection from a distant site through a scratch or bite, or reactivation of infection from a previous injury. We report a case of acute total knee arthroplasty joint infection becoming acutely infected by P multocida. We postulate that the mechanism of infection was direct contamination of the wound as a consequence of the patient being licked by his pet dog. We discuss the potential role played by thromboprophylaxis as a factor contributing to prolonged wound leak. PMID:24108765

  16. Carboxymethyl cellulose wafers containing antimicrobials: a modern drug delivery system for wound infections.

    PubMed

    Ng, Shiow-Fern; Jumaat, Nafisah

    2014-01-23

    Lyophilised wafers have been shown to have potential as a modern dressing for mucosal wound healing. The wafer absorbs wound exudates and transforms into a gel, thus providing a moist environment which is essential for wound healing. The objective of this study was to develop a carboxymethyl cellulose wafer containing antimicrobials to promote wound healing and treat wound infection. The pre-formulation studies began with four polymers, sodium carboxymethyl cellulose (NaCMC), methylcellulose (MC), sodium alginate and xanthan gum, but only NaCMC and MC were chosen for further investigation. The wafers were characterised by physical assessments, solvent loss, microscopic examination, swelling and hydration properties, drug content uniformity, drug release and efficacy of antimicrobials. Three of the antimicrobials, neomycin trisulphate salt hydrate, sulphacetamide sodium and silver nitrate, were selected as model drugs. Among the formulations, NaCMC wafer containing neomycin trisulphate exhibited the most desirable wound dressing characteristics (i.e., flexibility, sponginess, uniform wafer texture, high content drug uniformity) with the highest in vitro drug release and the greatest inhibition against both Gram positive and Gram negative bacteria. In conclusion, we successfully developed a NaCMC lyophilised wafer containing antimicrobials, and this formulation has potential for use in mucosal wounds infected with bacteria. PMID:24076463

  17. Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience.

    PubMed Central

    Jones, G; Jurkiewicz, M J; Bostwick, J; Wood, R; Bried, J T; Culbertson, J; Howell, R; Eaves, F; Carlson, G; Nahai, F

    1997-01-01

    OBJECTIVE: The purpose of the study is to define those patient variables that contribute to morbidity and mortality of median sternotomy wound infection and the results of treatment by debridement and closure by muscle flaps. BACKGROUND: Infection of the median sternotomy wound after open heart surgery is a devastating complication associated with significant mortality. Twenty years ago, these wounds were treated with either open packing or antibiotic irrigation, with a mortality approaching 50% in some series. In 1975, the authors began treating these wounds with radical sternal debridement followed by closure using muscle or omental flaps. The mortality of sternal wound infection has dropped to < 10%. METHODS: The authors' total experience with 409 patients treated over 20 years is described in relation to flap choices, hospital days after sternal wound closure, and incidence rates of morbidity and mortality. One hundred eighty-six patients treated since January 1988 were studied to determine which patient variables had impact on rates of flap closure complications, recurrent sternal wound infection, or death. Variables included obesity, history of smoking, hypertension, diabetes, poststernotomy septicemia, internal mammary artery harvest, use of intra-aortic balloon pump, and perioperative myocardial infarction and were analyzed using chi square tests. Fisher's exact tests, and multivariable logistic regression analysis. RESULTS: The mortality rate over 20 years was 8.1% (33/49). Additional procedures for recurrent sternal wound infection were necessary in 5.1% of patients. Thirty-one patients (7.6%) required treatment for hematoma, and 11 patients (2.7%) required hernia repair. Among patients treated since 1988, variables strongly associated with mortality were septicemia (p < 0.00001), perioperative myocardial infarction (p = 0.006), and intra-aortic balloon pump (p = 0.0168). Factors associated with wound closure complications were intra-aortic balloon pump

  18. A Case of Continuous Negative Pressure Wound Therapy for Abdominal Infected Lymphocele after Kidney Transplantation

    PubMed Central

    Franchin, Marco; Tozzi, Matteo; Soldini, Gabriele; Piffaretti, Gabriele

    2014-01-01

    Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy. PMID:25374744

  19. Improved Surgical Site Infection (SSI) rate through accurately assessed surgical wounds

    PubMed Central

    John, Honeymol; Nimeri, Abdelrahman; ELLAHHAM, SAMER

    2015-01-01

    Sheikh Khalifa Medical City's (SKMC) Surgery Institute was identified as a high outlier in Surgical Site Infections (SSI) based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) - Semi-Annual Report (SAR) in January 2012. The aim of this project was to improve SSI rates through accurate wound classification. We identified SSI rate reduction as a performance improvement and safety priority at SKMC, a tertiary referral center. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) best practice guidelines as a guide. ACS NSQIP is a clinical registry that provides risk-adjusted clinical outcome reports every six months. The rates of SSI are reported in an observed/expected ratio. The expected ratio is calculated based on the risk factors of the patients which include wound classification. We established a multidisciplinary SSI taskforce. The members of the SSI taskforce included the ACS NSQIP team members, quality, surgeons, nurses, infection control, IT, pharmacy, microbiology, and it was chaired by a colorectal surgeon. The taskforce focused on five areas: pre-op showering and hair removal, skin antisepsis, prophylactic antibiotics, peri-operative maintenance of glycaemia, and normothermia. We planned audits to evaluate our wound classification and our SSI rates based on the SAR. Our expected SSI rates in general surgery and the whole department were 2.52% and 1.70% respectively, while our observed SSI rates were 4.68% and 3.57% respectively, giving us a high outlier status with an odd's ratio of 1.72 and 2.03. Wound classifications were identified as an area of concern. For example, wound classifications were preoperatively selected based on the default wound classification of the booked procedure in the Electronic Medical Record (EMR) which led to under classifying wounds in many occasions. A total of 998 cases were reviewed, our rate of incorrect wound classification

  20. Implementing evidence-based practice findings to decrease postoperative sternal wound infections following open heart surgery.

    PubMed

    Haycock, Camille; Laser, Craig; Keuth, Jennifer; Montefour, Kerry; Wilson, Melissa; Austin, Kerry; Coulen, Charmaine; Boyle, Deborah

    2005-01-01

    Sternal wound infections following open heart surgery are an infrequent occurrence but can have significant impact on patient morbidity, length of stay, and cost of care. The objective of this project initiative was to decrease the incidence of sternal wound infections by examining and changing current practice in the preoperative and postoperative management of patients undergoing open heart surgery. Following a literature review of interdisciplinary best practices, process teams were formed to evaluate our own patient cohort with documented infection. Five key areas were addressed: (1) preoperative skin preparation, (2) antibiotic prophylaxis, (3) blood glucose control, (4) wound care management, and (5) hand hygiene. A retrospective chart review of patients with documented sternal wound infections status post-mediastinal open heart surgery revealed that the average postoperative glucose was 201 mg/dL. An inquiry of practice variations determined the absence of a common provider and causative organism. A change model guided project initiatives and sustainability of new behaviors and practice. Each element of the project initiative had defined outcome measures. Staff nurses participated in peer education and outcome data collection. Following the implementation of evidence based practice changes, a linear decrease in sternal wound infections was documented. Nurses play a critical role in identifying, orchestrating, and evaluating change efforts in clinical practice. Outcomes are enhanced when nurses collaborate with all stakeholders in the practice improvement initiative. PMID:16141774

  1. Offset layered closure reduces deep wound infection in early-onset scoliosis surgery.

    PubMed

    Grzywna, Alexandra M; Miller, Patricia E; Glotzbecker, Michael P; Emans, John B

    2016-07-01

    Deep wound infection is a common complication in early-onset scoliosis (EOS) surgery. Soft tissue technique has received less attention as a means to reduce infection. A retrospective review of 1170 EOS surgeries (single surgeon, institution) investigated the impact of offset layered closure (OLC) and soft tissue awareness. The introduction of OLC reduced deep infection from 3.0% in 99 surgeries to 0.37% in 1071. Logistic regression confirmed that OLC led to significantly lower odds of infection (P=0.007). This deep infection rate (0.37%) is more typical of elective surgery, providing a more optimistic view of infection in EOS surgery than generally reported. PMID:27196268

  2. Assessment and management of wound infection: the role of silver.

    PubMed

    Stephen-Haynes, Jackie; Toner, Louise

    2007-03-01

    The appropriate selection of anti-microbial dressings has become an increasing challenge within clinical practice with an increasing array of dressing availability. A major area of growth has been in dressings containing silver. This article will discuss the rationale for use of silver dressings in the context of wound bed preparation, and offers guidance on their selection and appropriate use. PMID:17505354

  3. Intracardiac Abscess with Cutaneous Fistula Secondary to Ventricular Septal Defect Repair Simulating Sternal Wound Infection

    PubMed Central

    Keshavamurthy, Suresh; Sepulveda, Edgardo; Miranda, Cyndee Cruz; Okamoto, Toshihiro; Pettersson, Gosta Bengt

    2014-01-01

    Cutaneous fistula as a clinical presentation of intracardiac abscess of the right side is such an unusual occurrence that it has not until now been reported in the English-language medical literature. We present a rare case of right-sided infective endocarditis caused by Achromobacter xylosoxidans in which recurrent infection presented as sternal wound discharge. The infection was found to have an intracardiac origin and was successfully managed by radical débridement on cardiopulmonary bypass. PMID:24955054

  4. Evaluation of healing of infected cutaneous wounds treated with different energy densities

    NASA Astrophysics Data System (ADS)

    Santos, Nicole R. S.; Cangussú, Maria C. T.; N. dos Santos, Jean; Pinheiro, Antonio L. B.

    2011-03-01

    We aimed assess the effects of different energy densities of the association of red/IR laser light on the healing of cutaneous wounds infected Staphylococcus aureus. Background: Wound infection is the most common complication on healing wounds and cause both vascular and cellular responses on the tissue. Several therapeutics is used for improving wound healing including the use of different light sources, such as the Laser. Some energy densities present positive photobiological effects on the healing process. Material and Methods: 24 young adult male Wistar rats, under general anesthesia, had their dorsum shaven, cleaned and a 1 x 1cm cutaneous wound created with a scalpel and left without no suturing or dressings. The wounds were infected with Staphylococcus aureus and were randomly divided in 8 subgroups of 3 animals in each: Control, Group 10J/cm2, Group 20J/cm2, and Group 30J/cm2, 7 and 14 days each group. Laser phototherapy was carried out with a diode (λ680nm/790nm, P= 30mW/40mW, CW, Laser, Ø = 3mm, PD=424mW/cm2 and 566mW/cm2, t=11.8/ 8.8 sec, E=0.35J) and started immediately after surgery and repeated at every other day during 7 days. Laser light was applied on 4 points around wounded area. The animals were killed at either 8th or 15th day after contamination. Specimens were taken, routinely cut and processed to wax, stained and underwent histological analysis. The results were statistically analyzed. Results: Both 20 and 30J/cm2 caused intense collagen deposition at the end of the experimental time. But, when 20 J/cm2 was used the fibers were also well organized. Conclusion: Our results indicate that irradiated subjects showed improved wound healing being the 20 J/cm2 the energy the caused better histological response.

  5. A Case of Wound Infection with Providencia rettgeri and Coincident Gout in a Patient from Guam

    PubMed Central

    Barnhill, Jason; Griffin, Jaclyn M

    2015-01-01

    Providencia rettgeri (P. rettgeri) is a ubiquitous organism that is infrequently associated with human disease. Here we report the isolation of this organism from a polymicrobial wound infection resulting from ruptured tophi on a 54-year-old male patient from Guam. We describe the identification and confirmation of this organism, and propose metabolic synergy as a possible mechanism of pathogenesis. To our knowledge, this is the first published report of a wound infection colonized by P. rettgeri from Guam, and the first report to speculate upon the role of bacterial synergy in P. rettgeri pathogenesis. PMID:26568901

  6. A Case of Wound Infection with Providencia rettgeri and Coincident Gout in a Patient from Guam.

    PubMed

    Washington, Michael A; Barnhill, Jason; Griffin, Jaclyn M

    2015-11-01

    Providencia rettgeri (P. rettgeri) is a ubiquitous organism that is infrequently associated with human disease. Here we report the isolation of this organism from a polymicrobial wound infection resulting from ruptured tophi on a 54-year-old male patient from Guam. We describe the identification and confirmation of this organism, and propose metabolic synergy as a possible mechanism of pathogenesis. To our knowledge, this is the first published report of a wound infection colonized by P. rettgeri from Guam, and the first report to speculate upon the role of bacterial synergy in P. rettgeri pathogenesis. PMID:26568901

  7. Coronary artery bypass surgery in diabetic patients – risk factors for sternal wound infections

    PubMed Central

    Lenz, Kristina; Brandt, Michael; Fraund-Cremer, Sandra; Cremer, Jochen

    2016-01-01

    The incidence of sternal wound infections (SWI) after coronary artery bypass surgery (CABG) as reported worldwide is low. However, it is associated with significant increase of postoperative mortality and treatment costs. The major risk factors discussed are diabetes mellitus and bilateral IMA harvesting of the internal mammary artery. This study analyses data of 590 patients receiving CABG concerning the risk factors for SWI. Sternal wound infections occur significantly more often in diabetic patients, one crucial and significant additional risk factor is obesity. PMID:27547690

  8. Murine Model Imitating Chronic Wound Infections for Evaluation of Antimicrobial Photodynamic Therapy Efficacy.

    PubMed

    Fila, Grzegorz; Kasimova, Kamola; Arenas, Yaxal; Nakonieczna, Joanna; Grinholc, Mariusz; Bielawski, Krzysztof P; Lilge, Lothar

    2016-01-01

    It is generally acknowledged that the age of antibiotics could come to an end, due to their widespread, and inappropriate use. Particularly for chronic wounds alternatives are being thought. Antimicrobial Photodynamic Therapy (APDT) is a potential candidate, and while approved for some indications, such as periodontitis, chronic sinusitis and other niche indications, its use in chronic wounds is not established. To further facilitate the development of APDT in chronic wounds we present an easy to use animal model exhibiting the key hallmarks of chronic wounds, based on full-thickness skin wounds paired with an optically transparent cover. The moisture-retaining wound exhibited rapid expansion of pathogen colonies up to 8 days while not jeopardizing the host survival. Use of two bioluminescent pathogens; methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa permits real time monitoring of the pathogens. The murine model was employed to evaluate the performance of four different photosensitizers as mediators in Photodynamic Therapy. While all four photosensitizers, Rose Bengal, porphyrin TMPyP, New Methylene Blue, and TLD1411 demonstrated good to excellent antimicrobial efficacy in planktonic solutions at 1 to 50 μM concentrations, whereas in in vivo the growth delay was limited with 24-48 h delay in pathogen expansion for MRSA, and we noticed longer growth suppression of P. aeruginosa with TLD1411 mediated Photodynamic Therapy. The murine model will enable developing new strategies for enhancement of APDT for chronic wound infections. PMID:27555843

  9. Murine Model Imitating Chronic Wound Infections for Evaluation of Antimicrobial Photodynamic Therapy Efficacy

    PubMed Central

    Fila, Grzegorz; Kasimova, Kamola; Arenas, Yaxal; Nakonieczna, Joanna; Grinholc, Mariusz; Bielawski, Krzysztof P.; Lilge, Lothar

    2016-01-01

    It is generally acknowledged that the age of antibiotics could come to an end, due to their widespread, and inappropriate use. Particularly for chronic wounds alternatives are being thought. Antimicrobial Photodynamic Therapy (APDT) is a potential candidate, and while approved for some indications, such as periodontitis, chronic sinusitis and other niche indications, its use in chronic wounds is not established. To further facilitate the development of APDT in chronic wounds we present an easy to use animal model exhibiting the key hallmarks of chronic wounds, based on full-thickness skin wounds paired with an optically transparent cover. The moisture-retaining wound exhibited rapid expansion of pathogen colonies up to 8 days while not jeopardizing the host survival. Use of two bioluminescent pathogens; methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa permits real time monitoring of the pathogens. The murine model was employed to evaluate the performance of four different photosensitizers as mediators in Photodynamic Therapy. While all four photosensitizers, Rose Bengal, porphyrin TMPyP, New Methylene Blue, and TLD1411 demonstrated good to excellent antimicrobial efficacy in planktonic solutions at 1 to 50 μM concentrations, whereas in in vivo the growth delay was limited with 24–48 h delay in pathogen expansion for MRSA, and we noticed longer growth suppression of P. aeruginosa with TLD1411 mediated Photodynamic Therapy. The murine model will enable developing new strategies for enhancement of APDT for chronic wound infections. PMID:27555843

  10. Long-term results of pectoralis major muscle transposition for infected sternotomy wounds.

    PubMed Central

    Pairolero, P C; Arnold, P G; Harris, J B

    1991-01-01

    During an 11.5-year period, 100 consecutive patients (79 male, 21 female) underwent repair of an infected sternotomy wound. Sixty-five patients had failed attempts at wound closure by other physicians. Median age was 61.5 years (range, 5 to 85 years). Reconstruction included muscle in 79 patients, omentum in 4, and both in 15. A total of 175 muscles were transposed, including 169 pectoralis major, 3 rectus abdominis, 2 external oblique, and 1 latissimus dorsi. Median number of operations was four (range, 1 to 11). Mechanical ventilation was required in 30 patients. Two perioperative deaths occurred, one related to sepsis. Median follow-up was 4.2 years (range, 1.3 to 13.5 years). Twenty-six patients had recurrent infection. Median time from our closure to recurrence was 5.5 months (range, 0.3 to 27.6 months). Cause of recurrence was inadequate removal of cartilage in 16 patients, bone in 6, and retained foreign body in 4. Eighteen patients had the wound reopened with further resection; 10 had another muscle or omentum transposition. There were 30 late deaths, only one related to recurrent infection. At the time of death or last follow-up, 92 patients had a healed chest wall. Transposition of the pectoralis major muscle remains an excellent method of management for infected sternotomy wounds. Failure is directly related to persistent infection of cartilage, bone, or retained foreign bodies. PMID:2039289

  11. Ciprofloxacin-Loaded Keratin Hydrogels Prevent Pseudomonas aeruginosa Infection and Support Healing in a Porcine Full-Thickness Excisional Wound

    PubMed Central

    Roy, Daniel C.; Tomblyn, Seth; Burmeister, David M.; Wrice, Nicole L.; Becerra, Sandra C.; Burnett, Luke R.; Saul, Justin M.; Christy, Robert J.

    2015-01-01

    Objective: Cutaneous wound infection can lead to impaired healing, multiple surgical procedures, and increased hospitalization time. We tested the effectiveness of keratin-based hydrogels (termed “keratose”) loaded with ciprofloxacin to inhibit infection and support healing when topically administered to porcine excision wounds infected with Pseudomonas aeruginosa. Approach: Using a porcine excisional wound model, 10 mm full-thickness wounds were inoculated with 106 colony-forming units of P. aeruginosa and treated on days 1 and 3 postinoculation with ciprofloxacin-loaded keratose hydrogels. Bacteria enumeration and wound healing were assessed on days 3, 7, and 11 postinjury. Results: Ciprofloxacin-loaded keratose hydrogels reduced the amount of P. aeruginosa in the wound bed by 99.9% compared with untreated wounds on days 3, 7, and 11 postinjury. Ciprofloxacin-loaded keratose hydrogels displayed decreased wound contraction and reepithelialization at day 7 postinjury. By day 11, wounds treated with ciprofloxacin-keratose hydrogels contained collagen-rich granulation tissue and myofibroblasts. Wounds treated with ciprofloxacin-loaded keratose hydrogels exhibited a transient increase in macrophages in the wound bed at day 7 postinjury that subsided by day 11. Innovation: Current therapies for wound infection include systemic antibiotics, which could lead to antibiotic resistance, and topical antimicrobial treatments, which require multiple applications and can delay healing. Here, we show that ciprofloxacin-loaded keratose hydrogels inhibit cutaneous wound infection without interfering with key aspects of the healing process including granulation tissue deposition and remodeling. Conclusions: Ciprofloxacin-loaded keratose hydrogels have the potential to serve as a point-of-injury antibiotic therapy that prevents infection and supports healing following cutaneous injury. PMID:26244102

  12. Actinobacillus spp. and related bacteria in infected wounds of humans bitten by horses and sheep.

    PubMed Central

    Peel, M M; Hornidge, K A; Luppino, M; Stacpoole, A M; Weaver, R E

    1991-01-01

    We describe the isolation of Actinobacillus lignieresii and an A. equuli-like bacterium from an infected horse-bite wound in a 22-year-old stable foreman and A. suis from a bite injury in a 35-year-old man who had been attacked by a horse. A. lignieresii was also isolated in pure culture from an infected sheep-bite wound in a rural worker. These species of the genus Actinobacillus are primarily associated with animals and animal diseases and are rarely isolated from humans. The purpose of this report is to raise awareness of the possible occurrence of Actinobacillus spp. in bite wounds inflicted by farm animals and to discuss the difficulties encountered in the identification of species of Actinobacillus and related bacteria. PMID:1774260

  13. Neutropenia exacerbates infection by Acinetobacter baumannii clinical isolates in a murine wound model

    PubMed Central

    Grguric-Smith, Laryssa M.; Lee, Hiu H.; Gandhi, Jay A.; Brennan, Melissa B.; DeLeon-Rodriguez, Carlos M.; Coelho, Carolina; Han, George; Martinez, Luis R.

    2015-01-01

    The Gram negative coccobacillus Acinetobacter baumannii has become an increasingly prevalent cause of hospital-acquired infections in recent years. The majority of clinical A. baumannii isolates display high-level resistance to antimicrobials, which severely compromises our capacity to care for patients with A. baumannii disease. Neutrophils are of major importance in the host defense against microbial infections. However, the contribution of these cells of innate immunity in host resistance to cutaneous A. baumannii infection has not been directly investigated. Hence, we hypothesized that depletion of neutrophils increases severity of bacterial disease in an experimental A. baumannii murine wound model. In this study, the Ly-6G-specific monoclonal antibody (mAb), 1A8, was used to generate neutropenic mice and the pathogenesis of several A. baumannii clinical isolates on wounded cutaneous tissue was investigated. We demonstrated that neutrophil depletion enhances bacterial burden using colony forming unit determinations. Also, mAb 1A8 reduces global measurements of wound healing in A. baumannii-infected animals. Interestingly, histological analysis of cutaneous tissue excised from A. baumannii-infected animals treated with mAb 1A8 displays enhanced collagen deposition. Furthermore, neutropenia and A. baumannii infection alter pro-inflammatory cytokine release leading to severe microbial disease. Our findings provide a better understanding of the impact of these innate immune cells in controlling A. baumannii skin infections. PMID:26528277

  14. Nanohybrids of Silver Particles Immobilized on Silicate Platelet for Infected Wound Healing

    PubMed Central

    Chu, Chia-Yu; Peng, Fu-Chuo; Chiu, Ying-Fang; Lee, Hsing-Chuan; Chen, Chien-Wen; Wei, Jiun-Chiou; Lin, Jiang-Jen

    2012-01-01

    Silver nanoparticles supported on nanoscale silicate platelets (AgNP/NSP) possess interesting properties, including a large surface area and high biocide effectiveness. The nanohybrid of AgNP/NSP at a weight ratio 7/93 contains 5-nm Ag particles supported on the surface of platelets with dimensions of approximately 80×80×1 nm3. The nanohybrid expresses a trend of lower cytotoxicity at the concentration of 8.75 ppm Ag and low genotoxicity. Compared with conventional silver ions and the organically dispersed AgNPs, the nanohybrid promotes wound healing. We investigated overall wound healing by using acute burn and excision wound healing models. Tests on both infected wound models of mice were compared among the AgNP/NSP, polymer-dispersed AgNPs, the commercially available Aquacel, and silver sulfadiazine. The AgNP/NSP nanohybrid was superior for wound appearance, but had similar wound healing rates, vascular endothelial growth factor (VEGF)-A levels and transforming growth factor (TGF)-β1 expressions to Aquacel and silver sulfadiazine. PMID:22693632

  15. Review of Subcutaneous Wound Drainage in Reducing Surgical Site Infections after Laparotomy

    PubMed Central

    Manzoor, B.; Heywood, N.; Sharma, A.

    2015-01-01

    Purpose. Surgical site infections (SSIs) remain a significant problem after laparotomies. The aim of this review was to assess the evidence on the efficacy of subcutaneous wound drainage in reducing SSI. Methods. MEDLINE database was searched. Studies were identified and screened according to criteria to determine their eligibility for meta-analysis. Meta-analysis was performed using the Mantel-Haenszel method and a fixed effects model. Results. Eleven studies were included with two thousand eight hundred and sixty-four patients. One thousand four hundred and fifty patients were in the control group and one thousand four hundred and fourteen patients were in the drain group. Wound drainage in all patients shows no statistically significant benefit in reducing SSI incidence. Use of drainage in high risk patients, contaminated wound types, and obese patients appears beneficial. Conclusion. Using subcutaneous wound drainage after laparotomy in all patients is unnecessary as it does not reduce SSI risk. Similarly, there seems to be no benefit in using it in clean and clean contaminated wounds. However, there may be benefit in using drains in patients who are at high risk, including patients who are obese and/or have contaminated wound types. A well designed trial is needed which examines these factors. PMID:26783556

  16. Maggot Debridement Therapy of Infected Ulcers: Patient and Wound Factors Influencing Outcome – A Study on 101 Patients with 117 Wounds

    PubMed Central

    Steenvoorde, Pascal; Jacobi, Cathrien E; Van Doorn, Louk; Oskam, Jacques

    2007-01-01

    INTRODUCTION It has been known for centuries that maggots are potent debriding agents capable of removing necrotic tissue and slough. In January 2004, the US Food and Drug Administration decided to regulate maggot debridement therapy (MDT). As it is still not clear which wounds are likely or unlikely to benefit from MDT, we performed a prospective study to gain more insight in patient and wound characteristics influencing outcome. PATIENTS AND METHODS In the period between August 2002 and December 2005, patients with infected wounds with signs of gangrenous or necrotic tissue who seemed suited for MDT were enrolled in the present study. In total, 101 patients with 117 ulcers were treated. Most wounds were worst-case scenarios, in which maggot therapy was a treatment of last resort. RESULTS In total, 72 patients (71%) were classified as ASA III or IV. In total, 78 of 116 wounds (67%) had a successful outcome. These wounds healed completely (n = 60), healed almost completely (n = 12) or were clean at least (n = 6) at last follow-up. These results seem to be in line with those in the literature. All wounds with a traumatic origin (n = 24) healed completely. All wounds with septic arthritis (n = 13), however, failed to heal and led in half of these cases to a major amputation. According to a multivariate analysis, chronic limb ischaemia (odds ratio [OR], 7.5), the depth of the wound (OR, 14.0), and older age (≥ 60 years; OR, 7.3) negatively influenced outcome. Outcome was not influenced by gender, obesity, diabetes mellitus, smoking, ASAclassification, location of the wound, wound size or wound duration. CONCLUSIONS Some patient characteristics (i.e. gender, obesity, smoking behaviour, presence of diabetes mellitus and ASA-classification at presentation) and some wound characteristics (i.e. location of the wound, wound duration and size) do not seem to contra-indicate eligibility for MDT. However, older patients and patients with chronic limb ischaemia or deep wounds

  17. Combination of photodynamic and ultrasonic therapy for treatment of infected wounds in animal model

    NASA Astrophysics Data System (ADS)

    Menyaev, Yulian A.; Zharov, Vladimir P.

    2006-02-01

    One of the important problems of modern medicine is treatment of infected wounds. There are many diversified expedients of treatment, but none of them obey the modern physician completely. The aim of this study is to develop and test a new combined method of photodynamic ultrasonic therapy (PDUST) for treatment of infected wounds with focus on experimental trials. PDUST is based on a combination of two methods: photodynamic (PD) therapy (PDT) with photosensitizer and low frequency ultrasonic (US) therapy with antibiotic as tools for treatment of wounds and effectively killing bacteria. The main parameters are: US frequency - 26.5 kHz; US tip elongation - 40+/-20 μm wavelength of light emitting diodes (LED) array - 660+/-10 nm; light intensity on biotissue surface - 1-2 mW/cm2; photosensitizer - an aluminum disulfonated phtalocyanine dissolved in a physiological solution in concentration 10 mg/l. The experiments were carried out with 70 male chinchilla rabbits divided into 7 groups, thus the dynamics of wounds healing were studied in different modes of PDUST. The PD and US methods supplement each other and in conjunction provide additive and especially synergetic effects. The experimental data demonstrated advantages of new technology in comparison with conventional methods in cases of treatment of extended suppurative inflammatory and profound wounds. The more detailed study of PDUST method's mechanism, which is based on low intensity of LED light, PD therapy and US influence is required.

  18. A Comparison of Tissue versus Swab Culturing of Infected Diabetic Foot Wounds.

    PubMed

    Huang, Ying; Cao, Ying; Zou, Mengchen; Luo, Xiangrong; Jiang, Ya; Xue, Yaoming; Gao, Fang

    2016-01-01

    Objective. To compare the efficacy of swabbing versus tissue biopsy for microbiological diagnosis of diabetic foot infection. Methods. This was a prospective trial. Fifty-six patients with diabetic foot infection were divided into the following 3 groups according to the PEDIS grading system: grade 2 (n = 10), grade 3 (n = 29), and grade 4 (n = 17). Two specimens were collected from each wound for microbial culturing after debridement, including a superficial swab and a deep tissue punch biopsy specimen. Results. Swab culturing identified all of the microorganisms isolated from the corresponding deep tissue specimens in 9/10 of grade 2 wounds (90.0%), and this proportion decreased to 12/29 (41.4%) and 7/17 (41.2%) for grades 3 and 4 wounds, respectively (p = 0.02). Moreover, the sensitivity for identifying Gram-negative bacteria, such as E. coli and Citrobacter, by swabbing was low (33.3%). In addition, some Gram-negative bacteria, such as Serratia and Ralstonia pickettii, were isolated from deep tissues but not from swabs. Conclusions. Swab culturing may be reliable for identification of pathogens in diabetic foot wounds classified as grade 2. However, it is advisable to culture deep tissue specimens for wounds of grade ≥3 because swab culturing is associated with a high risk of missing pathogens, especially Gram-negative bacteria. PMID:27123004

  19. A Comparison of Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

    PubMed Central

    Huang, Ying; Cao, Ying; Zou, Mengchen; Luo, Xiangrong; Jiang, Ya; Xue, Yaoming; Gao, Fang

    2016-01-01

    Objective. To compare the efficacy of swabbing versus tissue biopsy for microbiological diagnosis of diabetic foot infection. Methods. This was a prospective trial. Fifty-six patients with diabetic foot infection were divided into the following 3 groups according to the PEDIS grading system: grade 2 (n = 10), grade 3 (n = 29), and grade 4 (n = 17). Two specimens were collected from each wound for microbial culturing after debridement, including a superficial swab and a deep tissue punch biopsy specimen. Results. Swab culturing identified all of the microorganisms isolated from the corresponding deep tissue specimens in 9/10 of grade 2 wounds (90.0%), and this proportion decreased to 12/29 (41.4%) and 7/17 (41.2%) for grades 3 and 4 wounds, respectively (p = 0.02). Moreover, the sensitivity for identifying Gram-negative bacteria, such as E. coli and Citrobacter, by swabbing was low (33.3%). In addition, some Gram-negative bacteria, such as Serratia and Ralstonia pickettii, were isolated from deep tissues but not from swabs. Conclusions. Swab culturing may be reliable for identification of pathogens in diabetic foot wounds classified as grade 2. However, it is advisable to culture deep tissue specimens for wounds of grade ≥3 because swab culturing is associated with a high risk of missing pathogens, especially Gram-negative bacteria. PMID:27123004

  20. Burn wounds infected by contaminated water: case reports, review of the literature and recommendations for treatment.

    PubMed

    Ribeiro, Noel F F; Heath, Christopher H; Kierath, Jessica; Rea, Suzanne; Duncan-Smith, Mark; Wood, Fiona M

    2010-02-01

    First-aid education for the management of burns advocates cool running water over burnt skin to limit soft tissue damage. However, the water used may itself constitute a risk. We report three cases of severe invasive and necrotizing infection in patients who used or immersed themselves in contaminated water in an attempt to extinguish the fire following acute major burns. Wound cultures from all patients yielded Aeromonas hydrophila and two yielded Bacillus cereus. One patient had a complex polymicrobial infection, including zygomycosis with Rhizomucor variabilis. All patients were treated aggressively with wound débridement, including one patient who required bilateral lower limb amputations to control progressive infection. All infections were successfully treated and all patients survived their burn injuries. We review the management of burns complicated by exposure to contaminated water leading to burn wound infections. We describe commonly reported organisms from various water sources, the appropriate initial empirical antimicrobial chemotherapy and present the clinician with a proposed algorithm for managing these serious infections. PMID:19501977

  1. Comparison of dextranomer and streptokinase-streptodornase in the treatment of venous leg ulcers and other infected wounds.

    PubMed

    Hulkko, A; Holopainen, Y V; Orava, S; Kangas, J; Kuusisto, P; Hyvärinen, E; Ervasti, E; Silvennoinen, E

    1981-01-01

    The clinical efficacy of dextranomer (Debrisan) and streptokinase-streptodornase (Varidase) was compared in a controlled randomized in-patient study. There were two patient groups: Group A consisting of 28 patients with a total of 31 venous leg ulcers and Group B consisting of 56 patients with other infected wounds (posttraumatic and postoperative wounds, amputation stumps, burn wounds, arteriosclerotic ulcers, decubital ulcers, ulcers due to bone disease, rheumatic ulcers, ulcers due to erysipelas and wounds of mixed aetiology). Both agents have a good cleansing effect as well as a good effect on infection and wet necrosis. Dextranomer stimulates the formation of granulation tissue faster than streptokinase-streptodornase. PMID:6172073

  2. Nitrosoglutathione generating nitric oxide nanoparticles as an improved strategy for combating Pseudomonas aeruginosa-infected wounds.

    PubMed

    Chouake, Jason; Schairer, David; Kutner, Allison; Sanchez, David A; Makdisi, Joy; Blecher-Paz, Karin; Nacharaju, Parimala; Tuckman-Vernon, Chaim; Gialanella, Phil; Friedman, Joel M; Nosanchuk, Joshua D; Friedman, Adam J

    2012-12-01

    Pseudomonas aeruginosa is a community-acquired, nosocomial pathogen that is an important cause of human morbidity and mortality; it is intrinsically resistant to several antibiotics and is capable of developing resistance to newly developed drugs via a variety of mechanisms. P aeruginosa's ubiquity and multidrug resistance (MDR) warrants the development of innovative methods that overcome its ability to develop resistance. We have previously described a nitric oxide-releasing nanoparticle (NO-np) platform that effectively kills gram-positive and gram-negative organisms in vitro and accelerates clinical recovery in vivo in murine wound and abscess infection models. We have also demonstrated that when glutathione (GSH) is added to NO-np, the nitroso intermediate S-nitrosoglutathione (GSNO) is formed, which has greater activity against P aeruginosa and other gram-negative organisms compared with NO-np alone. In the current study, we evaluate the potential of NO-np to generate GSNO both in vitro and in vivo in a murine excisional wound model infected with an MDR clinical isolate of P aeruginosa. Whereas NO-np alone inhibited P aeruginosa growth in vitro for up to 8 hours, NO-np+GSH completely inhibited P aeruginosa growth for 24 hours. Percent survival in the NO-np+GSH-treated isolates was significantly lower than in the NO-np (36.1% vs 8.3%; P=.004). In addition, NO-np+GSH accelerated wound closure in P aeruginosa-infected wounds, and NO-np+GSH-treated wounds had significantly lower bacterial burden when compared to NO-np-treated wounds (P<.001). We conclude that GSNO is easily generated from our NO-np platform and has the potential to be used as an antimicrobial agent against MDR organisms such as P aeruginosa. PMID:23377518

  3. Use of antibiotics in the management of postirradiation wound infection and sepsis

    SciTech Connect

    Brook, I.

    1988-07-01

    Ionizing gamma irradiation depresses the host defenses and enhances the susceptibility of the immunocompromised host to local and systemic infection due to endogenous or exogenous microorganisms. Trauma and wounding act synergistically and decrease the survival after exposure to irradiation. The current antimicrobial agents suitable for controlling serious infections and their use in post irradiation local and systemic infection with and without trauma are discussed. The experience gained in managing immunocompromised patients following chemotherapy is reviewed. Empiric single agent or combination agent therapy should be directed at the eradication of potential gram-negative as well as gram-positive pathogens. The most important organisms known to cause these infections are Pseudomonas sp. and Enterobacteriaceae. Management of intra-abdominal infections following trauma should include early surgical correlation and antimicrobials directed against the Bacteroides fragilis group and Enterobacteriaceae. Staphylococcus aureus and Streptococcus pyogenes cause most skin and soft tissue infections following trauma. Chemoprophylaxis of enteric sources of systemic infection can be achieved by antimicrobials that selectively inhibit the Enterobacteriaceae sp. and preserve the anaerobic flora. The management of infection in the injured and irradiated host includes supportive and restorative therapy. Supportive therapy includes debridement and cleansing of wounds, fluids, immunoglobulin, and antimicrobials. Restorative therapy includes definite surgery repair and replenishment of the immune system by use of immunomodulators, growth factors, and bone marrow transplantation. Further studies are needed to examine the usefulness of presently available drugs and experimental agents in the irradiated and traumatized host. 111 references.

  4. Excessive pediatric fasciitis necrotisans due to Pseudomonas aeruginosa infection successfully treated with negative pressure wound therapy.

    PubMed

    Szabó, Levente; Szegedi, István; Kiss, Csongor; Szikszay, Edit; Remenyik, Éva; Csízy, István; Juhász, István

    2015-01-01

    The case of a 10-year old female child is described with a history of myeloproliferative disorder having skin, bone and visceral involvement. Bone marrow biopsy revealed histiocytosis X. During chemotherapy necrotizing fasciitis of the lower abdominal wall was diagnosed. Multiple microbiological cultures taken from the wound base revealed Pseudomonas aeruginosa infection. Surgical necrectomy and application of negative pressure wound therapy (NPWT) was started together with intensive care treatment for sepsis. As both wound and general condition of the patient improved, autologous split thickness skin grafting was carried out in two sitting under continuing NPWT application. The applied skin grafts showed excellent take, the perilesional subcutaneous recesses resolved and complete healing was achieved after 28 days of NPWT treatment. Proper dermatological diagnosis and immediate escharectomy complemented with application of NPWT can be life-saving in the treatment of necrotizing fasciitis. PMID:26032296

  5. Fulminant infection by uncommon organisms in animal bite wounds.

    PubMed Central

    Dutta, J. K.

    1998-01-01

    In 1995 and 1996, 215 patients exposed to different species of animals were treated at the Amarnath Polyclinic, Balasore, in India. Among them were two children infected by uncommon organisms, i.e., Capnocytophaga canimorsus and Pasteurella multocida; the patients recovered with appropriate antibiotic therapy. PMID:10211359

  6. Human Wound Infection with Mannheimia glucosida following Lamb Bite.

    PubMed

    Lau, Jillian S Y; Omaleki, Lida; Turni, Conny; Barber, Stuart Richard; Browning, Glenn Francis; Francis, Michelle J; Graham, Maryza; Korman, Tony M

    2015-10-01

    Mannheimia spp. are veterinary pathogens that can cause mastitis and pneumonia in domestic cattle and sheep. While Mannheimia glucosida can be found as normal flora in oral and respiratory mucosa in sheep, there have been no reported cases of human infection with this organism. PMID:26202121

  7. [Wound management].

    PubMed

    Gresser, J; Bitz, K; Hegglin, J

    1992-07-01

    The following article is a check-list for wound care giving some practical hints. Special interest has been given to the themes of local anesthesia and prevention of infections. The indications and limits of the ambulant wound care are also discussed. Finally, a short explanation is given for the treatment of wounds situated at delicate regions of the body. PMID:1440441

  8. Photodynamic therapy with a cationic functionalized fullerene rescues mice from fatal wound infections

    PubMed Central

    Lu, Zongshun; Dai, Tianhong; Huang, Liyi; Kurup, Divya B; Tegos, George P; Jahnke, Ashlee; Wharton, Tim; Hamblin, Michael R

    2011-01-01

    Aims Fullerenes are under intensive study for potential biomedical applications. We have previously reported that a C60 fullerene functionalized with three dimethylpyrrolidinium groups (BF6) is a highly active broad-spectrum antimicrobial photosensitizer in vitro when combined with white-light illumination. We asked whether this high degree of in vitro activity would translate into an in vivo therapeutic effect in two potentially lethal mouse models of infected wounds. Materials & methods We used stable bioluminescent bacteria and a low light imaging system to follow the progress of the infection noninvasively in real time. An excisional wound on the mouse back was contaminated with one of two bioluminescent Gram-negative species, Proteus mirabilis (2.5 × 107 cells) and Pseudomonas aeruginosa (5 × 106 cells). A solution of BF6 was placed into the wound followed by delivery of up to 180 J/cm2 of broadband white light (400–700 nm). Results In both cases there was a light-dose-dependent reduction of bioluminescence from the wound not observed in control groups (light alone or BF6 alone). Fullerene-mediated photodynamic therapy of mice infected with P. mirabilis led to 82% survival compared with 8% survival without treatment (p < 0.001). Photodynamic therapy of mice infected with highly virulent P. aeruginosa did not lead to survival, but when photodynamic therapy was combined with a suboptimal dose of the antibiotic tobramycin (6 mg/kg for 1 day) there was a synergistic therapeutic effect with a survival of 60% compared with a survival of 20% with tobramycin alone (p < 0.01). Conclusion These data suggest that cationic fullerenes have clinical potential as an antimicrobial photosensitizer for superficial infections where red light is not needed to penetrate tissue. PMID:21143031

  9. The Healing Effect of Licorice on Pseudomonas aeruginosa Infected Burn Wounds in Experimental Rat Model

    PubMed Central

    Tanideh, Nader; Rokhsari, Pedram; Mehrabani, Davood; Mohammadi Samani, Soleiman; Sabet Sarvestani, Fatemeh; Ashraf, Mohammad Javad; Koohi Hosseinabadi, Omid; Shamsian, Shahram; Ahmadi, Nasrollah

    2014-01-01

    BACKGROUND Burn is still one of the most devastating injuries in emergency medicine while improvements in wound healing knowledge and technology have resulted into development of new dressings. This study was undertaken to evaluate the healing effect of licorice in Pseudomonas aeruginosa infected burn wounds of experimental rat model. METHODS One hundred and twenty female Sprague-Dawley rats were randomly allocated to 4 equal groups. Group A received silver sulfadiazine ointment, Group B received 10% licorice extract and Group C was considered as control group and received gel base as the base of medication. Group D did not receive any medication and just underwent burn injury. A standard 3rd degree burn wound was produced by a hot plate with similar size about 20% of total body surface area (TBSA) and at identical temperature. After 24 h of burn production, 108 colony forming units (CFU) of toxigenic strains of P. aeruginosa (PA 103) were inoculated subcutaneously into the burnt area. After 3, 7, 14, 21 and 28 days of therapy, the animals were sacrificed and burn areas were macroscopically examined and histologically evaluated. RESULTS Decrease in size of the burn wounds, in inflammation and re-epithelialization were poor in groups B-D. Infection to P. aeruginosa was still visible in groups B-D but was absent in Group A. The mean histological score, tensile strength, maximum stress, yield strength and stiffness in groups B-D were lower compared with Group A. CONCLUSION Licorice extract in 10% concentration was shown not to be effective in healing of P. aeruginosa infected burn wounds. PMID:25489532

  10. Efficacy of Topically Delivered Moxifloxacin against Wound Infection by Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus▿

    PubMed Central

    Jacobsen, F.; Fisahn, C.; Sorkin, M.; Thiele, I.; Hirsch, T.; Stricker, I.; Klaassen, T.; Roemer, A.; Fugmann, B.; Steinstraesser, L.

    2011-01-01

    Wound infection is a common risk for patients with chronic nonhealing wounds, causing high morbidity and mortality. Currently, systemic antibiotic treatment is the therapy of choice, despite often leading to several side effects and the risk of an insufficient tissue penetration due to impaired blood supply. If systemically delivered, moxifloxacin penetrates well into inflammatory blister fluid, muscle, and subcutaneous adipose tissues and might therefore be a possible option for the topical treatment of skin and infected skin wounds. In this study, topical application of moxifloxacin was investigated in comparison to mupirocin, linezolid, and gentamicin using a porcine wound infection and a rat burn infection model. Both animal models were performed either by an inoculation with methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. Wound fluid, tissue, and blood samples were taken, and bacterial counts as well as the moxifloxacin concentration were determined for a 14-day follow-up. A histological comparison of the rat burn wound tissues was performed. Both strains were susceptible to moxifloxacin and gentamicin, whereas mupirocin and linezolid were effective only against MRSA. All antibiotics showed efficient reduction of bacterial counts, and except with MRSA, infected burn wounds reached bacterial counts below 105 CFU/g tissue. Additionally, moxifloxacin was observed to promote wound healing as determined by histologic analysis, while no induction of bacterial resistance was observed during the treatment period. The use of topical antibiotics for the treatment of infected wounds confers many benefits. Moxifloxacin is therefore an ideal candidate, due to its broad antibacterial spectrum, its high efficiency, and its potential to promote wound healing. PMID:21343458

  11. Efficacy of topically delivered moxifloxacin against wound infection by Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus.

    PubMed

    Jacobsen, F; Fisahn, C; Sorkin, M; Thiele, I; Hirsch, T; Stricker, I; Klaassen, T; Roemer, A; Fugmann, B; Steinstraesser, L

    2011-05-01

    Wound infection is a common risk for patients with chronic nonhealing wounds, causing high morbidity and mortality. Currently, systemic antibiotic treatment is the therapy of choice, despite often leading to several side effects and the risk of an insufficient tissue penetration due to impaired blood supply. If systemically delivered, moxifloxacin penetrates well into inflammatory blister fluid, muscle, and subcutaneous adipose tissues and might therefore be a possible option for the topical treatment of skin and infected skin wounds. In this study, topical application of moxifloxacin was investigated in comparison to mupirocin, linezolid, and gentamicin using a porcine wound infection and a rat burn infection model. Both animal models were performed either by an inoculation with methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. Wound fluid, tissue, and blood samples were taken, and bacterial counts as well as the moxifloxacin concentration were determined for a 14-day follow-up. A histological comparison of the rat burn wound tissues was performed. Both strains were susceptible to moxifloxacin and gentamicin, whereas mupirocin and linezolid were effective only against MRSA. All antibiotics showed efficient reduction of bacterial counts, and except with MRSA, infected burn wounds reached bacterial counts below 10(5) CFU/g tissue. Additionally, moxifloxacin was observed to promote wound healing as determined by histologic analysis, while no induction of bacterial resistance was observed during the treatment period. The use of topical antibiotics for the treatment of infected wounds confers many benefits. Moxifloxacin is therefore an ideal candidate, due to its broad antibacterial spectrum, its high efficiency, and its potential to promote wound healing. PMID:21343458

  12. Surface enhanced Raman spectroscopy as a point-of-care diagnostic for infection in wound effluent

    NASA Astrophysics Data System (ADS)

    Ghebremedhin, Meron; Yesupriya, Shubha; Crane, Nicole J.

    2016-03-01

    In military medicine, one of the challenges in dealing with large combat-related injuries is the prevalence of bacterial infection, including multidrug resistant organisms. This can prolong the wound healing process and lead to wound dehiscence. Current methods of identifying bacterial infection rely on culturing microbes from patient material and performing biochemical tests, which together can take 2-3 days to complete. Surface Enhanced Raman Spectroscopy (SERS) is a powerful vibrational spectroscopy technique that allows for highly sensitive structural detection of analytes adsorbed onto specially prepared metal surfaces. In the past, we have been able to discriminate between bacterial isolates grown on solid culture media using standard Raman spectroscopic methods. Here, SERS is utilized to assess the presence of bacteria in wound effluent samples taken directly from patients. To our knowledge, this is the first attempt for the application of SERS directly to wound effluent. The utilization of SERS as a point-of-care diagnostic tool would enable physicians to determine course of treatment and drug administration in a matter of hours.

  13. [Experimental aprobation of the thermo-squirt method of treatment of infected and purulent wounds of the soft tissues].

    PubMed

    Furmanov, Iu A; Gvozdetskiĭ, V S; Terekhov, G V; Savitskaia, I M; Geĭlenko, O A; Titarenko, S N

    2010-01-01

    The influence of thermo-squirt processing on sanation of infected and purulent wounds of soft tissues was investigated in experiment. The possibility of application of the elaborated method for the wound surface disinfection and the tissues healing processes stimulation was proved. PMID:20469694

  14. Negative Pressure Wound Therapy Decreases Mortality in a Murine Model of Burn-Wound Sepsis Involving Pseudomonas aeruginosa Infection

    PubMed Central

    Dong, Maolong; Wang, Yaojun; Li, Xiao; Hu, Dahai

    2014-01-01

    Background The colonization of burn wounds by Pseudomonas aeruginosa can lead to septic shock, organ injuries, and high mortality rates. We hypothesized that negative pressure wound therapy (NPWT) would decrease invasion and proliferation of P. aeruginosa within the burn wound and reduce mortality. Methods Thermal injuries were induced in anesthetized mice, and P. aeruginosa was applied to the wound surface for 24 h. After removing the burn eschar and debridement, the animals were subjected to either NPWT or wet-to-dry (WTD) treatment protocols. The bacterial loads on the wound surface were assessed during 7 d of treatment, as were the concentrations of inflammatory cytokines in the peripheral blood samples. Survival was monitored daily for 14 d after burn induction. Finally, samples of wounded skin, lung, liver, and kidney were collected and subjected to histopathological examination. Results Applying P. aeruginosa to the burn wound surface led to sepsis. During early stages of treatment, NPWT reduced the mortality of the septic animals and levels of P. aeruginosa within the burn wound compared with WTD-treated animals. Circulating levels of cytokines and cytoarchitectural abnormalities were also significantly reduced via NPWT. Conclusions Our data indicate that NPWT inhibits the invasion and proliferation of P. aeruginosa in burn-wounded tissue and decreases early mortality in a murine model of burn-wound sepsis. These therapeutic benefits likely result from the ability of NPWT to decrease bacterial proliferation on the wound surface, reduce cytokine serum concentrations, and prevent damage to internal organs. PMID:24587379

  15. Clostridium glycolicum Wound Infections: Case Reports and Review of the Literature▿

    PubMed Central

    Jiang, Wei; Abrar, Sahibzada; Romagnoli, Mark; Carroll, Karen C.

    2009-01-01

    We describe two cases of Clostridium glycolicum wound infections in immunocompetent adults. The bacterium was identified by 16S rRNA gene sequencing. This is the third published report of the recovery of this organism from human clinical material and highlights the importance of the organism as a potential human pathogen. Our report extends the spectrum of the diseases caused by C. glycolicum. PMID:19261780

  16. The Physiology of Suberization: Roles in Resistance to Infection During Wound-Healing and in the Pink Eye Syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The suberized cells of potato native periderm and wound periderm provide broad and durable protection against infection, dehydration and other problems affecting tuber market quality. Suberization and maintenance of the resulting suberin barrier involve complex processes of great economic importanc...

  17. Effectiveness of Natural Antifungal Compounds in Controlling Infection by Grapevine Trunk Disease Pathogens through Pruning Wounds.

    PubMed

    Cobos, Rebeca; Mateos, Rosa María; Álvarez-Pérez, José Manuel; Olego, Miguel Angel; Sevillano, Silvia; González-García, Sandra; Garzón-Jimeno, Enrique; Coque, Juan José R

    2015-09-01

    Grapevine trunk fungal pathogens, such as Diplodia seriata and Phaeomoniella chlamydospora, can infect plants through pruning wounds. They cause grapevine trunk diseases and are involved in grapevine decline. Accordingly, the protection of pruning wounds is crucial for the management of grapevine trunk diseases. The efficacy of different natural antifungals in inhibiting the growth of several fungi causing grapevine trunk diseases was evaluated in vitro. The fungi showing greater in vitro efficacy were tested on autoclaved grape wood assays against D. seriata and P. chlamydospora. Based on results from these assays, chitosan oligosaccharide, vanillin, and garlic extract were selected for further evaluation on pruning wounds inoculated with D. seriata and P. chlamydospora in field trials. A significant decrease in plant mortality was observed after 2 years of growth in the plants treated with the different natural antifungals compared to the mortality rate observed in infected plants that were not treated with antifungals. Also, the infection rate for the inoculated pathogens was significantly reduced in plants treated with the selected natural antifungals. Therefore, natural antifungals represent a promising alternative for disease control and could provide significant economic benefits for the grape-growing industry. PMID:26162882

  18. Effectiveness of Natural Antifungal Compounds in Controlling Infection by Grapevine Trunk Disease Pathogens through Pruning Wounds

    PubMed Central

    Cobos, Rebeca; Mateos, Rosa María; Álvarez-Pérez, José Manuel; Olego, Miguel Angel; Sevillano, Silvia; González-García, Sandra; Garzón-Jimeno, Enrique

    2015-01-01

    Grapevine trunk fungal pathogens, such as Diplodia seriata and Phaeomoniella chlamydospora, can infect plants through pruning wounds. They cause grapevine trunk diseases and are involved in grapevine decline. Accordingly, the protection of pruning wounds is crucial for the management of grapevine trunk diseases. The efficacy of different natural antifungals in inhibiting the growth of several fungi causing grapevine trunk diseases was evaluated in vitro. The fungi showing greater in vitro efficacy were tested on autoclaved grape wood assays against D. seriata and P. chlamydospora. Based on results from these assays, chitosan oligosaccharide, vanillin, and garlic extract were selected for further evaluation on pruning wounds inoculated with D. seriata and P. chlamydospora in field trials. A significant decrease in plant mortality was observed after 2 years of growth in the plants treated with the different natural antifungals compared to the mortality rate observed in infected plants that were not treated with antifungals. Also, the infection rate for the inoculated pathogens was significantly reduced in plants treated with the selected natural antifungals. Therefore, natural antifungals represent a promising alternative for disease control and could provide significant economic benefits for the grape-growing industry. PMID:26162882

  19. Red blood cell ghosts as promising drug carriers to target wound infections.

    PubMed

    Berikkhanova, Kulzhan; Omarbaev, Rustam; Gulyayev, Alexandr; Shulgau, Zarina; Ibrasheva, Dilbar; Adilgozhina, Gulsim; Sergazy, Shynggys; Zhumadilov, Zhaxybay; Askarova, Sholpan

    2016-09-01

    Autologous red blood cell ghosts (RBC ghosts) can carry cytokines to the sites of inflammation. The targeting moiety of the RBC ghosts is associated with the nature of purulent inflammation, where the erythrocytes are phagocyted and encapsulated drugs are released. In the present study we have investigated the healing potential of RBC ghosts loaded with cytokine IL-1β and antibiotic. Additionally, the pharmacokinetic properties of RBC ghosts loaded with IL-1β were studied. 35 Male Wistar rats (250-300g) were used in the pharmacokinetic study and in a wound infection model where a suspension of Staphylococcus aureus was placed into a surgical cut of the skin and subcutaneous tissue in the femoral region. In order to monitor progression of the wound repair processes, wound swabs or aspiration biopsies were taken for analyses on the 1st-6th days. Wound repair dynamics assessment was based on suppression of S. aureus growth, signs of pain, time of disappearance of pus and infiltration around the wound. Visual observations, as well as microbiological and cytological analysis of wound exudates demonstrated a significant acceleration of healing processes in a group of animals treated with a local injection of IL-1β and ceftriaxone encapsulated into RBC ghosts when compared to the animals treated either with a local or IM injection of free drugs. For the pharmacokinetic study, single IV injections of either free or encapsulated IL-1β were made and the concentration of IL-1β in serum samples and tissue homogenates were determined. Encapsulation in RBC ghosts improved pharmacokinetic profiles of IL-1β by increasing the half-life, reducing its clearance, and increasing the deposition of the drug in the liver, spleen and lungs. These data suggest that RBC ghosts are effective drug carriers for targeted delivery of cytokines to the sites of inflammation, and have a potential for improving the treatment outcomes of purulent diseases. PMID:27062487

  20. Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics

    PubMed Central

    Murray, Clinton K.; Driscoll, Ian R.; Wickes, Brian L.; Wiederhold, Nathan; Sutton, Deanna A.; Sanders, Carmita; Mende, Katrin; Enniss, Brent; Feig, James; Ganesan, Anuradha; Rini, Elizabeth A.; Vento, Todd J.

    2015-01-01

    We describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence- and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed. PMID:25832301

  1. Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics.

    PubMed

    Farmer, Aaron R; Murray, Clinton K; Driscoll, Ian R; Wickes, Brian L; Wiederhold, Nathan; Sutton, Deanna A; Sanders, Carmita; Mende, Katrin; Enniss, Brent; Feig, James; Ganesan, Anuradha; Rini, Elizabeth A; Vento, Todd J

    2015-06-01

    We describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence- and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed. PMID:25832301

  2. Aeromonas jandaei and Aeromonas veronii dual infection of a human wound following aquatic exposure.

    PubMed Central

    Joseph, S W; Carnahan, A M; Brayton, P R; Fanning, G R; Almazan, R; Drabick, C; Trudo, E W; Colwell, R R

    1991-01-01

    Exudate removed from an infection that developed below the left eye of a 10-year-old male following a previously inflicted wound after aquatic exposure was cultured and revealed two different Aeromonas spp. Further characterization showed that one strain was phenotypically identical to Aeromonas veronii, while the other strain was confirmed by DNA hybridization analysis to be Aeromonas jandaei sp. nov. This is the first report of these more recently described aeromonads, thus far rarely reported from clinical disease, occurring simultaneously in a human infection. PMID:2037674

  3. Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

    PubMed Central

    Keel, Marius; Trentz, Otmar; Heinzelmann, Michael

    2006-01-01

    The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection. PMID:16835734

  4. Staphylococcus aureus and repeat bacteremia in febrile patients as early signs of sternal wound infection after cardiac surgery

    PubMed Central

    2014-01-01

    Background Sternal wound infection is a devastating complication of cardiothoracic surgery that carries high postoperative morbidity and mortality rates. We explored whether our current program of extensive bacteriological examination including repeat blood cultures may contribute to the early diagnosis of sternal wound infection. Methods We retrospectively analyzed 112 patients who were subjected to our bacteriological examination protocol including within 90 days after cardiothoracic surgery. Univariate and multivariate analyses were made in order to identify risk factors for sternal infection. Results The median patient age was 75 years, and 65 patients were male. In 35 cases (31.2%) the blood cultures showed the presence of bacterial infection with the following frequencies: Staphylococcus aureus, 18 cases; Coagulase-negative Staphylococcus, 7 cases; other organisms, 10 cases. Eleven patients presented repeat bacteremia on at least 2 different occasions. Twenty patients (17.8%) presented sternal wound infections. There was no difference in operative mortality between the patients with and without sternal wound infection. Univariate and multivariate analyses demonstrated that bilateral mammary artery use (OR, 13.68, 95% CI, 1.09-167.36, p = 0.043), positive blood culture for Staphylococcus aureus (OR, 19.51, 95% CI, 4.46-104.33, p < 0.0001), repeat bacteremia (OR, 17.98, 95% CI, 2.51-161.77, p = 0.004) were risk factors that were associated for sternal wound infection. Conclusion Repeat blood cultures in febrile patients appear to be useful for the early detection of Staphylococcus aureus and repeat bacteremia, and these were associated with sternal wound infection. Bilateral internal mammary artery use was another risk factor of sternal wound infection in febrile patients. These factors may identify patients suitable for expeditious radiological examination and aggressive treatments. PMID:24885820

  5. Incidence of wound infection in patients undergoing craniotomy: influence of type of shaving.

    PubMed

    Zentner, J; Gilsbach, J; Daschner, F

    1987-01-01

    How the method of shaving affects the incidence of deep postoperative wound infections was examined in 475 patients. It is shown that the rate of infection is not lower after wet shaving than after dry shaving. The overall infection rate was 4.2%, 2.9% in patients who had been shaved wet versus 5.5% in patients shaved dry. The difference is, however, not significant on the 5% level. With respect to dry shaving, the infection rate was not affected by whether the hair was removed with electric clippers alone (2.8%) or whether a disposable razor was also used for additional hair removal in the area of skin incision (3.2%). PMID:3630783

  6. Preparation and characterization of silver nanoparticle loaded amorphous hydrogel of carboxymethylcellulose for infected wounds.

    PubMed

    Das, Anup; Kumar, Ajay; Patil, Niranjan B; Viswanathan, Chandra; Ghosh, Deepa

    2015-10-01

    There is a growing demand for an appropriate and safe antimicrobial dressing to treat infected deep wounds. An amorphous gel formulation (SNP-CMC), containing silver nanoparticles (SNPs) and carboxymethylcellulose (CMC), was prepared in one step by the reduction of silver nitrate in situ. Spectrophotometric and microscopic analysis revealed that the SNPs were 7-21 nm in diameter. In simulated wound experiments, SNP-CMC gel was found to absorb 80.48 ± 4.69% w/w of saline and donate 17.43 ± 0.76% w/w of moisture within 24h indicating its dual fluid affinity. Cytocompatibility of the gel was assessed by proliferation studies with primary human skin cells. The antimicrobial activity studies showed that SNP-CMC containing 50 ppm of SNPs was effective against the growth of both Gram negative and Gram positive strains including methicillin-resistant Staphylococcus aureus (MRSA). These results indicate that SNP-CMC could be ideal for the treatment of deep infected wounds. PMID:26076624

  7. Superficially, longer, intermittent ozone theraphy in the treatment of the chronic, infected wounds.

    PubMed

    Białoszewski, Dariusz; Kowalewski, Michał

    2003-10-30

    Background. Ozone therapy - i.e. the treatment of patients by a mixture of oxygen and ozone - has been used for many years as a method ancillary to basic treatment, especially in those cases in which traditional treatment methods do not give satisfactory results, e.g. skin loss in non-healing wounds, ulcers, pressure sores, fistulae, etc. Material and methods. In the Department of Phisiotherapy of the Medical Faculty and the Department of the Orthopedics and Traumatology of the Locomotor System at the Medical University of Warsaw in the period from January 2001 until November 2002, 23 patients with heavy,chronic, antibiotic resistants septic complications after trauma, surgical procedures and secundary skin infetions were treated with ozone. The ozone therapy was administered using an authorial technique of superficially, longer, intermittent ozone application. Results. In the wounds of the all experienced patients the inhibition of septic processes and wound healing was much faster than normal. Conclusions. Our data confirm the advantages wich result from the technique of superficially, longer, intermittent ozone theraphy in combined treatment for septic complications in the soft tissue, especially in the locomotor system. These technique makes posttraumatic infections and promotes quicker healing of post-surgical and post-traumal complications - chronic septic infections. This method also lowers the cost of antibiotic therapy and is sometimes the only available auxiliary technique to support surgical procedures. PMID:17679848

  8. Can infected wounds be decontaminated with the use of the CO2 laser: An in vivo comparative study

    NASA Astrophysics Data System (ADS)

    Lima Verde Santos, Jose Z.; Barbosa Pinheiro, Antonio L.; Cavalcanti das Neves, Jerlucia; Ribeiro de Sena, Kesia X. d. F.; Matos de Oliveira, Marcos A.

    2003-06-01

    The aim of this study was to compare microbiologically the effects of the CO2 Laser and Chlorohexidine Gluconate (4%) on Staphylococcus aureus infected cutaneous wounds. Wound infection constitutes a big risk for patients and it is usually associated to increased morbidity, mortality and hospital costs. It is accepted that local treatment of these infections is effective. Standardized wounds created on the dorsum of 36 rats were infected with Staphylococcus aureus and treated during six days as follows: Group I: Chlorohexidine Gluconate applied to the wound surface during one minute during six days; Group II: Single CO2 Laser irradiation (8W,CW, unfocused, 8cm focal distance, 81530W/cm2), maintaining surface debris; Group III: Single CO2 Laser irradiation (8W,CW, unfocused, 8cm focal distance, 81530W/cm2), removing the surface debris. Daily samples were taken for microbiological analysis. Seven days after wounding the animals were killed a final sample taken. The use of Chlorohexidine Gluconate solution and the CO2 laser with the removal of the surface debris result in a significant reduction on the infectability of the Staphylococcus aureus when compared to non-treated infected wounds (p=0.00 e p=0.02). However, if the debris is left on the wound surface the resolution of the infection is less significant and results in non-significant differences on the number of Staphylococcus aureus when compared to non treated controls (p=0.14). No difference on infectability of the Staphylococcus aureus was detectable when the debris was removed of the surface of the wounds and when the Chlorohexidine solution was used (p=0.05). Therefore, the use of the CO2 laser would improve the resolution of the infection without further irradiating the tissue and consequently without further impairing wound healing. The fact that significant differences were observed between the two modalities of CO2 treatment indicates that the surface debris acts as a culture medium for bacterial

  9. Antibacterial Efficacy of Silver-Impregnated Polyelectrolyte Multilayers Immobilized on a Biological Dressing in a Murine Wound Infection Model

    PubMed Central

    Guthrie, Kathleen M.; Agarwal, Ankit; Tackes, Dana S.; Johnson, Kevin W.; Abbott, Nicholas L.; Murphy, Christopher J.; Czuprynski, Charles J.; Kierski, Patricia R.; Schurr, Michael J.; McAnulty, Jonathan F.

    2012-01-01

    Objective To investigate the antibacterial effect of augmenting a biological dressing with polymer films containing silver nanoparticles. Background Biological dressings, such as Biobrane, are commonly used for treating partial-thickness wounds and burn injuries. Biological dressings have several advantages over traditional wound dressings. However, as many as 19% of wounds treated with Biobrane become infected, and, once infected, the Biobrane must be removed and a traditional dressing approach should be employed. Silver is a commonly used antimicrobial in wound care products, but current technology uses cytotoxic concentrations of silver in these dressings. We have developed a novel and facile technology that allows immobilization of bioactive molecules on the surfaces of soft materials, demonstrated here by augmentation of Biobrane with nanoparticulate silver. Surfaces modified with nanometer-thick polyelectrolyte multilayers (PEMs) impregnated with silver nanoparticles have been shown previously to result in in vitro antibacterial activity against Staphylococcus epidermidis at loadings of silver that are noncytotoxic. Methods We demonstrated that silver-impregnated PEMs can be nondestructively immobilized onto the surface of Biobrane (Biobrane-Ag) and determined the in vitro antibacterial activity of Biobrane-Ag with Staphylococcus aureus. In this study, we used an in vivo wound infection model in mice induced by topical inoculation of S aureus onto full-thickness 6-mm diameter wounds. After 72 hours, bacterial quantification was performed. Results Wounds treated with Biobrane-Ag had significantly (P < 0.001) fewer colony-forming units than wounds treated with unmodified Biobrane (more than 4 log10 difference). Conclusions The results of our study indicate that immobilizing silver-impregnated PEMs on the wound-contact surface of Biobrane significantly reduces bacterial bioburden in full-thickness murine skin wounds. Further research will investigate whether

  10. Components and Quality Measures of DIME (Devitalized Tissue, Infection/Inflammation, Moisture Balance, and Edge Preparation) in Wound Care

    PubMed Central

    Snyder, Robert J.; Fife, Caroline; Moore, Zena

    2016-01-01

    ABSTRACT OBJECTIVES: To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures capture aspects of the DIME (Debridement/devitalized tissue, Infection or inflammation, Moisture balance, and wound Edge preparation/wound depth) principles. DISCUSSION: The treatment of chronic wounds often involves extended hospital stays and long-term outpatient follow-up visits with costly advanced therapeutic interventions. As complex care is required for chronic wounds, treatment guidelines such as DIME have evolved to include consideration of patient-centered concerns and etiology, as well as features of wound bed preparation. The US healthcare system is in the midst of transitioning to a quality-based system. However, as wound care is not yet a recognized specialty, it is poorly represented in the current approved quality-based measures. CONCLUSION: This article helps to identify the practice guidelines that are not currently represented by quality metrics. PMID:27089149

  11. Handheld fluorescence imaging device detects subclinical wound infection in an asymptomatic patient with chronic diabetic foot ulcer: a case report.

    PubMed

    Wu, Yichao C; Smith, Marlie; Chu, Ashley; Lindvere-Teene, Liis; Starr, Danielle; Tapang, Kim; Shekhman, Rachel; Wong, Olive; Linden, Ron; DaCosta, Ralph S

    2016-08-01

    Chronic wounds are a significant burden to global patient and health care infrastructures, and there is a need for better methods of early wound diagnosis and treatment. Traditional diagnosis of chronic wound infection by pathogenic bacteria, using clinical signs and symptoms, is based on visual inspection under white light and microbiological sampling (e.g. swabbing and/or biopsy) of the wound, which are subjective and suboptimal. Diagnosing microbial infection based on traditional clinical signs and symptoms in wounds of asymptomatic patients is especially challenging at the bedside. Bacteria are invisible to the unaided eye and wound sampling for diagnostic testing can cause unacceptable delays in diagnosis and treatment. To address this problem, we developed a new prototype handheld, portable fluorescence imaging device that enables non-contact, real-time, high-resolution visualisation of pathogenic bacteria and tissues in wounds. Herein, we report the clinical use of this imaging device in detecting subsurface heavy bacterial load and subclinical local infection in an asymptomatic 50-year-old patient with a non-healing diabetic foot ulcer. PMID:25907362

  12. Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases.

    PubMed

    Söylemez, Mehmet Salih; Özkan, Korhan; Kılıç, Bülent; Erinç, Samet

    2016-01-01

    Intermittent negative pressure wound therapy with instillation (NPWTi) is starting to be used successfully to treat early periprosthetic infections of endoprostheses. However, few articles have reported the outcome of treatment with intermittent NPWTi for late persistent periprosthetic infections of the hip. In this study, we report two cases who underwent several rounds of radical wound debridement for the treatment of a late persistent periprosthetic infection of the hip. Intermittent NPWTi was used in both cases. Patients were treated successfully and there was no recurrence after 3 and 1 years of follow-up, respectively. PMID:26929628

  13. Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases

    PubMed Central

    Söylemez, Mehmet Salih; Özkan, Korhan; Kılıç, Bülent; Erinç, Samet

    2016-01-01

    Intermittent negative pressure wound therapy with instillation (NPWTi) is starting to be used successfully to treat early periprosthetic infections of endoprostheses. However, few articles have reported the outcome of treatment with intermittent NPWTi for late persistent periprosthetic infections of the hip. In this study, we report two cases who underwent several rounds of radical wound debridement for the treatment of a late persistent periprosthetic infection of the hip. Intermittent NPWTi was used in both cases. Patients were treated successfully and there was no recurrence after 3 and 1 years of follow-up, respectively. PMID:26929628

  14. Effect of interferon-gamma treatment on the course of a burn wound infection.

    PubMed

    Hershman, M J; Sonnenfeld, G; Logan, W A; Pietsch, J D; Wellhausen, S R; Polk, H C

    1988-06-01

    Interferon-gamma (IFN-gamma) has been shown to have immunoregulatory properties and is able to modulate resistance to several microbial infections. This study was designed to determine the efficacy of IFN-gamma treatment in a murine burn wound infection model. Bacterial challenge consisted of Klebsiella pneumoniae (10(8) organisms/ml) or Pseudomonas aeruginosa (10(8) organisms/ml), applied topically immediately after burning. Groups of CBA/J mice received either IFN-gamma or RPMI-1640 medium (controls) subcutaneously. IFN-gamma was administered daily at a dose of 7,500 units for 5 days prior to bacterial challenge. Burn without bacterial challenge produced no mortality. Mice treated with IFN-gamma survived significantly longer than controls when the bacterial challenge was K. pneumoniae. There was no difference in survival when bacterial challenge was P. aeruginosa. The Ia antigen expression of peripheral blood mononuclear cells was severely reduced for 3 days post-burn. This drop was prevented on day 3 post-burn in mice treated with IFN-gamma. These data indicate that interferon was effective treatment in a murine model of Klebsiella burn wound infection and was associated with maintenance of Ia antigen expression that may have contributed to the action of the IFN-gamma. PMID:3137276

  15. Effect of near-infrared diode laser and indocyanine green to treat infections on different wound models

    NASA Astrophysics Data System (ADS)

    Topaloglu, Nermin; Yuksel, Sahru; Gulsoy, Murat

    2014-05-01

    The emergence of antibiotic resistant bacteria causes significant increase in deaths due to wound infections around the world. Nowadays, it could be impossible to find appropriate antibiotics to treat some bacterial strains, especially multidrug resistant types. The aim of this study is to use photodynamic therapy that destroys these kinds of bacteria with the interaction of Indocyanine green (ICG) and 808-nm diode laser. In this study, antibacterial Photodynamic Therapy technique that we call ICG-IR Laser PDT was applied on antibiotic-resistant strains of Staphylococcus aureus that infected two different types of wound model (excisional and abrasion wound model) in vivo. Wistar albino rats were used to create animal wound models. Excisional or abrasion wounds were formed on the dorsal skin of the rats. They were infected with Staphylococcus aureus. 300 mW and 500 mW of 808-nm diode laser were applied on the wounds for 30 minutes and 15 minutes of exposure duration, respectively. ICG concentrations applied topically were 500, 1000, 1500 and 2000 μg/ml. Then the tissue was dissected properly and homogenized in buffer solution. From this solution, bacterial cell count was determined by serial dilution method. 1-2 log reduction in viable cell count was observed after these applications. The temperature increase in the tissue was between 6-8°C during these applications. From these findings, it was understood that this method with 808-nm and ICG is promising but it must be improved by further dosimetry studies.

  16. Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

    PubMed

    Hu, Ning; Wu, Xing-Huo; Liu, Rong; Yang, Shu-Hua; Huang, Wei; Jiang, Dian-Ming; Wu, Qiang; Xia, Tian; Shao, Zeng-Wu; Ye, Zhe-Wei

    2015-08-01

    Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection. PMID:26223928

  17. [Investigation of the effect of ibuprofen on wound healing in experimental Staphylococcus aureus soft tissue infections].

    PubMed

    Çitil, M Uğur; Mete, Ergun; Oğuz, E Oğuzhan; Abban Mete, Gülçin; Şahin, Barbaros; Kaleli, İlknur

    2015-04-01

    Soft tissue infections (STIs) occur as a result of the colonization of pathogenic bacteria upon the destruction of normal skin microbial flora and the skin integrity. Streptococci and staphylococci are the most frequent causes of bacterial STIs. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often used in STIs because of their analgesic and antipyretic effects. However, evidence suggests that these drugs might delay both epithelization and angiogenesis in the early phases of wound healing because of an antiproliferative effect. The aim of this study was to investigate the effect of ibuprofen on the wound healing in STIs caused by Staphylococcus aureus in immunosuppressed mice. A total of 120 female Balb/c mice were used in the study and the mice were assigned to four test groups and two control groups. The test groups were defined as follows; B (Bacteria group, n= 23), BI (Bacteria + Ibuprofen group, n= 23), BA (Bacteria + Ampicillin group, n= 23), BIA (Bacteria + Ampicillin + Ibuprofen group, n= 21); and the control groups were defined as follows; S1B2 (only immunosuppressed controls, n= 15) and S2B2 (Sham group). Immunosupression was induced with cyclophosphamide and the experimental infection was generated by subcutaneous inoculation of bacterial suspension (2 x 10(8) cfu/ml) of methicillin-sensitive S.aureus ATCC 25923 to the right hind leg. Ibuprofen was given to the mice by gastric gavage (50 mg/kg/day), and ampicillin (100 mg/kg/day) by intramuscular injection. Wound sizes that appear in the animals were measured on a daily basis. Serum and tissue (epithelial tissue, connective tissue, sebaceous glands, sweat glands) samples were obtained on the first, third and seventh days. The tissue samples were examined histopathologically by hematoxylin-eosin (HE) staining method and IL-1, IL-6, TNF-α and VEGF (Vascular Endothelial Growth Factor) levels were determined in serum samples by ELISA method. The tissue cytokine reactions were also

  18. Perioperative hypothermia and incidence of surgical wound infection: a bibliographic study

    PubMed Central

    da Silva, Aline Batista; Peniche, Aparecida de Cassia Giani

    2014-01-01

    The purpose of this review article was to understand and analyze the scientific production related to the occurrence of perioperative hypothermia and the incidence of infection on the surgical site. For this purpose, a search was conducted in the databases LILACS, MEDLINE, PubMed, CINAHL and Cochrane, using the health science descriptors DECS, from 2004 to 2009. A total of 91 articles were found. After eliminating duplicate items and using selection criteria for inclusion, six manuscripts remained for analysis. The studies were classified as retrospective, prospective, case studies, and clinical trials. After analysis, the majority of studies showed that hypothermia must be prevented during the perioperative period to reduce complications in the healing process of the surgical incision. Therefore, unadverted hypothermia directly influences in surgical site healing, increasing the incidence of infection in the surgical wound. PMID:25628208

  19. Differential regulation of a hydroxyproline-rich glycoprotein gene family in wounded and infected plants.

    PubMed Central

    Corbin, D R; Sauer, N; Lamb, C J

    1987-01-01

    We have characterized three different transcripts induced by fungal elicitor, wounding, or infection which encode apoproteins of cell wall hydroxyproline-rich glycoproteins involved in plant defense against infection. The proteins encoded by two of these transcripts contain a proline-rich domain involving tandem repetition of the 16-amino-acid unit Tyr3-Lys-Ser-Pro4-Ser-Pro-Ser-Pro4. The third transcript encodes a protein with a proline-rich domain involving a variant of this 16-mer canonical repeat: Tyr3-His-Ser-Pro4-Lys-His-Ser-Pro4. Each transcript is encoded by a separate gene present at single or low copy number in the haploid genome. These transcripts exhibit markedly different patterns of accumulation in different stress conditions, indicating the operation of several distinct intercellular stress signal systems in higher plants. Images PMID:3437892

  20. Role of Arginine and Omega-3 Fatty Acids in Wound Healing and Infection

    PubMed Central

    Alexander, J. Wesley; Supp, Dorothy M.

    2014-01-01

    Significance: Only a few decades ago, the primary focus of nutritional supplementation was to prevent deficiencies of essential nutrients. It is now recognized that, at higher than essential levels, selected nutrients can have a pharmacologic effect to prevent or treat disease. Recent Advances: Two of the most important pharmaconutrients, arginine, and the omega-3 polyunsaturated fatty acids in fish oil, have been shown to have profound effects on wound healing and infections. Critical Issues: Both arginine and fish oils have independent benefits, but the combination appears to be much more effective. This combination has been shown to affect outcomes involving wound healing and infections, as reviewed here, and can also affect incidence and outcomes in cardiovascular disease, diabetes, organ transplant rejection, and other inflammatory conditions. These possibilities have not yet progressed to widespread clinical application. Future Directions: The optimal combinations of immunonutrients, timing of administration, and the doses needed for best results need to be determined in preclinical and clinical studies. Also, the mechanisms involved in the administration of pharmaconutrients need to be established. PMID:25371851

  1. The effect of clary sage oil on staphylococci responsible for wound infections

    PubMed Central

    Głowacka, Anna; Poznańska-Kurowska, Katarzyna; Kaszuba, Andrzej; Urbaniak, Anna; Kowalczyk, Edward

    2015-01-01

    Introduction The spreading of bacterial antibiotic resistance among clinical strains of pathogenic bacteria has made investigators to search for other active antibacterial agents which could provide a valuable complement to the existing therapies. Aim To determine the antibacterial activity of clary sage oil (Salvia sclarea L.) against Staphylococcus clinical strains which were isolated from patients with wound infections. Material and methods A comprehensive evaluation of Staphylococcus clinical strain resistance to antibiotics was performed. The constituents of clary sage oil were assayed by GC-FID-MS analysis. The minimal inhibitory concentration (MIC) of the tested essential oil against staphylococci by the micro-dilution broth method was determined. Results The clary sage oil was active against Staphylococcus aureus, S. epidermidis and S. xylosus with MIC values ranging from 3.75 to 7.00 µl/ml. Conclusions The results of the in vitro tests encourage to use formulations containing sage oil as the active natural antimicrobial agent. Because of its antimicrobial properties clary sage oil may be applied to treat wounds and skin infections. PMID:25821423

  2. Rational Evolution of Antimicrobial Peptides Containing Unnatural Amino Acids to Combat Burn Wound Infections.

    PubMed

    Xiong, Meng; Chen, Ming; Zhang, Jue

    2016-09-01

    Antimicrobial peptides have long been raised as a promising strategy to combat bacterial infection in burn wounds. Here, we attempted to rationally design small antimicrobial peptides containing unnatural amino acids by integrating in silico analysis and in vitro assay. Predictive quantitative sequence-activity models were established and validated rigorously based on a large panel of nonamer antimicrobial peptides with known antibacterial activity. The best quantitative sequence-activity model predictor was employed to guide genetic evolution of a peptide population. In the evolution procedure, a number of unnatural amino acids with desired physicochemical properties were introduced, resulting in a genetic evolution-improved population, from which seven peptide candidates with top scores, containing 1-3 unnatural amino acids, and having diverse structures were successfully identified, and their antibacterial potencies against two antibiotic-resistant bacterial strains isolated from infected burn wounds were measured using in vitro susceptibility test. Consequently, four (WL-Orn-LARKIV-NH2 , ARKRWF-Dab-FL-NH2 , KFI-Hag-IWR-Orn-R-NH2 and YW-Hag-R-Cit-RF-Orn-N-NH2 ) of the seven tested peptides were found to be more potent than reference Bac2A, the smallest naturally occurring broad spectrum antimicrobial peptide. Molecular dynamics simulations revealed that the designed peptides can fold into amphipathic helical structure that allows them to interact directly with microbial membranes. PMID:27062533

  3. Role of Arginine and Omega-3 Fatty Acids in Wound Healing and Infection.

    PubMed

    Alexander, J Wesley; Supp, Dorothy M

    2014-11-01

    Significance: Only a few decades ago, the primary focus of nutritional supplementation was to prevent deficiencies of essential nutrients. It is now recognized that, at higher than essential levels, selected nutrients can have a pharmacologic effect to prevent or treat disease. Recent Advances: Two of the most important pharmaconutrients, arginine, and the omega-3 polyunsaturated fatty acids in fish oil, have been shown to have profound effects on wound healing and infections. Critical Issues: Both arginine and fish oils have independent benefits, but the combination appears to be much more effective. This combination has been shown to affect outcomes involving wound healing and infections, as reviewed here, and can also affect incidence and outcomes in cardiovascular disease, diabetes, organ transplant rejection, and other inflammatory conditions. These possibilities have not yet progressed to widespread clinical application. Future Directions: The optimal combinations of immunonutrients, timing of administration, and the doses needed for best results need to be determined in preclinical and clinical studies. Also, the mechanisms involved in the administration of pharmaconutrients need to be established. PMID:25371851

  4. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds.

    PubMed Central

    Cooper, R A; Molan, P C; Harding, K G

    1999-01-01

    The antibacterial action of honey in infected wounds does not depend wholly on its high osmolarity. We tested the sensitivity of 58 strains of coagulase-positive Staphylococcus aureus, isolated from infected wounds, to a pasture honey and a manuka honey. There was little variation between the isolates in their sensitivity to honey: minimum inhibitory concentrations were all between 2 and 3% (v/v) for the manuka honey and between 3 and 4% for the pasture honey. Thus, these honeys would prevent growth of S. aureus if diluted by body fluids a further seven-fold to fourteen-fold beyond the point where their osmolarity ceased to be completely inhibitory. The antibacterial action of the pasture honey relied on release of hydrogen peroxide, which in vivo might be reduced by catalase activity in tissues or blood. The action of manuka honey stems partly from a phytochemical component, so this type of honey might be more effective in vivo. Comparative clinical trials with standardized honeys are needed. PMID:10472280

  5. Chitosan-hyaluronic acid/nano silver composite sponges for drug resistant bacteria infected diabetic wounds.

    PubMed

    Anisha, B S; Biswas, Raja; Chennazhi, K P; Jayakumar, R

    2013-11-01

    The aim of this work was to develop an antimicrobial sponge composed of chitosan, hyaluronic acid (HA) and nano silver (nAg) as a wound dressing for diabetic foot ulcers (DFU) infected with drug resistant bacteria. nAg (5-20 nm) was prepared and characterized. The nanocomposite sponges were prepared by homogenous mixing of chitosan, HA and nAg followed by freeze drying to obtain a flexible and porous structure. The prepared sponges were characterized using SEM and FT-IR. The porosity, swelling, biodegradation and haemostatic potential of the sponges were also studied. Antibacterial activity of the prepared sponges was analysed using Escherichia coli, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Klebsiella pneumonia. Chitosan-HA/nAg composite sponges showed potent antimicrobial property against the tested organisms. Sponges containing higher nAg (0.005%, 0.01% and 0.02%) concentrations showed antibacterial activity against MRSA. Cytotoxicity and cell attachment studies were done using human dermal fibroblast cells. The nanocomposite sponges showed a nAg concentration dependent toxicity towards fibroblast cells. Our results suggest that this nanocomposite sponges could be used as a potential material for wound dressing for DFU infected with antibiotic resistant bacteria if the optimal concentration of nAg exhibiting antibacterial action with least toxicity towards mammalian cells is identified. PMID:24060281

  6. Gentamicin-Impregnated Collagen Sponge: Effectiveness in Preventing Sternal Wound Infection in High-Risk Cardiac Surgery

    PubMed Central

    Rapetto, Filippo; Bruno, Vito D.; Guida, Gustavo; Marsico, Roberto; Chivasso, Pierpaolo; Zebele, Carlo

    2016-01-01

    Sternal wound infections represent one of the most frequent complications after cardiac surgery and are associated with high postoperative mortality. Several preventive methods have been introduced, and recently, gentamicin-impregnated collagen sponges (GICSs) have shown a promising effect in reducing the incidence of this type of complications. Gentamicin is an aminoglycoside antibiotic that has been widely used to treat infections caused by multiresistant bacteria; despite its effectiveness, its systemic use carries a risk of toxicity. GICSs appear to overcome this side effect, topically delivering high antibiotic concentrations to the wound and thus reducing the toxic-related events. Although several retrospective analyses and randomized controlled trials have studied the use of GICSs in cardiac surgery, conclusions regarding their efficacy in preventing sternal wound infection are inconsistent. We have reviewed the current literature focusing on high-risk patients. PMID:27279734

  7. Longitudinal study of horses for carriage of methicillin-resistant Staphylococcus aureus following wound infections.

    PubMed

    Bergström, Karin; Bengtsson, Björn; Nyman, Ann; Grönlund Andersson, Ulrika

    2013-05-01

    An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infections in horses in Sweden raised questions concerning the risk posed by horses to their surroundings following MRSA infections. This initiated a longitudinal study to investigate how long MRSA-infected horses remained positive and to test the sensitivity of different anatomical sampling sites for detection of MRSA. Between October 2008 and June 2010, 9 of 15 horses notified as having MRSA-infected wounds fitted the case criteria for the study. The cases were sampled at five anatomical sites (nostrils, corner of mouth, pastern, perineum, and previous infection site) on six to seven occasions or more during approximately 12-18 months. MRSA-specific broth and agar were used for culture. Verified MRSA isolates were spa-typed. The sensitivity of sampling sites was calculated. The most sensitive sampling site was the nostrils, with a sensitivity of 0.91 (95% CI: 0.59-1.00). The other test sites had a sensitivity of 0-0.09. Individual cases tested positive, but with time all tested negative. The observed carriage time ranged from 55 to 711 days (median=143, IQR: 111-172 days), but these data should be interpreted with caution since only a small number of cases were studied. PMID:23428383

  8. PET-CT imaging in patients with chronic sternal wound infections prior to reconstructive surgery: A case series.

    PubMed

    Read, Charlotte; Branford, Olivier A; Verjee, Liaquat S; Wood, Simon H

    2015-08-01

    Late presenting and recurrent sternal wound infections post-sternotomy are difficult to treat, with the clinical picture not necessarily reflecting the underlying problem. As a result of our experience, we suggest that these chronic cases should be managed using a different algorithm to acute sternal wound infection. Positron emission tomography combined with computerized tomography (PET-CT) imaging may be potentially useful in enabling accurate localization of disease sites, which guides adequate debridement prior to definitive reconstruction. It may also allow for disease surveillance and monitoring of the response to antimicrobial treatment. We present three cases which support the need for pre-operative imaging using PET-CT. PMID:25986418

  9. In Vitro Antibacterial Activity of Curcumin-Polymyxin B Combinations against Multidrug-Resistant Bacteria Associated with Traumatic Wound Infections.

    PubMed

    Betts, Jonathan W; Sharili, Amir S; La Ragione, Roberto M; Wareham, David W

    2016-06-24

    Bacterial infections resulting from nonsurgical traumatic wounds can be life threatening, especially those caused by multidrug-resistant (MDR) bacteria with limited therapeutic options. The antimicrobial activity of polymyxin B (1) and curcumin (2) alone and in combination was determined versus MDR bacterial isolates associated with traumatic wound infections. Cytotoxicity assays for 1 and 2 were undertaken in keratinocyte cell lines. Minimum inhibitory concentrations of 1 were significantly reduced in the presence of 2 (3- to 10-fold reduction), with synergy observed. Time-kill assays showed the combinations produced bactericidal activity. Cytotoxicity assays indicate the toxicity of 2 was reduced in the presence of 1. PMID:27295561

  10. Diffuse lymphatic leakage after continuous vacuum-assisted closure therapy for thoracic wound infection after rib stabilization.

    PubMed

    Dackam, Sandrine; Furrer, Katarzyna; Haug, Martin; Lardinois, D

    2015-01-01

    Vacuum-assisted closure (VAC) therapy is a useful tool in the management of a wide spectrum of complex wounds in cardiothoracic surgery. It promotes healing through the application of a controlled and localized negative pressure on porous polyurethane absorbent foams. Known advantages of the VAC therapy are the acceleration of wound healing, stimulation of granulation tissue and reduced tissue edema. Despite its excellent properties, some related complications after and during the therapy have been reported. We report the case of a 47-year-old female with a thoracic wound infection after rib stabilization, managed with open surgery and VAC therapy, which was complicated by a diffuse lymphatic leakage. This is the first case described of diffuse lymphatic leakage followed by partial necrosis of the breast after continuous VAC therapy. We recommend the application of a lower pressure level of this device for complex wounds of the chest wall near the breast. PMID:26675995

  11. The use of gentamicin-PMMA chains in abdominal surgery: a pilot study of prophylaxis against wound infection.

    PubMed

    Aubrey, D A; Jenkins, N H; Morgan, W P; Thomas, M

    1986-01-01

    A prospective study was carried out to examine the effectiveness of gentamicin-impregnated polymethylmethacrylate beads in the prevention of wound sepsis after gastro-intestinal surgery. The beads were laid in the abdominal and perineal incisions (61 wounds) of 55 patients at the end of the operative procedures, and were withdrawn in stages from the fifth post-operative day. This method of administration results in a sustained high antibiotic concentration in the wound with low serum and urine concentrations, thus eliminating the dangers of gentamicin toxicity. Wound infection occurred in only 1 instance, a favourable result when compared to historical controls. It is suggested that further controlled studies of this method of topical prophylactic antibiotic administration are indicated. PMID:3714759

  12. Dual delivery of chlorhexidine and platelet-derived growth factor-BB for enhanced wound healing and infection control.

    PubMed

    Jiang, Bin; Zhang, Gehan; Brey, Eric M

    2013-02-01

    Wound treatment can require molecules that both enhance healing and control infection. As in many biomedical applications, the options for therapeutic molecules may include both hydrophilic and hydrophobic molecules. The goal of this study was to investigate a polymer system for drug delivery that simultaneously delivers platelet-derived growth factor (PDGF)-BB, a hydrophilic protein known to promote wound healing, and chlorhexidine (CHX), a hydrophobic antimicrobial agent for infection treatment. Poly(lactic-co-glycolic acid) (PLGA) microspheres were prepared using different polymer formulations in a double emulsion process. CHX encapsulation efficiency was 19.6±0.8% and 28.9±1.5% for PLGA 50:50 and 85:15, respectively. The presence of CHX significantly increased PDGF-BB encapsulation efficiency relative to PDGF-BB alone. Both molecules could be released for up to 50 days and exhibited bioactivity for greater than 3 (PLGA 85:15) or 8 (PLGA 50:50) weeks using in vitro bacteria and cellular assays. An infected wound model was used to evaluate the system in vivo. Wounds treated with the dual delivery system showed decreased levels of infection and increased healing. Vascular analysis of wound tissues also showed higher levels of mature vasculature with the delivery of PDGF-BB. In conclusion, we have evaluated a drug delivery system for simultaneous delivery of hydrophobic and hydrophilic molecules and have shown that this system can improve healing and reduce bacteria levels in an infected wound model. This system could be applied to other therapeutic applications where sustained delivery of hydrophobic and hydrophilic molecules is required. PMID:23063555

  13. An update review on risk factors and scales for prediction of deep sternal wound infections.

    PubMed

    Buja, Alessandra; Zampieron, Alessandra; Cavalet, Sara; Chiffi, Daniele; Sandonà, Paolo; Vinelli, Angela; Baldovin, Tatjana; Baldo, Vincenzo

    2012-08-01

    Surgical site infections are the most common nosocomial infections in surgical patients. The preventable and the unmodifiable risk factors for deep sternal wound infections (DSWI) have been amply assessed in the literature. The aim of this review was to describe the results of the numerous published studies to describe all the DSWI risk factors and the scales devised to predict SWI, with a view to providing an update on this issue. A comprehensive search of the Medline and Embase databases was performed (considering studies from January 1995 to April 2011); and a manual search was also conducted using references cited in original publications and relevant review articles. There are several risk factors associated with DSWI, which could be classified in four categories as demographic (e.g. sex and age), behavioural (e.g. smoking and obesity), baseline clinical conditions (e.g. diabetes, hypertension and COPD) and surgical operative risk factors (e.g. duration of operation and emergency operation). Six scales for predicting the risk of DSWI are described in the literature: they vary not only in accuracy but also in ease of application and they are applied at different times (some only preoperatively and others also postoperatively). This study provides a broad update on our knowledge of the risk factors for DSWI and the scales for prediction with a view to improving the management of infections at cardiosurgery units. PMID:22151350

  14. Serum Neopterin and Procalcitonin Levels in Relationship with Pediatric Burn Wound Infections.

    PubMed

    Pilanci, Ozgur; Ergin, Sevgi; Sirekbasan, Serhat; Ersin, Idris; Habip, Zafer; Yuksel, Pelin; Kuvat, Nuray; Aslan, Mustafa; Dinc, Oyku; Saribas, Suat; Kocazeybek, Bekir

    2016-03-01

    Infection and septic complications in burn patients can be monitored by procalcitonin (PCT) and neopterin plasma values. The aim of the study was to investigate serum neopterin and PCT levels with WBC (white blood cell) and CRP (C-reactive protein) levels in patient group (PG) and healthy control group (HCG) and to investigate the relationship of these markers with burn wound infections (BWI). As the PG, 23 patients between 0-12 ages and up to 30% Total Body Surface Area (TBSA) burned and 15 HCG were included. PCT, neopterin, WBC, and CRP results on the first, the seventh, the fourteenth and the 21st day have been compared. During the follow-up period, 11 patients with BWI and 12 patients without BWI were classified as infected and non-infected patients, respectively. PCT and neopterin levels were detected higher in patients with BWI but no significant difference were present. Also, PCT and neopterin levels within the first 24 hours following the burn were detected higher in PG than HCG. CRP and WBC levels were detected high due to burn trauma. PCT and neopterin levels were increased in patients with BWI. PCT levels were increased during the pre-infectious period, while neopterin levels increased during the post-infectious period. PMID:27020868

  15. Bacteria Isolated from Conspecific Bite Wounds in Norway and Black Rats: Implications for Rat Bite–Associated Infections In People

    PubMed Central

    Zabek, Erin; Tang, Patrick; Parsons, Kirbee L.; Koehn, Martha; Jardine, Claire M.; Patrick, David M.

    2014-01-01

    Abstract Bites associated with wild and domestic Norway and black rats (Rattus norvegicus and Rattus rattus) may have a variety of health consequences in people. Bite-related infections are among the most significant of these consequences; however, there is little data on the infectious agents that can be transmitted from rats to people through biting. This is problematic because without an accurate understanding of bite-related infection risks, it is difficult for health professionals to evaluate the adequacy of existing guidelines for empirical therapy. The objectives of this study were to increase our knowledge of the bacterial species associated with rat bites by studying bite wounds that wild rats inflict upon one another and to review the literature regarding rat bites and bite wound management. Wild Norway and black rats (n=725) were trapped in Vancouver, Canada, and examined for bite wounds in the skin. All apparently infected wounds underwent aerobic and anaerobic culture, and isolated bacteria were identified. Thirty-six rats had bite wound–related infections, and approximately 22 different species of bacteria belonging to 18 genera were identified. Staphylococcus aureus was the most common isolate; however, the majority of infections (72.5%) were polymicrobial. Rat bites can result in infection with a number of aerobic and anaerobic Gram-positive and Gram-negative bacteria. In humans, these wounds are best managed through early recognition and cleansing. The benefit of prophylactic antimicrobial treatment is debatable, but given the deep puncturing nature of rodent bites, we suggest that they should be considered a high risk for infection. Antibiotics selected should include coverage for a broad range of bacterial species. PMID:24528094

  16. Phospholipid structured microemulsion as effective carrier system with potential in methicillin sensitive Staphylococcus aureus (MSSA) involved burn wound infection.

    PubMed

    Chhibber, Tanya; Wadhwa, Sheetu; Chadha, Parul; Sharma, Gajanand; Katare, Om Prakash

    2015-12-01

    Burn wounds are foremost site for bacterial colonization and multiplication. Staphylococcus aureus is one of the most predominant pathogen found in burn wounds. Fusidic acid (FA) is widely employed in the treatment of complicated skin infections caused by Staphylococcus aureus. Hence, the aim of this study was to investigate the usefulness and efficacy of topical FA (2% w/w) loaded biocompatible microemulsion-based-system (FA-ME) in eradicating MSSA bacterial infections which otherwise was less effective when dealt with conventional formulations. For construction of pseudoternary phase diagram, ratio of oil (IPM):water:Smix is 20:30:50% w/w and proportion of Smix (Phospholipid:Tween 80 (T80):Ethanol) is in the ratio of 1:2:1, respectively. The hypothesis relates here to the role of phospholipids as part of the nano-scale structure of microemulsion systems to overcome the hurdles of drug delivery. The prepared FA-ME system was evaluated for its therapeutic efficacy and carrier-specific characteristics such as globule size, % transmittance, transmission electron microscopy, drug content and stability. Selected microemulsion system was incorporated into gel form and evaluated for texture analysis, drug permeation in 24 h and treatment of burn wounds. Burn wound infection was established with MSSA ATCC 25923 in BALB/c mice and the process of wound healing as well as bacterial loading in the wound was estimated. The developed nanosized FA-ME system demonstrated improved wound healing, better spreadability and enhanced therapeutic efficacy due to the changes in the behavior of the drug molecules by way of carrier-characteristics. PMID:26004269

  17. Enhanced efficacy and anti-biofilm activity of novel nanoemulsions against skin burn wound multi-drug resistant MRSA infections.

    PubMed

    Song, Zhen; Sun, Hongwu; Yang, Yun; Jing, Haiming; Yang, Liuyang; Tong, Yanan; Wei, Chao; Wang, Zelin; Zou, Quanming; Zeng, Hao

    2016-08-01

    Multi-drug resistant MRSA (methicillin-resistant Staphylococcus aureus) is a global problem for human health, especially skin burn wound patients. Therefore, we estimated the antibacterial and anti-biofilm activity of a chlorhexidine acetate nanoemulsion (CNE) by previously ourselves designed against skin burn wound MRSA infections. Compared with its water solution (CHX), CNE showed a better and faster action against MRSA both in vitro and in vivo. Importantly, CNE was more effective at inhibiting biofilm formation and clearing the biofilm. We also found that the cell walls and membranes of MRSA were severely disrupted after treatment with CNE. Moreover, the relative electrical conductivity and the leakage of alkaline phosphates, K(+), Mg(2+), DNA and protein obviously increased because the cell wall and membrane were damaged. These data show that novel CNE is a promising potential antimicrobial candidate, especially for skin burn wound MRSA infections. PMID:26961464

  18. [Modern wound dressings].

    PubMed

    Triller, Ciril; Huljev, Dubravko; Planinsek Rucigaj, Tanja

    2013-10-01

    Chronic wounds are, due to the slow healing, a major clinical problem. In addition to classic materials, a great number of supportive wound dressings for chronic wound treatment, developed on the basis of new knowledge about the pathophysiological events in non-healing wounds, are available on the market. Today we know that modern wound dressings provide the best local environment for optimal healing (moisture, warmth, appropriate pH). Wound dressings control the amount of exudate from the wound and bacterial load, thus protecting local skin from the wound exudate and the wound from secondary infections from the environment. Using supportive wound dressings makes sense only when the wound has been properly assessed, the etiologic factors have been clarified and the obstacles making the wound chronic identified. The choice of dressing is correlated with the characteristics of the wound, the knowledge and experience of the medical staff, and the patient's needs. We believe that the main advantage of modern wound dressing versus conventional dressing is more effective wound cleaning, simple dressing application, painless bandaging owing to reduced adhesion to the wound, and increased absorption of the wound exudate. Faster wound granulation shortens the length of patient hospitalization, and eventually facilitates the work of medical staff. The overall cost of treatment is a minor issue due to faster wound healing despite the fact that modern supportive wound dressings are more expensive than conventional bandaging. The article describes different types of modern supportive wound dressings, as well as their characteristics and indications for use. PMID:24371980

  19. Topical silver treatment after escharectomy of infected full thickness burn wounds in rats.

    PubMed

    Chu, Chi-Sing; McManus, Albert T; Mason, Arthur D; Pruitt, Basil A

    2005-05-01

    White male Sprague Dawley rats (200 g.) with 20% full thickness scald burns seeded with 10 Pseudomonas aeruginosa, strain 59-1244, were used as experimental animals. Studies including the following: (1). Control groups. (2). DC pretreatment groups. (3). Treatment groups. P. aeruginosa infected burn wounds were excised, and then treated with either autograft or silver-nylon dressings, with (SNDC) or without (SN) application direct current. Excision and treatment were initiated 1, 2, 3, 4 or 5 days after burning and inoculation. (4). Groups for antimicrobial barrier function study. Mortality of each group was recorded at 21 days PB. With burns alone, there was no mortality. Without treatment 19 of 20 burn inoculated controls died. In the pretreatment study, the mortality of the group pretreated with SN was 95% while that of the group pretreated with SNDC was only 30%. With excision and autografting, PB mortality rose from 5/20 at day 2 PB to 19/20 at day 3 PB. In the excision and SN groups, mortality rose from 5/20 at day 3 PB to 18/20 at day 4 PB. In the excision and SNDC groups, mortality rose from 5/20 at day 3 PB to 18/20 at day 4 PB. In the antimicrobial barrier function study, the 10% mortality in the SN dressing group was significantly less than that of 95% in the plain nylon dressed group. Histologic examination revealed progressively deepening colonization of non-viable wound tissue, progressing to invasion of underlying viable tissue by PB day 4. With wound excision, SN, SNDC, and autografting were equally protective for the first two days, but only SN and SNDC extended this effect to the third PB day. In conclusion, SN and SNDC have a strong local anti-microbial effect on the burn wound when applied within 72 hours of the time of bacterial inoculation, but little effect if applied after the bacteria have invaded unburned vessels and viable tissue adjacent to the burn. PMID:15920422

  20. Tyrothricin--An underrated agent for the treatment of bacterial skin infections and superficial wounds?

    PubMed

    Lang, C; Staiger, C

    2016-06-01

    The antimicrobial agent tyrothricin is a representative of the group of antimicrobial peptides (AMP). It is produced by Bacillus brevis and consists of tyrocidines and gramicidins. The compound mixture shows activity against bacteria, fungi and some viruses. A very interesting feature of AMPs is the fact, that even in vitro it is almost impossible to induce resistances. Therefore, this class of molecules is discussed as one group that could serve as next generation antibiotics and overcome the increasing problem of bacterial resistances. In daily practice, the application of tyrothricin containing formulations is relatively limited: It is used in sore throat medications and in agents for the healing of infected superficial and small-area wounds. However, due to the broad spectrum antimicrobial activity and the low risk of resistance development it is worth to consider further fields of application. PMID:27455547

  1. Use of the Surgical Wound Infection Model To Determine the Efficacious Dosing Regimen of Retapamulin, a Novel Topical Antibiotic

    PubMed Central

    Rittenhouse, Stephen; Singley, Christine; Hoover, Jennifer; Page, Roni; Payne, David

    2006-01-01

    The effect of topically applied retapamulin ointment was evaluated using various dosing regimens in the Staphylococcus aureus and Streptococcus pyogenes wound infection model. Retapamulin (1%, wt/wt) was efficacious using twice-daily (b.i.d.) applications for 4 or 5 days. These data underpinned the decision to evaluate 1% retapamulin b.i.d. in clinical trials. PMID:17065626

  2. ‘This wound has spoilt everything’: emotional capital and the experience of surgical site infections

    PubMed Central

    Brown, Brian; Tanner, Judith; Padley, Wendy

    2014-01-01

    In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to ‘germs’ or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

  3. The use of desiccation to treat Staphylococcus aureus biofilm-infected wounds.

    PubMed

    Park, Eugene; Long, Sarah A; Seth, Akhil K; Geringer, Matthew; Xu, Wei; Chavez-Munoz, Claudia; Leung, Kai; Hong, Seok Jong; Galiano, Robert D; Mustoe, Thomas A

    2016-03-01

    Chronic wounds colonized with biofilm present a major burden to our healthcare system. While the current paradigm for wound healing is to maintain a moist environment, we sought to evaluate the effects of desiccation, and the ability of honey to desiccate wounds, on wound healing characteristics in Staphylococcus aureus biofilm wounds. In vivo biofilm wound healing after exposure to open-air desiccation, honey, molasses, and saline was analyzed using a rabbit ear model of S. aureus biofilm wounds previously developed by our group. Wound morphology was examined using scanning electron microscopy and granulation tissue deposition was measured using light microscopy with hematoxylin and eosin staining. Viable bacterial counts in rabbit ear biofilm wounds and scabs were measured using a drop dilution method. In vitro S. aureus growth curves were established using tryptic soy broth containing honey and glycerol. Gene expression analysis of rabbit ear wounds was performed using reverse transcription quantitative PCR. Rabbit ear S. aureus biofilm wounds exposed to open-air desiccation, honey, and molasses developed a dry scab, which displaced the majority of biofilm bacteria off of the wound bed. Wounds treated with open-air desiccation, honey, and molasses expressed lower levels of the inflammatory markers tumor necrosis factor-α and interleukin-1β at postoperative day 12 compared with wounds treated with saline, and had increased levels of granulation tissue formation. In vitro growth of S. aureus in tryptic soy broth was inhibited by the presence of honey to a greater extent than by the presence of osmolality-matched glycerol. Desiccation of chronic wounds colonized with biofilm via exposure to open air or honey leads to improved wound healing by decreasing bacterial burden and inflammation, and increasing granulation tissue formation. The ability of honey to help heal chronic wounds is at least in part due to its ability to desiccate bacterial biofilm, but other

  4. Effects of phosphate supplementation on Pseudomonas aeruginosa invasive behavior in burn wound infections: A simple approach to a big problem.

    PubMed

    Mohammadi-Samani, Soliman; Kouroshfard, Shahriyar; Azarpira, Negar

    2016-03-01

    This study was designed to investigate the effect of inorganic phosphate supplementation on invasive behavior of Pseudomonas aeruginosa in burn wound infections. An emulsion-based lotion containing sodium dihydrogen phosphate was formulated and then 50 female Sprague-Dawley rats with burn wounds were used to assess the effect of phosphate supplementation on swarming motility of P. aeruginosa. On the second day after burn, four groups of rats were inoculated with P. aeruginosa and one group was left as negative control. The treatment was started on day 3 and the animals were followed up for 4 weeks. Significant improvement in wound healing was observed in the phosphate-receiving group after the 4-week follow-up, compared to the negative control, positive control, and silver sulfadiazine-receiving groups. Histopathological assessment of the tissue samples also indicated the healing process in phosphate-enriched lotion receiving group. The results showed that inorganic phosphate supplementation results in alteration of the virulence behavior of P. aeruginosa and improvement in the wound healing process. In conclusion, phosphate supplementation would be a rational strategy in the eradication of P. aeruginosa wound infection. PMID:26787129

  5. Povidone-iodine: an adjunct in the treatmen of wound infections, dehiscences, and fistulas in head and neck surgery.

    PubMed

    Dedo, D D; Alonso, W A; Ogura, J H

    1977-01-01

    Extensive research has been done to elucidate the cellular and biochemical events of a healing wound. Similarly, new techniques are continually being investigated which would stimulate and augment the reparative process. This paper describes the uses and biochemistry of povidone-iodine which has gained widespread acceptance as a surgical preparation. However, its use as a topical agent for treating head and neck wound infections, dehiscences, and salivary fistulas has gained little recognition. Povidone-iodine is a unique compound formed by binding free iodine to polyvinylpyrrolidone. Previously, the toxic effects of iodine limited its use to preparation of the skin for surgery. When bound to the pyrrolidine molecule, iodine becomes water soluble and markedly less toxic. As a result, the broad antimicrobial spectrum of iodine may be used topically to control wound sepsis. It can be applied to mucosal surfaces without producing burns. The brown color acts as an indicator of its clinical effectiveness. When the dressings become light yellow or pale, free iodine is no longer being released and the dressing should be changed. Povidone-iodine is not a panacea for correcting interruption in the healing process during the postoperative period. The basic management of wound infections, dehiscences, and fistulas remains unchanged. Incision and drainage, debridement and flap contracture, lateralization, and diversion are necessary to initiate the healing process. Familarity with each phase of healing provides the basis for managing each of these surgical problems. Topical povidone-iodine not only controls wound sepsis but augments wound healing. The physiologic correlation with each phase of wound healing for these various surgical problems is elaborated and clinical cases presented. PMID:857382

  6. Polyvinyl alcohol nanofiber formulation of the designer antimicrobial peptide APO sterilizes Acinetobacter baumannii-infected skin wounds in mice.

    PubMed

    Sebe, Istvan; Ostorhazi, Eszter; Fekete, Aron; Kovacs, Krisztian N; Zelko, Romana; Kovalszky, Ilona; Li, Wenyi; Wade, John D; Szabo, Dora; Otvos, Laszlo

    2016-01-01

    Native and designer cationic antimicrobial peptides are increasingly acknowledged as host defense molecules rather than true antimicrobials. Due to their ability to activate the innate immune system, these structures are used to treat uninfected and bacterially-infected wounds, including those harboring Acinetobacter baumannii. Previously we documented that when administered intramuscularly or topically in liquid formulations, the proline-rich host defense peptide dimer A3-APO accelerates uninfected wound re-epithelization and eliminates systemic and local A. baumannii, methicillin-resistant Staphylococcus aureus and other pathogen load from infected lesions better than conventional antibiotics. In the current study we sought to produce and characterize a novel delivery system, suitable for immediate and convenient application in non-hospital environments. The APO monomer was incorporated into polyvinyl alcohol nanofibers and the complex was polymerized into a solid patch dressing. Mice were subjected to skin abrasion where the wounds were either left uninfected or were inoculated with a near lethal dose of multidrug resistant A. baumannii strain. Analyzed after 3 days, APO monomer-containing patches improved wound appearance significantly better than polymer patches without antibiotics. When compared to colistin, the APO patches accelerated wound healing, and statistically significantly reduced wound size and wound bacterial load. The in vivo antimicrobial effect was more extensive than after intramuscular administration of the peptide drug, by using only one tenth of the active pharmaceutical ingredient. These data suggest that the APO monomer-impregnated nanofiber dressing can be developed as an economical first-line treatment option to skin injuries in general and battlefield burn and blast injuries in particular. PMID:26319645

  7. Enzyme-responsive nanocomposites for wound infection prophylaxis in burn management: in vitro evaluation of their compatibility with healing processes

    PubMed Central

    Grützner, Verena; Unger, Ronald E; Baier, Grit; Choritz, Lars; Freese, Christian; Böse, Thomas; Landfester, Katharina; Kirkpatrick, C James

    2015-01-01

    Responsive, theranostic nanosystems, capable of both signaling and treating wound infections, is a sophisticated approach to reduce the most common and potentially traumatizing side effects of burn wound treatment: slowed wound healing due to prophylactic anti-infective drug exposure as well as frequent painful dressing changes. Antimicrobials as well as dye molecules have been incorporated into biodegradable nanosystems that release their content only in the presence of pathogens. Following nanocarrier degradation by bacterial enzymes, any infection will thus emit a visible signal and be effectively treated at its source. In this study, we investigated the effect of fluorescent-labeled hyaluronan nanocapsules containing polyhexanide biguanide and poly-L-lactic acid nanoparticles loaded with octenidine on primary human dermal microvascular endothelial cells, which play a major role in cutaneous wound healing. Microscopic and flow cytometric analysis indicated a time-dependent uptake of both the nanocapsules and the nanoparticles. However, enzyme immunoassays showed no significant influence on the expression of pro-inflammatory cell adhesion molecules and cytokines by the endothelial cells. Under angiogenic-stimulating conditions, the potential to form capillary-like structures in co-culture with dermal fibroblasts was not inhibited. Furthermore, cytotoxicity studies (the MTS and crystal violet assay) after short- and long-term exposure to the materials demonstrated that both systems exhibited less toxicity than solutions of the antiseptic agents alone in comparable concentrations. The results indicate that responsive antimicrobial nanocomposites could be used as an advanced drug delivery system and a promising addition to current best practice wound infection prophylaxis with few side effects. PMID:26150717

  8. Microbiological study of pathogenic bacteria isolated from paediatric wound infections following the 2008 Wenchuan earthquake.

    PubMed

    Ran, Ying-Chun; Ao, Xiao-Xiao; Liu, Lan; Fu, Yi-Long; Tuo, Hui; Xu, Feng

    2010-05-01

    On 12 May 2008, the Wenchuan earthquake struck in Sichuan, China. Within 1 month after the earthquake, 98 injured children were admitted to the Children's Hospital of Chongqing Medical University. According to clinical manifestations, 50 children were diagnosed with wound infections. Wound secretions were cultured for bacteria. Pathogen distribution and drug resistance were analyzed. A total of 99 pathogens were isolated; 16 (16%) were Gram-positive bacteria and 81 (82%) were Gram-negative bacteria. The distribution of pathogens isolated within 1 month after the earthquake was different to the distribution of pathogens in 546 general hospitalized cases in the y before the earthquake. The pathogens most frequently isolated 1 month after the earthquake were Acinetobacter baumannii (27%), Enterobacter cloacae (18%) and Pseudomonas aeruginosa (13%). The pathogens most frequently isolated in the y prior to the earthquake were Escherichia coli (27%), Staphylococcus aureus (23%) and coagulase-negative staphylococci (9%). The rate of isolated drug-resistant bacteria was higher in the earthquake cases than in the general hospitalized cases. In the cases injured in the earthquake, the rates of isolation of methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing E. cloacae, E. coli and Klebsiella pneumoniae were higher than in the cases from before the earthquake. Multidrug-resistant and pandrug-resistant A. baumannii were isolated at a higher rate in cases after the earthquake than in those before the earthquake. These changes in the spectrum of pathogens and in the drug resistance of the pathogens isolated following an earthquake will provide the basis for emergency treatment after earthquakes. PMID:20095936

  9. A Prospective Randomized Trial of Open Wound Treatment vs Occlusive Dressings in Elective Surgical Cases with Respect to Surgical Site Infections

    PubMed Central

    Grover, Anmol; Sidhu, D S

    2015-01-01

    Background Surgical wounds heal by primary intention in all the elective and emergency surgical procedures. Current practice is to place dressing over the closed wound before the patient leaves the sterile environment of the operating theatre. Dressing is a material applied to protect a wound and favour its healing. However, to leave wound open in direct contact to environment following any procedure by just applying some ointment on it, the so called open wound treatment is still controversial one. In the present study we have compared open wound treatment vs occlusive dressings in elective surgical cases with respect to surgical site infections. Materials and Methods The present study was conducted on 100 patients admitted for elective general surgery after taking written informed consent. Patients were divided randomly in to two equal groups each comprising of 50 patients. In Group A, patients had occlusive dressing till removal of stitches and in Group B, patients wounds were kept exposed to environment after the surgical procedure. Results In present study we observed total 7% of postoperative wounds were infected of all the clean and clean contaminated wounds we studied. In Group A, patients had occlusive dressing and these patients had 8% infection rate whereas in Group B patients, wounds were kept exposed to environment and these patients had 6% infection rate. Conclusion It is hereby concluded that in the elective surgical cases there is no harm in leaving the wounds open postoperatively. This method not only helps in arresting the infective pathology at a lesser stage but also saves surgeon’s time and patient’s money. PMID:26266164

  10. Real-time monitoring of bacterial infection in vivo: development of bioluminescent staphylococcal foreign-body and deep-thigh-wound mouse infection models.

    PubMed

    Kuklin, Nelly A; Pancari, Gregory D; Tobery, Timothy W; Cope, Leslie; Jackson, Jesse; Gill, Charles; Overbye, Karen; Francis, Kevin P; Yu, Jun; Montgomery, Donna; Anderson, Annaliesa S; McClements, William; Jansen, Kathrin U

    2003-09-01

    Staphylococcal infections associated with catheter and prosthetic implants are difficult to eradicate and often lead to chronic infections. Development of novel antibacterial therapies requires simple, reliable, and relevant models for infection. Using bioluminescent Staphylococcus aureus, we have adapted the existing foreign-body and deep-wound mouse models of staphylococcal infection to allow real-time monitoring of the bacterial colonization of catheters or tissues. This approach also enables kinetic measurements of bacterial growth and clearance in each infected animal. Persistence of infection was observed throughout the course of the study until termination of the experiment at day 16 in a deep-wound model and day 21 in the foreign-body model, providing sufficient time to test the effects of antibacterial compounds. The usefulness of both animal models was assessed by using linezolid as a test compound and comparing bioluminescent measurements to bacterial counts. In the foreign-body model, a three-dose antibiotic regimen (2, 5, and 24 h after infection) resulted in a decrease in both luminescence and bacterial counts recovered from the implant compared to those of the mock-treated infected mice. In addition, linezolid treatment prevented the formation of subcutaneous abscesses, although it did not completely resolve the infection. In the thigh model, the same treatment regimen resulted in complete resolution of the luminescent signal, which correlated with clearance of the bacteria from the thighs. PMID:12936968

  11. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation.

    PubMed

    Lemaignen, A; Birgand, G; Ghodhbane, W; Alkhoder, S; Lolom, I; Belorgey, S; Lescure, F-X; Armand-Lefevre, L; Raffoul, R; Dilly, M-P; Nataf, P; Lucet, J C

    2015-07-01

    The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the US Centers for Disease Control and Prevention (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single centre analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC-positive SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC-negative SSI, 2.1%). Median time to reoperation for CDC-negative SSI was 18 days (interquartile range, 14-26) and 16 (interquartile range, 11-24) for CDC-positive SSI (p 0.02). Microorganisms associated with CDC-negative SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%); only six were due to Staphylococcus aureus (4%), while CDC-positive SSI were mostly due to S. aureus (52/145, 36%) and germs from the digestive tract (52/145, 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical preoperative state, postoperative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries in female patients. The number of internal thoracic arteries used and factors affecting wound healing were primarily associated with CDC-negative SSI, whereas comorbidities and perioperative complications were mainly associated with CDC-positive SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology. PMID:25882356

  12. Microbial Profiling of Combat Wound Infection through Detection Microarray and Next-Generation Sequencing

    PubMed Central

    Allen, Jonathan E.; Brown, Trevor S.; Gardner, Shea N.; McLoughlin, Kevin S.; Forsberg, Jonathan A.; Kirkup, Benjamin C.; Chromy, Brett A.; Luciw, Paul A.; Elster, Eric A.

    2014-01-01

    Combat wound healing and resolution are highly affected by the resident microbial flora. We therefore sought to achieve comprehensive detection of microbial populations in wounds using novel genomic technologies and bioinformatics analyses. We employed a microarray capable of detecting all sequenced pathogens for interrogation of 124 wound samples from extremity injuries in combat-injured U.S. service members. A subset of samples was also processed via next-generation sequencing and metagenomic analysis. Array analysis detected microbial targets in 51% of all wound samples, with Acinetobacter baumannii being the most frequently detected species. Multiple Pseudomonas species were also detected in tissue biopsy specimens. Detection of the Acinetobacter plasmid pRAY correlated significantly with wound failure, while detection of enteric-associated bacteria was associated significantly with successful healing. Whole-genome sequencing revealed broad microbial biodiversity between samples. The total wound bioburden did not associate significantly with wound outcome, although temporal shifts were observed over the course of treatment. Given that standard microbiological methods do not detect the full range of microbes in each wound, these data emphasize the importance of supplementation with molecular techniques for thorough characterization of wound-associated microbes. Future application of genomic protocols for assessing microbial content could allow application of specialized care through early and rapid identification and management of critical patterns in wound bioburden. PMID:24829242

  13. Microbial profiling of combat wound infection through detection microarray and next-generation sequencing.

    PubMed

    Be, Nicholas A; Allen, Jonathan E; Brown, Trevor S; Gardner, Shea N; McLoughlin, Kevin S; Forsberg, Jonathan A; Kirkup, Benjamin C; Chromy, Brett A; Luciw, Paul A; Elster, Eric A; Jaing, Crystal J

    2014-07-01

    Combat wound healing and resolution are highly affected by the resident microbial flora. We therefore sought to achieve comprehensive detection of microbial populations in wounds using novel genomic technologies and bioinformatics analyses. We employed a microarray capable of detecting all sequenced pathogens for interrogation of 124 wound samples from extremity injuries in combat-injured U.S. service members. A subset of samples was also processed via next-generation sequencing and metagenomic analysis. Array analysis detected microbial targets in 51% of all wound samples, with Acinetobacter baumannii being the most frequently detected species. Multiple Pseudomonas species were also detected in tissue biopsy specimens. Detection of the Acinetobacter plasmid pRAY correlated significantly with wound failure, while detection of enteric-associated bacteria was associated significantly with successful healing. Whole-genome sequencing revealed broad microbial biodiversity between samples. The total wound bioburden did not associate significantly with wound outcome, although temporal shifts were observed over the course of treatment. Given that standard microbiological methods do not detect the full range of microbes in each wound, these data emphasize the importance of supplementation with molecular techniques for thorough characterization of wound-associated microbes. Future application of genomic protocols for assessing microbial content could allow application of specialized care through early and rapid identification and management of critical patterns in wound bioburden. PMID:24829242

  14. Clinical Trial on the Incidence of Wound Infection and Patient Satisfaction After Stoma Closure: Comparison of Two Skin Closure Techniques

    PubMed Central

    Yoon, Sang Il; Bae, Sun Mi; Park, Dong Guk

    2015-01-01

    Purpose Surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. Reports have described differences in the incidence of wound infection depending on the skin closure technique, but there is no consensus on the ideal closure technique for a stoma wound. The aim of this study was to compare the incidence of SSI and the patient satisfaction between a circumferential purse-string approximation (CPA) and a primary linear closure (PC) of a stoma wound. Methods This prospective nonrandomized trial enrolled 48 patients who underwent a stoma closure from February 2010 to October 2013. Patients were divided into two groups according to the stoma closing technique: the CPA group (n = 34) and the PC group (n = 14). The incidences of SSI for the two groups were compared, and the patients' satisfaction with the stoma closure was determined by using a questionnaire. Results SSI occurred in 3 of 48 patients (6.3%) and was more frequent in the PC group than in the CPA group (3/14 [21.4%] vs. 0/34 [0%], P = 0.021). Time to complete healing after stoma closure in the CPA group was 32 days (range, 14-61 days). Patients in the CPA group were more satisfied with the resulting wound scar (P = 0.043). Conclusion After stoma closure, CPA was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to PC. However, with the CPA technique, the time to heal is longer than it is with PC. PMID:25745624

  15. Comparative study of the effects of the use of the CO2 laser and of cholorhexidine on the healing of cutaneous wounds infected by the staphylococcus aureus

    NASA Astrophysics Data System (ADS)

    Matos de Oliveira, Marcos A.; Barbosa Pinheiro, Antonio L.; Azevedo Moreira, Ana C.; Pedreira Ramalho, Luciana M.; Brugnera, Aldo, Jr.; Zanin, Fatima A. A.; Costa Lima, Taciano L.

    2003-06-01

    The aim of this study was to compare histologic and microbiogically the use of the CO2 Laser and Chlorohexidine Gluconate (0.5% and 2%) on cutaneous wounds infected by Staphylococcus aureus. Wound infection constitutes a risk for the patients and it is usually associated to increase morbidity, mortality and hospital costs. It is accepted that local treatment of these infections is effective. Standardised wounds created on the dorsum of Wistar rats were infected with Staphylococcus aureus and treated as follows: Group 1: control; Group 2: Chlorohexidien Gluconate (0.5%), 1 min, six days; Group 3: Chlorohexidine Gluconate (2%), 1 min, six days; Group 4: CO2 Laser, CW, RSP, 8W, 10s, single application, maintaining surface debris; Group 5: CO2 Laser, CW, RSP, 8W, 10s, single application, removing surface debris. Eight days after wounding material from the surface of the wound was collected for microbiology and the animals were sacrificed and specimens taken for light microscopy. Microbiological examinations showed that on group 2 the bacteria were not found on 50% of the animals. On group 3 83% were germ-free, on group 4 50% and on group 5 66%. Histological examination showed a better result for CO2 laser treated wounds compared to others. It is concluded that the use of a 2% Cholohexidine solution was more effective on decontaminating the wounds. However, wounds treated with the CO2 laer and with the removal of surface debris healed better than the others.

  16. A clinical study on the efficacy of Panchavalkala cream in Vrana Shodhana w.s.r to its action on microbial load and wound infection

    PubMed Central

    Bhat, K. Shobha; Vishwesh, B. N.; Sahu, Manoranjan; Shukla, Vijay Kumar

    2014-01-01

    Background: The science of wound healing is advancing rapidly, particularly as a result of new therapeutic approaches. The wound healing effect of different herbal ointments have been enormous and are in wide practice these days. Aim: To evaluate the efficacy of Panchavalkala cream over wound debridement (wound infection and microbial load). Materials and Methods: Ghanasatwa (water extract) of the individual drugs of Panchavalkala was prepared and the extract formulated as herbal ointment. This was used to treat patients of infected chronic non healing wounds. The signs and symptoms of infection were graded before and during the course of treatment. Tissue biopsy to estimate the microbial load prior to and during the course of treatment was done. Results: The clinical symptoms like Slough, swelling, redness, pain, discharge, tenderness, and malodor in wounds showed statistically significant reduction following treatment. The microbial load of the wounds was also reduced significantly. Conclusion: In most of the cases, there was a progressive reduction in the microbial load with time, during the course of treatment indicating the efficacy of the formulation in reducing the microbial load and thus controlling infection, facilitating wound healing. PMID:25558157

  17. Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

    PubMed Central

    Mihaljevic, André L.; Müller, Tara C.; Kehl, Victoria; Friess, Helmut; Kleeff, Jörg

    2015-01-01

    Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of

  18. Dual-functional Polyurea Microcapsules for Chronic Wound Care Dressings: Sustained Drug Delivery and Non-leaching Infection Control

    NASA Astrophysics Data System (ADS)

    He, Wei

    A new design of dual-functional polyurea microcapsules was proposed for chronic wound dressings to provide both non-leaching infection control and sustained topical drug delivery functionalities. Quaternary ammonium functionalized polyurea microcapsules (MCQs) were synthesized under mild conditions through an interfacial crosslinking reaction between branched polyethylenimine (PEI) and 2,4-toluene diisocyanate (TDI) in a dimethylformamide/cyclohexane emulsion. An in-situ modification method was developed to endow non-leaching surface antimicrobial properties to MCQs via bonding antimicrobial surfactants to surface isocyanate residues on the polyurea shells. The resultant robust MCQs with both non-leaching antimicrobial properties and sustained drug releasing properties have potential applications in medical textiles, such as chronic wound dressings, for infection control and drug delivery.

  19. Biobased silver nanocolloid coating on silk fibers for prevention of post-surgical wound infections

    PubMed Central

    Dhas, Sindhu Priya; Anbarasan, Suruthi; Mukherjee, Amitava; Chandrasekaran, Natarajan

    2015-01-01

    Bombyx mori silk fibers are an important biomaterial and are used in surgical sutures due to their remarkable biocompatibility. The major drawback to the application of biomaterials is the risk of bacterial invasion, leading to clinical complications. We have developed an easy and cost-effective method for fabrication of antibacterial silk fibers loaded with silver nanoparticles (AgNPs) by an in situ and ex situ process using an aqueous extract of Rhizophora apiculata leaf. Scanning electron microscopy revealed that well dispersed nanoparticles impregnated the silk fibers both in situ and ex situ. The crystalline nature of the AgNPs in the silk fibers was demonstrated by X-ray diffraction. The thermal and mechanical properties of the silk fibers were enhanced after they were impregnated with AgNPs. The silver-coated silk fibers fabricated by the in situ and ex situ method exhibited more than 90% inhibition against Pseudomonas aeruginosa and Staphylococcus aureus. Silk fibers doped with AgNPs were found to be biocompatible with 3T3 fibroblasts. The results obtained represent an important advance towards the clinical application of biocompatible AgNP-loaded silk fibers for prevention of surgical wound infections. PMID:26491317

  20. Prosthetic Vascular Graft Infections: Bacterial Cultures from Negative-Pressure-Wound-Therapy Foams Do Not Improve Diagnostics.

    PubMed

    Scherrer, Alexandra U; Bloemberg, Guido; Zbinden, Reinhard; Zinkernagel, Annelies S; Fuchs, Claudio; Frauenfelder, Sandra; Rancic, Zoran; Mayer, Dieter; Hasse, Barbara

    2016-08-01

    We analyzed the diagnostic value of microorganisms cultured from negative-pressure-wound-therapy (NPWT) foam samples compared to that of microorganisms cultured from deep tissue samples from patients with vascular graft infections. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 58%, 86%, 81%, and 66%, respectively. The diagnostic value of microbiological cultures from NPWT foams was poor. PMID:27252462

  1. Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial)

    PubMed Central

    Calvert, Melanie; Bartlett, David C; Gheorghe, Adrian; Redman, Val; Dowswell, George; Hawkins, William; Mak, Tony; Youssef, Haney; Richardson, Caroline; Hornby, Steven; Magill, Laura; Haslop, Richard; Wilson, Sue; Morton, Dion

    2013-01-01

    Objective To determine the clinical effectiveness of wound edge protection devices in reducing surgical site infection after abdominal surgery. Design Multicentre observer blinded randomised controlled trial. Participants Patients undergoing laparotomy at 21 UK hospitals. Interventions Standard care or the use of a wound edge protection device during surgery. Main outcome measures Surgical site infection within 30 days of surgery, assessed by blinded clinicians at seven and 30 days and by patient’s self report for the intervening period. Secondary outcomes included quality of life, duration of stay in hospital, and the effect of characteristics of the patient and operation on the efficacy of the device. Results 760 patients were enrolled with 382 patients assigned to the device group and 378 to the control group. Six patients in the device group and five in the control group did not undergo laparotomy. Fourteen patients, seven in each group, were lost to follow-up. A total of 184 patients experienced surgical site infection within 30 days of surgery, 91/369 (24.7%) in the device group and 93/366 (25.4%) in the control group (odds ratio 0.97, 95% confidence interval 0.69 to 1.36; P=0.85). This lack of benefit was consistent across wound assessments performed by clinicians and those reported by patients and across all secondary outcomes. In the secondary analyses no subgroup could be identified in which there was evidence of clinical benefit associated with use of the device. Conclusions Wound edge protection devices do not reduce the rate of surgical site infection in patients undergoing laparotomy, and therefore their routine use for this role cannot be recommended. Trial registration Current Controlled Trials ISRCTN 40402832 PMID:23903454

  2. Update and validation of the Society for Vascular Surgery wound, ischemia, and foot infection threatened limb classification system.

    PubMed

    Mills, Joseph L

    2014-03-01

    The diagnosis of critical limb ischemia, first defined in 1982, was intended to delineate a patient cohort with a threatened limb and at risk for amputation due to severe peripheral arterial disease. The influence of diabetes and its associated neuropathy on the pathogenesis-threatened limb was an excluded comorbidity, despite its known contribution to amputation risk. The Fontaine and Rutherford classifications of limb ischemia severity have also been used to predict amputation risk and the likelihood of tissue healing. The dramatic increase in the prevalence of diabetes mellitus and the expanding techniques of arterial revascularization has prompted modification of peripheral arterial disease classification schemes to improve outcomes analysis for patients with threatened limbs. The diabetic patient with foot ulceration and infection is at risk for limb loss, with abnormal arterial perfusion as only one determinant of outcome. The wound extent and severity of infection also impact the likelihood of limb loss. To better predict amputation risk, the Society for Vascular Surgery Lower Extremity Guidelines Committee developed a classification of the threatened lower extremity that reflects these important clinical considerations. Risk stratification is based on three major factors that impact amputation risk and clinical management: wound, ischemia, and foot infection. This classification scheme is relevant to the patient with critical limb ischemia because many are also diabetic. Implementation of the wound, ischemia, and foot infection classification system in critical limb ischemia patients is recommended and should assist the clinician in more meaningful analysis of outcomes for various forms of wound and arterial revascularizations procedures required in this challenging, patient population. PMID:25812755

  3. A Genetic Approach to the Development of New Therapeutic Phages to Fight Pseudomonas Aeruginosa in Wound Infections

    PubMed Central

    Krylov, Victor; Shaburova, Olga; Krylov, Sergey; Pleteneva, Elena

    2012-01-01

    Pseudomonas aeruginosa is a frequent participant in wound infections. Emergence of multiple antibiotic resistant strains has created significant problems in the treatment of infected wounds. Phage therapy (PT) has been proposed as a possible alternative approach. Infected wounds are the perfect place for PT applications, since the basic condition for PT is ensured; namely, the direct contact of bacteria and their viruses. Plenty of virulent (“lytic”) and temperate (“lysogenic”) bacteriophages are known in P. aeruginosa. However, the number of virulent phage species acceptable for PT and their mutability are limited. Besides, there are different deviations in the behavior of virulent (and temperate) phages from their expected canonical models of development. We consider some examples of non-canonical phage-bacterium interactions and the possibility of their use in PT. In addition, some optimal approaches to the development of phage therapy will be discussed from the point of view of a biologist, considering the danger of phage-assisted horizontal gene transfer (HGT), and from the point of view of a surgeon who has accepted the Hippocrates Oath to cure patients by all possible means. It is also time now to discuss the possible approaches in international cooperation for the development of PT. We think it would be advantageous to make phage therapy a kind of personalized medicine. PMID:23344559

  4. A genetic approach to the development of new therapeutic phages to fight pseudomonas aeruginosa in wound infections.

    PubMed

    Krylov, Victor; Shaburova, Olga; Krylov, Sergey; Pleteneva, Elena

    2013-01-01

    Pseudomonas aeruginosa is a frequent participant in wound infections. Emergence of multiple antibiotic resistant strains has created significant problems in the treatment of infected wounds. Phage therapy (PT) has been proposed as a possible alternative approach. Infected wounds are the perfect place for PT applications, since the basic condition for PT is ensured; namely, the direct contact of bacteria and their viruses. Plenty of virulent ("lytic") and temperate ("lysogenic") bacteriophages are known in P. aeruginosa. However, the number of virulent phage species acceptable for PT and their mutability are limited. Besides, there are different deviations in the behavior of virulent (and temperate) phages from their expected canonical models of development. We consider some examples of non-canonical phage-bacterium interactions and the possibility of their use in PT. In addition, some optimal approaches to the development of phage therapy will be discussed from the point of view of a biologist, considering the danger of phage-assisted horizontal gene transfer (HGT), and from the point of view of a surgeon who has accepted the Hippocrates Oath to cure patients by all possible means. It is also time now to discuss the possible approaches in international cooperation for the development of PT. We think it would be advantageous to make phage therapy a kind of personalized medicine. PMID:23344559

  5. Methylene Blue-Loaded Dissolving Microneedles: Potential Use in Photodynamic Antimicrobial Chemotherapy of Infected Wounds

    PubMed Central

    Caffarel-Salvador, Ester; Kearney, Mary-Carmel; Mairs, Rachel; Gallo, Luigi; Stewart, Sarah A.; Brady, Aaron J.; Donnelly, Ryan F.

    2015-01-01

    Photodynamic therapy involves delivery of a photosensitising drug that is activated by light of a specific wavelength, resulting in generation of highly reactive radicals. This activated species can cause destruction of targeted cells. Application of this process for treatment of microbial infections has been termed “photodynamic antimicrobial chemotherapy” (PACT). In the treatment of chronic wounds, the delivery of photosensitising agents is often impeded by the presence of a thick hyperkeratotic/necrotic tissue layer, reducing their therapeutic efficacy. Microneedles (MNs) are an emerging drug delivery technology that have been demonstrated to successfully penetrate the outer layers of the skin, whilst minimising damage to skin barrier function. Delivering photosensitising drugs using this platform has been demonstrated to have several advantages over conventional photodynamic therapy, such as, painless application, reduced erythema, enhanced cosmetic results and improved intradermal delivery. The aim of this study was to physically characterise dissolving MNs loaded with the photosensitising agent, methylene blue and assess their photodynamic antimicrobial activity. Dissolving MNs were fabricated from aqueous blends of Gantrez® AN-139 co-polymer containing varying loadings of methylene blue. A height reduction of 29.8% was observed for MNs prepared from blends containing 0.5% w/w methylene blue following application of a total force of 70.56 N/array. A previously validated insertion test was used to assess the effect of drug loading on MN insertion into a wound model. Staphylococcus aureus, Escherichia coli and Candida albicans biofilms were incubated with various methylene blue concentrations within the range delivered by MNs in vitro (0.1–2.5 mg/mL) and either irradiated at 635 nm using a Paterson Lamp or subjected to a dark period. Microbial susceptibility to PACT was determined by assessing the total viable count. Kill rates of >96%, were achieved for

  6. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT

    PubMed Central

    Chaboyer, Wendy; Anderson, Vinah; Webster, Joan; Sneddon, Anne; Thalib, Lukman; Gillespie, Brigid M.

    2014-01-01

    Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing) and 46 women received standard care (Comfeel Plus® dressing). All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38–1.68); for the number of complications excluding SSI it was 0.98 (95% CI 0.34–2.79). A sample size of 784 (392 per group) would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study.

  7. Negative Pressure Wound Treatment of Infections Caused By Extensively Drug-Resistant Gram-Negative Bacteria After Liver Transplantation: Two Case Reports.

    PubMed

    Dondossola, D; Cavenago, M; Piconi, S; Antonelli, B; Melada, E; Lonati, C; Gatti, S; Rossi, G

    2015-09-01

    Although survival after liver transplantation (LT) has progressively improved over the last years, an increased prevalence of clinically relevant infections in LT patients is well documented. In particular, the spread of infections sustained by extensively drug-resistant bacteria (XDR) produced an increase in the incidence of wound infections. Implementation of treatments for these life-threatening events is mandatory. This study describes 2 LT patients in whom XDR wound infection was effectively treated using negative pressure wound treatment (NPWT) combined with targeted local and systemic antibiotic therapy. Over the last 3 years, 2 of 8 patients with XDR infection admitted to our unit developed wound infection caused by XDR Klebsiella pneumoniae (KP-XDR). Positive results of the abdominal fluid culture and of the wound swab for KP-XDR were followed by sepsis. In both cases wound debridement was required and deep fascial layer dehiscence was detected. Combination antibiotic therapy was administered for sepsis treatment and, after failure of conventional NPWT, a NPWT with local instillation (NPWTi; V.A.C.-Ulta/VeraFlo-Instillation Therapy-KCI USA, Inc., San Antonio, TX, USA) of colistin-rifampicin was applied. After NPWTi application a reduction in bacterial load and exudate was observed with reduction in inflammatory markers. A complete healing of wound was achieved and both patients are currently alive. Instillation and NPWT are widely discussed in the literature. Results of the present study indicate beneficial effects of NPWT combined with targeted local and systemic antibiotic therapy; in both cases a life-threatening complication was cured. We consider local instillation of selected antibiotics applied to NPWTi a valuable tool for deep wound infection sustained by XDR bacteria. PMID:26361664

  8. Beneficial effects of silver foam dressing on healing of wounds with ulcers and infection control of burn patients

    PubMed Central

    Yang, Bo; Wang, Xudong; Li, Zhonghua; Qu, Qi; Qiu, Yan

    2015-01-01

    Objective: To assess the beneficial effects of silver foam dressing on the healing of wounds with ulcers and infection control of burn patients. Methods: Eighty-four second-degree burn patients were selected and divided into a study group and a control group (n=42). After disinfection and cleaning, wound beds of the study group were covered with silver-containing soft-silicone foam dressing, and wound surfaces of the control group were wiped with 1% silver sulfadiazine cream (60 g/100 cm2). The two groups were checked weekly to observe wound healing progress and adverse reactions of the skin around wounds. Wound secretions were collected and subjected to bacterial culture. Related indices were recorded and quantified. Results: Thirty seven cases of the study group (88.1%) and 36 cases of the control group (85.7%) recovered to normal, and 3 (7.1%) and 2 cases (4.8%) in the two groups failed to recover. The recovery rates of the two groups were similar (P>0.05), but unrecovered patients in the study group had significantly higher proportions of repaired wounds (P<0.05). Wounds of the study group were healed significantly more rapidly than those of the control group (22.3±3.1 vs. 25.1±4.4, P<0.05). The study group had significantly higher proportions of repaired wounds from Day 7 to Day 21 (P<0.05), but the difference became less obvious with extended time to Day 28. The bacterial culture-positive (exceeding 105 organisms per gram of tissue) rates of both groups significantly reduced after treatment (Day 7 for the study group and Day 14 for the control group), and the rate of the study group was significantly lower at last (P<0.05). The study and control groups were observed 134 and 149 person-times respectively, with the normal wound-surrounding skin rates of 96.3% (129/134) and 88.6% (132/149) (P>0.05 except for on Day 14). Except for on Day 28, the study group had significantly lower pain scores than those of the control group (P<0.05), especially on Day 7 and

  9. Charts versus Discharge ICD-10 Coding for Sternal Wound Infection Following Coronary Artery Bypass Grafting

    PubMed Central

    Southern, Danielle A.; Doherty, Christopher; De Souza, Michael A.; Quan, Hude; Harrop, A. Robertson; Nickerson, Duncan; Rabi, Doreen

    2015-01-01

    Background Sternal wound infection (SWI) in patients undergoing coronary artery bypass grafting (CABG) can carry a significant risk of morbidity and mortality. The objective of this work is to describe the methods used to identify cases of SWI in an administrative database and to demonstrate the effectiveness of using an International Classification of Diseases, Tenth Revision (ICD-10) coding algorithm for this purpose. Methods ICD-10 codes were used to identify cases of SWI within one year of CABG between April 2002 and November 2009. We randomly chose 200 charts for detailed chart review (100 from each of the groups coded as having SWI and not having SWI) to determine the utility of the ICD-10 coding algorithm. Results There were 2,820 patients undergoing CABG. Of these, 264 (9.4 percent) were coded as having SWI. Thirty-eight cases of SWI were identified by chart review. The ICD-10 coding algorithm of T81.3 or T81.4 was able to identify incident SWI with a positive predictive value of 35 percent and a negative predictive value of 97 percent. The agreement between the ICD-10 coding algorithm and presence of SWI remained fair, with an overall kappa coefficient of 0.32 (95 percent confidence interval, 0.22–0.43). The effectiveness of identifying deep SWI cases is also presented. Conclusions This article describes an effective algorithm for identifying a cohort of patients with SWI following open sternotomy in large databases using ICD-10 coding. In addition, alternative search strategies are presented to suit researchers' needs. PMID:26396556

  10. A case report of the use of nanocrystalline silver dressing in the management of acute surgical site wound infected with MRSA to prevent cutaneous necrosis following revision surgery.

    PubMed

    Bhattacharyya, Mayukh; Bradley, Helen

    2008-03-01

    The authors report the use of nanocrystalline silver (Acticoat 7, Smith and Nephew, London, UK) in an acute surgical wound to prevent localized skin necrosis due to infection, thereby avoiding skin grafting as a secondary procedure. Two patients were successfully treated with Acticoat 7 dressings without using systemic antimicrobials after developing methicillin-resistant Staphylococcus aureus infection in the surgical site. Despite a history of smoking and incision through scar tissues, the wound did not progress into deep infection nor was there recurrence of infection at 2 years follow-up. The intention was to use this particular dressing to assess the effect of silver on infected keratinocytes in an acute wound environment. It is possible that the use of Acticoat 7 may reduce the bacterial loading at the wound site, thereby decreasing a propensity for skin necrosis caused by the infective process. This case report demonstrates that the acute surgical wound with impending cutaneous necrosis due to localized infection may be treated without oral antimicrobials. PMID:18372271

  11. The novel antibacterial drug XF-70 is a potent inhibitor of Staphylococcus aureus infection of the burn wound.

    PubMed

    Hurtuk, Michael G; He, L-K; Szilagyi, Andrea; Gamelli, Richard L; Hecht, David W; Kennedy, Richard H; Rhys-Williams, William; Love, William G; Shankar, Ravi

    2010-01-01

    The authors report the findings of in vivo studies of XF-70 (a novel, dicationic porphyrin) against Staphylococcus aureus in a murine model of a burn wound infection. Mice received a 15% total body scald burn wound, which were inoculated with S. aureus (1.8 x 10 CFU). After 24 hours, escharectomies were performed and groups (n = 8) received single or two doses (6 hours apart) of XF-70* (100 microg/wound) or silver sulfadiazine, Acticoat, or saline applied topically. Viable bacteria were quantified from homogenized burn tissue biopsies and the spleen by plating dilutions onto agar plates and CFU determination. A single dose of XF-70 reduced bacterial burden by 98.77% (untreated: 2.78 +/- 2.96 x 10 CFU/g vs XF-70 treated: 3.4 +/- 0.19 x 10 CFU/g, P < .01). Two XF-70 doses reduced the growth of S. aureus by 99.96% (1.2 +/- 0.6 x 10 CFU/g, P < .01). These results were similar to the results obtained from commonly used topical antibacterials silver sulfadiazine and Acticoat. The spleens of mice treated with saline had a robust growth of S. aureus (7.0 +/- 1.97 x 10 CFU/g) whereas those treated with one or two XF-70 doses grew only 3.5 +/- 0.002 x 10 CFU/g and 5.7 +/- 0.002 x 10 CFU/g, respectively, a significant (P < .001) reduction in S. aureus dissemination. Single and multiple doses of XF-70 were effective in controlling S. aureus growth in burn wounds and inhibited systemic dissemination of S. aureus. Early treatment of burn wounds with XF-70 may be effective in slowing bacterial dissemination to other tissues. PMID:20453736

  12. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    PubMed Central

    Dina Jarjis, Reem; Thomas Crewe, Bjørn; Henrik Matzen, Steen

    2016-01-01

    Introduction Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Methods This case report has been reported in line with the CARE criteria. Presentation of case A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction. Discussion Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey. Conclusion Although more research is needed for definitive conclusions of honey’s efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment. PMID:26773204

  13. [Importance of modern treatment procedures for infected and colonized wounds in dermatology].

    PubMed

    Daeschlein, G; Lutze, S; Arnold, A; von Podewils, S; Jünger, M

    2014-11-01

    In the coming years increasing numbers of patients with chronic ulcers and tumor wounds are to be expected, both of which are typically multifaceted diseases requiring complex and increasingly long-term ambulatory therapy. Therefore, in recent years special medical emphasis has been placed on efficacious therapies with good tolerability and also suitability regarding feasibility for outpatient treatment. Some of these methods, such as cold plasma therapy, extracorporeal shock wave therapy (ESWT), water-filtered infrared therapy (wIRA), electrostimulation (ES) and low level laser therapy (LLLT) have a good chance of success when applied as an adjuvant method in the multimodal treatment concept for patients with recalcitrant wounds. All of these methods have at least indirect antimicrobial properties which can be advantageous in cases of microbial infiltration of wounds. As for all other methods for treating recalcitrant wounds, the promising application of the aforementioned methods requires great expertise in wound healing together with a broad and continuous interdisciplinary diagnostics and therapy (wound center). PMID:25336295

  14. Synergistic Antibacterial Activity of Plant Peptide MBP-1 and Silver Nanoparticles Combination on Healing of Infected Wound Due to Staphylococcus aureus

    PubMed Central

    Salouti, Mojtaba; Mirzaei, Fatemeh; Shapouri, Reza; Ahangari, Azam

    2016-01-01

    Background: Wound infection is a common problem in hospitals and is typically caused by the antibiotic-resistant Staphylococcus aureus, which is a major pathogen for skin and soft tissue infections worldwide. Objectives: The aim of this study was to investigate the synergistic antibacterial effect of plant peptide MBP-1 and silver nanoparticles on infected wounds caused by S. aureus. Materials and Methods: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of MBP-1 and silver nanoparticles both on their own and in combination form were determined against S. aureus via macrodilution and microdilution methods. The synergistic antibacterial effect of silver nanoparticles and MBP-1 was investigated on infected wounds caused by S. aureus in a mouse model. Results: The MIC and MBC of MBP-1 were found to be 0.6 and 0.7 mg/mL, respectively. MIC and MBC of silver nanoparticles were determined to be 6.25 and 12.5 mg/L, respectively. MIC and MBC of the silver nanoparticles and MBP-1 combination were found to be 3.125 mg/mL, 0.5 mg/L; and 6.25 mg/mL, 0.6 mg/L, respectively. The infected wound healed properly after the combined use of MBP-1 and silver nanoparticles. Conclusions: The synergistic effect was found on the healing of infected wounds caused by S. aureus by using an MBP-1 and silver nanoparticles combination in a mouse model. PMID:27099683

  15. A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications.

    PubMed

    Chan, Monica; Yusuf, Erlangga; Giulieri, Stefano; Perrottet, Nancy; Von Segesser, Ludwig; Borens, Olivier; Trampuz, Andrej

    2016-03-01

    Deep sternal wound infection (DSWI) is a feared complication following cardiac surgery. This study describes clinical, microbiological, and treatment outcomes of DSWI and determines risk factors for complications. Of 55 patients with DSWI, 66% were male and mean age was 68.2years. Initial sternotomy was for coronary artery bypass graft in 49% of patients. Sternal debridement at mean 25.4±18.3days showed monomicrobial (94%), mainly Gram-positive infection. Secondary sternal wound infection (SSWI) occurred in 31% of patients, was mostly polymicrobial (71%), and was predominantly due to Gram-negative bacilli. Risk factors for SSWI were at least 1 revision surgery (odds ratio [OR] 4.8 [95% confidence interval {CI} 1.0-22.4], P=0.047), sternal closure by muscle flap (OR 4.6 [1.3-16.8], P=0.02), delayed sternal closure (mean 27 versus 14days, P=0.03), and use of vacuum-assisted closure device (100% versus 58%, P=0.008). Hospital stay was significantly longer in patients with SSWI (69days versus 48days, P=0.04). PMID:26707065

  16. Porous CS based membranes with improved antimicrobial properties for the treatment of infected wound in veterinary applications.

    PubMed

    Tonda-Turo, C; Ruini, F; Argentati, M; Di Girolamo, N; Robino, P; Nebbia, P; Ciardelli, G

    2016-03-01

    Recently, much attention has been given to the use of innovative solution for the treatment of infected wounds in animals. Current applied treatments are often un-effective leading to infection propagation and animal death. Novel engineered membranes based on chitosan (CS) can be prepared to combine local antimicrobial effect, high flexibility and easy manipulation. In this work, CS crosslinked porous membranes with improved antimicrobial properties were prepared via freeze-drying technique to promote wound healing and to reduce the bacterial proliferation in infected injuries. Silver nanoparticles (AgNPs) and gentamicin sulfate (GS) were incorporated into the CS matrices to impart antibacterial properties on a wild range of strains. CS based porous membranes were tested for their physicochemical, thermal, mechanical as well as swelling and degradation behavior at physiological condition. Additionally, GS release profile was investigated, showing a moderate burst effect in the first days followed by a decreasing release rate which it was maintained for at least 56 days. Moreover, porous membranes loaded with GS or AgNPs showed good bactericidal activity against both of Gram-positive and Gram-negative bacteria. The bacterial strains used in this work were collected in chelonians after carapace injuries to better mimic the environment after trauma. PMID:26706548

  17. Severe Wound Infection with Photobacterium damselae ssp. damselae and Vibrio harveyi, following a Laceration Injury in Marine Environment: A Case Report and Review of the Literature.

    PubMed

    Hundenborn, Jörg; Thurig, Steffi; Kommerell, Mechthild; Haag, Heike; Nolte, Oliver

    2013-01-01

    Marine microorganisms are uncommon etiologies of skin and skin structure infections, that is, wound infections. We report a case of severe wound infection, caused by the marine Photobacterium damselae (Vibrionaceae), in a 64-year-old male patient, returning from Australia. The isolate tested positive for pPHDD1, a plasmid conferring high-level virulence. Furthermore, the wound was coinfected with Vibrio harveyi, a halophile bacterium, which has never been reported from human infections before. Identification was achieved by use of Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry (MALDI-TOF) and confirmed by 16S rDNA sequencing. Data retrieval from bibliography was complicated since P. damselae has been renamed often with a number of synonyms present in the literature: Photobacterium damsela, Vibrio damselae, Vibrio damsela, Pasteurella damselae, and Listonella damsela. With all synonyms used as query terms, a literature search provided less than 20 cases published worldwide. A majority of those cases presenting as severe wound infection are even fatal following progression into necrotizing fasciitis. Management with daily wound dressing and antibiotic therapy (ofloxacin empirically, followed by doxycycline after availability of microbiology) led in the reported case to a favorable outcome, which seems to be, however, the exception based on a review of the available literature. PMID:24171004

  18. Severe Wound Infection with Photobacterium damselae ssp. damselae and Vibrio harveyi, following a Laceration Injury in Marine Environment: A Case Report and Review of the Literature

    PubMed Central

    Hundenborn, Jörg; Thurig, Steffi

    2013-01-01

    Marine microorganisms are uncommon etiologies of skin and skin structure infections, that is, wound infections. We report a case of severe wound infection, caused by the marine Photobacterium damselae (Vibrionaceae), in a 64-year-old male patient, returning from Australia. The isolate tested positive for pPHDD1, a plasmid conferring high-level virulence. Furthermore, the wound was coinfected with Vibrio harveyi, a halophile bacterium, which has never been reported from human infections before. Identification was achieved by use of Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry (MALDI-TOF) and confirmed by 16S rDNA sequencing. Data retrieval from bibliography was complicated since P. damselae has been renamed often with a number of synonyms present in the literature: Photobacterium damsela, Vibrio damselae, Vibrio damsela, Pasteurella damselae, and Listonella damsela. With all synonyms used as query terms, a literature search provided less than 20 cases published worldwide. A majority of those cases presenting as severe wound infection are even fatal following progression into necrotizing fasciitis. Management with daily wound dressing and antibiotic therapy (ofloxacin empirically, followed by doxycycline after availability of microbiology) led in the reported case to a favorable outcome, which seems to be, however, the exception based on a review of the available literature. PMID:24171004

  19. Contamination of an operating theatre by Gram-negative bacteria. Examination of water supplies, cleaning methods and wound infections

    PubMed Central

    Thomas, Mair E. M.; Piper, Elizabeth; Maurer, Isobel M.

    1972-01-01

    This paper describes a search for Gram-negative bacteria in an operating theatre and the steps taken to reduce the level of environmental contamination. A high rate of infection in clean wounds prompted a bacteriological survey. Potential sources of infection found, and the measures employed are described in the hope that others may be encouraged to examine familiar equipment critically and to improve hygiene even in old premises. The choice, design, use and care of cleaning and sterilizing equipment were open to criticism. In particular, a currently popular floor-scrubbing machine provided a breeding ground for Pseudomonas aeruginosa and was distributing it in the theatre environment. ImagesPlate 1 PMID:4622481

  20. Aloe vera Gel: Effective Therapeutic Agent against Multidrug-Resistant Pseudomonas aeruginosa Isolates Recovered from Burn Wound Infections

    PubMed Central

    Goudarzi, Mehdi; Fazeli, Maryam; Azad, Mehdi; Seyedjavadi, Sima Sadat; Mousavi, Reza

    2015-01-01

    Objective. Aloe vera is an herbal medicinal plant with biological activities, such as antimicrobial, anticancer, anti-inflammatory, and antidiabetic ones, and immunomodulatory properties. The purpose of this study was investigation of in vitro antimicrobial activity of A. vera gel against multidrug-resistant (MDR) Pseudomonas aeruginosa isolated from patients with burn wound infections. Methods. During a 6-month study, 140 clinical isolates of P. aeruginosa were collected from patients admitted to the burn wards of a hospital in Tehran, Iran. Antimicrobial susceptibility test was carried out against the pathogens using the A. vera gel and antibiotics (imipenem, gentamicin, and ciprofloxacin). Results. The antibiogram revealed that 47 (33.6%) of all isolates were MDR P. aeruginosa. The extract isolated from A. vera has antibacterial activity against all of isolates. Also, 42 (89.4%) isolates were inhibited by A. vera gel extract at minimum inhibitory concentration (MIC) ≤ 200 µg/mL. MIC value of A. vera gel for other isolates (10.6%) was 800 µg/mL. All of MDR P. aeruginosa strains were inhibited by A. vera at similar MIC50 and MIC90 200 µg/mL. Conclusion. Based on our results, A. vera gel at various concentrations can be used as an effective antibacterial agent in order to prevent wound infection caused by P. aeruginosa. PMID:26266047

  1. Therapy of infections in mice irradiated in mixed neutron/photon fields and inflicted with wound trauma: A review of current work. (Reannouncement with new availability information)

    SciTech Connect

    Ledney, G.D.; Madonna, G.S.; Elliott, T.B.; Moore, M.M.; Jackson, W.E.

    1991-12-31

    When host antimicrobial defenses are severely compromised by radiation or trauma in conjunction with radiation, death from sepsis results. To evaluate therapies for sepsis in radiation casualties, the authors developed models of acquired and induced bacterial infections in irradiated and irradiated-wounded mice. Animals were exposed to either a mixed radiation field of equal proportions of neutrons and gamma rays (n/gamma = 1) from a TRIGA reactor or pure gamma rays from 60 (Co sources). Skin wounds (15% of total body surface area) were inflicted under methoxyflurane anesthesia 1 h after irradiation. In all mice, wounding after irradiation decreased resistance to infection. Treatments with the immunomodulator synthetic trehalose dicorynomycolate (S-TDCM) before or after mixed neutron-gamma irradiation or gamma irradiation increased survival. Therapy with S-TDCM for mice irradiated with either a mixed field or gamma rays increased resistance to Klebsiella pneumoniae-induced infections.

  2. In vivo bioluminescence imaging to evaluate systemic and topical antibiotics against community-acquired methicillin-resistant Staphylococcus aureus-infected skin wounds in mice.

    PubMed

    Guo, Yi; Ramos, Romela Irene; Cho, John S; Donegan, Niles P; Cheung, Ambrose L; Miller, Lloyd S

    2013-02-01

    Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents. PMID:23208713

  3. Chloramphenicol encapsulated in poly-ε-caprolactone–pluronic composite: nanoparticles for treatment of MRSA-infected burn wounds

    PubMed Central

    Kalita, Sanjeeb; Devi, Banasmita; Kandimalla, Raghuram; Sharma, Kaustav Kalyan; Sharma, Arup; Kalita, Kasturi; Kataki, Amal Chandra; Kotoky, Jibon

    2015-01-01

    The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased precipitously over the past several decades, with far-reaching health care and societal costs. MRSA infections in the context of burn wounds lead to invasive disease that could potentially cause mortality. Chloramphenicol is a well-known broad-spectrum bacteriostatic antibiotic that has been used since 1949, but due to its hydrophobicity, poor penetration in skin, fast degradation, and toxicity, its application has been hindered. Furthermore, it has been demonstrated that old antibiotics such as chloramphenicol remained active against a large number of currently prevalent resistant bacterial isolates due to their low-level use in the past. Recently, the novel nanoparticulate drug-delivery system has been used and reported to be exceptionally useful for topical therapeutics, due to its distinctive physical characteristics such as a high surface-to-volume ratio and minuscule size. It helps to achieve better hydrophilicity, bioavailability, and controlled delivery with enhanced therapeutic index, which has resulted in decreased toxicity levels compared to the crude drug. Here, we report a novel chloramphenicol loaded with poly(ε-caprolactone) (PCL)-pluronic composite nanoparticles (CAM-PCL-P NPs), physicochemical characterizations, and its bioactivity evaluation in a MRSA-infected burn-wound animal model. CAM-PCL-P NPs could encapsulate 98.3% of the drug in the nanoparticles and release 81% of the encapsulated drug over 36 days with a time to 50% drug release of 72 hours (51%). Nanoparticle suspensions maintained the initial properties with respect to size and encapsulation efficiency, even after 6 months of storage at 4°C and 25°C, respectively (P>0.05). Significant reduction in the level of toxicity was observed for CAM-PCL-P NPs compared with that of free drug as confirmed from hemolytic activity against human blood erythrocytes and cytotoxicity assay against an MCF-7

  4. Negative Pressure Wound Therapy With Instillation (NPWTi) Better Reduces Post-debridement Bioburden in Chronically Infected Lower Extremity Wounds Than NPWT Alone

    PubMed Central

    Goss, S.G.; Schwartz, J.A.; Facchin, F.; Avdagic, E.; Gendics, C.; Lantis, J.C.

    2014-01-01

    Objective An overabundance of bacteria in the chronic wound plays a significant role in the decreased ability for primary closure. One means of decreasing the bioburden in a wound is to operatively debride the wound for wound bed optimization prior to application of other therapy, such as Negative Pressure Wound Therapy (NPWT). We undertook a prospective pilot study to assess the efficacy of wound bed preparation for a standard algorithm (sharp surgical debridement followed by NPWT) versus one employing sharp surgical debridement followed by Negative Pressure Wound Therapy with Instillation (NPWTi). Methods Thirteen patients, corresponding to 16 chronic lower leg and foot wounds were taken to the operating room for debridement. The patients were sequentially enrolled in 2 treatment groups: the first receiving treatment with operative debridement followed by 1 week of NPWT with the instillation of quarter strength bleach solution; the other receiving a standard algorithm consisting of operative debridement and 1 week of NPWT. Quantitative cultures were taken pre-operatively after sterile preparation and draping of the wound site (POD # 0, pre-op), post-operatively once debridement was completed (POD # 0, post-op), and on post-operative day 7 after operative debridement (POD # 7, post-op). Results After operative debridement (post-operative day 0) there was a mean of 3 (±1) types of bacteria per wound. The mean CFU/gram tissue culture was statistically greater – 3.7 × 106 (±4 × 106) in the NPWTi group, while in the standard group (NPWT) the mean was 1.8 × 106 (±2.36 × 106) CFU/gram tissue culture (p = 0.016); at the end of therapy there was no statistical difference between the two groups (p = 0.44). Wounds treated with NPWTi had a mean of 2.6 × 105 (±3 × 105) CFU/gram of tissue culture while wounds treated with NPWT had a mean of 2.79 × 106 (±3.18 × 106) CFU/gram of tissue culture (p = 0.43). The mean absolute reduction in

  5. Wound Care.

    PubMed

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve. PMID:26022525

  6. Intervention for Postpartum Infections Following Caesarean Section

    ClinicalTrials.gov

    2015-04-20

    Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

  7. The protective effect of topical rifamycin treatment against sternal wound infection in diabetic patients undergoing on-pump coronary artery bypass graft surgery

    PubMed Central

    Aygun, Fatih; Kuzgun, Ahmet; Ulucan, Seref; Keser, Ahmet; Akpek, Mahmut; Kaya, Mehmet G

    2014-01-01

    Summary Objectives The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients, 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores, patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery, and the control group (n = 73) received no topical treatment. Results Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73, p = 1.0). No superficial sternal wound infection was observed in the rifamycin group, however, it did occur in one patient in the control group (0/78 vs 1/73, p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant, locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI. PMID:24687038

  8. Common questions about wound care.

    PubMed

    Worster, Brooke; Zawora, Michelle Q; Hsieh, Christine

    2015-01-15

    Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Occlusion of the wound is key to preventing contamination. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Severe burns and wounds that cover large areas of the body or involve the face, joints, bone, tendons, or nerves should generally be referred to wound care specialists. PMID:25591209

  9. Analysis of Healing Effect of Alginate Sulfate Hydrogel Dressing Containing Antimicrobial Peptide on Wound Infection Caused by Methicillin-Resistant Staphylococcus aureus

    PubMed Central

    Babavalian, Hamid; Latifi, Ali Mohammad; Shokrgozar, Mohammad Ali; Bonakdar, Shahin; Mohammadi, Sajjad; Moosazadeh Moghaddam, Mehrdad

    2015-01-01

    Background: Wound infections caused by methicillin-resistant Staphylococcus aureus are a health problem worldwide; therefore, it is necessary to develop new antimicrobial compounds. Considering broad-spectrum antimicrobial activity and low probability of drug resistance to peptides, applications these peptides are being studied extensively. Objectives: In this study, to control drug release over time, an alginate sulfate-based hydrogel impregnated with the CM11 peptide as the antimicrobial agent was developed, and its healing effects were tested on skin infections caused by methicillin-resistant S. aureus strains in a mouse model. Materials and Methods: Minimum inhibitory and minimum bactericidal concentrations of the CM11 peptide and alginate hydrogel in combination with the peptide were determined. Forty mice were divided into 4 groups: 1 group as a negative control (without treatment; however, 5 mice received hydrogel dressing without peptide), 1 group as a positive control (2% mupirocin treatment), and 2 groups as test groups. To establish skin infection, 200 μL of bacterial suspension with 3 × 108 CFU/mL concentration was subcutaneously injected in the scapular region of the mice. On the basis of the in vitro minimal bactericidal concentration of the alginate hydrogel containing peptide for 15 clinical isolates, hydrogel containing 128 mg/L of peptide was used for wound dressing over an 8-day period. Results: The highest and lowest numbers of wounds were observed on day 2 in the negative and positive control groups, respectively. During the 8-day period, the positive control and hydrogel containing peptide treatment groups showed similar levels of wound healing. Conclusions: This study showed that compared to standard drug treatment, treatment with hydrogel containing peptide had substantial antibacterial effects on S. aureus wound infections in mice. PMID:26487923

  10. Prevention of bloodstream infections by photodynamic inactivation of multiresistant Pseudomonas aeruginosa in burn wounds

    NASA Astrophysics Data System (ADS)

    Hashimoto, M. C. E.; Prates, R. A.; Toffoli, D. J.; Courrol, L. C.; Ribeiro, M. S.

    2010-02-01

    Bloodstream infections are potentially life-threatening diseases. They can cause serious secondary infections, and may result in endocarditis, severe sepsis or toxic-shock syndrome. Pseudomonas aeruginosa is an opportunistic pathogen and one of the most important etiological factors responsible for nosocomial infections, mainly in immuno-compromissed hosts, characteristic of patients with severe burns. Its multiresistance to antibiotics produces many therapeutic problems, and for this reason, the development of an alternative method to antibiotic therapy is needed. Photodynamic inactivation (PDI) may be an effective and alternative therapeutic option to prevent bloodstream infections in patients with severe burns. In this study we report the use of PDI to prevent bloodstream infections in mice with third-degree burns. Burns were produced on the back of the animals and they were infected with 109 cfu/mL of multi-resistant (MR) P. aeruginosa. Fifteen animals were divided into 3 groups: control, PDT blue and PDT red. PDT was performed thirty minutes after bacterial inoculation using 10μM HB:La+3 and a light-emitting diode (LED) emitting at λ=460nm+/-20nm and a LED emitting at λ=645 nm+/-10nm for 120s. Blood of mice were colected at 7h, 10h, 15h, 18h and 22h pos-infection (p.i.) for bacterial counting. Control group presented 1×104 cfu/mL in bloodstream at 7h p.i. increasing to 1×106 at 22h, while mice PDT-treated did not present any bacteria at 7h; only at 22h p.i. they presented 1×104cfu/mL. These results suggest that HB:La+3 associated to blue LED or red LED is effective to delay and diminish MR P.aeruginosa bloodstream invasion in third-degree-burned mice.

  11. Evaluation of Gallium Citrate Formulations against a Multidrug-Resistant Strain of Klebsiella pneumoniae in a Murine Wound Model of Infection.

    PubMed

    Thompson, Mitchell G; Truong-Le, Vu; Alamneh, Yonas A; Black, Chad C; Anderl, Jeff; Honnold, Cary L; Pavlicek, Rebecca L; Abu-Taleb, Rania; Wise, Matthew C; Hall, Eric R; Wagar, Eric J; Patzer, Eric; Zurawski, Daniel V

    2015-10-01

    Skin and soft tissue infections (SSTIs) are a common occurrence in health care facilities with a heightened risk for immunocompromised patients. Klebsiella pneumoniae has been increasingly implicated as the bacterial agent responsible for SSTIs, and treatment can be challenging as more strains become multidrug resistant (MDR). Therefore, new treatments are needed to counter this bacterial pathogen. Gallium complexes exhibit antimicrobial activity and are currently being evaluated as potential treatment for bacterial infections. In this study, we tested a topical formulation containing gallium citrate (GaCi) for the treatment of wounds infected with K. pneumoniae. First, the MIC against K. pneumoniae ranged from 0.125 to 2.0 μg/ml GaCi. After this in vitro efficacy was established, two topical formulations with GaCi (0.1% [wt/vol] and 0.3% [wt/vol]) were tested in a murine wound model of MDR K. pneumoniae infection. Gross pathology and histopathology revealed K. pneumoniae-infected wounds appeared to close faster with GaCi treatment and were accompanied by reduced inflammation compared to those of untreated controls. Similarly, quantitative indications of infection remediation, such as reduced weight loss and wound area, suggested that treatment improved outcomes compared to those of untreated controls. Bacterial burdens were measured 1 and 3 days following inoculation, and a 0.5 to 1.5 log reduction of CFU was observed. Lastly, upon scanning electron microscopy analysis, GaCi treatment appeared to prevent biofilm formation on dressings compared to those of untreated controls. These results suggest that with more preclinical testing, a topical application of GaCi may be a promising alternative treatment strategy for K. pneumoniae SSTI. PMID:26239978

  12. Evaluation of Gallium Citrate Formulations against a Multidrug-Resistant Strain of Klebsiella pneumoniae in a Murine Wound Model of Infection

    PubMed Central

    Thompson, Mitchell G.; Truong-Le, Vu; Alamneh, Yonas A.; Black, Chad C.; Anderl, Jeff; Honnold, Cary L.; Pavlicek, Rebecca L.; Abu-Taleb, Rania; Wise, Matthew C.; Hall, Eric R.; Wagar, Eric J.; Patzer, Eric

    2015-01-01

    Skin and soft tissue infections (SSTIs) are a common occurrence in health care facilities with a heightened risk for immunocompromised patients. Klebsiella pneumoniae has been increasingly implicated as the bacterial agent responsible for SSTIs, and treatment can be challenging as more strains become multidrug resistant (MDR). Therefore, new treatments are needed to counter this bacterial pathogen. Gallium complexes exhibit antimicrobial activity and are currently being evaluated as potential treatment for bacterial infections. In this study, we tested a topical formulation containing gallium citrate (GaCi) for the treatment of wounds infected with K. pneumoniae. First, the MIC against K. pneumoniae ranged from 0.125 to 2.0 μg/ml GaCi. After this in vitro efficacy was established, two topical formulations with GaCi (0.1% [wt/vol] and 0.3% [wt/vol]) were tested in a murine wound model of MDR K. pneumoniae infection. Gross pathology and histopathology revealed K. pneumoniae-infected wounds appeared to close faster with GaCi treatment and were accompanied by reduced inflammation compared to those of untreated controls. Similarly, quantitative indications of infection remediation, such as reduced weight loss and wound area, suggested that treatment improved outcomes compared to those of untreated controls. Bacterial burdens were measured 1 and 3 days following inoculation, and a 0.5 to 1.5 log reduction of CFU was observed. Lastly, upon scanning electron microscopy analysis, GaCi treatment appeared to prevent biofilm formation on dressings compared to those of untreated controls. These results suggest that with more preclinical testing, a topical application of GaCi may be a promising alternative treatment strategy for K. pneumoniae SSTI. PMID:26239978

  13. Reconstruction of severely infected gluteal osteoradionecrosis using negative-pressure wound therapy and latissimus dorsi musculocutaneous flaps.

    PubMed

    Kim, Sang Wha; Youn, Dong Geun; Hwang, Kyu Tae; Kim, Jeong Tae; Kim, Youn Hwan

    2016-01-01

    Radiotherapy is mandatory for aggressive cancer treatment. Unfortunately, the high-energy radiation used can lead to severe osteoradionecrosis. Radical debridement of devitalized bone and soft tissue coupled with reconstruction using well-vascularized tissues is the accepted treatment for this condition. However, osteoradionecrosis cannot be controlled easily or rapidly. The aim of this study was to present the results of the use of serial negative-pressure wound therapy (NPWT) in combination with a latissimus dorsi myocutaneous flap for treatment of gluteal osteoradionecrosis in a consecutive series of patients. Between January 2003 and December 2012, nine patients underwent reconstruction using serial NPWT and latissimus dorsi myocutaneous flaps. We applied negative-pressure dressings for at least 8 weeks. Final reconstruction was performed after the infection was controlled. The superior gluteal artery and vein were used as recipient vessels in all the cases. The mean interval between operation and radiation therapy was 28.3 ± 8.3 years, and the mean number of debridement performed was 6.3 ± 1. NPWT dressings were applied for 8-12 weeks (mean, 9.3 ± 2 weeks). The defects ranged in size from 14 × 8 cm to 18 × 15 cm. The flap size ranged from 15 × 10 cm to 18 × 15 cm. All flaps survived uneventfully except in one patient who experienced chronic seroma and wound dehiscence. There were no recurrences of osteomyelitis during the follow-up periods (mean, 14 ± 6.1 months). Based on the results obtained from this consecutive series of patients, we suggest that this methodology may provide an alternative approach for the treatment of severe osteoradionecrosis of the gluteal region. PMID:25641653

  14. Symbiosis theory-directed green synthesis of silver nanoparticles and their application in infected wound healing

    PubMed Central

    Wen, Lu; Zeng, Pei; Zhang, Liping; Huang, Wenli; Wang, Hui; Chen, Gang

    2016-01-01

    In this study, silver nanoparticles (AgNPs) were synthesized for the first time using an antibacterial endophytic fungus of Chinese medicinal herb Orchidantha chinensis, which has anti-inflammatory and antimicrobial activities. The AgNPs were analyzed by various characterization techniques to reveal their morphology, chemical composition, and stability. Also, the relationship between Chinese medicinal herbs, endophytic fungi, and the property of AgNPs was investigated for the first time. Interestingly, an experiment performed in this study revealed the proteins produced by the endophytic fungus to be capped on the nanoparticles, which led to an increase in the stability of spherical and polydispersed AgNPs with low aggregation for over 6 months. More importantly, further study demonstrated that the AgNPs possessed superior antibacterial activity and effectively promoted wound healing. Altogether, the biosynthesis of active AgNPs using the endophytic fungus from Chinese medicinal herb based on the symbiosis theory is simple, eco-friendly, and promising. PMID:27358563

  15. Exploration of alginate hydrogel/nano zinc oxide composite bandages for infected wounds

    PubMed Central

    Mohandas, Annapoorna; PT, Sudheesh Kumar; Raja, Biswas; Lakshmanan, Vinoth-Kumar; Jayakumar, Rangasamy

    2015-01-01

    Alginate hydrogel/zinc oxide nanoparticles (nZnO) composite bandage was developed by freeze-dry method from the mixture of nZnO and alginate hydrogel. The developed composite bandage was porous with porosity at a range of 60%–70%. The swelling ratios of the bandages decreased with increasing concentrations of nZnO. The composite bandages with nZnO incorporation showed controlled degradation profile and faster blood clotting ability when compared to the KALTOSTAT® and control bandages without nZnO. The prepared composite bandages exhibited excellent antimicrobial activity against Escherichia coli, Staphylococcus aureus, Candida albicans, and methicillin resistant S. aureus (MRSA). Cytocompatibility evaluation of the prepared composite bandages done on human dermal fibroblast cells by Alamar assay and infiltration studies proved that the bandages have a non-toxic nature at lower concentrations of nZnO whereas slight reduction in viability was seen with increasing nZnO concentrations. The qualitative analysis of ex-vivo re-epithelialization on porcine skin revealed keratinocyte infiltration toward wound area for nZnO alginate bandages. PMID:26491307

  16. Factors Affecting Wound Healing

    PubMed Central

    Guo, S.; DiPietro, L.A.

    2010-01-01

    Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. PMID:20139336

  17. Efficacy of the Quorum Sensing Inhibitor FS10 Alone and in Combination with Tigecycline in an Animal Model of Staphylococcal Infected Wound

    PubMed Central

    Cacciatore, Ivana; Baldassarre, Leonardo; Orlando, Fiorenza; Pierpaoli, Elisa; Lucarini, Guendalina; Orsetti, Elena; Provinciali, Mauro; Fornasari, Erika; Di Stefano, Antonio; Giacometti, Andrea; Offidani, Annamaria

    2016-01-01

    In staphylococci, quorum sensing regulates both biofilm formation and toxin production, moreover it has been demonstrated to be inhibited by RNAIII inhibiting peptide (RIP). Aim our study was to evaluate the in vitro activity and its in vivo efficacy of the combined administration of FS10, a novel RIP derivative, and tigecycline in an animal model of methicillin-resistant (MR) and methicillin-sensitive (MS) Staphylococcus aureus wound infection. Using a 1.x2 cm template, one full thickness wound was established through the panniculus carnosus on the back subcutaneous tissue of each animal. Infection was determined by inoculation of 5x107 CFU/ml of bacteria, that produced an abscess within 24 h, after this, treatment was initiated. The study included, for each strain, a control group without infection, a control infected group that did not receive any treatment and a control infected group with drug-free foam dressing, and three infected groups treated, respectively, with: FS10-soaked foam dressing (containing 20 μg FS10), daily intraperitoneal tigecycline (7 mg/Kg), FS10-soaked foam dressing (containing 20 μg FS10) and daily intraperitoneal injections of tigecycline (7 mg/Kg). The main outcome measures were quantitative culture and histological examination of tissue repair. The highest inhibition of infection was achieved in the group that received FS10-soaked and parenteral tigecycline reducing the bacterial load from 107 CFU/ml to about 103 CFU/g for MSSA and to about 104 CFU/g for MRSA. The group treated with FS10-soaked foam dressing associated with parenteral tigecycline showed, histologically, better overall healing with epithelialization and collagen scores significantly higher than those of the other groups in both strains. In conclusion, the combined use of topical FS10 with i.p. tigecycline induced positive interaction in vivo, resulting in an enhanced therapeutic benefit versus staphylococcal infections in murine wound models. PMID:27253706

  18. Frequency of Pseudomonas aeruginosa serotypes in burn wound infections and their resistance to antibiotics.

    PubMed

    Estahbanati, Hamid Karimi; Kashani, Parnian Pour; Ghanaatpisheh, Fahimeh

    2002-06-01

    Pseudomonas aeruginosa plays a prominent role as an etiological agent involved in serious infections in burned patients. In this study P. aeruginosa infections were analyzed at the Motahari Burn Center in Tehran (from 22 December 1998 to April 1999) to estimate their frequency, antibiotic susceptibility and serotypes. One hundred and eighty-four positive cultures and 205 bacterial strains were isolated among swabs or biopsy specimens during the study period. Pseudomonas was found to be the most common (57%) followed by Acinetobacter (17%), Escherichia coli (12%), Staphylococcus aureus (8%) and other organisms (6%). The frequency of P. aeruginosa resistance to gentamicin, ceftizoxime, carbenicillin, cephalothin and ceftazidime was over 90%. The antibiotics to which P. aeruginosa was most sensitive were amikacin and tetracyclin. The "O" serotypes isolated from the 117 Pseudomona aeroginosa isolates were serotypes O:2, O:5, O:6, O:8, O:11, O:12 and O:16. The most common serotype was O:6 (20/17%) followed by O:11 (18/15%) and O:5 (14/12%). The serotype most resistant was O:16 (8%) and the most sensitive was O:8 (2%). Since treatment of infection with available antibiotics according to the results attained proved to be difficult, prevention of infection in the burned patients is considered as an appropriate means of conquering overcoming infection problems. The sum of frequencies of serotypes O:6, O:11, O:5 and O:16 was more than 60%, therefore vaccination of burn patients with polyvalent antiserum to these serotypes could possibly produce immunity in more than half of the burned patients. PMID:12052372

  19. Efficacy of topical and systemic antibiotic treatment of meticillin-resistant Staphylococcus aureus in a murine superficial skin wound infection model.

    PubMed

    Vingsbo Lundberg, Carina; Frimodt-Møller, Niels

    2013-09-01

    Meticillin-resistant Staphylococcus aureus (MRSA) is a rapidly spreading pathogen associated predominantly with skin infections. The lack of clinical evidence indicating the best treatment strategy to combat MRSA skin infections prompted us to investigate the efficacy of available treatment options in an experimental skin wound infection model in mice. Mice were treated either topically with retapamulin (1%), fusidic acid (2%) or mupirocin (2%) or systemically with linezolid (50-100 mg/kg/day) or vancomycin (50-200 mg/kg/day) twice daily for 3 days or 6 days and the total bacterial loads in the skin lesions were determined. Retapamulin, fusidic acid and mupirocin treatment for 3 days reduced the bacterial loads by 2.5, 2.9 and 2.0 log(10) CFU, respectively, and treatment for 6 days by 5.0, 4.2 and 5.1 log(10) CFU, respectively, compared with non-treated controls (P < 0.001). Systemic treatment with linezolid for 6 days reduced the bacterial loads by 1.6 log(10) CFU compared with non-treated mice (P < 0.001), whereas vancomycin treatment showed no effect on reducing the bacterial loads in infected skin lesions. These findings suggest that topical treatment with retapamulin and mupirocin is significantly more effective than systemic treatment with linezolid and vancomycin in eradicating MRSA in skin wounds. Retapamulin and mupirocin may provide an alternative to fusidic acid treatment of MRSA in skin wounds when resistance to fusidic acid is suspected. PMID:23837927

  20. The influence of moisture wound healing on the incidence of bacterial infection and histological changes in healthy human skin after treatment of interactive dressings.

    PubMed

    Koupil, J; Brychta, P; Horký, D; Smola, J; Prásek, J

    2003-01-01

    In this article the authors discuss the problem faced by physicians when trying to use moisture-retentive dressing in pressure sores (decubitus ulcers). First, they report the results of an in vitro study using a new model of experimental wound (radio-isotopic investigation) that assesses the release of Ringer's solution from interactive dressings continually during fourteen hours. Second, they perform an animal experiment that assesses the incidence of wound infection in defects treated conventionally or using interactive dressings. The defects treated with interactive pads had lower incidence of wound infection, and the process of wound healing was rapid. Finally, the authors discuss their experience in four paraplegic patients with decubitus ulcers where they used moisture-retentive dressing on ulcers and on the surrounding intact skin before surgical procedure to detect the possibility of maceration of healthy skin. Histological evaluation was performed in order to find microscopically changes after moisture healing. The changes of healthy skin were not significant after treatment of moisture-retentive dressings. PMID:14733252

  1. Chronic Wound Biofilm Model

    PubMed Central

    Ganesh, Kasturi; Sinha, Mithun; Mathew-Steiner, Shomita S.; Das, Amitava; Roy, Sashwati; Sen, Chandan K.

    2015-01-01

    Significance: Multispecies microbial biofilms may contribute to wound chronicity by derailing the inherent reparative process of the host tissue. In the biofilm form, bacteria are encased within an extracellular polymeric substance and become recalcitrant to antimicrobials and host defenses. For biofilms of relevance to human health, there are two primary contributing factors: the microbial species involved and host response which, in turn, shapes microbial processes over time. This progressive interaction between microbial species and the host is an iterative process that helps evolve an acute-phase infection to a pathogenic chronic biofilm. Thus, long-term wound infection studies are needed to understand the longitudinal cascade of events that culminate into a pathogenic wound biofilm. Recent Advances: Our laboratory has recently published the first long-term (2 month) study of polymicrobial wound biofilm infection in a translationally valuable porcine wound model. Critical Issues: It is widely recognized that the porcine system represents the most translationally valuable approach to experimentally model human skin wounds. A meaningful experimental biofilm model must be in vivo, include mixed species of clinically relevant microbes, and be studied longitudinally long term. Cross-validation of such experimental findings with findings from biofilm-infected patient wounds is critically important. Future Directions: Additional value may be added to the experimental system described above by studying pigs with underlying health complications (e.g., metabolic syndrome), as is typically seen in patient populations. PMID:26155380

  2. Wound healing for the clinician.

    PubMed

    Zitelli, J

    1987-01-01

    Wound healing is a complex sequence of events, beginning with tissue injury, mediated by inflammation, and ending long after reepithelialization is complete. Research and controlled clinical experience have provided a better understanding so that clinicians can influence the events of healing to decrease pain, control bleeding, infection, and cosmetic result as well as speed the time for complete healing. The following is a summary of guidelines for the management of wound healing: (1) wound creation; wounds should be created with minimal necrosis of tissue in order to prevent delays in healing. Electrosurgical, cryosurgical, and laser surgical wounds heal more slowly than wounds created by scalpel excision or curettage. Electro-coagulation should be used sparingly in sutured wounds. Large lesions are best treated in a single stage rather than in divided treatments since the rate of wound healing is not proportional to the area but instead to the logarithm of the area. Thus, the total healing time is much shorter if done in a single treatment session. (2) use of drugs; corticosteroids given before or within three days of wounding in dose of prednisone 40 mg or greater will inhibit wound healing. Vitamin A topically or systemically may reverse this inhibition. Aspirin and other nonsteroidal anti-inflammatory agents are more important for their effects on platelet function and bleeding than on wound healing. (3) wound dressings; the use of occlusive dressings to promote moist wound healing is the most significant advance in wound management. Occlusive dressings shorten the time for healing, decrease pain, reduce wound contamination, and improve the cosmetic result. (4) control of wound contraction and scar formation; at the time of wound formation, guiding sutures may be helpful in wound healing by secondary intention in order to control the direction of wound contraction and prevent distortion. Intralesional steroids may be useful for hypertrophic scars and keloids

  3. Streptococcus hongkongensis sp. nov., isolated from a patient with an infected puncture wound and from a marine flatfish.

    PubMed

    Lau, Susanna K P; Curreem, Shirly O T; Lin, Cherry C N; Fung, Ami M Y; Yuen, Kwok-Yung; Woo, Patrick C Y

    2013-07-01

    A bacterium, HKU30(T), was isolated from the infected tissue of a patient with wound infection after puncture by a fish fin. Cells are facultative anaerobic, non-spore-forming, non-motile, Gram-positive cocci arranged in chains. Colonies were non-haemolytic. The strain was catalase, oxidase, urease and Voges-Proskauer test negative. It reacted with Lancefield's group G antisera and was resistant to optochin. It grew on bile aesculin agar and in 5 % NaCl. It was unidentified by three commercial identification systems. 16S rRNA gene sequence analysis indicated that the bacterium shared 98.2, 97.7, 97.4 and 97.1 % nucleotide identities with Streptococcus iniae, Streptococcus pseudoporcinus, Streptococcus parauberis and Streptococcus uberis, respectively. The DNA G+C content was 35.6 ± 0.9 mol% (mean ± sd). In view of the occupational exposure of the patient, an epidemiological study was performed to isolate the bacterium from marine fish. Two strains, with similar phenotypic and genotypic characteristics to those of HKU30(T), were isolated from a three-lined tongue sole (Cynoglossus abbreviatus) and an olive flounder (Paralichthys olivaceus) respectively. Phylogenetic analysis of four additional housekeeping genes, groEL, gyrB, sodA and rpoB, showed that the three isolates formed a distinct branch among known species of the genus Streptococcus, being most closely related to S. parauberis (CCUG 39954(T)). DNA-DNA hybridization demonstrated ≤ 53.8 % DNA relatedness between the three isolates and related species of the genus Streptococcus. A novel species, Streptococcus hongkongensis sp. nov., is proposed. The type strain is HKU30(T) ( = DSM 26014(T) = CECT 8154(T)). PMID:23264498

  4. Systemic inflammatory responses and multiple organ dysfunction syndrome following skin burn wound and Pseudomonas aeruginosa infection in mice.

    PubMed

    Li, Na; Hu, Xiaolong; Liu, Yang; Wang, Yaojun; Wang, Yunchuan; Liu, Jiaqi; Cai, Weixia; Bai, Xiaozhi; Zhu, Xiongxiang; Han, Juntao; Hu, Dahai

    2013-08-01

    Burn wound-related sepsis is associated with the development of systemic inflammatory response syndrome and multiple organ dysfunction syndrome (MODS). This study is aimed at investigating the development and progression of SIS and MODS in a mouse model of skin burn sepsis. C57BL/6J mice were randomly divided into the sham, burn, Pseudomonas, and burn/Pseudomonas groups. The back skin of the sham, burn, and burn/Pseudomonas groups was burned about 10% of total area with using 37°C or 98°C water for 8 s, respectively, followed by inoculating with Pseudomonas aeruginosa. The Pseudomonas group was infected with P. aeruginosa without burn injury. Their body weights, mortality, organ histology, and function as well as systemic inflammation were measured longitudinally. The burn/Pseudomonas mice lost more body weights than did mice from the other groups and had a significantly higher mortality rate (P < 0.05). The burn/Pseudomonas mice exhibited significantly higher levels of bacterial loads in different organs and serum endotoxin, interleukin 1β, interleukin 6, tumor necrosis factor α, and C-reactive protein than those in mice from the other groups (P < 0.05). The burn/Pseudomonas mice also displayed more severe liver, lung, and kidney tissue damage and impaired organ functions, particularly at 72 h after inoculation than did the burn and Pseudomonas groups of mice. Our data indicate that burn and P. aeruginosa infection induced severe sepsis and rapidly progressed into systemic inflammatory response syndrome and MODS in mice. PMID:23707977

  5. IL-15 Superagonist Expands mCD8+ T, NK and NKT Cells after Burn Injury but Fails to Improve Outcome during Burn Wound Infection

    PubMed Central

    Patil, Naeem K.; Luan, Liming; Bohannon, Julia K.; Guo, Yin; Hernandez, Antonio; Fensterheim, Benjamin; Sherwood, Edward R.

    2016-01-01

    Background Severely burned patients are highly susceptible to opportunistic infections and sepsis, owing to the loss of the protective skin barrier and immunological dysfunction. Interleukin-15 (IL-15) belongs to the IL-2 family of common gamma chain cytokines and stimulates the proliferation and activation of T (specifically memory CD8), NK and NKT cells. It has been shown to preserve T cell function and improve survival during cecal ligation and puncture (CLP)-induced sepsis in mice. However, the therapeutic efficacy of IL-15 or IL-15 superagonist (SA) during infection after burn injury has not been evaluated. Moreover, very few, if any, studies have examined, in detail, the effect of burn injury and infection on the adaptive immune system. Thus, we examined the effect of burn and sepsis on adaptive immune cell populations and the effect of IL-15 SA treatment on the host response to infection. Methods Mice were subjected to a 35% total body surface area burn, followed by wound infection with Pseudomonas aeruginosa. In some experiments, IL-15 SA was administered after burn injury, but before infection. Leukocytes in spleen, liver and peritoneal cavity were characterized using flow cytometry. Bacterial clearance, organ injury and survival were also assessed. Results Burn wound infection led to a significant decline in total white blood cell and lymphocyte counts and induced organ injury and sepsis. Burn injury caused decline in CD4+ and CD8+ T cells in the spleen, which was worsened by infection. IL-15 treatment inhibited this decline and significantly increased cell numbers and activation, as determined by CD69 expression, of CD4+, CD8+, B, NK and NKT cells in the spleen and liver after burn injury. However, IL-15 SA treatment failed to prevent burn wound sepsis-induced loss of CD4+, CD8+, B, NK and NKT cells and failed to improve bacterial clearance and survival. Conclusion Cutaneous burn injury and infection cause significant adaptive immune dysfunction. IL-15

  6. Pyoderma Gangrenosum Mimicking an Infected Wound following Dynamic Hip Screw Fixation

    PubMed Central

    Nizamoglu, Metin

    2015-01-01

    Pyoderma gangrenosum (PG) is an inflammatory ulcerative neutrophilic dermatosis that can occur following skin trauma. The correct diagnosis is not often made immediately as the condition can mimic an infective appearance. This leads to delays in the appropriate management of high dose steroids. Although debridement can offer aid in resolving lesions, this is contraindicated in the acute phase as this can cause acceleration of the pathogenic process. Biopsy of the lesion does not offer a definitive diagnosis; therefore suspicion must be maintained as the diagnosis is ultimately a clinical one. Any postoperative pustular ulcerative lesion not improving despite antibiotic therapy that also yields negative bacteriological and fungal studies should lead to consideration of this diagnosis. We document the first case of PG developing following intertrochanteric femur fracture fixation using dynamic hip screw. PMID:26380139

  7. Effects of inoculum density and wounding on stem infection of three Eastern U.S. forest species by Phytophthora ramorum

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Seedlings of three Eastern US forest species (red maple, northern red oak, and chestnut oak) were inoculated by applying Phytophthora ramorum sporangia to stems at different inoculum densities with and without wounding. Disease occurred in all treatments involving wounds, and no disease was observe...

  8. Wound Microbiology and Associated Approaches to Wound Management

    PubMed Central

    Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.

    2001-01-01

    The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds. PMID:11292638

  9. [Negative pressure wound therapy - review].

    PubMed

    Gudmundsdottir, Ingibjorg; Steingrimsson, Steinn; Valsdottir, Elsa; Gudbjartsson, Tomas

    2014-04-01

    Negative pressure wound therapy (NPWT) is a new therapeutic option in wound healing and was first described in its present form in 1997. A vacuum source is used to create sub-atmospheric pressure in the local wound environment to promote healing. This is achieved by connecting a vacuum pump to a tube that is threaded into a wound gauze or foam filler dressing covered with a drape. This concept in wound treatment has been shown to be useful in treating different wound infections, including diabetic wounds as well as complex infections of the abdomen and thorax. NPWT has been used in Iceland for over a decade and its use is steadily increasing. This review describes the indications and outcome of NPWT and is aimed at a broad group of doctors and nurses where recent Icelandic studies on the subject are covered. PMID:24713539

  10. Possible healthcare-associated transmission as a cause of secondary infection and population structure of Staphylococcus aureus isolates from two wound treatment centres in Ghana.

    PubMed

    Kpeli, G; Darko Otchere, I; Lamelas, A; Buultjens, A L; Bulach, D; Baines, S L; Seemann, T; Giulieri, S; Nakobu, Z; Aboagye, S Y; Owusu-Mireku, E; Pluschke, G; Stinear, T P; Yeboah-Manu, D

    2016-09-01

    We have previously shown that secondary infections of Buruli ulcer wounds were frequently caused by Staphylococcus aureus. To gain understanding into possible routes of secondary infection, we characterized S. aureus isolates from patient lesions and surrounding environments across two Ghanaian health centres. One hundred and one S. aureus isolates were isolated from wounds (n = 93, 92.1%) and the hospital environment (n = 8, 7.9%) and characterized by the spa gene, mecA and the Panton-Valentine leucocidin toxin followed by spa sequencing and whole genome sequencing of a subset of 49 isolates. Spa typing and sequencing of the spa gene from 91 isolates identified 29 different spa types with t355 (ST152), t186 (ST88), and t346 dominating. Although many distinct strains were isolated from both health centres, genotype clustering was identified within centres. In addition, we identified a cluster consisting of isolates from a healthcare worker, patients dressed that same day and forceps used for dressing, pointing to possible healthcare-associated transmission. These clusters were confirmed by phylogenomic analysis. Twenty-four (22.8%) isolates were identified as methicillin-resistant S. aureus and lukFS genes encoding Panton-Valentine leucocidin were identified in 67 (63.8%) of the isolates. Phenotype screening showed widespread resistance to tetracycline, erythromycin, rifampicin, amikacin and streptomycin. Genomics confirmed the widespread presence of antibiotic resistance genes to β-lactams, chloramphenicol, trimethoprim, quinolone, streptomycin and tetracycline. Our findings indicate that the healthcare environment probably contributes to the superinfection of Buruli ulcer wounds and calls for improved training in wound management and infection control techniques. PMID:27547406

  11. Antimicrobial photodynamic therapy with RLP068 kills methicillin-resistant Staphylococcus aureus and improves wound healing in a mouse model of infected skin abrasion PDT with RLP068/Cl in infected mouse skin abrasion.

    PubMed

    Vecchio, Daniela; Dai, Tianhong; Huang, Liyi; Fantetti, Lia; Roncucci, Gabrio; Hamblin, Michael R

    2013-09-01

    Photodynamic therapy (PDT) is an alternative treatment for infections that can kill drug resistant bacteria without damaging host-tissue. In this study we used bioluminescent methicillin-resistant Staphylococcus aureus, in a mouse skin abrasion model, to investigate the effect of PDT on bacterial inactivation and wound healing. RLP068/Cl, a tetracationic Zn(II)phthalocyanine derivative and toluidine blue (TBO) were used. The light-dose response of PDT to kill bacteria in vivo and the possible recurrence in the days post-treatment were monitored by real-time bioluminescence imaging, and wound healing by digital photography. The results showed PDT with RLP068/Cl (but not TBO) was able to kill bacteria, to inhibit bacterial re-growth after the treatment and to significantly accelerate the wound healing process (© 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim). PMID:22987338

  12. New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections

    PubMed Central

    Dou, Jian-Lin; Jiang, Yi-Wei; Xie, Jun-Qiu; Zhang, Xiao-Gang

    2016-01-01

    Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, “a return to the pre-antibiotic era”, is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic. PMID:27120596

  13. New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections.

    PubMed

    Dou, Jian-Lin; Jiang, Yi-Wei; Xie, Jun-Qiu; Zhang, Xiao-Gang

    2016-01-01

    Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, "a return to the pre-antibiotic era", is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic. PMID:27120596

  14. Pressure ulcers. Local wound care.

    PubMed

    Goode, P S; Thomas, D R

    1997-08-01

    Local care of pressure ulcers includes wound cleansing, débridement, and dressings. Wound cleansing should remove loose debris and exudate but should not damage viable tissue. Saline irrigation is the standard. Débridement is often necessary for Stage III and IV pressure ulcers and can be performed autolytically, mechanically, enzymatically, or sharply. Prompt débridement is essential for infected wounds. Dressings should keep the wound bed continuously moist, should not be toxic to granulation tissue, and should keep the surrounding intact skin dry. Randomized, controlled clinical trials are necessary to define optimal local wound care further. PMID:9227943

  15. Wound dressings: selecting the most appropriate type.

    PubMed

    Broussard, Karen C; Powers, Jennifer Gloeckner

    2013-12-01

    Appropriate wound dressing selection is guided by an understanding of wound dressing properties and an ability to match the level of drainage and depth of a wound. Wounds should be assessed for necrosis and infection, which need to be addressed prior to selecting an ideal dressing. Moisture-retentive dressings include films, hydrogels, hydrocolloids, foams, alginates, and hydrofibers and are useful in a variety of clinical settings. Antimicrobial-impregnated dressings can be useful in wounds that are superficially infected or are at higher risk for infection. For refractory wounds that need more growth stimulation, tissue-engineered dressings have become a viable option in the past few decades, especially those that have been approved for burns, venous ulcers, and diabetic ulcers. As wounds heal, the ideal dressing type may change, depending on the amount of exudate and depth of the wound; thus success in wound dressing selection hinges on recognition of the changing healing environment. PMID:24062083

  16. Skin tissue engineering for the infected wound site: biodegradable PLA nanofibers and a novel approach for silver ion release evaluated in a 3D coculture system of keratinocytes and Staphylococcus aureus.

    PubMed

    Mohiti-Asli, Mahsa; Pourdeyhimi, Behnam; Loboa, Elizabeth G

    2014-10-01

    Wound infection presents a challenging and growing problem. With the increased prevalence and growth of multidrug-resistant bacteria, there is a mounting need to reduce and eliminate wound infections using methodologies that limit the ability of bacteria to evolve into further drug-resistant strains. A well-known strategy for combating bacterial infection and preventing wound sepsis is through the delivery of silver ions to the wound site. High surface area silver nanoparticles (AgNPs) allowing extensive silver ion release have therefore been explored in different wound dressings and/or skin substitutes. However, it has been recently shown that AgNPs can penetrate into the stratum corneum of skin or diffuse into the cellular plasma membrane, and may interfere with a variety of cellular mechanisms. The goal of this study was to introduce and evaluate a new type of high surface area metallic silver in the form of highly porous silver microparticles (AgMPs). Polylactic acid (PLA) nanofibers were successfully loaded with either highly porous AgMPs or AgNPs and the antimicrobial efficacy and cytotoxicity of the two silver-based wound dressings were assessed and compared. To better mimic the physiological environment in vivo where both human cells and bacteria are present, a novel coculture system combining human epidermal keratinocytes and Staphylococcus aureus bacteria was designed to simultaneously evaluate human skin cell cytotoxicity with antimicrobial efficacy in a three-dimensional environment. We found that highly porous AgMPs could be successfully incorporated in nanofibrous wound dressings, and exhibited comparable antimicrobial efficacy and cytotoxicity to AgNPs. Further, PLA nanofibers containing highly porous AgMPs exhibited steady silver ion release, at a greater rate of release, than nanofibers containing AgNPs. The replacement of AgNPs with the newly introduced AgMPs overcomes concerns regarding the use of nanoparticles and holds great promise as skin

  17. Skin Tissue Engineering for the Infected Wound Site: Biodegradable PLA Nanofibers and a Novel Approach for Silver Ion Release Evaluated in a 3D Coculture System of Keratinocytes and Staphylococcus aureus

    PubMed Central

    Mohiti-Asli, Mahsa; Pourdeyhimi, Behnam

    2014-01-01

    Wound infection presents a challenging and growing problem. With the increased prevalence and growth of multidrug-resistant bacteria, there is a mounting need to reduce and eliminate wound infections using methodologies that limit the ability of bacteria to evolve into further drug-resistant strains. A well-known strategy for combating bacterial infection and preventing wound sepsis is through the delivery of silver ions to the wound site. High surface area silver nanoparticles (AgNPs) allowing extensive silver ion release have therefore been explored in different wound dressings and/or skin substitutes. However, it has been recently shown that AgNPs can penetrate into the stratum corneum of skin or diffuse into the cellular plasma membrane, and may interfere with a variety of cellular mechanisms. The goal of this study was to introduce and evaluate a new type of high surface area metallic silver in the form of highly porous silver microparticles (AgMPs). Polylactic acid (PLA) nanofibers were successfully loaded with either highly porous AgMPs or AgNPs and the antimicrobial efficacy and cytotoxicity of the two silver-based wound dressings were assessed and compared. To better mimic the physiological environment in vivo where both human cells and bacteria are present, a novel coculture system combining human epidermal keratinocytes and Staphylococcus aureus bacteria was designed to simultaneously evaluate human skin cell cytotoxicity with antimicrobial efficacy in a three-dimensional environment. We found that highly porous AgMPs could be successfully incorporated in nanofibrous wound dressings, and exhibited comparable antimicrobial efficacy and cytotoxicity to AgNPs. Further, PLA nanofibers containing highly porous AgMPs exhibited steady silver ion release, at a greater rate of release, than nanofibers containing AgNPs. The replacement of AgNPs with the newly introduced AgMPs overcomes concerns regarding the use of nanoparticles and holds great promise as skin

  18. Comparison of negative pressure wound therapy (NPWT) &conventional wound dressings in the open fracture wounds

    PubMed Central

    Arti, Hamidreza; Khorami, Mohsen; Ebrahimi-Nejad, Vahid

    2016-01-01

    Objective: Successful closure is a primary step of treatment in open fracture wounds. Delayed healing or complications can lead to increased treatment duration, costs and disability rates. The aim of this study was to compare Negative Pressure Wound Therapy (NPWT) and conventional wound dressings in patients with open fracture wounds. Methods: In a prospective randomized clinical trial study, 90 patients with open fractures that were referred for treatment were enrolled between February 2013 to March 2015. Patients were divided into two groups. Group I underwent NPWT and group II underwent conventional wound dressing. Then patients were followed up for one month. Within the one month, the number of dressing change varied based on the extent of the wound. Duration of wound healing, presence of infection and the number of hospitalization days in these patients were recorded and compared at the end of the study between the two groups. Questionnaires and check lists were used to collect data. Analysis was done with SPSS 20, paired sample T-test, and chi-square tests. P<0.05 was considered significant. Results: There was a significant difference between the rate of wound healing in the group one or NPWT group and group II (conventional wound dressings) P<0.05. There was no significant difference between two groups in incidence of infection (P=0.6). Conclusion: Using NPWT expedites the healing process of extremity wounds. It is more economical and can be considered as a substitute for the treatment of extremity wounds. PMID:27022347

  19. Negative Pressure Wound Therapy

    PubMed Central

    2006-01-01

    Executive Summary Objective This review was conducted to assess the effectiveness of negative pressure wound therapy. Clinical Need: Target Population and Condition Many wounds are difficult to heal, despite medical and nursing care. They may result from complications of an underlying disease, like diabetes; or from surgery, constant pressure, trauma, or burns. Chronic wounds are more often found in elderly people and in those with immunologic or chronic diseases. Chronic wounds may lead to impaired quality of life and functioning, to amputation, or even to death. The prevalence of chronic ulcers is difficult to ascertain. It varies by condition and complications due to the condition that caused the ulcer. There are, however, some data on condition-specific prevalence rates; for example, of patients with diabetes, 15% are thought to have foot ulcers at some time during their lives. The approximate community care cost of treating leg ulcers in Canada, without reference to cause, has been estimated at upward of $100 million per year. Surgically created wounds can also become chronic, especially if they become infected. For example, the reported incidence of sternal wound infections after median sternotomy is 1% to 5%. Abdominal surgery also creates large open wounds. Because it is sometimes necessary to leave these wounds open and allow them to heal on their own (secondary intention), some may become infected and be difficult to heal. Yet, little is known about the wound healing process, and this makes treating wounds challenging. Many types of interventions are used to treat wounds. Current best practice for the treatment of ulcers and other chronic wounds includes debridement (the removal of dead or contaminated tissue), which can be surgical, mechanical, or chemical; bacterial balance; and moisture balance. Treating the cause, ensuring good nutrition, and preventing primary infection also help wounds to heal. Saline or wet-to-moist dressings are reported as

  20. Wound Care: Preventing Infection

    MedlinePlus

    ... your pharmacist to recommend a nonperfumed, pH-balanced lotion. Wash anything that comes into contact with your ... check manufacturer’s instructions). Do not use alcohol-based lotions on your skin, as it dries it out ...

  1. [Application of modern wound dressings in the treatment of chronic wounds].

    PubMed

    Triller, Ciril; Huljev, Dubravko; Smrke, Dragica Maja

    2012-10-01

    Chronic and acute infected wounds can pose a major clinical problem because of associated complications and slow healing. In addition to classic preparations for wound treatment, an array of modern dressings for chronic wound care are currently available on the market. These dressings are intended for the wounds due to intralesional physiological, pathophysiological and pathological causes and which failed to heal as expected upon the use of standard procedures. Classic materials such as gauze and bandage are now considered obsolete and of just historical relevance because modern materials employed in wound treatment, such as moisture, warmth and appropriate pH are known to ensure optimal conditions for wound healing. Modern wound dressings absorb wound discharge, reduce bacterial contamination, while protecting wound surrounding from secondary infection and preventing transfer of infection from the surrounding area onto the wound surface. The use of modern wound dressings is only justified when the cause of wound development has been established or chronic wound due to the underlying disease has been diagnosed. Wound dressing is chosen according to wound characteristics and by experience. We believe that the main advantages of modern wound dressings versus classic materials include more efficient wound cleaning, simpler placement of the dressing, reduced pain to touch, decreased sticking to the wound surface, and increased capacity of absorbing wound exudate. Modern wound dressings accelerate the formation of granulation tissue, reduce the length of possible hospital stay and facilitate personnel work. Thus, the overall cost of treatment is reduced, although the price of modern wound dressings is higher than that of classic materials. All types of modern wound dressings, their characteristics and indications for use are described. PMID:23193824

  2. Choosing a Wound Dressing Based on Common Wound Characteristics

    PubMed Central

    Dabiri, Ganary; Damstetter, Elizabeth; Phillips, Tania

    2016-01-01

    Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a particular wound type is an important element in facilitating wound healing. Recent Advances: Researchers have sought to design wound dressings that aim to optimize each stage in the healing process. In addition, dressings have been designed to target and kill infection-causing bacteria, with the incorporation of antimicrobial agents. Critical Issues: Chronic wounds are frequently dynamic in presentation, and the numerous wound dressings available make dressing selection challenging for the practitioner. Choosing the correct dressing decreases time to healing, provides cost-effective care, and improves patient quality of life. Future Directions: Research into the mechanisms of wound healing has enhanced our ability to heal chronic wounds at a faster rate through the use of moisture-retentive dressings. Newer dressings are incorporating the use of nanotechnology by incorporating miniature electrical sensors into the dressing. These dressings are engineered to detect changes in a wound environment and alert the patient or practitioner by altering the color of the dressing or sending a message to a smartphone. Additional investigations are underway that incorporate biologic material such as stem cells into dressings. PMID:26858913

  3. Emerging new drugs for wound repair.

    PubMed

    Meier, Karen; Nanney, Lillian B

    2006-03-01

    Every year, millions of people experience burns, suffer from nonhealing wounds, or have acute wounds that become complicated by infection, dehiscence or problematic scarring. Effective wound treatment requires carefully considered interventions often requiring multiple clinic or hospital visits. The resulting costs of wound care are staggering, and more efficacious and cost-effective therapies are needed to decrease this burden. Unfortunately, the expenses and difficulties encountered in performing clinical trials have led to a relatively slow growth of new treatment options for the wound management. Research efforts attempting to examine wound pathophysiology have been hampered by the lack of an adequate chronic wound healing model, and the complexity of the wound healing cascade has limited attempts at pharmacological modification. As such, currently available wound healing therapies are only partially effective. Therefore, many new therapies are emerging that target various aspects of wound repair and the promise of new therapeutic interventions is on the immediate horizon. PMID:16503824

  4. Office management of minor wounds.

    PubMed Central

    Gouin, S.; Patel, H.

    2001-01-01

    OBJECTIVE: To review office interventions for minor wounds not requiring sutures, such as abrasions, bites, and lacerations. QUALITY OF EVIDENCE: Most information on minor wound management comes from descriptive studies. Few comparative studies examine the effectiveness of topical antisepsis for minor wounds. Several clinical trials have demonstrated that tissue adhesives produce short- and long-term cosmetic results equivalent to those achieved with suture materials. MAIN MESSAGE: Sterile saline is the least toxic solution for wound irrigation. Chlorhexidine (2%) and povidone iodine (10%) have been the most investigated antiseptic solutions. Systemic antibiotics are unnecessary for wounds unlikely to be infected. All bite wounds require special attention. Primary closure of bite wounds is indicated in certain circumstances: less than 12-hour-old nonpuncture wounds, uninfected wounds, and low-risk lesions (such as on the face). In spite of their many advantages, skin tapes should be used for low-tension wounds only. The popularity of tissue adhesives has greatly increased. Since the advent of newer products (with increased bonding strength and flexibility), adhesives are used to manage most lacerations except those in areas of high tension (e.g., joints) and on mucosal surfaces. CONCLUSION: Minor wounds not requiring sutures can be managed easily in the office. PMID:11340758

  5. Delayed wound healing and postoperative surgical site infections in patients with rheumatoid arthritis treated with or without biological disease-modifying antirheumatic drugs.

    PubMed

    Tada, Masahiro; Inui, Kentaro; Sugioka, Yuko; Mamoto, Kenji; Okano, Tadashi; Kinoshita, Takuya; Hidaka, Noriaki; Koike, Tatsuya

    2016-06-01

    Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease duration, 16.9 years) after 332 elective orthopedic surgeries. We also attempted to evaluate the effects of individual medications on infection. Rates of bDMARD and conventional synthetic DMARD (csDMARD) administration were 30.4 and 91.0 %, respectively. Risk factors for SSI were advanced age (odds ratio [OR], 1.11; P = 0.045), prolonged surgery (OR, 1.02; P = 0.03), and preoperative white blood cell count >10,000/μL (OR, 3.66; P = 0.003). Those for delayed wound healing were advanced age (OR, 1.16; P = 0.001), prolonged surgery (OR, 1.02; P = 0.007), preoperative white blood cell count >10,000/μL (OR, 4.56; P = 0.02), and foot surgery (OR, 6.60; P = 0.001). Risk factors for SSI and medications did not significantly differ. No DMARDs were risk factors for any outcome examined. Biological DMARDs were not risk factors for postoperative SSI. Foot surgery was a risk factor for delayed wound healing. PMID:27129711

  6. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

    PubMed

    Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George

    2014-01-01

    Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population. PMID:24126108

  7. Genotype-dependent expression of specific members of potato protease inhibitor gene families in different tissues and in response to wounding and nematode infection.

    PubMed

    Turrà, David; Bellin, Diana; Lorito, Matteo; Gebhardt, Christiane

    2009-05-01

    Protease inhibitors (PIs) are small ubiquitous proteins with a variety of biological functions in plants, including protein stabilization, modulation of apoptosis and defense against pathogens. Kunitz-like inhibitors (PKPIs) and proteinase inhibitors 1 (PI-1) are abundant in storage organs of potato plants and are up-regulated in other tissues in response to biotic and abiotic stress. However, little information is available on genotype-dependent regulation of individual PKPI group- and PI-1 genes. We isolated, sequenced and characterized four novel full-length PI-1 cDNAs (PPI3A2, PPI3A4, PPI2C4 and PPI2C1A) from Solanum tuberosum cv. Desirée. Specific primers were developed for PI-1 genes PPI3A2, PPI3B2 and PPI2C4 and the three PKPI homology groups A, B and C. Their expression profiles were studied by semi-quantitative RT-PCR in comparison with transcripts of the PI-1, Pin2 and PR1 gene families in various tissues, after wounding and Globodera rostochiensis infection of nematode-resistant genotypes P40 and LB7/4/c-I-7, and susceptible cv. Desirée. Individual PI-1 genes and PKPI homology groups were expressed in a tissue- and genotype-dependent manner after wounding and nematode infection. The differences in PI expression patterns were related to the intensity, type of inhibitors produced, and the kinetics of induction. Therefore, different genotype-environment combinations produce different sets of PI transcripts. Potato plants reacted to G. rostochiensis infection by modulating PKPI, PI-1 and Pin2, but not PR1 gene expression, suggesting that the jasmonic acid but not the salicylic acid defense signaling pathway is activated. PI expression profiles were not correlated with the resistance status of the potato genotype infected with G. rostochiensis. PMID:19095329

  8. Wound care in venous ulcers.

    PubMed

    Mosti, G

    2013-03-01

    Wound dressings: ulcer dressings should create and maintain a moist environment on the ulcer surface. It has been shown that in an ulcer with a hard crust and desiccated bed, the healing process is significantly slowed and sometimes completely blocked so favouring infection, inflammation and pain. In contrast a moist environment promotes autolytic debridement, angiogenesis and the more rapid formation of granulation tissue, favours keratinocytes migration and accelerates healing of wounds. Apart from these common characteristics, wound dressings are completely different in other aspects and must be used according to the ulcer stage. In necrotic ulcers, autolytic debridement by means of hydrogel and hydrocolloids or with enzymatic paste is preferred. In case of largely exuding wounds alginate or hydrofibre are indicated. When bleeding occurs alginate is indicated due to its haemostatic power. Where ulcers are covered by granulation tissue, polyurethane foams are preferred. When infection coexists antiseptics are necessary: dressing containing silver or iodine with large antibacterial spectrum have proved to be very effective. In the epithelization stage polyurethane films or membranes, thin hydrocolloids or collagen based dressings are very useful to favour advancement of the healing wound edge. Despite these considerations, a Cochrane review failed to find advantages for any dressing type compared with low-adherent dressings applied beneath compression. Surgical debridement and grafting of wounds, negative wound pressure treatment: surgical and hydrosurgical debridement are indicated in large, necrotic and infected wounds as these treatments are able to get rid of necrotic, infected tissue very quickly in a single surgical session, thereby significantly accelerating wound bed preparation and healing time. Negative wound pressure treatment creating a negative pressure on ulcer bed is able to favour granulation tissue and shorten healing time. In case of hard

  9. A new flexible DBD device for treating infected wounds: in vitro and ex vivo evaluation and comparison with a RF argon plasma jet

    NASA Astrophysics Data System (ADS)

    Boekema, B. K. H. L.; Vlig, M.; Guijt, D.; Hijnen, K.; Hofmann, S.; Smits, P.; Sobota, A.; van Veldhuizen, E. M.; Bruggeman, P.; Middelkoop, E.

    2016-02-01

    Cold plasma has been shown to provide a promising alternative antimicrobial treatment for wound healing. We developed and tested a flexible surface dielectric barrier discharge (DBD) and compared it to an argon gas based plasma jet operated remotely with a distance between plasma plume and sample of 8 mm. Tests were conducted using different models: on cultured cells, on ex vivo human skin and on bacteria (Pseudomonas aeruginosa) (on agar, in suspension, in collagen/elastin matrix or on ex vivo human skin), allowing us to directly compare bactericidal with safety aspects under identical conditions. Both plasma devices were highly efficient when used on bacteria in non-buffered solutions, but DBD was faster in reaching the maximum bacterial reduction. Treatment of bacteria on intact skin with DBD resulted in up to 6 log reductions in 3 min. The jet was far less efficient on intact skin. Even after 8 min treatment no more than 2 log reductions were obtained with the jet. Treatment of bacteria in burn wound models with DBD for 6 min resulted in a 4.5 log reduction. Even when using DBD for 6 min on infected burn wound models with colonizing or biofilm phase bacteria, the log reductions were 3.8 or 3.2 respectively. DBD plasma treatment for 6 min did not affect fibroblast viability, whereas a treatment for 8 min was detrimental. Similarly, treatment with DBD or plasma jet for 6 min did also not affect the metabolic activity of skin biopsies. After treatment for 8 min with DBD or plasma jet, 78% or 60% of activity in skin biopsies remained, respectively. Multiple treatments of in vitro burn wound models with surface DBD for 6 min or with plasma jet for 8 min did not affect re-epithelialization. With the flexible surface DBD plasma strip we were able to quickly inactivate large numbers of bacteria on and in skin. Under the same conditions, viability of skin cells or re-epithelialization was not affected. The DBD source has potential for treating

  10. Wound dressings.

    PubMed

    Lionelli, Gerald T; Lawrence, W Thomas

    2003-06-01

    There are currently hundreds of dressings on the market to aid in wound management. Before selecting a dressing for a particular wound, a practitioner must assess carefully the needs of the wound to understand which dressing would provide maximal benefit. Frequently, there is not one clear best choice, and it is crucial that the pros and cons of each dressing modality be understood. This article has provided a framework to assist in dressing assessment. PMID:12822729