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The therapy of infectedwounds is based on the knowledge of the pathophysiology of infection and on early diagnosis. The development of an infection depends on the general condition of the patient, local factors like foreign body contamination and tissue necrosis and the pathogenicity of the bacteria. The diagnosis of a woundinfection is made upon the classical symptoms dolor, rubor, calor, tumor and functio laesa and depends on continuous wound care and repeated clinical judgement. The differentiation between an abscess as encapsulated infection and a diffuse non localized phlegmonous inflammation has different therapeutic consequences as the surgical treatment of an abscess consists of incision and drainage whereas the excision of infected tissue is necessary in phlegmones. The wound revision is a special form of excision. The surgical debridement is the most effective part of the therapy. Excision of infected and necrotic tissue help the phagocytic cells in infection fighting and remove the ideal culture medium for bacteria. The use of antibiotics can be very helpful if stringent indications are applied. Additional therapeutic approaches like improvement of local oxygen supply and enhancement of phagocytic function of macrophages could support the surgical therapy of the infectedwound. PMID:3374957
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.
Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.
. Sternal woundinfections (SWIs) can be subdivided into two types, superficial or deep, that require different treatments.\\u000a The clinical diagnosis of superficial SWI is normally easy to perform, whereas the involvement of deep tissues is frequently\\u000a difficult to detect. Therefore, there is a need for an imaging study that permits the assessment of SWIs and is able to distinguish
Mauro Liberatore; Vittorio Fiore; Antonio D’Agostini; Daniela Prosperi; Anna Paola Iurilli; Claudio Santini; Pia Baiocchi; Maurizia Galiè; Gian Domenico Di Nucci; Riccardo Sinatra
Deep sternal woundinfections (DSWI) continue to be a relatively uncommon event occurring in about 1%-2% of all patients undergoing cardiac surgery. However, the sheer number of cardiac surgery patients and the relatively high mortality associated with DSWIs makes them of clinical relevance. This review will describe the current incidence of DSWIs and their associated morbidity and mortality as well as risk factors for the development of this complication. The microbiology of DSWIs will be reviewed and strategies to prevent these complications will be discussed with a focus on interventions that may be undertaken by the clinical anesthesiologist. PMID:18831296
Mauermann, William J; Sampathkumar, Priya; Thompson, Rodney L
... in groin or armpits wound has thick, brown/gray discharge skin around the wound turns black or ... and spirit. Eat well and drink plenty of water to strengthen your body’s own natural healing abilities. ...
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 woundinfections and testing new antimicrobial strategies. Results: Animal models of external traumatic woundinfections 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.
Dai, Tianhong; Kharkwal, Gitika B; Tanaka, Masamitsu; Huang, Ying-Ying; Bil de Arce, Vida J
Sternal woundinfection is a life-threatening complication after cardiac surgery associated with high morbidity and mortality. Past treatment options have included closed suction and continuous irrigation. Current paradigms in the management of sternal woundinfection include surgical debridement, vacuum-assisted closure therapy, flap coverage, and sternal plating. We provide a general overview of sternal woundinfection and treatment options for the plastic surgeon.
Singh, Kimberly; Anderson, Erica; Harper, J. Garrett
Objectives: Surgical-site infections are a very expensive complication in cardiac surgery. Thus, the total costs for coronary artery bypass grafting (CABG) surgery may substantially increase when a deep sternal woundinfection (DSWI) occurs. This may be due to an extended length of stay (LOS), the need for additional surgical procedures, vacuum-assisted wound dressing and antibiotic therapy. This study compares the
Karolin Graf; Ella Ott; Ralf-Peter Vonberg; Christian Kuehn; Axel Haverich; Iris Freya Chaberny
OBJECTIVE: Surgical woundinfections remain a significant source of postoperative morbidity. This study was undertaken to determine prospectively the incidence of postoperative woundinfections in children in a multi-institutional fashion and to identify the risk factors associated with the development of a woundinfection in this population. SUMMARY BACKGROUND DATA: Despite a large body of literature in adults, there have been only two reports from North America concerning postoperative woundinfections in children. METHODS: All infants and children undergoing operation on the pediatric surgical services of three institutions during a 17-month period were prospectively followed for 30 days after surgery for the development of a woundinfection. RESULTS: A total of 846 of 1021 patients were followed for 30 days. The overall incidence of woundinfection was 4.4%. Factors found to be significantly associated with a postoperative woundinfection were the amount of contamination at operation (p = 0.006) and the duration of the operation (p = 0.03). Comparing children who developed a woundinfection with those who did not, there were no significant differences in age, sex, American Society of Anesthesiologists (ASA) preoperative assessment score, length of preoperative hospitalization, location of operation (intensive care unit vs. operating room), presence of a coexisting disease or remote infection, or the use of perioperative antibiotics. CONCLUSIONS: Our results suggest that woundinfections in children are related more to the factors at operation than to the overall physiologic status. Procedures can be performed in the intensive care unit without any increase in the incidence of woundinfection.
Horwitz, J R; Chwals, W J; Doski, J J; Suescun, E A; Cheu, H W; Lally, K P
Chronic woundinfections are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Woundinfection may initially be manifest as bacterial colonization, and it is only when colonization is combined with other factors, such as decreased vascular supply, intrinsic virulence of specific bacteria (eg, Staphylococcus aureus), and host immune factors, that true infection occurs. The microbiology of chronic wounds is complex, and it is difficult to discern which bacteria are culpable. Deep cultures or quantitative biopsies of wound tissue may be necessary. In some instances, such as in the presence of certain mycobacteria, isolation of specific organisms confirms causation. In many instances, it is appropriate to treat these wounds empirically with a combination of topical antiseptics and systemic antibiotics, especially in the presence of invasive infections. PMID:20797512
A new combined photoultrasonic (CPUS) technology for the treatment of infectedwounds is suggested. The CPUS principal operation is based on the topical application of a photosensitizer followed by light irradiation in combination with low frequency ultrasonic (US) treatment of wounds. In CPUS, two methods - photodynamic (PDT) and ultrasonic therapies supplement each other beneficially and in conjunction provide a significant effect of deep suppurative inflammatory wounds treatment. The main advantages of the new technology are the combined application of an antibiotic solution and photodynamic therapy to destroy antibiotic- resistant microorganisms, an effective mixing of a photosensitizer in the wound, the US enhancement of photosensitizer impregnation into the membranes of bacteria, the US clearing of wound surface from necrotic products, an increased effective light dose exposure in the whole volume of the deep wound when the light does not penetrate totally inside the wound, an additional bactericidal effect under the US impact, and the combined effect of CPUS activation of the immune system.
Zharov, Vladimir P.; Menyaev, Yulian A.; Kalinin, Konstantin L.; Zmievskoy, Gregory N.; Velsher, Leonid Z.; Podkolzin, Alexander A.; Stakhanov, Mikhail L.; Gorchak, Yury Y.; Sarantsev, V. P.
Background: Wound protectors are plastic sheaths that can be used to line a wound during surgery. Wound protectors can facilitate retraction of an incision without the need for other mechanical retractors and have been proposed as deterrents to woundinfection. The purpose of this study was to define the ability of wound protectors to reduce the rate of infection when
K. W. Kercher; T. H. Nguyen; K. L. Harold; M. E. Poplin; B. D. Matthews; R. F. Sing; B. T. Heniford
Woundinfection plays an important role in the development of chronicity, delaying wound healing. This study aimed to identify the bacterial pathogens present in infectedwounds and characterise their resistance profile to the most common antibiotics used in therapy. Three hundred and twelve wound swab samples were collected from 213 patients and analysed for the identification of microorganisms and for the determination of their antibiotic susceptibility. Patients with diverse type of wounds were included in this retrospective study, carried out from March to September 2012. A total of 28 species were isolated from 217 infectedwounds. The most common bacterial species detected was Staphylococcus aureus (37%), followed by Pseudomonas aeruginosa (17%), Proteus mirabilis (10%), Escherichia coli (6%) and Corynebacterium spp. (5%). Polymicrobial infection was found in 59 (27·1%) of the samples and was mainly constituted with two species. The most common association was S. aureus/P. aeruginosa. All Gram-positives were susceptible to vancomycin and linezolid. Gram-negatives showed quite high resistance to the majority of antibiotics, being amikacin the most active against these bacteria. This study is mostly oriented to health care practitioners who deal with wound management, making them aware about the importance of woundinfection and helping them to choose the adequate treatment options to control microbial infection in wounds. PMID:23433007
Bessa, Lucinda J; Fazii, Paolo; Di Giulio, Mara; Cellini, Luigina
The microbiology of animal bite woundinfections 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 woundinfections 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 infectedwound 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 woundinfections in humans. PMID:21482724
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
Postoperative wound drainages are a possible tool of infections during the whole time of its use. Bacterial spreading within the drainage system is promoted by retrograde movement of secretions and by suspending gas bubbles. It is facilitated by wrong handling. Disconnecting the drainage system will lead to a bacterial contamination in 7%. Changing the bottles too often will increase the infection rates of wounds, may be dangerous for the staff and wastes money. The physical properties must be known, and daily measuring and documentation of the amount of wound secretions are mandatory. Non-disposable suction drainages with a high suction pressure, made of plastic material, are proven to be better than other systems. PMID:2815960
Deep sternal woundinfections continue to be an uncommon but potentially devastating complication of cardiac surgical procedures. Numerous risk factors have been identified but only a few can be characterized as modifiable. These risk factors and their modifications are reviewed in the following article.
Rahnella aquatilis is a water-residing gram-negative rod, a member of the family Enterobacteriaceae, isolated rarely from clinical specimens of immunocompromised patients. A case of a surgical woundinfection caused by R. aquatilis in a patient who underwent a prosthetic surgical intervention is reported. The presence of inducible beta-lactamase was suggested by the disk induction test and the conventional agar dilution assay. Literature on R. aquatilis infections in humans is reviewed. Images
Maraki, S; Samonis, G; Marnelakis, E; Tselentis, Y
Objective: Postoperative woundinfections generally cause considerable extra morbidity, mortality and costs. As nowadays length of hospitalization shortens, post-discharge surveillance is important to get reliable information on the prevalence of postoperative woundinfections. In this study, the prevalences of sternal wound (SWI) and donor site infections (DSI) during hospitalization as well as, 30 and 90 days after cardiac surgery were
Daisy Jonkers; Ted Elenbaas; Peter Terporten; Fred Nieman; Ellen Stobberingh
... infection to the bloodstream, involving other organs • Septic shock , a critical illness involving the whole body, which ... antibiotics. In the case of sepsis or septic shock, intensive care and life support may be needed. ...
The incidence of postoperative woundinfection in a general surgical unit is reported both before and after transfer from a “Nightingale” type multibed ward to a new “race-track” type of surgical ward with controlled ventilation and with 40% of its beds in single rooms. Following transfer postoperative woundinfection was reduced by about 55%.With the use of certain types of
It has never been shown that wearing surgical face masks decreases postoperative woundinfections. On the contrary, a 50% decrease has been reported after omitting face masks. The present study was designed to reveal any 30% or greater difference in general surgery woundinfection rates by using face masks or not.
Objective: To report our experience with the laparoscopically harvested omental flap in the treatment of deep sternal woundinfection, and to present a modification and introduce two supportive techniques in the perioperative management. Methods: Between June 2005 and September 2007, six patients with grade IV (El Oakley–Wright classification) deep sternal woundinfection following a median sternotomy for coronary artery bypass
Jan J. van Wingerden; Matijn E. H. Coret; Christianne A. van Nieuwenhoven; Eric R. Totté
Background. Sternal woundinfection remains a signif- icant complication. We reviewed the incidence and the treatment of sternal woundinfection after heart transplantation. Methods. Of 226 patients who had a heart transplanta- tion, 20 (8.8%) underwent postoperative wound debride- ment for superficial or deep sternal woundinfection. The incidence and the survival of patients with sternal woundinfection were analyzed.
Michel Carrier; Louis P. Perrault; Michel Pellerin; Richard Marchand; Pierre Auger; Guy B. Pelletier; Michel White; Normand Racine; Denis Bouchard
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 woundinfections.
Dai, Tianhong; Garcia, Barbara; Murray, Clinton K.; Vrahas, Mark S.
Background. The treatment of deep sternal woundinfections remains controversial. Currently advocated procedures carry the risk of reinfections. The significance of local antibiotic-releasing systems as an adjuvant therapy to avoid reinfections is the subject of the presented study.Methods. Forty-two patients with deep sternal wound complication were treated with radical wound debridement, sternal refixation, retrosternal suction drainage, bilateral pectoralis major muscle
Rainer G Leyh; Claus Bartels; Hans-Hinrich Sievers
Woundinfection is a form of host damage resulting from an imbalance in pathogen virulence and the host immune response. However, at present, diagnosis is based solely on bacterial numbers or inflammatory signs and is therefore not precise. Thus, infection diagnosis requires indicators of both of these factors. We focused on wound fluid because it includes both bacteria and host cells. The purpose of this study was to establish biomarkers that reflect both bacterial and host factors using the reverse transcription-polymerase chain reaction method on the centrifugal precipitation of wound fluids (wound fluid RT-PCR). We created full thickness wounds in animal models of the three groups: control, colonization and infection, which were conditioned by administration of different concentrations of Pseudomonas aeruginosa dispersion. Messenger RNA expression in bacteria and host cells was analysed. Expression of bacterial housekeeping genes was detected in the samples in the colonization and infection groups. Expression of host housekeeping genes was detected in all samples from the three groups. Expression of toxA, encoding the virulence factor exotoxin A, was detected in 90% of samples in the infection group only. Expression of Foxp3, encoding the transcription factor forkhead box P3, was detected in 100% of samples only in the colonization group. These results revealed that wound fluid RT-PCR analysis reflected both bacterial virulence and the host immune status, and we determined the combination of novel biomarkers that can discriminate these three groups. We anticipate that wound fluid RT-PCR could be applied in the future to diagnose woundinfection. PMID:22141756
Introduction: Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years, there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs, measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost. Methods: Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results: One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 ± 1.2 years, and 54% were men. Preoperative diagnoses included colorectal cancer (57%), inflammatory bowel disease (20%), diverticulitis (10%), and benign polyp disease (5%). SSIs were identified in 45 patients (26%). Twenty-two (49%) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of $6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions: The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.
Smith, Robert L.; Bohl, Jamie K.; McElearney, Shannon T.; Friel, Charles M.; Barclay, Margaret M.; Sawyer, Robert G.; Foley, Eugene F.
We retrospectively collected and analysed data from patients with sternal woundinfections between 1995 and 2001, which were treated with different wound management strategies, and compared them with our patients from 2002 to 2011, who were treated with the sternal negative pressure wound therapy (NPWT). From 1995 to 2001, a total of 198 patients (group A) with a mean age of 65 ± 10 years developed sternal woundinfection (67% deep) after cardiac surgery. Wound management consisted of surgical debridement and immediate sternal closure or open packing. From 2002 to 2011, a total of 326 patients (group B) (71% deep) were managed with NPWT at the time of surgical debridement. Total mortality was 10% in group A and 3·6% in group B. Recurrence rates were 34 and 8·5%, respectively, for the groups A and B. The meantime of NPWT was 11 days. In group B patients, 75% proceeded to sternal closure. With the introduction of NPWT, the treatment of sternal woundinfections could be substantially improved. Particularly, the high recurrence rates could be minimised; furthermore, the goal to salvage the sternal bone is facilitated. PMID:22943741
3 Abstract: Infection is a major factor that postpones wound healing specially in traumatic wounds. Many reports indicate important role of washing solutions on preventing woundinfections. Tap water has been used for centuries as a wound cleanser without evidence of adverse effects or associated infection risk. Normal sterile saline is also regarded as the most appropriate and preferred cleansing
Background. Sternal woundinfection remains a significant complication. We reviewed the incidence and the treatment of sternal woundinfection after heart transplantation.Methods. Of 226 patients who had a heart transplantation, 20 (8.8%) underwent postoperative wound debridement for superficial or deep sternal woundinfection. The incidence and the survival of patients with sternal woundinfection were analyzed.Results. The incidence of sternal
Michel Carrier; Louis P Perrault; Michel Pellerin; Richard Marchand; Pierre Auger; Guy B Pelletier; Michel White; Normand Racine; Denis Bouchard
BACKGROUND: Woundinfection 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
Tobias Hirsch; Malte Spielmann; Baraa Zuhaili; Till Koehler; Magdalena Fossum; Hans-Ulrich Steinau; Feng Yao; Lars Steinstraesser; Andrew B Onderdonk; Elof Eriksson
Auto-, iso-, or xenografts of skin and synthetics placed on surface wounds freshly contaminated with Pseudomonas aeruginosa stabilizes the wound bacterial population in rats over a 24-h period. When these wounds contained a bacterial contamination established for 24 h prior to grafting, only skin and the synthetic polyhydroxyethylmethacrylate were effective in lowering the initial bacterial concentration. Polyurethane foam and nylon velour were not effective in the established infection model. Skin placed on a contaminated wound for 2 h or longer appeared to equilibrate with the underlying muscle so that the bacterial count per milligram of skin was similar to that of the muscle. It was suggested that this preparation would be useful to obtain an estimate of surface contamination without biopsy of the infected muscle. Skin grafts in place for 2 h significantly lowered the bacterial count in a wound with an established infection. A second decrease occurred between 4 and 24 h after grafting. Histological studies of contaminated and exposed panniculus muscle showed that leukocytes tend to migrate from the muscle surface to its base. Skin grafts and polyhydroxyethylmethacrylate appear to reverse the white cell migration so that the cells move toward the surface of the muscle with preservation of normal staining characteristics in the muscle. It is suggested that this alteration in cell movement after graft application might modify the white cell function and result in a greater bactericidal activity. Apparently, grafts lower bacterial levels in an established infection by modifying the host response to the surface contamination. Images
Saymen, Dennis G.; Nathan, Paul; Holder, Ian Alan; Hill, Edward O.; Macmillan, Bruce G.
OBJECTIVE: To develop an instrument to reliably predict the occurrence of sternal woundinfection (SWI).DESIGN: Instrument development with retrospective chart review.SETTING: Southwestern university-affiliated medical center.PATIENTS: One hundred eighty-five adults who underwent cardiac surgery. SWI developed in 94 patients, and 91 remained infection free. In phase I, there were 82 subjects: SWI developed in 41, and 41 remained infection free. In
Thirty cases of invasive infection of the burn wound with opportunistic fungi of the Phycomycetes and Aspergillus species occurred. Mycotic invasion of the burn wound has a wide clinical spectrum including focal and multifocal infection, deep invasion wit...
Visceral injuries, woundinfection and sepsis were investigated in 226 inpatients who sustained electrical burns over a period of 15 years. Four patients who sustained thoracic and abdominal organ injuries were noted in this series. The patients had injuries of the small intestine, stomach, colon and the lung. All the patients received operative treatment. Two of them died of sepsis.
M. Haberal; N. Uçar; Ü. Bayraktar; Z. Öner; N. Bilgin
The primary aim of this study was to determine the incidents of pseudomonas aeruginosa in post-operative woundinfection and its sensitivity pattern to commonly used antibiotics. During a period of six months between February to December, 2005, 115 specimens were collected from King Abdullah University Hospital, Princess Basma Hospital, Princess Badea and Princess Rahma Hospitals. Samples were obtained from the
Background. Deep sternal woundinfection (DSWI) is a serious complication of cardiac operations performed by median sternotomy. We attempted to define the predictors of DSWI and to describe the outcomes of two treatment strategies used at our institution.Methods. Retrospective review was performed using prospectively gathered data on 12,267 consecutive cardiac surgical patients from 1990 to 1995. Chart review was performed
Michael A Borger; Vivek Rao; Richard D Weisel; Joan Ivanov; Gideon Cohen; Hugh E Scully; Tirone E David
A 10-month-old child from the Middle East received complete correction for tetralogy of Fallot. Despite an initially uneventful postoperative course, he developed severe deep sternal woundinfection after 7 days. This complication was endogenously acquired caused by a resistant and rarely present in Europe, Streptococcus pneumonia. Following surgical debridement, betadine rinsing for 3 days and with a course of specific
Summary WE would like to present the results of a prospective study of the woundinfection rate in Our Lady’s Hospital, Navan, over\\u000a an eleven month period. This study consisted of 602 consecutive patients operated on between January 1983 and November 1983\\u000a in the New Operating Theatre Suite opened in Janary 1982. An overall infection rate of 4.1% was achieved.\\u000a \\u000a One
Mycobacterium fortuitum infection of the sternum following cardiac surgery is a rare occurrence.It is usually diagnosed late\\u000a and has a considerable mortality. We present a female patient with mycobacterium fortuitum sternal woundinfection following\\u000a mitral valve replacement, who was successfully managed with radical surgical debridement combined with multidrug antibiotics.\\u000a Multidrug antibiotic therapy is essential because of the emergence of resistant
An imaging study is needed that can detect sternal woundinfections and distinguish between superficial and deep ster- nal woundinfection when a clinical diagnosis is uncertain and a decision regarding surgical intervention must be made. We retrospectively reviewed the 99mTc-leukocyte scans of 29 patients referred to rule out stemat woundinfection. The presence or absence of deep or superficial
Jeffrey A. Cooper; Sarah L. Elmendorf; John P. Teixeira; Ilk Brian; Eric D. Foster
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.
Dai, Tianhong; Huang, Ying-Ying; Sharma, Sulbha K.; Hashmi, Javad T.; Kurup, Divya B.; Hamblin, Michael R.
Objective: This retrospective chart review study aimed to evaluate whether a more aggressive staged approach can reduce morbility and mortality following post-cardiotomy deep sternal woundinfection. Methods: Between 1979 and 2000, 14 620 patients underwent open heart surgery: mediastinitis developed in 124 patients (0.85%). Patients were divided in two groups: in 62 patients (Group A) (1979-1994) an initial attempt of
M. De Feo; R. Gregorio; A. Della Corte; A. Renzulli; R. Utili
Objective: This retrospective chart review study aimed to evaluate whether a more aggressive staged approach can reduce morbility and mortality following post-cardiotomy deep sternal woundinfection. Methods: Between 1979 and 2000, 14?620 patients underwent open heart surgery: mediastinitis developed in 124 patients (0.85%). Patients were divided in two groups: in 62 patients (Group A) (1979–1994) an initial attempt of conservative
M De Feo; R Gregorio; A Della Corte; C Marra; C Amarelli; A Renzulli; R Utili; M Cotrufo
Deep sternal woundinfection (DSWI) is an uncommon but serious complication of median sternotomy in cardiac surgery, associated with significant mortality and morbidity. We performed a retrospective review of 30,102 consecutive cardiac surgical patients operated on at our institution from 1990 to 2003 and found an incidence of DSWI of 0.77%. The in-hospital mortality rate was 6.9% for DSWI patients
Gilbert H. L. Tang; Manjula Maganti; Richard D. Weisel; Michael A. Borger
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 woundinfection 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 ?L per injection) or saline control (50 ?L per injection) 30 min after woundinfection. Mice were killed at days 3 and 7 after woundinfection, and bacterial colonization, wound size, wound leukocyte accumulation, and peripheral blood were evaluated. At days 3 and 7 after woundinfection, 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 woundinfection or chronic nonhealing wounds in elderly patients. PMID:23856924
Background The aim of this study was to evaluate various clinical parameters that would influence the occurrence of woundinfection (WI)\\u000a in elective laparoscopic surgery (LS) for colorectal carcinoma.\\u000a \\u000a \\u000a \\u000a Methods The study included 290 patients who underwent LS between June 2001 and December 2005. WI was diagnosed within 30 days of the\\u000a operation, and both superficial and deep incision surgical site infection
Otolaryngologists commonly evaluate patients with findings suspicious for deep space soft tissue infections of the neck. In this case, a woman with a history of injection drug use (IDU) presented with dysphagia, odynophagia, and neck pain. Multiple neck abscesses, too small to drain, were seen on imaging. Despite broad-spectrum intravenous antibiotics, she unexpectedly and rapidly developed respiratory failure requiring intubation. Further work-up diagnosed wound botulism (WB). To our knowledge, this is the first report of WB presenting as a deep neck space infection, and illustrates the importance of considering this deadly diagnosis in patients with IDU history and bulbar symptoms. PMID:22645053
Gouveia, Christopher; Mookherjee, Somnath; Russell, Matthew S
In a patient with mediastinitis after cardiac surgery Paenibacillus pasadenensis was detected in his sternal wound. Paenibacilli are gram-positive, aerobic, bacteria related to bacilli. Until recently these organisms were not known to cause human disease. A few cases of human infection caused by another member of this genus, P alvei, have been reported. The authors describe the first infection with P pasadenensis in humans. P pasadenensis was detected by broad-range bacterial 16S rRNA PCR. Treatment consisted of surgical debridement and antibiotics, vancomycin and ciprofloxacin followed by clindamycin and ciprofloxacin, resulting in complete recovery.
Anikpeh, Y Flammer; Keller, P; Bloemberg, GV; Grunenfelder, J; Zinkernagel, A S
Cutaneous aspergillosis is a rare infection most often seen in immunocompromised patients. We report a case of primary cutaneous aspergillosis infection in a nonhealing scalp wound of an immunocompetent elderly patient. The patient had a cutaneous malignancy of the scalp treated with surgical excision but complicated by poor wound healing. Fungal culture of the nonhealing wound revealed Aspergillus niger. The nonhealing wound subsequently resolved with retapamulin ointment 1% and ketoconazole gel 2%. PMID:21644495
Reproducible experimental surgical-woundinfections in mice for use in the evaluation of topical antibacterial agents are described. The experimental would was created on the backs of mice by means of a midline incision and was infected by means of cotton sutures monocontaminated with Staphylococcus aureus or Pseudomonas aeruginosa. The course of these woundinfections was followed by quantitation of surface bacteria through use of a surface rinse technique. Surface wound counts of the infecting organisms thus obtained appeared to reflect the dynamics of the total wound count, as determined by homogenization of biopsied tissue. Treatment of infectedwounds with a placebo cream had only a slight effect on surface wound counts and on mortality in the case of the S. aureus infection but enhanced markedly the lethality of the P. aeruginosa infection. Images
The design of materials for cutaneous wound dressings has advanced from passive wound covers to bioactive materials that promote skin regeneration and prevent infection. Crosslinked poly(N-isopropylacrylamide) (PNIPAAm)-based hydrogels have been investigated for a number of biomedical applications. While these materials can be used for drug delivery, limited cell interactions restrict their biological activity. In this article, acryoyl-lysine (A-Lys) was incorporated into poly(ethylene glycol) crosslinked PNIPAAm to enhance biological activity. A-Lys could be incorporated into the hydrogels to improve cellular interaction in vitro, while maintaining swelling properties and thermoresponsive behavior. Polyhexamethylene biguanide, an antimicrobial agent, could be encapsulated and released from the hydrogels and resulted in decreased bacteria counts within 2 hours. Two in vivo animal wound models were used to evaluate the hydrogel wound dressing. First, application of the hydrogels to a rodent cutaneous wound healing model resulted in significant increase in healing rate when compared with controls. Moreover, the hydrogels were also able to decrease bacteria levels in an infectedwound model. These results suggest that PNIPAAm hydrogels containing A-Lys are promising wound dressings due to their ability to promote healing and deliver active antimicrobial drugs to inhibit infection. PMID:22121043
Jiang, Bin; Larson, Jeffery C; Drapala, Pawel W; Pérez-Luna, Víctor H; Kang-Mieler, Jennifer J; Brey, Eric M
An outbreak of post-operative woundinfections due to Mycobacterium abscessus is described. During a 5-month period 45 post-surgical patients developed woundinfection, manifested by wound breakdown,\\u000a cellulitis, and discharge and progressing slowly to suppuration and sinus formation. The majority (43\\/45) had undergone out-patient\\u000a operations, and 40 had had surgery in the inguinal region. The source of infection was identified as
R. Chadha; M. Grover; A. Sharma; A. Lakshmy; M. Deb; A. Kumar; G. Mehta
BackgroundVacuum-assisted closure therapy is a novel treatment employed to aid wound healing in different areas of the body and recently also in sternotomy wounds. Aggressive vacuum-assisted closure treatment of the sternum in postoperative deep woundinfection enhances sternal preservation and the rate of possible rewiring.
Ronny I Gustafsson; Johan Sjögren; Richard Ingemansson
The objective of this study was to develop and validate a decision model, using an artificial neural network, that predicts infection in uncomplicated, traumatic, sutured wounds. The study was a prospective, cohort study of all patients presenting to the emergency department of a county teaching hospital with uncomplicated wounds that required suturing. In evaluating and treating wounds, emergency medicine (EM) faculty and residents, resident physicians in primary-care specialties, and supervised medical students on EM clerkships followed a standardized wound-management protocol. Clinicians estimated the likelihood of subsequent infection using a 5-point scale. Wound healing was followed until sutures were removed. Wound outcome data were collected by medical personnel blinded to the initial prediction. Student's t-tests and Pearson's chi-square statistic were used to identify independent predictors that served as input variables. Woundinfection was the single output variable. Neural network analysis was used to assign weights to input variables and derive a decision equation. A total of 1,142 wounds were analyzed in the study. The overall infection rate was 7.2%. The most predictive factors for woundinfection were wound location, wound age, depth, configuration, contamination, and patient age. To derive a decision equation for the model, the network was trained on data from half of the subjects and tested on the remainder. When used as a diagnostic test for woundinfection, the decision model had a sensitivity of 70%, as compared to 54% for physicians, and a specificity of 76%, as compared to 78% for physicians. We conclude that through the use of combinations of 7 clinical variables available at the time of initial wound management, a neural network-derived decision model may be used to identify uncomplicated, traumatic wounds at higher risk for infection. PMID:12563571
Lammers, Richard L; Hudson, Donna L; Seaman, Matthew E
Detection of woundinfection is based on evaluation of the well-known signs of inflammation like rubor (redness), calor (heat), tumor (swelling), and dolor (pain) by medical doctors and/or time-consuming procedures requiring special machinery. There is currently no rapid diagnostic device available for the indication of woundinfection, which would especially be helpful in home care of chronic ulcer patients. In this study, a new concept for a fast diagnostic tool for woundinfection based on lysozyme and elastase triggered release of dye from a peptidoglycan matrix was investigated. The matrix consisted of alginate/agarose and peptidoglycan covalently labeled with Remazol brilliant blue. Lysozyme activity in postoperative wounds and decubitus wound fluids was significantly elevated upon infection (4830 ± 1848 U mL(-1)) compared to noninfected wounds (376 ± 240 U mL(-1)). Consequently, incubation of 8% (w/v) labeled agarose/peptidoglycan blend layers with infectedwound fluid samples for 2 h at 37 °C resulted in a 4-fold higher amount of dye released than measured for noninfected wounds. For alginate/peptidoglycan beads, a 7-fold higher amount of dye was released in case of infectedwound fluid samples compared to noninfected ones. Apart from lysozyme, proteases [i.e., gelatinase matrix metalloproteinase MMP-2 and MMP-9 and elastase] were detected in wound fluids (e.g., using Western blotting). When dosed in ratios typical for wounds, a slight synergistic effect was measured for peptidoglycan hydrolysis (i.e., dye release) between lysozyme and these proteases. Incubation of a double-layer system consisting of stained and nonstained peptidoglycan with infectedwound fluids resulted in a color change from yellow to blue, thus allowing simple visual detection of woundinfection. PMID:21388768
Hasmann, Andrea; Wehrschuetz-Sigl, Eva; Kanzler, Gertraud; Gewessler, Ulrike; Hulla, Elisabeth; Schneider, Konstantin P; Binder, Barbara; Schintler, Michael; Guebitz, Georg M
Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.(R)) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal woundinfection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as
A total of 101 consecutive elective colon operations were performed with no postoperative woundinfection. Patients with a wide variety of diagnoses and procedures were included in the series. Many factors contribute to the formation of postoperative woundinfections. A comprehensive approach with attention to preoperative nutritional assessment, bowel preparation, wound protection, sterile technique, closure of the incision, and systemic prophylactic antibiotics contributed to the overall good results. PMID:6430140
Pello, M J; Beauregard, W; Shaikh, K; Camishion, R C
We describe the case of a wounded soldier with a gluteus infection from which Leclercia adecarboxylata was cultured. To our knowledge, this is only the second report of this unusual pathogen being isolated from an abscess and the first report of L. adecarboxylata as the etiology of a war woundinfection. PMID:23707132
Michael, Zapor; McGann, Patrick T; Alao, Omolara; Stevenson, Lindsay; Lesho, Emil; Viscount, Helen
We investigated the value of a full-time audit nurse personally following up every patient from admission to 30 days postoperatively in order to obtain accurate surgical woundinfection rates. Our results show that this type of audit is an effective, although time-consuming, way of collecting accurate data on woundinfection rates. It enabled the early identification of problem areas in
Infection of the sternotomy wound is a potentially devastating and sometimes lethal complication following cardiac surgery. Established treatment may involve a combination of debridement, packing, delayed closure, plastic reconstruction, re-wiring and irrigation dependent on the severity of infection. Vacuum assisted closure, originally adopted for the treatment of non-healing wounds, has recently gained popularity among various surgical specialities in managing complex
Objective: To identify risk factors for sternal woundinfection following coronary artery bypass surgery (CABG), and to compare early and mid-term survival outcome. Methods: Data were prospectively collected for 4228 patients who underwent CABG surgery between April 1997 and March 2001. One hundred and nine (2.6%) patients developed sternal woundinfection. We used logistic regression to identify independent risk factors
John C. Y Lu; Antony D Grayson; Pankaj Jha; Arun K Srinivasan; Brian M Fabri
On 26 December 2004, a tsunami devastated the west coast of Thailand and caused 8457 injuries and 5395 deaths. Data were collected from 26 December 2004 to 31 January 2005 at four public hospitals to describe the character and treatment of wounds of 523 persons who were injured during tsunami and sought medical treatment. Wounds were contaminated with mud, sand, debris and sea water and had an infection rate of 66.5% (674/1013). Most wounds (45%) had poly-microbial infection with gram-negative rods such as Escherichia coli, Klebsiella pneumoniae, Proteus and Pseudomonas species. The risk of woundinfection increased with size of the wound and presence of an open fracture. Infections occurred more frequently on the lower than upper trunk of the body. Early treatment with antibiotics was protective against woundinfection. Many patients asked to have their wounds sutured so that they could return to their village to look for their families and to repair damage. This report suggests that wounds should be aggressively debrided and suturing postponed if possible. Patients should be given broad spectrum antibiotics to assist with wound healing. PMID:19912391
A gelatinase-based device for fast detection of woundinfection was developed. Collective gelatinolytic activity in infectedwounds was 23 times higher (p???0.001) than in noninfected wounds and blisters according to the clinical and microbiological description of the wounds. Enzyme activities of critical wounds showed 12-fold elevated enzyme activities compared with noninfected wounds and blisters. Upon incubation of gelatin-based devices with infectedwound fluids, an incubation time of 30 minutes led to a clearly visible dye release. A 32-fold color increase was measured after 60 minutes. Both matrix metalloproteinases and elastases contributed to collective gelatinolytic enzyme activity as shown by zymography and inhibition experiments. The metalloproteinase inhibitor 1,10-phenanthroline (targeting matrix metalloproteinases) and the serine protease inhibitor phenylmethlysulfonyl fluoride (targeting human neutrophil elastase) inhibited gelatinolytic activity in infectedwound fluid samples by 11-37% and 60-95%, respectively. Staphylococcus aureus and Pseudomonas aeruginosa, both known for gelatinase production, were isolated in infectedwound samples. PMID:23627267
Heinzle, Andrea; Papen-Botterhuis, Nicole E; Schiffer, Doris; Schneider, Konstantin P; Binder, Barbara; Schintler, Michael; Haaksman, Ingrid K; Lenting, Herman B; Gübitz, Georg M; Sigl, Eva
Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.®) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal woundinfection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate) decrease in the incidence of deep sternal woundinfection. If more insight is to be gained from fewer clinical cases, then various potentially confounding factors should be fully disclosed before complications can be attributed to the technique itself or improvements to negative-pressure wound therapy for deep sternal woundinfection can be accepted as evidence-based and the guidelines for its use adapted. The authors propose the adoption of a simple checklist in such cases.
The consequences of deep woundinfections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and the choice of a prophylactic antibiotic regimen. We recommend that cardiac surgery programs supplement their audit processes and ongoing vigilance for infections with periodic, multidisciplinary reviews of best-practice standards for preoperative, intraoperative, and postoperative patient care.
Titer of antibodies to microorganisms obtained from wound and blood of 46 patients with burns of IIIAB--IV degree was studied. The majority of the burned patients have ability to synthesize antibodies. Agglutination of the bacteria by antibodies promoted location of infectious agent in primary focus and impeded bacteria to spread into blood and generalization of process. Not all microorganisms of wound provoke antibodies synthesis, i.e. woundinfection. Therefore bacteriologic study must be supplemented by serum diagnosis. Detection of bacteria in the blood without serologic data do not permit to consider these bacteria as etiologic factor of woundinfection. PMID:12162077
Pal'tsyn, A A; Kolokol'chikova, E G; Alekseev, A A; Krutikov, M G; Bobrovnikov, A E; Chervonskaia, N V; Badikova, A K; Grishina, I A
Background. Diabetes mellitus is a risk factor for deep sternal woundinfection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal woundinfection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal woundinfection.Methods. In
Anthony P Furnary; Kathryn J Zerr; Gary L Grunkemeier; Albert Starr
ISSUE: A devastating complication of coronary artery bypass graft (CABG) surgery is post-operative surgical site woundinfections. In 2001, Baptist Medical Center (BMC) experienced a post-operative CABG surgical woundinfection rate that was above the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance System (NISS) rate.PROJECT: A multidisciplinary performance improvement team, consisting of the chiefs of Cardiovascular
The sternum woundinfection, caused by Mycobacterium tuberculosis after a cardiac surgery, is an extremely rare postoperative complication. It requires a high degree of suspicion for a correct diagnosis. Often a successful treatment is impeded by the insidious nature of tuberculosis infection and the time-consuming diagnosis process. We report two cases in which we successfully treated this infection with sternum resection, wound debridement, and antituberculosis medication. PMID:23006691
Summary A recent publication, where three experienced workers in the field of managing post-operative contaminated open wounds, especially\\u000a of the abdominal wall, underscores the considerable number of different methods that are in vogue. Infected abdominal wounds\\u000a are usually treated by debridement, the administration of appropriate antibiotics and wound closure on a delayed basis. In\\u000a the presence of a surgical implant, the
The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is\\u000a controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following\\u000a appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department\\u000a of surgery. The
Gerald T. McGreal; Aislinn Joy; Brian Manning; John L. Kelly; Joseph A. O’Donnell; W. William; O. Kirwan; H. Paul Redmond
Summary \\u000a Between 1.4.96 and 1.3.97 27 patients with acute infections of bone and soft tissues (n = 13), chronic osteomyelitis (n = 8), and chronic wounds (n = 6) were treated by using Instillation-Vacuum-Sealing. Polyvinylalcohol sponges with drainage tubes were used to cover the\\u000a internal or external wound surfaces which resulted from surgical debridement. Having hermetically covered the wound with
W. Fleischmann; M. Russ; A. Westhauser; M. Stampehl
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.
Kramer, Axel; Assadian, Ojan; Frank, Matthias; Bender, Claudia; Hinz, Peter
Abstract The objective of this multicentre, randomized, controlled field study was to determine the efficacy of ketanserin gel in preventing exuberant granulation tissue formation (hypergranulation) and infection in equine lower limb wounds. Horses and ponies (n = 481) with naturally occurring wounds were randomized to either topical treatment with ketanserin gel (n = 242) or a positive control (Belgium, Germany: ethacridin lactate solution, n = 120; France, United Kingdom: malic, benzoic, and salicylic acid [MBS] cream, n = 119). Treatment continued until the wound healed (success), formed hypergranulation tissue (failure), or became infected (failure). Treatment was terminated after 6 months in all remaining animals. Ketanserin was successful in 88% of cases. Wounds treated with ketanserin were 2 and 5 times more likely to heal successfully than were those treated with MBS or ethacridin lactate, respectively. Ketanserin gel is thus more effective than these standard treatments in preventing hypergranulation tissue and infection of equine lower limb wounds.
Diabetes mellitus is an epidemic multisystemic chronic disease that frequently is complicated by complex woundinfections. Innovative topical antimicrobial therapy agents are potentially useful for multimodal treatment of these infections. However, an appropriately standardized in vivo model is currently not available to facilitate the screening of these emerging products and their effect on wound healing. To develop such a model, we analyzed, tested, and modified published models of wound healing. We optimized various aspects of the model, including animal species, diabetes induction method, hair removal technique, splint and dressing methods, the control of unintentional bacterial infection, sampling methods for the evaluation of bacterial burden, and aspects of the microscopic and macroscopic assessment of wound healing, all while taking into consideration animal welfare and the '3Rs' principle. We thus developed a new woundinfection model in rats that is optimized for testing topical antimicrobial therapy agents. This model accurately reproduces the pathophysiology of infected diabetic wound healing and includes the current standard treatment (that is, debridement). The numerous benefits of this model include the ready availability of necessary materials, simple techniques, high reproducibility, and practicality for experiments with large sample sizes. Furthermore, given its similarities to infected-wound healing and treatment in humans, our new model can serve as a valid alternative for applied research. PMID:22330650
Mendes, João J; Leandro, Clara I; Bonaparte, Dolores P; Pinto, Andreia L
Aim: Clinical studies suggest that smoking is associated with wound necrosis after breast cancer surgery. However, the significance of smoking as a risk factor for woundinfection, skin flap necrosis, and epidermolysis when adjusting for other potential risk factors remains to be studied.Methods: From June 1994 through August 1996, 425 patients underwent breast cancer surgery as simple mastectomy, modified radical
L. T. Sørensen; J. Hørby; E. Friis; B. Pilsgaard; T. Jørgensen
Introduction: Battlefield wounds are frequently contaminated with pathogenic microorganisms present on uniforms and skin. Although the development of serious infections can often be prevented by antibiotics, the rise in worldwide incidence of multiply antibiotic-resistant bacteria necessitates the discovery of alternative methods. In addition, traumatic wounds and burns may contain non-perfused tissue where antibiotics cannot penetrate efficiently. The possibility also exists
Michael R Hamblin; Faten Gad; R Rox Anderson; Tayyaba Hasan
We present three cases of deep sternal woundinfections after sternotomy, with partial dehiscence and instability of sternum, successfully treated with combined therapy based on hyperbaric oxygen (HBO), parenteral and intranasal antibiotics, daily debridements and medications. After a short hospitalization (10 days) to detect involved bacteria, depth of the wounds and choice of right antibiotic therapy, all patients continued the
A. Lappa; M. R. Malpieri; M. Cicco; A. Bucci; F. Araimo; D. Alampi
We present three cases of deep sternal woundinfections after sternotomy, with partial dehiscence and instability of sternum, successfully treated with combined therapy based on hyperbaric oxygen (HBO), parenteral and intranasal antibiotics, daily debridements and medications. After a short hospitalization (10 days) to detect involved bacteria, depth of the wounds and choice of right antibiotic therapy, all patients continued the
A. Lappa; M. R. Malpieri; M. Cicco; A. Bucci; F. Araimo; D. Alampi
Wound healing is a complex and fragile process, which can be complicated by infection and inflammation. In this study, multiple cases are reviewed pictorially for the purpose of recording improved wound healing using the antimicrobial Silver Sol gel. The daily use of Silver Sol gel results in reduced infection (including MRSA), which leads to less inflammation. By reducing the inflammation
We report the results of our investigations on the effect of antimicrobial photodynamic treatment (APDT) with poly-lysine-conjugated chlorin p6 (pl-cp6) on proinflammatory cytokine expression and wound healing in a murine excisional wound model infected with Pseudomonas aeruginosa. Treatment of infectedwounds with pl-cp6 and light doses of 60 and 120 J/cm(2) reduced the bacterial load by ~1.5 and 2.0 log, respectively, after 24 h. The treated wounds healed ~5 days earlier as compared to untreated control and wound closure was not dependent on light dose. Interestingly, at 96 h post-treatment, drug-treated wounds irradiated at 60 J/cm(2) showed considerable reduction of proinflammatory cytokines IL-6 (approximately five times) and TNF-? (approximately four times) compared to untreated control. Further, exposure of culture supernatants to similar light dose and pl-cp6 concentration under in vitro conditions reduced the protease activity by ~50 % as compared to the untreated control, suggesting inactivation of extracellular virulent factors. Additionally, histological analysis of treated infectedwounds showed complete reepithelialization, ordered collagen fibers, and considerable decrease in inflammatory cell infiltration compared to untreated wounds. These results imply that pl-cp6-mediated PDT reduces hyperinflammatory response of infectedwounds, leading to acceleration of wound healing. PMID:22454129
Wounds sustained by sharks and their skate and ray relatives have been observed to heal rapidly and without infection. A protective secretion produced by epidermal mucus cells in stingrays is being investigated to understand its role in the healing proces...
Battlefield wounds are frequently contaminated with pathogenic microorganisms present on uniforms and skin. Although the development of serious infections can often be prevented by antibiotics, the rise in worldwide incidence of multiply antibiotic-resist...
Background: Our clinical impression derived from >95% follow-up of patients was that our woundinfection rate was higher than\\u000a the 1-10% reported in the literature. The purpose of this study was to determine the incidence and risk factors for wound\\u000a infection in open bariatric surgery. Methods: We queried our prospectively acquired bariatric surgery outcomes database, and\\u000a retrospectively audited the charts
Nicolas V. Christou; Joyce Jarand; Jean-Loup Sylvestre; Alexander P. H. McLean
Objective: To assess the impact of deep sternal woundinfection on in-hospital mortality and mid-term survival following adult cardiac surgery. Methods: Prospectively collected data on 4586 consecutive patients who underwent a cardiac surgical procedure via a median sternotomy from 1st January 2001 to 31st December 2005 were analysed. Patients with a deep sternal woundinfection (DSWI) were identified in accordance
Anand Sachithanandan; Prakash Nanjaiah; Peter Nightingale; Ian C. Wilson; Timothy R. Graham; Stephen J. Rooney; Bruce E. Keogh; Domenico Pagano
Between January 2002 and January 2009, 39 patients with post-cardiotomy staphylococcal deep sternal woundinfection were treated primarily by a vacuum-assisted closure method (group A). Results were compared with those of 30 patients with staphylococcal deep sternal woundinfection who received closed mediastinal irrigation with antibiotics (group B). The prevalence of methicillin-resistance was similarly high in both groups (64.1% in
Marisa De Feo; Mariano Vicchio; Gianantonio Nappi; Maurizio Cotrufo
Background. Deep sternotomy woundinfections during the neonatal period, their management utilizing the pectoralis major muscle flap (PMF), and their follow-up are reported.Methods. Seven hundred-twenty consecutive pediatric cardiac operations performed from 1995 to mid 1998 in 108 neonates and 612 infants are reviewed. Nine children (1.25%), 6 neonates and 3 infants, developed deep sternotomy woundinfections and underwent PMF reconstruction.
Background. Coagulase-negative staphylococci are commonly isolated from wounds of patients after median sternotomy; however, the epidemiology of these infections is poorly described and the morbidity, mortality, and cost of care remain undefined.Methods. Retrospectively, we studied all patients with sternal woundinfections attributable to coagulase-negative staphylococci after 22,180 open heart procedures performed at the Cleveland Clinic between January 1, 1988, and
Objective: To assess the impact of deep sternal woundinfection on in-hospital mortality and mid-term survival following adult cardiac surgery. Methods: Prospectively collected data on 4586 consecutive patients who underwent a cardiac surgical procedure via a median sternotomy from 1st January 2001 to 31st December 2005 were analysed. Patients with a deep sternal woundinfection (DSWI) were identified in accordance
Anand Sachithanandan; Prakash Nanjaiah; Peter Nightingale; Ian C. Wilson; Timothy R. Graham; Stephen J. Rooney; Bruce E. Keogh; Domenico Pagano
Abstract Objective: To identify risk factors for sternal woundinfection following coronary artery bypass surgery (CABG), and to compare early and mid-term survival outcome. Methods: Data were prospectively collected for 4228 patients who,underwent CABG surgery between April 1997 and March 2001. One hundred,and nine (2.6%) patients developed sternal wound,infection. We used logistic regression to identify independent risk factors associated with
John C. Y. Lu; Antony D. Grayson; Pankaj Jha; Arun K. Srinivasan; Brian M. Fabri
Staphylococcus aureus infections are associated with considerable morbidity and, in certain situations, mortality. The association between the nasal carriage of S. aureus and subsequent infection has been comprehensively established in a variety of clinical settings, in particular, patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis (CAPD), and in patients undergoing surgery. Postoperative woundinfections are associated with a high degree
Objective: Prediction of surgical site infection and mortality after cardiac surgery might allow for interventions to reduce adverse outcomes. We sought to evaluate existing risk scores. Methods: We included 809 consecutive patients undergoing coronary artery bypass surgery. Data were collected prospectively. Infections were defined as deep sternal woundinfection or mediastinitis by using established criteria and evaluated 60 days after
Mical Paul; Aeyal Raz; Leonard Leibovici; Rita Holinger; Bina Rubinovitch
This study investigated the number and type of chronic wounds actually treated by Dutch nursing home physicians (NHPs). It was also the goal to know how many of the treated chronic wounds they considered infected. The NHPs were asked to choose and rank their top five out of several provided criteria for chronic woundinfection. After this, the ranking was compared with the choices an international multidisciplinary Delphi group of wound experts made in 2005. A cross-sectional descriptive survey was conducted using the information from a self-reported questionnaire in a representative sample of Dutch NHPs. About 361 NHPs (25%) were sent a questionnaire. Of the 361 physicians, 139 (38.5%) filled in and returned the questionnaire of which 121 were valid. Of the NHPs, 73.5% actually treated at least one chronic pressure ulcers (PU), whereas 26.5% did not treat any. Of the responding NHPs,31.6 % treated at least one, but never more than two chronic post surgical wounds , whereas 68.4% of the NHPs treated none [corrected]. Chronic venous leg ulcers, arterial ulcers and diabetic ulcers scored infrequently and less than the other two sorts of chronic wounds. Of the Dutch NHPs, 53% considered that none of the PU infected. The other chronic wounds were judged far less frequently to be infected. Dutch NHPs appeared to use more 'traditional' criteria such as 'puss/abscess' and 'malodour' to identify infection and did not change their criteria by wound type. According to this study, NHPs do not frequently see many chronic wounds. The most frequent type of wounds treated was PU. For NHPs, the identification of infection of all types of chronic wounds is difficult. The use of criteria that is not in line with consensus documents may lead to ineffective treatment and even seriously damage patients: the clinical identification of infection is still dependent on experts' opinion. Further research on triggers for the suspicion of woundinfection and the development of an evidence-based guideline is necessary. PMID:19719523
Rondas, A A L M; Schols, J M G A; Stobberingh, E E; Price, P E
Diabetic patients often have ulcers on their lower-limbs that are infected by multiple biofilm-forming genera of bacteria, and the elimination of the biofilm has proven highly successful in resolving such wounds in patients. To that end, antimicrobial peptides have shown potential as a new anti-biofilm approach. The single human cathelicidin peptide LL-37 has been shown to have antimicrobial and anti-biofilm activity against multiple Gram-positive and Gram-negative human pathogens, and have wound-healing effects on the host. The combination of the anti-biofilm effect and wound-healing properties of LL-37 may make it highly effective in resolving polymicrobially infectedwounds when topically applied. Such a peptide or its derivatives could be a platform from which to develop new therapeutic strategies to treat biofilm-mediated infections of wounds. This review summarizes known mechanisms that regulate the endogenous levels of LL-37 and discusses the anti-biofilm, antibacterial, and immunological effects of deficient vs. excessive concentrations of LL-37 within the wound environment. Here, we review recent advances in understanding the therapeutic potential of this peptide and other clinically advanced peptides as a potential topical treatment for polymicrobial infectedwounds.
Understanding the pathology resulting from Staphylococcus aureus and Pseudomonas aeruginosa polymicrobial woundinfections 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 woundinfection in the presence of P. aeruginosa resulted in induced expression of USA300 virulence factors Panton-Valentine leukocidin and ?-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 woundinfections.
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.
Sternal woundinfection (SWI) is a serious complication after cardiac surgery. In a previous randomized controlled trial,\\u000a the addition of local collagen-gentamicin in the sternal wound before wound closure was found to significantly reduce the\\u000a incidence of postoperative woundinfections compared with the routine intravenous prophylaxis of isoxazolyl-penicillin only.\\u000a The aims of the present study were to analyse the microbiological
Ö. Friberg; R. Svedjeholm; J. Källman; B. Söderquist
Infection of plants by bacterial leaf pathogens at wound sites is common in nature. Plants defend wound sites to prevent pathogen invasion, but several pathogens can overcome spatial restriction and enter leaf tissues. The molecular mechanisms used by pathogens to suppress containment at woundinfection sites are poorly understood. Here, we studied Pseudomonas syringae strains causing brown spot on bean and blossom blight on pear. These strains exist as epiphytes that can cause disease upon wounding caused by hail, sand storms and frost. We demonstrate that these strains overcome spatial restriction at wound sites by producing syringolin A (SylA), a small molecule proteasome inhibitor. Consequently, SylA-producing strains are able to escape from primary infection sites and colonize adjacent tissues along the vasculature. We found that SylA diffuses from the primary infection site and suppresses acquired resistance in adjacent tissues by blocking signaling by the stress hormone salicylic acid (SA). Thus, SylA diffusion creates a zone of SA-insensitive tissue that is prepared for subsequent colonization. In addition, SylA promotes bacterial motility and suppresses immune responses at the primary infection site. These local immune responses do not affect bacterial growth and were weak compared to effector-triggered immunity. Thus, SylA facilitates colonization from wounding sites by increasing bacterial motility and suppressing SA signaling in adjacent tissues. PMID:23555272
Misas-Villamil, Johana C; Kolodziejek, Izabella; Crabill, Emerson; Kaschani, Farnusch; Niessen, Sherry; Shindo, Takayuki; Kaiser, Markus; Alfano, James R; van der Hoorn, Renier A L
A novel murine experimental woundinfection 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 woundinfection 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
Bacterial flora in burn patients undergoes change over period of time and is dependent upon many factors. Study of burn flora is not only helpful in locating entry of multidrug resistant bacterial strains into the unit’s usual flora but also in determining current antibiotic susceptibilities. Since no studies are available from India that have studied sequential emergence of different microorganisms in burn wound, present study was carried out to study evolution of bacterial flora in burn wounds and its correlation with invasive woundinfection. Environmental sampling was also carried out for possible sources of infection. Patients with 20-70% of total burn surface were enrolled and followed up for entire duration of stay. Clinical & treatment details were noted. Surface wound swabs were collected on first, third, seventh, tenth and fourteenth day post admission. Environmental sampling was done every three months. Of 215 wound swabs collected from 71 patients, 72 were sterile and 143 yielded 214 isolates. Colonization rates were 33% on first day, 94% on 7th day and 100% by 14th day. 42% swabs grew gram negative bacteria. Overall Staphylococcus aureus was the predominant isolate (45%) followed by Pseudomonas aeruginosa (13.9%), beta hemolytic Streptococci (9.4%). Maximum invasive infections were seen at the seventh day. A high level of environmental contamination was seen with S. aureus, a substantial portion being MRSA. Better control of environmental contamination and disinfection along with rigorous hand washing and barrier precautions are recommended to prevent infection of wounds.
Objective: The purpose of the study was to determine whether electrolyzed ox- idized water (EOW) functions as a bacte- ricide in burn injury with Pseudomonas aeruginosa infection in a rat burn-wound model. Methods: Anesthetized Sprague- Dawley rats (n 5 31) were subjected to third-degree burns to 30% of total body surface area. Two days after injury, all rats were infected
BACKGROUND: Woundinfections are a common complication of surgery that add significantly to the morbidity of patients and costs of treatment. The global trend towards reducing length of hospital stay post-surgery and the increase in day case surgery means that surgical site infections (SSI) will increasingly occur after hospital discharge. Surveillance of SSIs is important because rates of SSI are
Emily S Petherick; Jane E Dalton; Peter J Moore; Nicky Cullum
Ten cases of surgical woundinfection in which Propionibacterium acnes was probably the aetiologic agent were reviewed; in five the organism was isolated in pure culture. Six patients underwent a neurosurgical procedure. The average time for development of infection was 17·5 days (range 1–30 days). All patients were cured by surgical drainage and, in nine cases, with appropriate antimicrobial therapy.
J. Esteban; J. M. Ramos; P. Jimenez-Castillo; F. Soriano
Summary Sternal wound dehiscence and infection are major problems for patients and health care providers. A range of risk factors, including diabetes, obesity and internal thoracic artery harvest, has been implicated. Several pathophysiological mechanisms, which may account for the development of infection, have been proposed. There is a growing body of evidence which suggests that sternal ischaemia may play a
Background. Sternal woundinfection is a relatively rare but potentially devastating complication of open heart operations. The most common treatments after debridement are rewiring with antibiotic irrigation and muscle flaps. Here we present the results of a prospective trial to determine the appropriate roles of closed-chest catheter irrigation and muscle flap closure for sternotomy infection and to assess the effect
Richard P. Rand; Richard P. Cochran; Salim Aziz; Bradley O. Hofer; Margaret D. Allen; Edward D. Verrier; Karyn S. Kunzelman
Wire fixation after median sternotomy is a safe proce- dure, but it is still associated with potential woundinfection including bony dehiscence. In case of infection and dehiscence the sternum is re-fixated with steel wires. If this is insufficient, then flap reconstruction would be another option. We describe an alternative way for com- plicated sternal closure by using a rigid
Andre Plass; Jürg Grünenfelder; Oliver Reuthebuch; Robert Vachenauer; Jean-Marc Gauer; Gregor Zünd; Michele Genoni
Background Complex skin defects resulting from acute skin trauma and chronic, nonhealing wounds are life-threatening injuries. Infection is one of the most common obstacles to the healing of these types of wounds. Host defense peptides (HDPs) possessing a broad spectrum of activity against microorganisms and serving as innate immune modulators have emerged as potential treatment strategies for infectedwounds. The Problem The increase in multidrug-resistant clinical bacterial isolates highlights the need for new and innovative anti-infective therapies for the treatment of both acute and chronic skin wounds. Basic/Clinical Science To address the critical need for new therapeutic options to reduce infection and improve wound healing, a bioengineered skin substitute (BSS) tissue has been created to act as an anti-infective living human skin tissue that provides enhanced expression of the endogenous HDP, cathelicidin. To generate a BSS exhibiting these antimicrobial properties, the clinically tested NIKS progenitor cells were employed to provide a source of genetically uniform, nontumorigenic, pathogen-free human keratinocytes that are amenable to genetic engineering using nonviral means. Clinical Care Relevance Pathogenic bacterial strains are increasingly developing antibiotic resistance, thereby forcing the clinician to use potent antibiotics with deleterious effects on keratinocyte viability and migration. Therefore, an urgent need exists for new wound therapies that can circumvent many of the problems associated with current antibiotic treatments. Conclusion Enhanced expression of cathelicidin in a genetically engineered human BSS has been shown to inhibit the bacterial growth of a multidrug-resistant clinical strain of Acinetobacter baumannii in vivo, creating a new and innovative therapeutic option for combating these debilitating woundinfections while also promoting healing.
Thomas-Virnig, Christina L.; Allen-Hoffmann, B. Lynn
We report a case of an 80-year old male patient who sustained a major rupture of the right ventricle after surgical revision of an infected sternotomy wound following coronary artery bypass surgery. The rupture of the right ventricle occurred despite an early wound debridement and the use of negative pressure wound therapy on the sternum that did not provide sufficient stability to the sternum after the sternal wires were removed. The rupture resulted in a major bleeding but by establishing emergent cardiopulmonary bypass, the patient was saved. PMID:23357524
Thorsteinsson, David T; Valsson, Felix; Geirsson, Arnar; Gudbjartsson, Tomas
The recent increased recovery of anaerobic bacteria from children has led to greater appreciation of their role in paediatric infections at all body sites, including post-surgical wounds (PSW). In studies that employed adequate method for recovery of aerobic and anaerobic bacteria polymicrobial, aerobic and anaerobes were isolated from over half of the patients with PSW. The wounds studied were those that developed following these surgical procedures: head and neck surgery for malignancies, post-thoracotomy, spinal fusion and gastrostomy tube insertion. Staphylococcus aureus and aerobic gram-negative bacilli were found at all sites. However, a correlation was generally found between the site of the wounds and microbial flora recovered from the wound. Organisms that resided in the mucous membranes close to the surgical site predominated in the wound next to these areas. Enteric Gram-negative rods, Group D enterococcus and Bacteroides fragilis group predominated in wounds relating to the gut flora, while Streptococcus spp., pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp. were most frequently recovered in wounds proximal to the oral area. Management of PSW should include administration of antimicrobials effective against the polymicrobial bacterial flora adjacent to the anatomic site of the wound. PMID:12581479
We aimed assess the effects of different energy densities of the association of red/IR laser light on the healing of cutaneous woundsinfected Staphylococcus aureus. Background: Woundinfection 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 (?680nm/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.
Santos, Nicole R. S.; Cangussú, Maria C. T.; N. Dos Santos, Jean; Pinheiro, Antonio L. B.
Though seldom reported, Solobacterium moorei, which was first described in 2000, has been identified in specimens from patients with root canals, periradicular lesions, periodontal disease, dentoalveolar abscesses, bacteremia, septic thrombophlebitis, and halitosis. In the present study, we describe 9 cases of mixed woundinfection, from a pool of 400 surgical woundinfections that we have studied, in which S. moorei was isolated or found in a clone library. All isolates of S. moorei were identified by 16S rRNA gene sequence analysis, and then six were examined for their physiological and biochemical characteristics and for antimicrobial susceptibility. The results of the present study indicate that Solobacterium moorei may be a significant component in some mixed surgical woundinfections and that surgical management and antimicrobial therapy may be indicated when these bacteria are identified in significant situations. PMID:20071554
Zheng, Guili; Summanen, Paula H; Talan, David; Bennion, Robert; Rowlinson, Marie-Claire; Finegold, Sydney M
Though seldom reported, Solobacterium moorei, which was first described in 2000, has been identified in specimens from patients with root canals, periradicular lesions, periodontal disease, dentoalveolar abscesses, bacteremia, septic thrombophlebitis, and halitosis. In the present study, we describe 9 cases of mixed woundinfection, from a pool of 400 surgical woundinfections that we have studied, in which S. moorei was isolated or found in a clone library. All isolates of S. moorei were identified by 16S rRNA gene sequence analysis, and then six were examined for their physiological and biochemical characteristics and for antimicrobial susceptibility. The results of the present study indicate that Solobacterium moorei may be a significant component in some mixed surgical woundinfections and that surgical management and antimicrobial therapy may be indicated when these bacteria are identified in significant situations.
Zheng, Guili; Summanen, Paula H.; Talan, David; Bennion, Robert; Rowlinson, Marie-Claire; Finegold, Sydney M.
Acinetobacter baumannii (Ab) is a frequent cause of hospital acquired pneumonia and recently has increased in incidence as the causative agent of severe disease in troops wounded in Afghanistan and Iraq. Ab clinical isolates are frequently extremely resistant to antimicrobials, significantly complicating our capacity to treat infections due to this pathogen. Hence, the development of innovative therapeutics targeting mechanisms to which the bacteria are unlikely to evolve resistance is urgently needed. We examined the capacity of a nitric oxide-releasing nanoparticle (NO-np) to treat woundsinfected with Ab. We found that the NO-nps were therapeutic in an experimental Ab murine wound model. Treatment with NO-nps significantly accelerated healing of infectedwounds. Histological study demonstrated that NO-np treatment reduced suppurative inflammation, decreased microbial burden, and reduced the degradation of collagen. Furthermore, NO-np treatment alters the local cytokine milieu. In sum, we demonstrated that the NO-nps are an easily administered topical antimicrobial for the treatment of Ab woundinfections, and our findings suggest that NO-nps may also be ideal for use in combat or disaster situations. PMID:21178416
Mihu, Mircea Radu; Sandkovsky, Uriel; Han, George; Friedman, Joel M; Nosanchuk, Joshua D; Martinez, Luis R
A three month prospective audit of woundinfection following emergency and elective caesarean section was carried out in five West Yorkshire hospitals. Among 4076 women undergoing delivery in the five obstetric departments, the caesarean rate was 15·4%. The overall infection rate was 45628 (7·2%) with a range of 2·5–17·2% between the five centres. The infection rate was 14226 (6·2%) when
C. Nice; A. Feeney; P. Godwin; M. Mohanraj; A. Edwards; A. Baldwin; A. Choyce; A. Hunt; C. Kinnaird; M. Maloney; W. Anderson; L. Campbell
Pasteurella multocida is a Gram-negative bacterium recovered from a wide variety of wild and domestic animals and has mostly been associated with\\u000a infection following animal bites. We present the first reported case of a patient who developed a postoperative sternal wound\\u000a infection due to P. multocida complicated by bloodstream infection. The outcome was favorable following surgical debridement and antimicrobial therapy.
R. Baillot; P. Voisine; L. M. E. G. Côté; Y. Longtin
Nosocomial and surgical-site infections are significant burdens to the health care system that account for $5 billion and $1.6 billion each year in the United States, respectively. These infections are associated with significant morbidity and mortality rates, increased length of hospitalization, and increased treatment costs that are often not reimbursed by third-party payers. Approximately 40% of sternal woundinfections in
While infected skin wounds are on the increase because of ageing populations, rising incidence of diabetes, and antibiotic resistance, we lack relevant in vivo or in vitro models to study many aspects of bacterial interaction with skin. The aim of this study was to develop three-dimensional models of normal human skin to study bacterial infection. The common dermatological pathogens Staphylococcus aureus and Pseudomonas aeruginosa were used to infect tissue-engineered skin, and the course of infection in the skin was examined over several days. Two forms of model were developed-one in which bacteria were introduced directly to 10 mm wounds in the epidermis, and another in which wounds were created by burning a 4 mm hole in the center of the tissue before inoculation. The bacteria flourished within the engineered skin, and colonized the upper epidermal layers before invasion into the dermis. Infection with P. aeruginosa caused a loss of epidermis and de-keratinization of the skin constructs, as well as partial loss of basement membrane. These novel complex human skin infection models could be used to investigate microbial invasion of normal skin epithelium, basement membrane, and connective tissue, and as a model to study approaches to reduce bacterial burden in skin wounds. PMID:19292658
Neutrophil influx is an early inflammatory response that is essential for the clearance of bacteria and cellular debris during cutaneous wounding. A non-invasive real-time fluorescence imaging technique was developed to examine the kinetics of enhanced green fluorescence protein-polymorphonuclear leukocyte (EGFP-PMN) influx within a wound. We hypothesized that infection or systemic availability would directly regulate the dynamics of EGFP-PMN recruitment and the efficiency of wound closure. Neutrophil recruitment increased dramatically over the first 24 hours from 106 at 4 hours up to a maximum of 5×106 EGFP-PMNs at 18 hours. A high rate of EGFP-PMN turnover was evidenced by ?80% decrease in EGFP signal within 6 hours. In response to wound colonization by Staphylococcus aureus or injection of GM-CSF, systemic PMNs increased twofold above saline control. This correlated with an increase in EGFP-PMN recruitment up to ?107 within the wound. Despite this effect by these distinct inflammatory drivers, wound closure occurred at a rate similar to the saline-treated control group. In summary, a non-invasive fluorescence-based imaging approach combined with genetic labeling of neutrophils provides a dynamic inner view of inflammation and the kinetics of neutrophil infiltration into the wounded skin over extended durations.
Kim, Min-Ho; Liu, Wei; Borjesson, Dori L.; Curry, Fitz-Roy E.; Miller, Lloyd S.; Cheung, Ambrose L.; Liu, Fu-Tong; Isseroff, R Rivkah; Simon, Scott I.
Background and purpose Mechanically failed internal fixation following hip fracture is often treated by salvage arthroplasty. If deep woundinfection is present, a 2-stage procedure is often used. We have used a 1-stage procedure in infected cases, and we now report the outcome. Patients and methods We reviewed 16 cases of deep woundinfection after mechanically failed hip fracture fixation, treated between 1994 and 2010. In all patients, a joint prosthesis was implanted in a 1-stage procedure. Results After an average follow-up period of 12 (2–18) years, no reinfection was detected. In 4 cases, a hip dislocation occurred and 3 of these needed further surgery. Interpretation A 1-stage procedure for arthroplasty of an infected, mechanically failed hip fracture fixation is feasible and carries a low risk of infection.
Klatte, Till O; O'Loughlin, Padraigh F; Citak, Mustafa; Rueger, Johannes M; Gehrke, Thorsten; Kendoff, Daniel
Objectives: The objective of this study is to introduce modifications in paraspinous muscle flap surgery and compare this new variation's ability to salvage infected hardware with the classic technique. Infected posterior spine wounds are a difficult problem for reconstructive surgeons. As per experience, hardware retention in infectedwounds maintains spinal stability, decreases length of stay, and decreases the wound healing complication rate. Methods: An 11-year retrospective office and hospital chart review was conducted between July 1996 and August 2007. All patients who underwent paraspinous muscle flap reconstruction for postspine surgery woundinfections during this time period were included. There were 51 patients in the study representing the largest reported series, to date, for this procedure. Twenty-two patients underwent treatment using the modified technique and 29 patients were treated using the classic technique. Results: There was no statistical difference between the 2 groups in demographics, medical history, or reason for initial spine surgery. The hardware salvage rate associated with the modified technique was greater than the rate associated with the classic technique (95.4% vs 75.8%; P = .03). There were fewer postreconstruction wound healing complications requiring hospital readmission in the modified technique group than the classic group (13.6% vs 44.8%; P = .04). Patients in the modified technique group demonstrated a shorter mean length of stay than the patients in the classic group (23.7 days vs 29.7; P = .25). Conclusions: The modified paraspinous muscle flap technique is an excellent option for spinal wound reconstruction, preservation of spinal hardware, and local infection control.
Mericli, Alexander F.; Moore, John H.; Copit, Steven E.; Fox, James W.; Tuma, Gary A.
Few studies have analysed the bacterial pathogenesis of infections associated with war-wound in the Eastern Mediterranean region. We analysed surgical woundinfections of 1200 patients injured during the Libyan conflict in 2011 and admitted to the emergency services at Tripoli medical centre. Culture swabs or surgical wound debridement samples were collected and cultures were identified and tested for antimicrobial resistance. Of the 1200 patients studied, 498 (42%) were infected with at least 1 pathogen and 57 with >2 pathogens. The most common species were Acinetobacter spp. (isolated from 144 patients), coagulase-negative staphylococci (122), Escherichia coli (107), Pseudomnonas aeruginosa (92) and Klebsiella spp. (86). A high level of resistance to the antibiotics tested was found, especially among Acinetobacter spp. Multi-drug-resistant Gram-negative bacilli were an important complicating factor in woundinfections associated with war injuries among injured patients in Libya. Effective policies are needed to control and treat such infections particularly in trauma and emergency services. PMID:23882961
Summary Background In many animals, the epidermis is in permanent contact with the environment and represents a first line of defense against pathogens and injury. Infection of the nematode Caenorhabditis elegans by the natural fungal pathogen Drechmeria coniospora induces the expression in the epidermis of antimicrobial peptide (AMP) genes such as nlp-29. Here, we tested the hypothesis that injury might also alter AMP gene expression and sought to characterize the mechanisms that regulate the innate immune response. Results Injury induces a wound-healing response in C. elegans that includes induction of nlp-29 in the epidermis. We find that a conserved p38-MAP kinase cascade is required in the epidermis for the response to both infection and wounding. Through a forward genetic screen, we isolated mutants that failed to induce nlp-29 expression after D. coniospora infection. We identify a kinase, NIPI-3, related to human Tribbles homolog 1, that is likely to act upstream of the MAP2K SEK-1. We find NIPI-3 is required only for nlp-29 induction following infection and not following wounding. Conclusions Our results show that the C. elegans epidermis actively responds to wounding and infection via distinct pathways that converge on a conserved signaling cassette that controls the expression of the AMP gene nlp-29. A comparison between these results and MAP kinase signaling in yeast gives insights into the possible origin and evolution of innate immunity.
Pujol, Nathalie; Cypowyj, Sophie; Ziegler, Katja; Millet, Anne; Astrain, Aline; Goncharov, Alexandr; Jin, Yishi; Chisholm, Andrew D.; Ewbank, Jonathan J.
Twenty?five wound dressing compounds were screened for control of Chondrostereum purpureum infection of pruning wounds on willows (Salix spp.), apples (Malus domestica), and golden queen peaches (Prunus persica). None were completely effective but products giving best control were: Garrison; Shell pruning grease; and cyproconazole + iodocarb. C. purpureum infection with Nectec Liquid and copper oxychloride treatments was significantly (P >
Objective: Postoperative deep sternal woundinfection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep woundinfection. We also devised an innovative closure technique post VAC therapy using thermo
Maria Pia Tocco; Alberto Costantino; Milva Ballardini; Claudio D’Andrea; Marcello Masala; Eusebio Merico; Luigi Mosillo; Paolo Sordini
The effect of acute herpes simplex virus type 1 (HSV-1) infection on the healing process of intraoral wounds and tooth extraction sockets in the rat was studied. A standardized size of the buccal mucosa was excised and molars were extracted and a HSV-1 suspension was topically applied. The virus infectedwounds were clinically characterized by erythema and swelling and histologically by heavy inflammation cell infiltrate and abscesses during the first week. The acute HSV-1 infection was found to significantly delay healing of both types of wounds by 3 days. Antiviral treatment with acyclovir (ACV) decreased the degree of inflammation and improved healing of the infectedwounds. The present results indicate a delayed and disturbed healing of wounds in the oral cavity in the presence of HSV-1. The findings may have a clinical significance for primary or latent HSV-1 infections in conjunction with surgical intervention in the oral cavity. PMID:2286928
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
Peel, M M; Hornidge, K A; Luppino, M; Stacpoole, A M; Weaver, R E
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.
Peel, M M; Hornidge, K A; Luppino, M; Stacpoole, A M; Weaver, R E
Quorum sensing is a cell-to-cell communication that occurs via autoinducers, regulating a number of bacterial virulence factors including the opportunistic wound pathogen Pseudomonas aeruginosa, which uses the N-(3-oxododecanoyl)-homoserine lactone as one of the two main autoinducers; however, little is known about its role in chronic woundinfection. This study was designed to quantify this autoinducer from P. aeruginosa-infectedwounds with the aim of examining the possible use of autoinducers as an indicator of chronic woundinfection. Pressure-induced ischemic wounds were infected with P. aeruginosa (N=12) or uninfected as a control (N=12). The autoinducer was quantified by bioassay method employing Escherichia coli DH5 alpha (pJN105L, pSC11) or Agrobacterium tumefaciens NTL4 (pZLR4) reporter, which expresses beta-galactosidase when exposed to P. aeruginosa quorum sensing signals. The average concentration of autoinducer was 0.33 pmol/g at day 3 and 0.49 pmol/g at day 7 in the infectedwounds, as detected from tissue samples. A linear correlation between autoinducer concentration and bacterial counts was observed. No autoinducer was detected in tissue samples from the uninfected control group. Our findings indicate that the quantification of autoinducers is possible and quorum sensing system could play a role in in vivo woundinfection models, and also suggest possible clinical implications of autoinducer signal quantification in diagnosis of chronic woundinfection. PMID:18211577
We describe two cases of Clostridium glycolicum woundinfections 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.
Jiang, Wei; Abrar, Sahibzada; Romagnoli, Mark; Carroll, Karen C.
Background. This study was designed to determine whether decreasing nasal bacterial colonization by applying Mupirocin (MPN) intranasally decreases sternal woundinfections.Methods. We prospectively followed 992 consecutive open heart surgery (OHS) patients who did not receive MPN prophylaxis (group I) from January 1, 1995 to October 31, 1996. Group II consisted of 854 consecutive patients followed prospectively from December 1, 1997
George E Cimochowski; Michael D Harostock; Robert Brown; Mark Bernardi; Nancy Alonzo; Kathy Coyle
The antibacterial potential of the crude leaves extracts of Psidium guajava Linn. against some bacteria associated with surgical wound, burns, skin and soft tissue infections were investigated under different conditions. Phytochemical screening of the crude leaves extracts revealed the presence of some bioactive compounds that have been associated with antimicrobial activities. Aqueous extracts was more potent in inhibiting the growth
Objectives: To evaluate a simple treatment algorithm in sternal woundinfection (SWI) allowing for primary closure and to describe the differentsurgical techniquesand their associatedmorbidity and mortality. Methods:A retrospective analysis of all patients operatedon between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were usedto
Alain Jean Poncelet; Benoit Lengele; Francis Zech; David Glineur; Jean-Christophe Funken; Philippe Noirhomme
Objective: To report our experience using two staged bilateral pectoralis major flap as the sole treatment modality for sternal woundinfection. Methods: A retrospective study of 9417 open-heart surgery cases performed between 1998 and 2003 at The Prince Charles Hospital. Sixty-eight patients were referred to the plastic surgical team for consideration of bilateral pectoralis major flap as the sole treatment
Clement H. K. Wong; Shireen Senewiratne; Bruce Garlick; Daniel Mullany
Objectives: To evaluate a simple treatment algorithm in sternal woundinfection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality. Methods: A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate
Alain Jean Poncelet; Benoit Lengele; Bénédicte Delaere; Francis Zech; David Glineur; Jean-Christophe Funken; Gebrine El Khoury; Philippe Noirhomme
Objective: Early post-sternotomy tracheostomy is not infrequently considered in this era of percutaneous tracheostomy. There is, however, some controversy about its association with sternal woundinfections. Methods: Consecutive patients who had percutaneous tracheostomy following median sternotomy for cardiac operation at our institution from March 1998 through January 2007 were studied, and compared to contemporaneous patients. We identified risk factors for
Dumbor L. Ngaage; Alexander R. Cale; Steven Griffin; Levant Guvendik; Michael E. Cowen
Objective: Although deep sternal woundinfection (DSWI) after cardiac surgery is infre- quent, its consequences are serious. The purposes of this study were to define the risk fac- tors, and to establish the best surgical treatment for DSWI. Methods: Retrospective analysis for 863 patients who underwent cardiac surgery was per- formed. The patients were divided into the DSWI group (n=17)
A 10-month-old child from the Middle East received complete correction for tetralogy of Fallot. Despite an initially uneventful postoperative course, he developed severe deep sternal woundinfection after 7 days. This complication was endogenously acquired caused by a resistant and rarely present in Europe, Streptococcus pneumonia. Following surgical debridement, betadine rinsing for 3 days and with a course of specific
Background. Previous studies on predictors of deep sternal woundinfection (DSWI) have identified either respiratory failure or tracheostomy as a risk factor for the occurrence of this complication. This study was con- ducted to analyze the interaction between these two variables. We hypothesize that respiratory failure and not tracheostomy per se is associated with an increased risk of DSWI. Methods.
Parwis B. Rahmanian; David H. Adams; Javier G. Castillo; Joanna Chikwe; Farzan Filsoufi
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 infectedwound 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)-?1 expressions to Aquacel and silver sulfadiazine.
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 nm(3). 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 infectedwound 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)-?1 expressions to Aquacel and silver sulfadiazine. PMID:22693632
. To evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy, we designed a\\u000a randomized control trial at the Emergency Department of Mexico City General Hospital, including 350 patients with acute abdomen\\u000a suggestive of appendicitis, without any other infection clinically evident. The trial was randomized into 2 groups. Group\\u000a I patients received prophylactic systemic antibiotics
Carlos R. Cervantes-Sánchez; Rafael Gutiérrez-Vega; Jorge A. Vázquez-Carpizo; Cesar Athié-Gutiérrez
Objective: To study the aerobic and anaerobic microbiology of woundinfections following spinal fusion in children. Methods: Retrospective review of clinical and microbiological records. Results: Aspirates of pus from 18 infection sites showed bacterial growth. Anaerobic bacteria only were recovered in 3 (17%) specimens, aerobic bacteria only in 3 (17%) and mixed aerobic and anaerobic bacteria in 12 (67%). Forty-two
Abstract Objective: Deep wound,infections pose an increasing problem,in cardiac surgery patients. Prospective infection monitoring is thus a means of identifying possible risk factors. Methods: Within a period of 5 months, a total of 376 adult patients, 260 men and 116 women, with a mean age of 62.6 years (range 18?88), underwent coronary bypass grafting (nà 281) or other cardiac surgery
Heinz G. Jakob; Marianne Borneff-lipp; Alfons Bach; Stefanie Von Pu Ckler; Ju Rgen Windeler; Hans-gu Nther Sonntag; Siegfried Hagl
Objective: Deep woundinfections pose an increasing problem in cardiac surgery patients. Prospective infection monitoring is thus a means of identifying possible risk factors. Methods: Within a period of 5 months, a total of 376 adult patients, 260 men and 116 women, with a mean age of 62.6 years (range 18–88), underwent coronary bypass grafting (n=281) or other cardiac surgery
Heinz G Jakob; Marianne Borneff-Lipp; Alfons Bach; Stefanie von Pückler; Jürgen Windeler; Hans-Günther Sonntag; Siegfried Hagl
One of the important problems of modern medicine is treatment of infectedwounds. 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 infectedwounds 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 ?m 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.
We studied 119 bacterial strains isolated from postoperative infectedwounds. All these strains were considered to be strains that derived from the same number of nosocomial infections, all the postoperative infections of the wounds being nosocomial infections. Regarding their frequency, we isolated the following strains: E. coli--68 strains (57%), S. aureus--37 strains (31%), Pseudomonas spp.--9 strains (8%) and Proteus spp.--5 strains (4%). We performed the bacteriological study of these strains and some correlations between them and the surgical diagnosis. In order to help the surgical therapy of the overinfected wounds, we tested the drug sensitivity of all these strains. The results regarding the drug sensitivity show that these strains have different types of resistance to antibiotics, the Pseudomonas strains being the most resistant. We noticed a continuous decrease of the sensitivity of the isolated strains to certain antimicrobial drugs, and this focuses the attention on the necessity of monitoring the antibiotic prescriptions in hospitals. Taking into account the results obtained after this study, we should reconsider the concept of nosocomial infections control through prevention activities, in order to reduce the incidence and to identify the potential causes that can lead to nosocomial infections. PMID:15341326
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 woundinfections. 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
Ribeiro, Noel F F; Heath, Christopher H; Kierath, Jessica; Rea, Suzanne; Duncan-Smith, Mark; Wood, Fiona M
Sternal woundinfection post-cardiac surgery is a serious complication that can lead to increased length of stay, substantial financial impact, and increased mortality. The occurrence of sternal woundinfections has been reported from 0.4% to 4% of postoperative cardiac surgeries. It is imperative that every heart surgery program implements the best practice to prevent the detrimental effects of sternal woundinfections. In an effort to improve the cardiothoracic (CT) surgery program in a community hospital, a decision was made to create a specialty floor including specialized nurses to care for open-heart surgery patients. In October 2010, a group of these nurses formed a working committee to explore ways to improve the overall care of our CT surgery patients. A vision and purpose for this committee were identified: (1) update and improve practice for CT surgery patients utilizing evidence-based standards, (2) successfully disseminate this information to all staff caring for the CT surgery patients, and (3) evaluate the impact of any practice changes on patient outcomes. An initial focus for the committee was to standardize sternal wound care among all staff members on the cardiovascular floors, cardiac care unit, and progressive care unit. PMID:22157494
Daptomycin in combination with surgical therapy has shown to be effective for treatment of deep sternal woundinfection in cardiac surgery. However, till now midterm results in terms of re-infection or re-operation in patients who were successfully treated with daptomycin for gram-positive deep sternal woundinfection are not published. Herein, we present midterm results in patients treated successfully with daptomycin after cardiac surgery.
Daptomycin in combination with surgical therapy has shown to be effective for treatment of deep sternal woundinfection in cardiac surgery. However, till now midterm results in terms of re-infection or re-operation in patients who were successfully treated with daptomycin for gram-positive deep sternal woundinfection are not published. Herein, we present midterm results in patients treated successfully with daptomycin after cardiac surgery. PMID:23351310
Ort, Katharina R; Jebran, Fawad A; Bireta, Christian; Danner, Bernhard C; Bougioukas, Ioannis; Schoendube, Friedrich A; Popov, Aron F
Gemifloxacin (SB-265805) is a potent, novel fluoroquinolone with broad-spectrum antimicrobial activity. In this study, the efficacy of gemifloxacin was studied in experimental models of Gram-negative pyelonephritis (caused by Escherichia coli or Proteus mirabilis) and Gram-positive woundinfection resulting from Streptococcus pyogenes, Staphylococcus epidermidis or Staphylococcus aureus. Gemifloxacin activity against these pathogens was compared with those of amoxycillin-clavulanate, ciprofloxacin, cefuroxime, azithromycin, trovafloxacin, grepafloxacin, levofloxacin and tosufloxacin. Oral treatment was initiated 1 h after infection and continued once or twice daily for 3 days. Around 17 h after the end of treatment, animals were killed and the infected kidneys or the skin around the wound site were excised for the enumeration of viable bacteria. In the pyelonephritis model (either microorganism), gemifloxacin reduced bacterial numbers significantly (P < 0.01) compared with no treatment. No comparator agent had a greater effect than gemifloxacin. Notably, grepafloxacin and azithromycin were significantly less effective (P < 0.01) than gemifloxacin against E. coli pyelonephritis, and amoxycillin-clavulanate, azithromycin and trovafloxacin were inferior (P < 0.01) against P. mirabilis infection. In the S. pyogenes woundinfection model, gemifloxacin, amoxycillin-clavulanate, cefuroxime and azithromycin reduced bacterial numbers significantly compared with controls (P < 0.01). Results for the comparator quinolones were not significantly different from untreated controls (P > 0.05). Gemifloxacin was also effective against staphylococcal infection, as were grepafloxacin and levofloxacin, while ciprofloxacin, trovafloxacin and tosufloxacin were significantly less effective against these pathogens than gemifloxacin (P < 0.01). No comparator agent had greater activity than gemifloxacin against S. pyogenes or S. aureus infections. These data demonstrate the potential benefit of gemifloxacin in the treatment of Gram-negative urinary tract infection and Gram-positive skin and soft tissue infection. PMID:10824038
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.
Background Deep sternal woundinfection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound\\u000a infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC) therapy and omental-muscle flap reconstrucion.\\u000a We describe this strategy and examine the outcome and long-term quality of life (QOL) it achieves.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We retrospectively examined 16 patients treated for deep sternal woundinfection
Background: The incidence of postoperative surgical site infections (SSIs) is difficult to estimate because of the current trend of early discharge after surgery. Both operation-related and host factors should be taken into consideration in the prevention of SSIs. We wanted to determine the actual incidence of SSIs and evaluate the risk factors in our clinic, using an extended follow-up period
Arto Rantala; Olli-Pekka Lehtonen; Juha Niinikoski
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.
The aim of this study was to evaluate the efficacy of distinctin in the management of cutaneous methicillin-resistant Staphylococcus aureus (MRSA) woundinfections in an experimental mouse model. Wounds, made in the panniculus carnosus of BALB/c mice, were inoculated with 5?×?10(7) colony-forming units (CFU) of MRSA. Mice were treated with topical distinctin (1 mg/kg of body weight), topical teicoplanin (7 mg/kg of body weight), intraperitoneal teicoplanin (7 mg/kg of body weight); topical teicoplanin and daily intraperitoneal teicoplanin; topical distinctin and daily intraperitoneal teicoplanin. Bacterial cultures of excised tissues and histological examination of microvessel density and of vascular endothelial growth factor (VEGF) expression were studied. It was found that topical distinctin combined with parenteral teicoplanin inhibited bacterial growth to levels comparable with those observed in uninfected animals. Wounded areas of animals treated with distinctin were characterized by a more mature granulation tissue, with a more organized and denser type of connective tissue, compared to mice treated only with teicoplanin. Treatment with topical distinctin had a significant impact on VEGF expression and microvessel density. The combined use of distinctin with teicoplanin may be useful in the management of infectedwounds by significantly inhibiting bacterial growth and accelerating the repair process. PMID:22729599
Simonetti, O; Cirioni, O; Ghiselli, R; Goteri, G; Orlando, F; Monfregola, L; De Luca, S; Zizzi, A; Silvestri, C; Veglia, G; Giacometti, A; Guerrieri, M; Offidani, A; Scaloni, A
HemCon® bandage is an engineered chitosan acetate preparation used as a hemostatic control dressing, and its chemical structure suggests that it should also be antimicrobial. We tested its ability to rapidly kill bacteria in vitro and in mouse models of infectedwounds. We used the Gram-negative species Pseudomonas aeruginosa and Proteus mirabilis and the Gram-positive Staphylococcus aureus that had all
Marina Burkatovskaya; George P Tegos; Emilia Swietlik; Tatiana N Demidova; Ana P Castano; Michael R. Hamblin
A man in his early 80s presented to our emergency department with painless redness and swelling in his right leg. One week prior, he cleaned up floodwater in his basement after Hurricane Irene passed the Mid-Atlantic region of the USA in August 2011. Physical examination included large purple bullae and raised concern for necrotising fasciitis. Wound culture revealed a polymicrobial infection including Leclercia adecarboxylata. PMID:23109419
The Pseudomonas aeruginosa quorum-sensing systems, las and rhl, control the production of numerous virulence factors. In this study, we have used the burned-mouse model to examine the contribution of quorum-sensing systems to the pathogenesis of P. aeruginosa infections in burn wounds. Different quorum- sensing mutants of P. aeruginosa PAO1 that were defective in the lasR, lasI ,o rrhlI gene or
KENDRA P. RUMBAUGH; JOHN A. GRISWOLD; BARBARA H. IGLEWSKI; ABDUL N. HAMOOD
Background. Mortality after deep sternal woundinfection (DSWI) ranges between 5% and 47%. Variables predicting hospital mortality and prolonged hospital stay are still to be assessed.Methods. Among 13,420 patients who underwent cardiac surgery in our institution between 1979 and 1999, DSWI developed in 112 cases (0.8%). Multiple variables were recorded prospectively and analyzed retrospectively as predictors of hospital death and
Marisa De Feo; Attilio Renzulli; Gennaro Ismeno; Rosario Gregorio; Alessandro Della Corte; Riccardo Utili; Maurizio Cotrufo
Objective:Toreportourexperienceusingtwostagedbilateralpectoralismajorflapasthesoletreatmentmodalityforsternalwoundinfection. Methods: A retrospective study of 9417 open-heart surgery cases performed between 1998 and 2003 at The Prince Charles Hospital. Sixty-eight patients were referred to the plastic surgical team for consideration of bilateral pectoralis major flap as the sole treatment modality for sternal woundinfection. Results: There was a trend for early referral for flap operation (median 10 days) (p
Clement H. K. Wong; Shireen Senewiratne; Bruce Garlick; Daniel Mullany
Background Woundinfection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative woundinfections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of woundinfection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390).
The aim of this study was to retrospectively evaluate the results of reconstructing infected post-sternotomy wounds, with\\u000a either sternal plating and\\/or pectoralis major flap transposition or pedicled omentoplasty after previous vacuum-assisted\\u000a closure (VAC) therapy. Between January 2005 and December 2010, 36 patients, suffering from deep sternal woundinfection (DSWI)\\u000a after coronary artery bypass grafting procedure, received (plastic) reconstructive surgery. All
Rutger M. Schols; Thomas M. A. S. Lauwers; Gijs G. Geskes; René R. W. J. van der Hulst
Background: Deep sternal woundinfection is a serious and potentially lethal complication of cardiac surgery when performed through a median sternotomy. We describe the outcome of a new treatment strategy with C-reactive protein level-guided vacuum-assisted closure used at our department. Methods: Data from 16 consecutive adult patients who had deep sternal woundinfections after cardiac surgery were reviewed. Patients with
Ronny Gustafsson; Per Johnsson; Lars Algotsson; Sten Blomquist; Richard Ingemansson
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.
Objective To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing woundinfection after minor dermatological surgery. Design Prospective randomised placebo controlled double blind multicentre trial. Setting Primary care in a regional centre in Queensland, Australia. Participants 972 minor surgery patients. Interventions A single topical dose of chloramphenicol (n=488) or paraffin ointment (n=484; placebo). Main outcome measure Incidence of infection. Results The incidence of infection in the chloramphenicol group (6.6%; 95% confidence interval 4.9 to 8.8) was significantly lower than that in the control group (11.0%; 7.9 to 15.1) (P=0.010). The absolute reduction in infection rate was 4.4%, the relative reduction was 40%, and the relative risk of woundinfection in the control group was 1.7 (95% confidence interval 1.1 to 2.5) times higher than in the intervention group. The number needed to treat was 22.8. Conclusion Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant. Trial registration Current Controlled Trials ISRCTN73223053.
Trauma, whether caused by an accident or in an intentional manner, results in significant morbidity and mortality. The goal of this study was to develop a novel biomaterial surface in vitro and ex vivo that provides both localized infection resistance nd hemostatic properties. Our hypothesis is that a combination of specific surface characteristics can be successfully incorporated into a single biomaterial. Functional groups were created with woven Dacron (Cntrl) material via exposure to ethylenediamine (C-EDA). The antibiotic ciprofloxacin (Cipro) was then applied to the C-EDA material using pad/autoclave technique (C-EDA-AB) followed by surface immobilization of the coagulation cascade enzyme thrombin (C-EDA-AB-Thrombin). Antimicrobial activity by the C-EDA-AB surface persisted for 5 days compared with Cntrl and dipped controls, which lasted <1 h. C-EDA-AB-Thrombin surfaces had 2.6- and 105-fold greater surface thrombin activity compared with nonspecifically bound thrombin and Cipro-dyed surfaces, respectively. Surface thrombus formation ex vivo was evident after 1 min of exposure, with thrombus organization evident by 2.5 min. In contrast, C-EDA-AB and Cntrl segments showed only blood protein adsorption on the fibers. Thus, this study demonstrated that Cipro and thrombin can be simultaneously incorporated onto a biomaterial surface while maintaining their respective biological activities. PMID:16028237
Phaneuf, Matthew D; Bide, Martin J; Hannel, Susan L; Platek, Michael J; Monahan, Thomas S; Contreras, Mauricio A; Phaneuf, Tina M; LoGerfo, Frank W
We investigated the effect of topical temporin A in the management of methicillin-resistant strain of Staphylococcus aureus (MRSA)-infected experimental surgical wounds in mice. The wound, cut through the panniculus carnosus of BALB/c mice, was inoculated with 5x10(7) colony-forming units of MRSA. Mice were treated with Allevyn, temporin A-soaked Allevyn, Allevyn and daily intraperitoneal teicoplanin (7mg/kg), temporin A-soaked Allevyn and daily intraperitoneal teicoplanin. Main outcome measurements were: quantitative bacterial culture, histological examination with assessment of micro-vessel density and of vascular endothelial growth factor (VEGF) expression in tissue sections, and VEGF plasma levels alike. Treatment with temporin-A associated with teicoplanin injection significantly reduced bacterial load to 0.85 x 10(1)+/-0.1 x 10(1)CFU/ml. Histological examination showed that infected mice receiving temporin A-soaked Allevyn (with or without teicoplanin) had a higher degree of granulation tissue formation and collagen deposition compared to the other treated groups. A significant increase in serum VEGF expression was observed in mice receiving temporin A topically and temporin A topically associated with intraperitoneal teicoplanin. In conclusion our results demonstrated that temporin A is effective in the management of infectedwounds, by a significant bacterial growth inhibition and acceleration of wound repair process. PMID:18255189
OBJECTIVES To evaluate the outcome of treatment for deep sternal woundinfection (DSWI) in a nationwide patient cohort, before and after the introduction of negative-pressure wound therapy (NPWT). METHODS This was a population-based cohort of all patients treated for DSWI in Iceland out of 2446 open heart operations performed between 2000 and 2010. Length of hospital stay, survival and reoperations were compared in (i) 23 patients treated with open and/or closed irrigation before August 2005 (conventional treatment, CvT group) and in (ii) 20 patients treated after this time with NPWT as a first-line therapy (NPWT group). RESULTS The DSWI rate was 1.8% and did not change during the study period. Demographics were similar for both groups, except for peripheral arterial disease which was less common in the NPWT group. Coagulase-negative staphylococci were also more common (as the only pathogen identified) in the NPWT group (70% vs 30%, P = 0.01). The median length of hospital stay was 43 days in both groups and the sternum could be closed with delayed primary closure in all except 2 patients, one in each group. Eight patients in the CvT group required surgical revision for re-infections, including debridement and rewiring, when compared with 1 patient in the NPWT group (P = 0.02). Furthermore, 6 patients in the CvT group developed late chronic infections of the sternum requiring surgical revision, compared with one in the NPWT group (P = 0.10). The 30-day mortality was not significantly different between groups (4% vs 0%, P > 0.1) and the same was true for 1-year mortality (17% vs 0%, P = 0.11). CONCLUSIONS NPWT significantly reduces the risk of early re-infections in patients with DSWI. There was a lower rate of late chronic sternal infections and lower mortality in the NPWT group, but the difference was not statistically significant. We conclude that NPWT should be considered as a first-line treatment for most DSWIs.
Steingrimsson, Steinn; Gottfredsson, Magnus; Gudmundsdottir, Ingibjorg; Sjogren, Johan; Gudbjartsson, Tomas
Complications of infection can increase burn-related morbidity and mortality. Early detection of burn woundinfection could lead to more precise and effective treatment, reducing systemic complications and the need for long-term, broad-spectrum intravenous antibiotics. Quantitative cultures from biopsies are the accepted standard to determine infection. However, this methodology can take days to yield results and is invasive. This investigation focuses on the use of noninvasive imaging to determine the infection status of burn wounds in a controlled in vivo model. Full-thickness burn wounds were created on the dorsum of adult male rats (n = 6). Twenty-four hours after burn wound creation, wounds in the "Infected" group were inoculated with a vehicle containing 1 × 10(8) colony forming unit Staphylococcus aureus. "Control" group animals received vehicle alone. Subsequently, the wounds were imaged daily for a total of 10 days and the differences of skin optical properties were assessed using spatial frequency domain imaging at 16 different wavelengths from 500 to 700 nm. Regions of interest on the resulting images were selected and averaged at each time point. Statistically significant differences in average absorption and reduced scattering coefficients (?(a) and ?(s)') at 620 and 700 nm were observed between the two groups (P < .05). Differential optical properties were most evident by day 4 and persisted throughout the time course. Differential signature changes in optical properties are evident in infected burn wounds. This novel application of spatial frequency domain imaging may prove to be a valuable adjunct to burn wound assessment. Further work will be aimed at determining dose-response relationships and prokaryotic species differences. PMID:23292572
Nguyen, Thu T A; Ramella-Roman, Jessica C; Moffatt, Lauren T; Ortiz, Rachel T; Jordan, Marion H; Shupp, Jeffrey W
Background Chronic wounds affect millions of people and cost billions of dollars in the United States each year. These wounds harbor polymicrobial biofilm communities, which can be difficult to elucidate using culturing methods. Clinical molecular microbiological methods are increasingly being employed to investigate the microbiota of chronic infections, including wounds, as part of standard patient care. However, molecular testing is more sensitive than culturing, which results in markedly different results being reported to clinicians. This study compares the results of aerobic culturing and molecular testing (culture-free 16S ribosomal DNA sequencing), and it examines the relative abundance score that is generated by the molecular test and the usefulness of the relative abundance score in predicting the likelihood that the same organism would be detected by culture. Methods Parallel samples from 51 chronic wounds were studied using aerobic culturing and 16S DNA sequencing for the identification of bacteria. Results One hundred forty-five (145) unique genera were identified using molecular methods, and 68 of these genera were aerotolerant. Fourteen (14) unique genera were identified using aerobic culture methods. One-third (31/92) of the cultures were determined to be?1% of the relative abundance of the wound microbiota using molecular testing. At the genus level, molecular testing identified 85% (78/92) of the bacteria that were identified by culture. Conversely, culturing detected 15.7% (78/497) of the aerotolerant bacteria and detected 54.9% of the collective aerotolerant relative abundance of the samples. Aerotolerant bacterial genera (and individual species including Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis) with higher relative abundance scores were more likely to be detected by culture as demonstrated with regression modeling. Conclusion Discordance between molecular and culture testing is often observed. However, culture-free 16S ribosomal DNA sequencing and its relative abundance score can provide clinicians with insight into which bacteria are most abundant in a sample and which are most likely to be detected by culture.
Nosocomial and surgical-site infections are significant burdens to the health care system that account for $5 billion and $1.6 billion each year in the United States, respectively. These infections are associated with significant morbidity and mortality rates, increased length of hospitalization, and increased treatment costs that are often not reimbursed by third-party payers. Approximately 40% of sternal woundinfections in cardiac surgery patients are caused by Staphylococcus aureus and the prevalence of methicillin-resistant S aureus (MRSA) has risen dramatically in the past 2 to 3 decades. The economic burden that is associated with MRSA is significant; infections caused by MRSA cost approximately $3700 more to treat than infections caused by methicillin-sensitive S aureus, and the death rate for MRSA infection is nearly 3 times that of methicillin-sensitive S aureus. Thus, interventions to prevent nosocomial infection in patients who undergo cardiac surgery may improve outcomes and decrease costs. Advances in diagnostic testing may help to target intranasal antibiotic therapy to those patients who are most likely to receive a benefit. The LightCycler System is a fast and effective polymerase chain reaction-based diagnostic test that may be used to identify patients with nasal colonization of S aureus. Carrier status can be determined in a matter of hours rather than days as is the case with traditional culture techniques. PMID:14647029
Salvage laryngectomy carries a high risk of post-operative infection with reported rates of 40-61%. The purpose of this study was to analyse infections in our own patients and review the potential impact of our current antibiotic prophylaxis (AP). A retrospective analysis of infection in 26 consecutive patients between 2000 and 2010 undergoing salvage total laryngectomy (SL) following recurrent laryngeal cancer after failed radiotherapy or chemo-radiation was undertaken. The antibiotic prophylaxis was intravenous teicoplanin, cefuroxime and metronidazole at induction and for the following 24 h. Infection was defined by Tabet and Johnson's grade 5, categorized as pharyngocutaneous fistula. Fifteen patients (58%) developed a post-operative woundinfection, which occurred on average at 12 days after surgery. Univariate analysis demonstrated three risk variables that had a significant correlation with infection: alcohol consumption (p = 0.01), cN stage of tumour (p < 0.01), and pre-operative albumin levels <3.2 g/L (p = 0.012). There was a trend, though not significant, for increased infection in patients with high or low BMIs. The most common organisms isolated from clinical samples from infected patients were methicillin-resistant Staphylococcus aureus MRSA (43%), Pseudomonas aeruginosa (36%), Serratia marcescens, Proteus mirabilis and Enterococcus faecalis (7% each). All these organisms are typical hospital-acquired pathogens. Pseudomonas and Serratia were not covered by the prophylactic regime we used. The current antibiotic regime following SL is inadequate as the rate of infection is high. It would therefore seem logical to trial a separate antibiotic protocol of AP for patients undergoing SL that would include an extended course of antibiotics after the standard prophylaxis. In addition, infection rates may also be reduced by improving the metabolic state of patients pre-operatively by multi-disciplinary action. Steps should also be taken to reduce cross-infection with nosocomial pathogens in these patients. Other aspects of surgical management should be also taken in consideration. PMID:22274693
Quorum sensing is a mechanism through which a bacterial population receives input from neighboring cells and elicits an appropriate response to enable survival within the host. Inhibiting quorum sensing by RNAIII-inhibiting peptide (RIP) has been demonstrated as a very effective mode of prevention and therapy for device-associated staphylococcal infections and was tested here for healing of wounds that are otherwise resistant to conventional antibiotics. Wounds, established through the panniculus carnosus of BALB/c mice, were inoculated with 5 × 107 CFU of methicillin-resistant Staphylococcus aureus. Mice were treated with Allevyn, RIP-soaked Allevyn (containing 20 ?g RIP), daily intraperitoneal teicoplanin (7 mg/kg of body weight), Allevyn and teicoplanin, and RIP-soaked Allevyn and daily intraperitoneal teicoplanin. The main outcome measures were quantitative bacterial culture and histological examination with assessment of microvessel density and of vascular endothelial growth factor (VEGF) expression in tissue sections. Treatment with RIP-soaked Allevyn together with teicoplanin injection greatly reduced the bacterial load to 13 CFU/g (control untreated animals had 108 CFU/g bacteria). All other treatments were also significantly effective but only reduced the bacterial load to about 103 CFU/ml. Histological examination indicated that only treatment with RIP-soaked Allevyn with teicoplanin injection restored epithelial, granulation, and collagen scores, as well as microvessel density and VEGF expression, to the levels found with uninfected mice. In conclusion, we observed that RIP may be useful for the management of infectedwounds and that it could represent an exciting and future alternative to the conventional antibiotics, at present considered the gold-standard treatments for methicillin-resistant S. aureus infections.
Quorum sensing is a mechanism through which a bacterial population receives input from neighboring cells and elicits an appropriate response to enable survival within the host. Inhibiting quorum sensing by RNAIII-inhibiting peptide (RIP) has been demonstrated as a very effective mode of prevention and therapy for device-associated staphylococcal infections and was tested here for healing of wounds that are otherwise resistant to conventional antibiotics. Wounds, established through the panniculus carnosus of BALB/c mice, were inoculated with 5 x 10(7) CFU of methicillin-resistant Staphylococcus aureus. Mice were treated with Allevyn, RIP-soaked Allevyn (containing 20 microg RIP), daily intraperitoneal teicoplanin (7 mg/kg of body weight), Allevyn and teicoplanin, and RIP-soaked Allevyn and daily intraperitoneal teicoplanin. The main outcome measures were quantitative bacterial culture and histological examination with assessment of microvessel density and of vascular endothelial growth factor (VEGF) expression in tissue sections. Treatment with RIP-soaked Allevyn together with teicoplanin injection greatly reduced the bacterial load to 13 CFU/g (control untreated animals had 10(8) CFU/g bacteria). All other treatments were also significantly effective but only reduced the bacterial load to about 10(3) CFU/ml. Histological examination indicated that only treatment with RIP-soaked Allevyn with teicoplanin injection restored epithelial, granulation, and collagen scores, as well as microvessel density and VEGF expression, to the levels found with uninfected mice. In conclusion, we observed that RIP may be useful for the management of infectedwounds and that it could represent an exciting and future alternative to the conventional antibiotics, at present considered the gold-standard treatments for methicillin-resistant S. aureus infections. PMID:18391046
BACKGROUND: Despite improved use of peri-operative antibiotic prophylaxis, surgical site infections following coronary artery bypass grafting (CABG) continue to occur, with high case-fatality rates and costs. Few data are currently available on the impact of deep sternal woundinfections (DSWI) on length of hospital stay, and no such data exist for community hospitals (as opposed to teaching hospitals). We assessed
C. Kirchner; J. Daley; A. Kim; H. Zhang; Y. Mitina; E. Abrutyn
The purpose of this study was to examine the effect of toluidine blue (TB)-mediated photodynamic therapy (PDT) on oral wound\\u000a infections in rats. The study called for a combination treatment of a 1mg\\/ml solution of TB with a red light at three intensity\\u000a settings of 12 J\\/cm2, 24 J\\/cm2 and 48 J\\/cm2. In the group that was given the highest light dose of
J. Lin; L. J. Bi; Z. G. Zhang; Y. M. Fu; T. T. Dong
The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5- × 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.
In this gross science activity, follow an easy recipe to make fake wounds to fool your friends or gross someone out during Halloween. Explore how and why scabs form to heal wounds and protect our bodies from infections. This activity guide includes a step-by-step instructional video.
Mycoplasma hominis is a commensal of the genitourinary tract. It mostly causes infections to associated structures of this system; however,\\u000a occasionally it is a pathogen in nongenitourinary tract infections. Since, M. hominis strains require special growth conditions and cannot be Gram stained, they may be missed or delay diagnosis. This report\\u000a describes a deep woundinfection caused by M. hominis
Matthijs R. Krijnen; Thecla Hekker; Johan Algra; Paul I. J. M. Wuisman; Barend J. Van Royen
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 infectedwound 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 infectedwound model. This system could be applied to other therapeutic applications where sustained delivery of hydrophobic and hydrophilic molecules is required. PMID:23063555
Eleven clinical strains isolated from infectedwound specimens were subjected to polyphasic taxonomic analysis. Sequence analysis of the 16S rRNA gene showed that all 11 strains were phylogenetically related to Slackia exigua. Additionally, conventional and biochemical tests of 6 of the 11 strains were performed as supplementary methods to obtain phenotypic identification by comparison with the phenotypes of the relevant type strains. S. exigua has been considered an oral bacterial species in the family Coriobacteriaceae. This organism is fastidious and grows poorly, so it may easily be overlooked. The 16S rRNA gene sequences and the biochemical characteristics of four of the S. exigua strains isolated for this study from various infections indicative of an intestinal source were almost identical to those of the validated S. exigua type strain from an oral source and two of the S. exigua strains from oral sources evaluated in this study. Thus, we show for the first time that S. exigua species can be isolated from extraoral infections as well as from oral infections. The profiles of susceptibility to selected antimicrobials of this species were also investigated for the first time.
Kim, Keun-Sung; Rowlinson, Marie-Claire; Bennion, Robert; Liu, Chengxu; Talan, David; Summanen, Paula; Finegold, Sydney M.
Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.
Mioton, Lauren M; Jordan, Sumanas W; Hanwright, Philip J; Bilimoria, Karl Y
The effect of topically applied retapamulin ointment was evaluated using various dosing regimens in the Staphylococcus aureus and Streptococcus pyogenes woundinfection 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.
Rittenhouse, Stephen; Singley, Christine; Hoover, Jennifer; Page, Roni; Payne, David
The effect of topically applied retapamulin ointment was evaluated using various dosing regimens in the Staphylococcus aureus and Streptococcus pyogenes woundinfection 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
Rittenhouse, Stephen; Singley, Christine; Hoover, Jennifer; Page, Roni; Payne, David
Background. Intracutaneous suture technique has been our standard method for closing sternal wounds in cardiac surgery, mainly for cosmetic reasons. However, an increased rate of postoperative infections has been reported in cosmetic surgery with this method compared with the percutanous or transcutaneous closure technique. A comparison of these two techniques in cardiac surgery is presented.Methods. In a randomized study, 300
Ivar Risnes; Michel Abdelnoor; Svein Tore Baksaas; Runar Lundblad; Jan L Svennevig
Tuberculous osteomyelitis of sternum after open heart surgery is a rare disease entity. We report a case of woundinfection with osteomyelitis caused by Mycobacterium tuberculosis in a patient with diabetic nephropathy, requiring peritoneal dialysis after coronary artery bypass grafting, who was successfully treated with antituberculous agents and surgical debridement. In addition, we provide a literature review on reported cases
Teresa K. Wang; Chi-Fong Wong; Wing-Kuk Au; Vincent C. Cheng; Samson S. Wong
BACKGROUND: Sternal woundinfection (SWI) is an uncommon but potentially life-threatening complication of cardiac surgery. Predisposing factors for SWI are multiple with varied frequencies in different studies. The purpose of this study was to assess the incidence, risk factors, and mortality of SWI after coronary artery bypass grafting (CABG) at Tehran Heart Center. METHODS: This study prospectively evaluated multiple risk
Abbas Salehi Omran; Abbasali Karimi; S Hossein Ahmadi; Setareh Davoodi; Mehrab Marzban; Namvar Movahedi; Kyomars Abbasi; Mohammad Ali Boroumand; Saeed Davoodi; Naghmeh Moshtaghi
Polymorphonuclear neutrophils (PMNs) are critical for the formation, maintenance, and resolution of bacterial abscesses. However, the mechanisms that regulate PMN survival and proliferation during the evolution of an abscess are not well defined. Using a mouse model of Staphylococcus aureus abscess formation within a cutaneous wound, combined with real-time imaging of genetically tagged PMNs, we observed that a high bacterial burden elicited a sustained mobilization of PMNs from the bone marrow to the infectedwound, where their lifespan was markedly extended. A continuous rise in wound PMN number, which was not accounted for by trafficking from the bone marrow or by prolonged survival, was correlated with the homing of c-kit(+)-progenitor cells from the blood to the wound, where they proliferated and formed mature PMNs. Furthermore, by blocking their recruitment with an antibody to c-kit, which severely limited the proliferation of mature PMNs in the wound and shortened mouse survival, we confirmed that progenitor cells are not only important contributors to PMN expansion in the wound, but are also functionally important for immune protection. We conclude that the abscess environment provides a niche capable of regulating PMN survival and local proliferation of bone marrow-derived c-kit(+)-progenitor cells. PMID:21278352
Kim, Min-Ho; Granick, Jennifer L; Kwok, Cindy; Walker, Naomi J; Borjesson, Dori L; Curry, Fitz-Roy E; Miller, Lloyd S; Simon, Scott I
The consequences of deep woundinfections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and the choice of a prophylactic antibiotic regimen. We recommend that cardiac surgery programs supplement their audit processes and ongoing vigilance for infections with periodic, multidisciplinary reviews of best-practice standards for preoperative, intraoperative, and postoperative patient care. PMID:23678210
Background\\/Aims\\/Methods: This is a follow-up study from a recent randomized controlled trial conducted at the Women and Children’s Hospital of Buffalo that investigated the use of antimicrobial sutures (AMS) for wound closure during cerebrospinal fluid shunting procedures. Our purpose was to determine the average cost of shunt infections at our institution and estimate the healthcare savings associated with reduced infection
Jonathan Stone; Thomas J. Gruber; Curtis J. Rozzelle
A local woundinfection developed in a 42-year-old female patient after replacement of ascending aorta, aortic arch and supra-aortic vessels, following aortic dissection. Because of the high risk of infection due to the vascular prosthesis and its location at the upper part of the sternum, a right pectoral muscular flap, detached from the humerus and vascularized by medial perforators originating
Olivier Chavanon; Frédéric Thony; Jacques Lebeau; Dominique Blin
Background: Performing a delayed primary wound closure is often recommended in patients with gangrenous or perforated appendicitis who have undergone an appendectomy. It can result in increased pain as well as an extended hospital stay which, in turn, increases hospital costs. Delayed primary wound closure remains controversial. The general policy in our institution is to perform a primary wound closure.
Mostafa Mehrabi Bahar; Ali Jangjoo; Ahmad Amouzeshi; Kamran Kavianifar
Preoperative scalp shaving has been a well-established practice among neurosurgeons based on the belief that hair removal prevents postoperative infections. Apart from aiding in improved visualization of the incision line, ease of closure, and dressing application, there are concerns that the presence of hair at the surgical site may interfere with the surgical procedure. Preoperative scalp shaving is a controversial practice, and many neurosurgeons are moving toward not removing any hair or clipping minimal hair along the incision line rather than shaving the scalp. The following is a systematic review of articles related to preoperative scalp shaving before cranial surgeries and the implications for postoperative woundinfections. Eighteen articles were identified as potentially relevant based on the search criteria. These articles were selected based on the inclusion and exclusion criteria to provide concise background information and an explanation of scalp-shaving practices in neurosurgery leading to the clinical question posed. An evidence table was compiled to organize the study data and identify key points. The review brings strong evidence that preoperative scalp shaving does not confer any benefit against postoperative woundinfection and, paradoxically, may lead to higher rates of infection. Because hair removal neither contributes benefits to the surgery itself nor decreases the risk of woundinfection but has considerable cosmetic value for the patient, many of the authors recommended that cranial surgeries should be done without hair shaving. PMID:22555352
A mutant deficient for the 19-kDa extracellular fibrinogen-binding protein (Fib) from Staphylococcus aureus has been constructed. The gene was inactivated by allele replacement. A 2.0-kb fragment from transposon Tn4001 carrying the gene for gentamicin resistance was inserted into the gene encoding Fib (fib). The genotype was verified by PCR analysis, and the loss of Fib was demonstrated by Western blotting (immunoblotting). The mutation has not altered the ability of the strain to bind to fibrinogen or fibronectin compared with that of the isogenic parental strain, FDA486. The mutant, designated K4.3, was compared with strain FDA486 in a woundinfection model in rats. Sixty-eight percent of the rats challenged with parental strain FDA486 developed severe clinical signs of woundinfection, whereas only 29% of the animals challenged with isogenic mutant K4.3 showed severe symptoms (P < 0.01). The weight loss of animals infected with the wild type was also significantly different from that of animals infected with the mutant strain. The result demonstrates that the extracellular 19-kDa fibrinogen-binding protein from S. aureus contributes to the virulence in woundinfection and delays the healing process.
Palma, M; Nozohoor, S; Schennings, T; Heimdahl, A; Flock, J I
The primary question addressed was whether muscle flaps (MFs) offer a significant advantage over an omental flap (OF) in the management of deep sternal woundinfection (DSWI) following cardiovascular surgery in terms of outcome (morbidity and mortality). Altogether, 333 citations (from PubMed and EMBASE and using a manual search, without language restriction) were identified using the reported strategy. Focusing on publications from single institutions with experience with both types of flap in the treatment of DSWI, 16 studies represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. These 16 observational studies covered 1046 patients, and all reported mortality rates. Unadjusted data from five of six studies investigating a possible association between mortality and flap type suggested a higher mortality rate following reconstruction with MFs. A meta-analysis of all six studies indicates a slight, but not significant, survival advantage for reconstruction with an OF [overall relative risk 1.29 (95% confidence interval 0.58-2.88)]. Thirteen studies reported on the number of individual postoperative complications for a total of 964 patients. Data, unadjusted for potentially confounding surgical factors, on complications following flap closure, such as complete or partial flap loss, haematoma, arm or shoulder weakness and chronic chest wall pain, suggested that these complications were more common following MF reconstruction. Four studies evaluated patients with recurrent sternal woundinfection (n=521). Two of these were associated with a high incidence (>17.5%) of re-exploration for recurrent sternal infection following MF reconstruction. The most commonly reported complications following an OF were abdominal or diaphragmatic hernias, with an incidence of <5%. We conclude that the weight of current evidence is insufficient to prove the superiority of reconstruction with MFs to a laparotomy-harvested, OF in the treatment of DSWI. The results suggest that use of the omentum may be associated with lower mortality and fewer complications. PMID:21543366
van Wingerden, Jan J; Lapid, Oren; Boonstra, Piet W; de Mol, Bas A J M
The current study was conducted to know the incidence, predisposing factors, spectrum, clinical profile and antifungal susceptibility (AFS) of fungal woundinfection (FWI) in burn patients. Of a total of 71 patients, 20 (28.2%) emerged with the diagnosis of FWI. Fungal pathogens in this study were Candida tropicalis (14%), Candida parapsilosis (5.6%), Aspergillus niger (2.8%) and one each of Candida albicans (1.4%), Candida glabrata (1.4%), Syncephalestrum (1.4%) and Fusarium solani (1.4%). All patients with mould infections expired before the mycological culture results could be conveyed to clinicians. Of the yeasts isolated in the study, one each of C. tropicalis and C. albicans showed cross-resistance to azoles. All the moulds were susceptible to amphotericin B. This study depicted that fungal invasion is associated with a high mortality, burn size 30-60% and high incidence of inhalational injury. Fungal invasion was detected on an average of 14 days after injury. Association of use of four classes of drugs - aminoglycosides, imipenem, vancomycin and third generation cephalosporins and use of total parenteral nutrition was observed. Expedient laboratory diagnosis of FWI and appropriate systemic antifungal therapy guided by AFS may improve outcome for severely injured burn victims. PMID:21740469
A growth-chamber experiment was conducted to determine how foliar disease or wounding affects the ability of 2 phylloplane yeasts (Rhodotorula glutinis and Cryptococcus laurentii) to colonize leaves of tall fescue (Festuca arundinacea). Yeasts were applied separately and together onto healthy leaves, leaves infected with Rhizoctonia solani (diseased), and mechanically bruised (wounded) leaves. In all 3 trials, the leaf disturbance treatment significantly affected the abundance of yeast on the phylloplane of tall fescue. Yeast abundance on the diseased or wounded leaves was significantly greater than on the nontreated, healthy leaves. In 2 of the 3 trials, the yeast species applied also had a significant affect on yeast abundance. Typically, R. glutinis was significantly more abundant than C. laurentii when applied individually, but not significantly greater than the total yeast colony-forming units of the co-inoculated treatment. When the 2 yeasts were co-inoculated onto the leaves, R. glutinis comprised 89.7%, 75.4%, and 67.6% of the recovered yeast colony-forming units on healthy, diseased, and wounded leaves, respectfully. Our data suggest that these 2 species of yeasts will differentially colonize compromised leaf tissue with disease or wounds favoring populations of R. glutinis over C. laurentii. PMID:19935888
Surgical glove dusting powders are commonly used as mold-release agents and to facilitate donning. Cornstarch and CaCO3 are commonly used absorbable dusting powders. This experimental study demonstrates that these absorbable dusting powders significantly potentiate bacterial growth and enhance a wound’s inflammatory response. The infection-potentiating effects of CaCO3 are significantly greater than those of cornstarch.
Brett C. Odum; J. Stewart O’Keefe; Wilfredo Lara; George T. Rodeheaver; Richard F. Edlich
Chloroplastic LOXs are implicated in the biosynthesis of oxylipins like jasmonic acid and C6 volatiles among others. In this study, we isolated the cDNA of a novel chloroplast-targeted Phaseolus vulgaris LOX, (PvLOX6). This gene is highly induced after wounding, non-host pathogen infection, and by signaling molecules as H2O2, SA, ethylene and MeJA. The phylogenetic analysis of PvLOX6 showed that it
Helena Porta; Rosa Elia Figueroa-Balderas; Mario Rocha-Sosa
Genes for acidic, extracellular and basic, intracellular pathogenesis-related (PR) proteins of tobacco were studied for their response to tobacco mosaic virus (TMV) infection, ethephon treatment, wounding and UV light. The genes encoding the acidic PR proteins (PR-1, PR-2, PR-3, PR-4 and PR-5) responded similarly to the different forms of stress. They appeared to be highly inducible by TMV, moderately inducible
Frans Th. Brederode; Huub J. M. Linthorst; John F. Bol
Objective: The purpose of this study was to assess the influence of povidone–iodine mediastinal irrigation used for the treatment of deep sternal woundinfection (DSWI) on thyroid function. Methods: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone–iodine irrigation for DSWI. The median age of patients was 8 months (18 days–5.3 years). Serum concentrations of total
L. Kovacikova; P. Kunovsky; P. Skrak; V. Hraska; L. Kostalova; E. Tomeckova
Objective: The purpose of this study was to assess the influence of povidone-iodine mediastinal irrigation used for the treatment of deep sternal woundinfection (DSWI) on thyroid function. Methods: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone-iodine irrigation for DSWI. The median age of patients was 8 months (18 days-5.3 years). Serum concentrations of total
L. Kovacikova; P. Kunovsky; P. Skrak; V. Hraska; L. Kostalova; E. Tomeckova
Serious non-fatal complications of cardiac surgery include deep sternal woundinfection (DSWI) and haemorrhage. Understanding the factors associated with these complications (both pre-operatively and intra-operatively) may aid in the prevention and avoidance of such complications. The aim of the current report is to identify factors associated with DSWI and haemorrhage for all patients undergoing cardiac surgical procedures in Victorian public
Penelope J. Robinson; Baki Billah; Karin Leder; Christopher M. Reida; Australia Baker
A method for label-free, electrochemical impedance immunosensing for the detection and quantification of three infection biomarkers in both buffer and directly in the defined model matrix of mock wound fluid is demonstrated. Triggering Receptor-1 Expressed on Myeloid cells (TREM-1) and Matrix MetalloPeptidase 9 (MMP-9) are detected via direct assay and N-3-oxo-dodecanoyl-l-HomoSerineLactone (HSL), relevant in bacterial quorum sensing, is detected using a competition assay. Detection is performed with gold screen-printed electrodes modified with a specific thiolated antibody. Detection is achieved in less than 1h straight from mock wound fluid without any extensive sample preparation steps. The limits of detection of 3.3 pM for TREM-1, 1.1 nM for MMP-9 and 1.4 nM for HSL are either near or below the threshold required to indicate infection. A relatively large dynamic range for sensor response is also found, consistent with interaction between neighbouring antibody-antigen complexes in the close-packed surface layer. Together, these three novel electrochemical immunosensors demonstrate viable multi-parameter sensing with the required sensitivity for rapid woundinfection detection directly from a clinically relevant specimen. PMID:22137369
Ciani, Ilenia; Schulze, Holger; Corrigan, Damion K; Henihan, Grace; Giraud, Gerard; Terry, Jonathan G; Walton, Anthony J; Pethig, Ronald; Ghazal, Peter; Crain, Jason; Campbell, Colin J; Bachmann, Till T; Mount, Andrew R
Pseudomonas aeruginosa is a frequent participant in woundinfections. Emergence of multiple antibiotic resistant strains has created significant problems in the treatment of infectedwounds. Phage therapy (PT) has been proposed as a possible alternative approach. Infectedwounds 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:23420928
Krylov, Victor; Shaburova, Olga; Krylov, Sergey; Pleteneva, Elena
Pseudomonas aeruginosa is a frequent participant in woundinfections. Emergence of multiple antibiotic resistant strains has created significant problems in the treatment of infectedwounds. Phage therapy (PT) has been proposed as a possible alternative approach. Infectedwounds 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
Krylov, Victor; Shaburova, Olga; Krylov, Sergey; Pleteneva, Elena
Objective: To find out the most common bacterial pathogens responsible for post-operative woundinfection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative woundinfection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85%) isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%), was the predominant organism. S. aureus was sensitive to rifampicin (89.58%), levofloxacin (60.42%), and vancomycin (54.17%). Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%), gatifloxacin (51.35%), and meropenem (51.35%). Escherichia coli was sensitive to levofloxacin (72.41%) and ciprofloxacin (62.07%). Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%), levofloxacin (63.16%), gatifloxacin (63.16%), and linezolid (56.52%). Proteus mirabilis was sensitive to ciprofloxacin (75%) and linezolid (62.50). Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14%) followed by levofloxacin (50%). Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.
Goswami, Nutanbala N.; Trivedi, Hiren R.; Goswami, Alpesh Puri P.; Patel, Tejas K.; Tripathi, C. B.
Vacuum-assisted closure (VAC) device is widely used to treat infectedwounds in clinical work. Although the effect of VAC with different negative pressure values is well established, whether different negative pressures could result in varying modulation of wound relative cytokines was not clear. We hypothesise that instead of the highest negative pressure value the suitable value for VAC is the one which is the most effective on regulating wound relative cytokines. Infectedwounds created on pigs' back were used to investigate the effects of varying negative pressure values of VAC devices. Wounds were treated with VAC of different negative pressure values or moist gauze, which was set as control. The VAC foam, semiocclusive dresses and moist gauze were changed on days 3, 5, 7 and 9 after wounds were created. When changing dressings, tissues from wounds were harvested for bacteria count and histology examination including Masson's trichrome stain and immunohistochemistry for microvessels. Western blot was carried out to test the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Results showed that on days 3 and 5 the number of bacteria in wounds treated by VAC with 75, 150, 225 and 300 mmHg was significantly decreased compared with that in wounds treated by gauze and 0 mmHg pressure value. However, there was no difference in wounds treated with negative pressure values of 75 , 150, 225 and 300 mmHg at any time spot. Immunohistochemistry showed that more microvessels were generated in wounds treated by VAC using 75 and 150 mmHg negative pressure comparing with that using 225 and 300 mmHg on days 3 and 5. However this difference vanished on days 7 and 9. Morphological evaluation by Masson's trichrome staining showed increased collagen deposition in VAC of 75 and 150 mmHg compared with that in VAC of 225 and 300 mmHg. Western blot showed that the expression of VEGF and bFGF significantly increased when the wounds treated with 75 and 150 mmHg negative pressure values compared with the wounds treated with 225 and 300 mmHg on day 5. Treatment using VAC with different negative pressure values more than 75 mmHg has similar efficiency on reducing bacteria in the infectedwound. VAC with negative pressure values of 75 and 150 mmHg promote wound healing more quickly than other pressure values. Moreover, comparing with vigorous negative pressure, relatively moderate pressures contribute to wound healing via accelerated granulation growth, increased angiogenic factor production and improved collagen fibre deposition. Further study of this model may show other molecular mechanisms. PMID:22640026
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
Thomas, Mair E. M.; Piper, Elizabeth; Maurer, Isobel M.
Non-thermal (low-temperature) physical plasma is under intensive study as an alternative approach to control superficial wound and skin infections when the effectiveness of chemical agents is weak due to natural pathogen or biofilm resistance. The purpose of this study was to test the individual susceptibility of pathogenic bacteria to non-thermal argon plasma and to measure the effectiveness of plasma treatments against bacteria in biofilms and on wound surfaces. Overall, Gram-negative bacteria were more susceptible to plasma treatment than Gram-positive bacteria. For the Gram-negative bacteria Pseudomonas aeruginosa, Burkholderia cenocepacia and Escherichia coli, there were no survivors among the initial 10(5) c.f.u. after a 5 min plasma treatment. The susceptibility of Gram-positive bacteria was species- and strain-specific. Streptococcus pyogenes was the most resistant with 17?% survival of the initial 10(5) c.f.u. after a 5 min plasma treatment. Staphylococcus aureus had a strain-dependent resistance with 0 and 10?% survival from 10(5) c.f.u. of the Sa 78 and ATCC 6538 strains, respectively. Staphylococcus epidermidis and Enterococcus faecium had medium resistance. Non-ionized argon gas was not bactericidal. Biofilms partly protected bacteria, with the efficiency of protection dependent on biofilm thickness. Bacteria in deeper biofilm layers survived better after the plasma treatment. A rat model of a superficial slash woundinfected with P. aeruginosa and the plasma-sensitive Staphylococcus aureus strain Sa 78 was used to assess the efficiency of argon plasma treatment. A 10 min treatment significantly reduced bacterial loads on the wound surface. A 5-day course of daily plasma treatments eliminated P. aeruginosa from the plasma-treated animals 2 days earlier than from the control ones. A statistically significant increase in the rate of wound closure was observed in plasma-treated animals after the third day of the course. Wound healing in plasma-treated animals slowed down after the course had been completed. Overall, the results show considerable potential for non-thermal argon plasma in eliminating pathogenic bacteria from biofilms and wound surfaces. PMID:20829396
Ermolaeva, Svetlana A; Varfolomeev, Alexander F; Chernukha, Marina Yu; Yurov, Dmitry S; Vasiliev, Mikhail M; Kaminskaya, Anastasya A; Moisenovich, Mikhail M; Romanova, Julia M; Murashev, Arcady N; Selezneva, Irina I; Shimizu, Tetsuji; Sysolyatina, Elena V; Shaginyan, Igor A; Petrov, Oleg F; Mayevsky, Evgeny I; Fortov, Vladimir E; Morfill, Gregor E; Naroditsky, Boris S; Gintsburg, Alexander L
The innate immune system differentially regulates the expression of host defense peptides to combat infection during wound healing. We enhanced the expression of a host defense peptide, human ? defensin-3 (hBD-3), in keratinocytes to generate a three-dimensional biologic dressing to improve healing of infectedwounds. The NIKS human keratinocyte cell line was stably transfected ex vivo with a construct containing an epidermis-specific promoter driving hBD-3(NIKShBD-3) using non-viral methods. Levels of hBD-3 mRNA and protein in three-dimensional skin tissue produced from NIKShBD-3 were determined using quantitative PCR and ELISA, respectively. Tissue architecture was characterized by hematoxylin and eosin staining, and by indirect immunofluorence using proliferation and keratinocyte differentiation markers. Antimicrobial activity was assessed using an in vitro bacterial growth assay and in vivo using a murine burn infection model. Three-dimensional full thickness skin tissues containing epidermal NIKShBD-3 or control NIKS possessed histologic features of interfollicular epidermis and exhibited normal tissue growth and differentiation. NIKShBD-3 tissue contained approximately 5-fold more hBD-3 protein than tissue containing unmodified control NIKS. In vitro studies showed that NIKShBD-3 tissue produced a significant reduction in the growth of Staphylococcusaureus (S. aureus) mprF compared to control tissue. In an in vivo infected murine burn model, NIKShBD-3 tissue resulted in a 90% reduction in bacterial growth. These results demonstrate that sustained delivery of hBD-3 by a bioengineered skin tissue results in a therapeutically relevant reduction in growth of a S. aureus strain in an animal model of infected third degree burn wounds.
Gibson, Angela L.; Thomas-Virnig, Christina L.; Centanni, John M.; Schlosser, Sandy J.; Johnston, Colette E.; Van Winkle, Kelly F.; Szilagyi, Andrea; He, Li-Ke; Shankar, Ravi; Allen-Hoffmann, B. Lynn
The innate immune system differentially regulates the expression of host defense peptides to combat infection during wound healing. We enhanced the expression of a host defense peptide, human beta defensin-3 (hBD-3), in keratinocytes to generate a three-dimensional biologic dressing to improve healing of infectedwounds. The NIKS human keratinocyte cell line was stably transfected ex vivo with a construct containing an epidermis-specific promoter driving hBD-3 (NIKS(hBD) (-3) ) using nonviral methods. Levels of hBD-3 mRNA and protein in three-dimensional skin tissue produced from NIKS(hBD) (-3) were determined using quantitative polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. Tissue architecture was characterized by hematoxylin and eosin staining and by indirect immunofluorescence using proliferation and keratinocyte differentiation markers. Antimicrobial activity was assessed using an in vitro bacterial growth assay and in vivo using a murine burn infection model. Three-dimensional full thickness skin tissues containing epidermal NIKS(hBD) (-3) or control NIKS possessed histologic features of interfollicular epidermis and exhibited normal tissue growth and differentiation. NIKS(hBD) (-3) tissue contained approximately fivefold more hBD-3 protein than tissue containing unmodified control NIKS. In vitro studies showed that NIKS(hBD) (-3) tissue produced a significant reduction in the growth of Staphylococcus aureus multiple peptide resistance factor (mprF) compared with control tissue. In an in vivo infected murine burn model, NIKS(hBD) (-3) tissue resulted in a 90% reduction in bacterial growth. These results demonstrate that sustained delivery of hBD-3 by a bioengineered skin tissue results in a therapeutically relevant reduction in growth of a S.?aureus strain in an animal model of infected third-degree burn wounds. PMID:22564233
Gibson, Angela L; Thomas-Virnig, Christina L; Centanni, John M; Schlosser, Sandy J; Johnston, Colette E; Van Winkle, Kelly F; Szilagyi, Andrea; He, Li-Ke; Shankar, Ravi; Allen-Hoffmann, B Lynn
Leishmania donovani causes human visceral leishmaniasis. The parasite infectious cycle comprises extracellular flagellated promastigotes that proliferate inside the insect vector, and intracellular nonmotile amastigotes that multiply within infected host cells. Using primary macrophages infected with virulent metacyclic promastigotes and high spatiotemporal resolution microscopy, we dissect the dynamics of the early infection process. We find that motile promastigotes enter macrophages in a polarized manner through their flagellar tip and are engulfed into host lysosomal compartments. Persistent intracellular flagellar activity leads to reorientation of the parasite flagellum toward the host cell periphery and results in oscillatory parasite movement. The latter is associated with local lysosomal exocytosis and host cell plasma membrane wounding. These findings implicate lysosome recruitment followed by lysosome exocytosis, consistent with parasite-driven host cell injury, as key cellular events in Leishmania host cell infection. This work highlights the role of promastigote polarity and motility during parasite entry. PMID:21501831
A protective secretion produced by epidermal mucus cells in stingrays is being investigated to understand its role in wound healing and to identify mucus-associated antimicrobial compounds with the potential for development into novel therapeutics to trea...
C. Walsh C. A. Luer J. Wyffels K. Ritchie L. Edsberg
We reviewed the hospital course of 77 diabetic and 69 nondiabetic subjects who had incision, drainage, and exploration of infected puncture wounds of the foot. Diabetics were 5 times more likely to have multiple operations and 46 times more likely to have a lower extremity amputation than nondiabetics. The interval from injury to surgery was significantly longer in diabetics than nondiabetics. Total lymphocyte count and hemoglobin, hematocrit, and albumin values were significantly lower in diabetics than in nondiabetics. Diabetic amputees had higher prevalences of nonpalpable pulses, nephropathy, neuropathy, and osteomyelitia as compared with diabetic nonamputees. The neuropathic diabetic foot is not protected by pain. When combined with other comorbid factors, this may increase morbidity associated with puncture wounds of the foot. PMID:9241975
Armstrong, D G; Lavery, L A; Quebedeaux, T L; Walker, S C
Disseminated fungal infections are normally opportunistic infections in the immunocompromised population. Current literature has documented a high mortality rate with these infections in civilian trauma or as complications of severe burns. There is only one published case of fungal infection in a combat-injured individual to date, which resulted in mortality despite aggressive debridement and appropriate antifungal agents. We present here three patients in whom aggressive debridement, antifungals, and the addition of dilute Dakin's solution with negative pressure wound therapy was used to treat angioinvasive mold. Angioinvasive fungal infection continue to be one of the most aggressive and devastating infections that our combat-injured patients face. With the addition of dilute Dakin's solution, we successfully managed three critically ill patients. Previous literature had shown close to 30% mortality associated with cutaneous mucormycosis and the mortality rate approaches 100% with disseminated angioinvasive fungal infections. These results provide hope not only for the combat-injured patients being treated for both local and disseminated angioinvasive fungal infections, but also for the civilian trauma and immunocompromised patients. PMID:23707840
Lewandowski, Louis; Purcell, Richard; Fleming, Mark; Gordon, Wade T
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
Background The incidence of Sternal woundinfection as reported worldwide is 0.43–2.3% [1–7]. The incidence is low and has serious effects\\u000a on the patients in terms of the morbidity, hospital stay, cost as well as mortality. This study proposes to identify the risk\\u000a factors, changing bacteriologic and the treatment outcomes.\\u000a \\u000a \\u000a \\u000a \\u000a Methods 6492 consecutive patients who had median sternotomy for open heart surgery
Kelechi Emmanuel Okonta; Mohanraj Anbarasu; Vijay Agarwal; Jacob Jamesraj; Valikapathalil Mathew Kurian; Sethuratnam Rajan
Marine microorganisms are uncommon etiologies of skin and skin structure infections, that is, woundinfections. We report a case of severe woundinfection, 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 woundinfection 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.
Plants and animals can recognize the invasion of pathogens through their perception of pathogen-associated molecular patterns (PAMPs) by pattern recognition receptors (PRRs). Plant PRRs identified have been exclusively receptor-like kinases/proteins (RLK/Ps), and no RLK/P that can detect viruses has been identified to date. RNA silencing (RNA interference, RNAi) is regarded as an antiviral basal immunity because the majority of plant viruses has RNA as their genomes and encode RNA silencing suppressor (RSS) proteins to counterattack antiviral RNAi. Many RSSs were reported to bind to double-stranded RNAs (dsRNAs), which are regarded as viral PAMPs. We have recently identified a tobacco calmodulin (CaM)-like protein, rgs-CaM, as a PRR that binds to diverse viral RSSs through its affinity for the dsRNA-binding domains. Because rgs-CaM seems to target RSSs for autophagic degradation with self-sacrifice, the expression level of rgs-CaM is important for antiviral activity. Here, we found that the rgs-CaM expression was induced immediately (within 1 h) after wounding at a wound site on tobacco leaves. Since the invasion of plant viruses is usually associated with wounding, and several hours are required for viruses to replicate to a detectable level in invaded cells, the wound-induced expression of rgs-CaM seems to be linked to its antiviral function, which should be ready before the virus establishes infection. CaMs and CaM-like proteins usually transduce calcium signals through their binding to endogenous targets. Therefore, rgs-CaM is a unique CaM-like protein in terms of binding to exogenous targets and functioning as an antiviral PRR. PMID:23073002
The effects of water and chloroform extracts of the leaves of Lawsonia inermis (henna plant) against the primary invaders of burnt wounds was investigated. Clinical isolates of Staphylococcus aureus, Streptococcus sp, Pseudemonas aeruginosa, Candida albicans, Fusarium oxysporum, and Aspergillus niger were treated with extracts of the leaves of L. inermis for antimicrobial activity using in vitro agar incorporation method and
Oxygen is a necessary component of norm a l wound healing and is required for multiple cell functions, including the killing of bacte- ria by leuko cytes. A new ox y g e n - g e n e r a t i n g dressing has been developed that prov i d e s i n t e rmittent
Terry E. Wright; Wyatt G. Payne; Francis Ko; Daniel Ladizinsky; Neil Bowlby; Roy Neeley; Brian Mannari; Martin C. Robson
The effective treatment of infectedwounds continues to be a serious challenge, mainly due to the rise of antibiotic-resistant bacteria. Photodynamic therapy (PDT) refers to the topical or systemic administration of a non-toxic, photosensitizing agent (PS), followed by irradiation with visible light of a suitable wavelength. The possibility of applying the PDT locally is what makes it so favorable to the treatment of infectedwounds. The goal of this study was to evaluate the action of the PDT in the inactivation in vitro of microorganisms coming from infectedwounds, using methylene blue (MB) and photodithazine (PDZ) as the PS and comparing the efficacy of these two compounds for PDT on bacteria. For the application of PDT, isolated microorganisms identified from material collected from wounds were suspended in a saline solution containing 10(6) viable cells/ml. Each isolated microorganism was submitted to PDT with MB and with PDZ in accordance with the following treatment groups: N/T-no treatment; T1-PDT with PDZ; T2-PDT with MB; T3-irradiation without PS; T4-treatment with PDZ without light; and T5-treatment with MB without light. As a light source, an LED-based device was used (Biopdi/Irrad-Lead 660), composed of 54 LEDs, each with 70 mW of power in the 660 nm region of the electromagnetic spectrum. Each tray of 96 wells was irradiated with an intensity of 25 mW/cm(2) and a dose of light of 50 J/cm(3) for 33 min. All the tests were made in duplicate. It was then concluded that the PDT with PDZ was capable of inhibiting the growth of gram-positive bacteria samples, however it did not have the same effect on gram-negative bacteria, which showed growth greater than 100,000 CFU; the PDT with MB showed an effectiveness on gram-positive as well as gram-negative bacteria, for it was able to inhibit bacterial growth in both cases. PMID:23455656
Pereira de Lima Carvalho, Denise; Guerra Pinto, Juliana; Di Paula Costa Sorge, Camila; Rodrigues Benedito, Fabiana Regis; Khouri, Sonia; Ferreira Strixino, Juliana
We report the use of a microfluidic 3D bone tissue model, as a high-throughput means of evaluating the efficacy of biomaterials aimed at accelerating orthopaedic implant-related wound-healing while preventing bacterial infection. As an example of such biomaterials, inkjet-printed micropatterns were prepared to contain antibiotic and biphasic calcium phosphate (BCP) nanoparticles dispersed in a poly(D,L-lactic-co-glycolic) acid matrix. The micropatterns were integrated with a microfluidic device consisting of eight culture chambers. The micropatterns immediately and completely killed Staphylococcus epidermidis upon inoculation, and enhanced the calcified extracellular matrix production of osteoblasts. Without antibiotic elution, bacteria rapidly proliferated to result in an acidic microenvironment which was detrimental to osteoblasts. These results were used to demonstrate the tissue model's potential in: (i) significantly reducing the number of biomaterial samples and culture experiments required to assess in vitro efficacy for wound-healing and infection prevention and (ii) in situ monitoring of dynamic interactions of biomaterials with bacteria as wells as with tissue cells simultaneously. PMID:22061488
Lee, Joung-Hyun; Gu, Yexin; Wang, Hongjun; Lee, Woo Y
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.
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infectedwounds 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 woundinfection 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 woundinfection, 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.
Guo, Yi; Ramos, Romela Irene; Cho, John S.; Donegan, Niles P.; Cheung, Ambrose L.
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infectedwounds 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 woundinfection 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 woundinfection, 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
Guo, Yi; Ramos, Romela Irene; Cho, John S; Donegan, Niles P; Cheung, Ambrose L; Miller, Lloyd S
Background: The prevalence of nosocomial infection in Australian hospitals is estimated to be between 5.5% and 6.3%. Since 1989, infection control professionals (ICPs) in hospitals accredited by the Australian Council on Health Care Standards (ACHS) have been encouraged to collect nosocomial infection data according to ACHS methodology. Method: In 1996, we surveyed members of the Australian Infection Control Association to
All published cases of wound botulism were reviewed to describe the epidemiology, clinical manifestations, diagnosis, and treatment of this rare infection. The MEDLINE data base of English-language literature was searched from 1966 to 1992, using the keywords "wound botulism". Cases published during this period were identified, and the bibliographies of these articles were used to identify cases published before MEDLINE's search limit of 1966. Because of the limited number of published cases, all were reviewed. Data related to epidemiology, clinical manifestations, diagnosis and treatment were collected on each case. When possible, cross-references from case series or reviews were used to corroborate and supplement data for a given case. There were 40 cases identified as wound botulism. The case fatality rate was 10%. The 36 survivors had significant morbidity requiring prolonged medical care. Wound botulism is a rare life-threatening complication of trauma and i.v. drug abuse. The diagnosis should be considered in any patient with either of these risk factors who develop paresis of cranial nerves and a descending pattern of weakness. Treatment, including administration of antitoxin, should be initiated prior to definitive diagnosis by microbiologic laboratory tests. PMID:8066973
The identification and diagnosis of diabetic foot ulcer (DFU) infections remains a complex problem. Because inflammatory responses to microbial invasion may be diminished in persons with diabetes, clinical signs of infection are often absent in persons with DFUs when infection is limited to localized tissue. In the absence of these clinical signs, microbial load is believed to be the best
BACKGROUND: Despite dramatic improvements in the management of burns, infection still remains a serious risk for the burn patient. The aim of this study was to shed light on the impact of acute burn injury with or without infection on cytokine profiles. METHODS: Sprague-Dawley rats (n = 21) were randomized into three groups: 1) burn only 2) burn and infection
Lars Steinstraesser; Olaf Burkhard; Ming H Fan; Frank Jacobsen; Marcus Lehnhardt; Grace Su; Adrien Daigeler; Hans U Steinau; Daniel Remick; Stewart C Wang
Septic complications are rare following laparoscopic cholecystectomy if prophylactic antibiotics are given, as demonstrated in previous studies. Antibiotic treatment may be unnecessary and, therefore, undesirable, so we compared two forms of prophylaxis: a cephalosporin antibiotic and bag extraction of the dissected gallbladder. A total of 76 patients undergoing laparoscopic cholecystectomy were randomised to either receive an antibiotic or to have their gallbladder removed from the abdomen in a plastic bag. Complicated cases were excluded. There was a total of 6 woundinfections (7.9%), 3 in each of the study groups. All these were associated with skin commensals. There were no other septic complications. Bacteriological studies grouped the organisms isolated from the bile and the wound as potential pathogens and likely commensals. A total of 10 potential pathogens were isolated, 9 of which were found in the group receiving antibiotics. We conclude that septic sequelae of uncomplicated laparoscopic cholecystectomy are uncommon, but clearly not entirely prevented by antibiotic or mechanical prophylaxis. Prophylactic antibiotics may not be required in uncomplicated laparoscopic cholecystectomy. Further study is warranted.
Harling, R.; Moorjani, N.; Perry, C.; MacGowan, A. P.; Thompson, M. H.
Hoof abscesses are probably the most common cause of acute severe lameness in horses encountered by veterinarians and farriers. Most affected horses show sudden, severe (acute) lameness; the degree of lameness varies from being subtle in the early stages to non-weight bearing. There is still debate between the veterinary and farrier professions as to who should treat a hoof abscess and the best method to resolve the abscess. Puncture wounds to the sole of the foot can introduce bacteria and debris to the solar surface of the distal phalanx and produce a fracture or a septic pedal osteitis. PMID:22981199
INTRODUCTION: Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. METHODS: This study is an observational report on complex wound management, infection and psychoemotional control
Marc Maegele; Sven Gregor; Nedim Yuecel; Christian Simanski; Thomas Paffrath; Dieter Rixen; Markus M Heiss; Claudia Rudroff; Stefan Saad; Walter Perbix; Frank Wappler; Andreas Harzheim; Rosemarie Schwarz; Bertil Bouillon
There are various primary treatment modalities of managing deep sternal woundinfection (DSWI) following cardiac surgery, namely surgical debridement with primary reclosure in conjunction with irrigation, Vacuum-assisted closure (V.A.C. ) therapy, and primary or delayed flap closure. The purpose of this study was to assess whether there is consensus of the primary management of DSWI using one method as a
Christoph Schimmer; Sebastian-Patrick Sommer; Marc Bensch; Rainer Leyh
In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal woundinfections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI
Orjan Friberg; Lars-Goran Dahlin; Jan Kallman; Erik Kihlstrom; Bo Soderquist; Rolf Svedjeholm
We present a case of a 77-year old female who had undergone a coronary artery bypass grafting with an aortic valve replacement and developed three month later a Methicillin-Resistant Staphylococcus aureus (MRSA) sternal woundinfection which was successful treated with Daptomycin combined with vacuum-assisted closure (VAC).
Aron F Popov; Jan D Schmitto; Theodor Tirilomis; Christian Bireta; Kasim O Coskun; Suyog A Mokashi; Alexander Emmert; Martin Friedrich; Christoph H Wiese; Friedrich A Schoendube
A stabilized collagen gel is disclosed as are methods of making this collagen gel which is useful as a wound dressing to prevent dehydration of the subject being treated and infection of the wound. The collagen gel of the invention is stabilized by combin...
Surveillance for surgical site infection (SSI) in cesarean-section (C-section) in our hospital, carried out between September 1998 and July 1999, identified areas of deficiency in aseptic techniques that have contributed to increased incisional surgical site infection rates (ISSI) rates. On the basis of these findings, we intensified the infection control presence in this area and increased the number of in-services
Burn wounds are prone to infection by Pseudomonas aeruginosa, which is an opportunistic pathogen causing various human diseases. During infection, the bacterium senses environmental changes and regulates the expression of genes appropriate for survival. A purine-auxotrophic mutant of P. aeruginosa was unable to replicate efficiently on burn wounds, suggesting that burn wounds are purine-deficient environments. An in vivo expression technology based on purEK gene expression was applied to the burned mouse infection model to isolate P. aeruginosa genes that are specifically induced during infection. Four such in vivo-inducible (ivi) genetic loci were identified, including the gene for a superoxide response regulator (soxR), the gene for a malate synthase G homologue (glcG), an antisense transcript of a putative regulator responding to copper (copR), and an uncharacterized genetic locus. SoxR of Escherichia coli is known to regulate genes involved in protecting the bacterium against oxidative stress. The expression of soxR was proven to be highly inducible during the infection of burned mice and also inducible by treatment with paraquat, which is a redox-cycling reagent generating intracellular superoxide. The SoxR protein functions as an autorepressor in the absence of paraquat, whereas in the presence of paraquat, this autorepression is diminished. Furthermore, a soxR null mutant was shown to be much more sensitive than wild-type P. aeruginosa to macrophage-mediated killing. In support of this observation, a soxR null mutant exhibited a significant delay in causing systemic infections in the burned mice. Since most mortality in burn patients is caused by systemic infection, the defect in the ability to cause efficient bacteremia in burned mice suggests an important role of the soxR gene in the infection of burn wounds.
A local woundinfection developed in a 42-year-old female patient after replacement of ascending aorta, aortic arch and supra-aortic vessels, following aortic dissection. Because of the high risk of infection due to the vascular prosthesis and its location at the upper part of the sternum, a right pectoral muscular flap, detached from the humerus and vascularized by medial perforators originating
Olivier Chavanon; Frederic Thony; Jacques Lebeau; Dominique Blin
Infection is a common complication in open fractures that compromises the healing of bone and can result in loss of limb or life. Currently, the clinical standard of care for treating contaminated open fractures comprises a staged approach, wherein the wound is first treated with non-biodegradable antibiotic-laden poly(methyl methacrylate) (PMMA) beads to control the infection followed by bone grafting. Considering that tissue regeneration is associated with new blood vessel formation, which takes up to 6 weeks in segmental defects, a biodegradable bone graft with sustained release of an antibiotic is desired to prevent the implant from becoming infected, thus allowing the processes of both vascularization and new bone formation to occur unimpeded. In the present study, we utilized biodegradable porous polyurethane (PUR) scaffolds as the delivery vehicle for vancomycin. Hydrophobic vancomycin free base (V-FB) was obtained by precipitating the hydrophilic vancomycin hydrochloride (V-HCl) at pH 8. The decreased solubility of V-FB resulted in an extended vancomycin release profile in vitro, as evidenced by the fact that active vancomycin was released for up to 8 weeks at concentrations well above both the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). Using PUR prepared from lysine triisocyanate (LTI) (PUR(LTI)), the extended in vitro release profile observed for V-FB translated to improved infection control in vivo compared to V-HCl in a contaminated critical-sized fat femoral segmental defect. The performance of PUR(LTI)/V-FB was comparable to PMMA/V-HCl beads in vivo. However, compared with PMMA, PUR is a biodegradable system which does not require the extra surgical removal step in clinical use. These results suggest that PUR scaffolds incorporating V-FB could be a potential clinical therapy for treatment of infected bone defects. PMID:20382191
Li, Bing; Brown, Kate V; Wenke, Joseph C; Guelcher, Scott A
BackgroundThe VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the
Tatjana M Fleck; Michael Fleck; Reinhard Moidl; Martin Czerny; Rupert Koller; Pietro Giovanoli; Michael J Hiesmayer; Daniel Zimpfer; Ernst Wolner; Martin Grabenwoger
Background We investigate disinfection of a reconstructed human skin model contaminated with biofilm-formative Staphylococcus aureus employing plasma discharge in liquid. Principal Findings We observed statistically significant 3.83-log10 (p<0.001) and 1.59-log10 (p<0.05) decreases in colony forming units of adherent S. aureus bacteria and 24 h S. aureus biofilm culture with plasma treatment. Plasma treatment was associated with minimal changes in histological morphology and tissue viability determined by means of MTT assay. Spectral analysis of the plasma discharge indicated the presence of highly reactive atomic oxygen radicals (777 nm and 844 nm) and OH bands in the UV region. The contribution of these and other plasma-generated agents and physical conditions to the reduction in bacterial load are discussed. Conclusions These findings demonstrate the potential of liquid plasma treatment as a potential adjunct therapy for chronic wounds.
Kim, Paul Y.; Kim, Yoon-Sun; Koo, Il Gyo; Jung, Jae Chul; Kim, Gon Jun; Choi, Myeong Yeol; Yu, Zengqi; Collins, George J.
The effect of suturing with a very short stitch on the development of wound complications in midline incisions was investigated. Three hundred sixty-eight patients were analysed. The suture length to wound length ratio and mean stitch length were calculated. Woundinfection occurred in 4% (four of 103) of patients sutured with a mean stitch length of less than 4 cm, in
Wound closure requires deep understanding of wound physiology, anatomy, and the healing phase of the wound. The basic principles of wound closure, diabetes control, normal nutrition status, infection control, mechanical stress avoidance, and nursing care are all important elements in achieving healing of acute and chronic wounds. This goal is achievable only through the interdisciplinary approach to wound healing. A
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.
Objective To assess the value of single-dose, intravenous, prophylactic ampicillin and sulbactam (AS) in the prevention of woundinfections during open prosthetic inguinal hernia repair by a double-blind, prospective, randomized trial. Summary Background Data The use of antibiotic prophylaxis during open prosthetic inguinal hernia surgery is controversial, and no prospective trial has been conducted to examine this issue. Methods Patients undergoing unilateral, primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.5 g intravenous AS before the incision or an equal volume of placebo according to a predetermined code of which the surgeons were unaware. Patients with recurrent, femoral, bilateral, giant, or incarcerated hernias or any systemic diseases were excluded. Age, sex, body mass index, American Society of Anesthesiologists score, type of hernia, type of anesthesia, duration of surgery, and use of drains were recorded. Infection was defined according to the criteria of Centers for Disease Control. Patients were evaluated 1 week, 1 month, 6 months, and 1 year after surgery by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher’s exact, and Student t tests as appropriate. Results Between September 1996 and July 1998, 280 patients (140 AS, 140 placebo group) entered the protocol. Four patients from the AS group and seven from the placebo group were excluded because of inadvertent antibiotic administration or follow-up problems. Groups were well matched for all the variables studied and postoperative complications, excluding woundinfections, which occurred at a rate of 0.7% in the AS group and 9% in the placebo group (P = .00153). Twelve patients in the placebo group developed woundinfections, requiring five repeat hospital admissions in three patients. These three patients suffered deep infections reaching the graft, which resulted in graft loss in two. The single infected patient in the AS group had his graft removed as well because of deep persistent infection. Conclusions This study documented a significant (10-fold) decrease in overall woundinfections when single-dose, intravenous AS was used during Lichtenstein hernia repair. Deep infections and woundinfection-related readmissions were also reduced by the use of AS. Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial. AS proved to be an effective antimicrobial agent.
Yerdel, Mehmet A.; Akin, Emin B.; Dolalan, Sukru; Turkcapar, Ahmet G.; Pehlivan, Mevlut; Gecim, Ibrahim E.; Kuterdem, Ercument
... wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty ... as a rusty nail, the more dirt and debris are dragged into the wound, increasing the chance ...
A 52-year-old man suffering from dilated cardiomyopathy underwent implantable left ventricular assist device (LVAD) insertion as a bridge to transplantation. He presented with evidence of LVAD-related mediastinitis and pump pocket infection 57 days after the LVAD implantation. The mediastinum was reopened and irrigated. A large amount of pus was observed around the outflow and inflow conduits and in the pump pocket. Negative pressure wound therapy (NPWT) was initiated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood and mediastinal pus. Enterobacter cloacae was also isolated by mediastinal pus culture after the beginning of the NPWT. Three weeks after the start of the NPWT, the pus culture became negative, and omental transposition and sternal closure were performed. Intravenous antibiotics were administered until day 42, with the treatment subsequently switched to oral antibiotics. He was discharged from the hospital on day 57 and followed up at the outpatient clinic. Our findings suggest that NPWT followed by omental transposition be useful to treat mediastinitis or pump pocket infection after implantable LVAD insertion. PMID:23535582
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 10?M HB:La+3 and a light-emitting diode (LED) emitting at ?=460nm+/-20nm and a LED emitting at ?=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.
Hashimoto, M. C. E.; Prates, R. A.; Toffoli, D. J.; Courrol, L. C.; Ribeiro, M. S.
Infection after augmentation mammoplasty is not common, with the reported incidence between 1% and 7%. The use of prophylactic antibiotics, however, is widespread in plastic surgery: It was documented in a 1975 survey in which 43% of responding plastic surgeons used prophylactic antibiotics. Fifteen years since this survey, surgeons have witnessed an explosion in antibiotic variety and have participated in
In this study, we tested the contribution of flagellar motility, flagellin structure, and its glycosylation in Pseudomonas aeruginosa using genetically defined flagellar mutants. All mutants and their parent strains were tested in a burned-mouse model of infection. Motility and glycosylation of the flagellum appear to be important determinants of flagellar-mediated virulence in this model. This is the first report where
Shiwani K. Arora; Alice N. Neely; Barbara Blair; Stephen Lory; Reuben Ramphal
A cluster of six pediatric cases of deep-seated Staphylococcus aureus infection after heart operations prompted us to perform molecular typing of the S. aureus isolates by pulsed-field gel electrophoresis. This revealed the presence of genotypically distinct isolates in four of the six patients. Isolates of two patients were genotypically identical. All patients carried S. aureus in the anterior nares. In
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 woundinfection model in mice. Mice were treated either topically with retapamulin (1%), fusidic acid (2%) or mupirocin (2%) or systemically with linezolid (50-100mg/kg/day) or vancomycin (50-200mg/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 2.0log10 CFU, respectively, and treatment for 6 days by 5.0, 4.2 and 5.1log10 CFU, respectively, compared with non-treated controls (P<0.001). Systemic treatment with linezolid for 6 days reduced the bacterial loads by 1.6log10 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
With the help of a surgical nurse and using data-processing techniques, a prospective clinical study was conducted to determine the woundinfection rate in two hospitals in Calgary. The overall sepsis rate was 5.2% and the clean wound rate 3.5%. The latter is the more meaningful figure as it allows for comparison between hospitals, specialties and individuals and is a good guide for hospital morbidity reviews. The groundwork for succeeding woundinfection is laid in the operating theatre, and it is believed that woundinfection would be reduced more by attention to Halsted's principles than by more rigid aseptic techniques. It is estimated that wound sepsis costs the Province of Alberta 1.5 million dollars per year for hospitalization alone. This amounts to roughly $1 per person per year. The annual cost of a prospective study such as the present one is approximately $7000. This is equivalent to the cost of hospitalizing 24 patients with infectedwounds for one week (at $300 per week). One dividend of a prospective study is an associated reduction in infection rate. This reduction more than pays for the cost of the program.
With the recent increase in bacterial resistance to conventional antibiotics, the early-stage detection and control of infection has become imperative in the fight against opportunistic pathogens in healthcare. The traditional ?-lactam wonder-drugs (e.g. penicillin and cephalosporins), are rendered inactive due to enzymatic hydrolysis by bacterial ?-lactamase enzymes as a bacterial defence mechanism. However, this deactivation mechanism produces different responses in the two aforementioned drugs - with the cephalosporins showing a molecular rearrangement mechanism which could be utilised for prodrug delivery. This unique mechanism could mean that inactive forms of cephalosporin antibiotics, once used as chemotherapeutics in oncology, could once again be used in the fight against disease as sensors to detect and treat bacterial colonisation. Therefore, we hypothesize that cephalosporin-dye bandages might provide an effective method to visually detect, and subsequently control, the early stages of an infection using photoantimicrobial chemotherapy (PACT). PMID:23245203
Brocklesby, Kayleigh L; Johns, Stephen C; Jones, Allison E; Sharp, Duncan; Smith, Robert B
Background It is generally believed that the accompanying conditions in patients with inflammatory bowel disease (IBD) are associated\\u000a with a high incidence of surgical site infection (SSI), and sometimes these patients are classified as compromised hosts without\\u000a definitive clinical evidence. The aim of this study was to clarify the impact of IBD on the occurrence and features of SSI\\u000a in patients
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 infectedwounds, 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.
We report a clear corneal woundinfection occurring in a 74-year-old man caused by a member of the Mycobacterium chelonae–Mycobacterium abscessus complex, presenting as crystalline keratopathy with recurrent hypopyon. This led to perforation after phacoemulsification with posterior chamber intraocular lens implantation. Only after corneal biopsy of the incision was the causative organism isolated and found to be sensitive to clarithromycin
Juan Javier Servat; Jerome C. Ramos-Esteban; Shachar Tauber; Frank J. Bia
OBJECTIVE--To establish whether a single preoperative dose of cefotaxime plus metronidazole was as effective as a standard three dose regimen of cefuroxime plus metronidazole in preventing woundinfection after colorectal surgery. DESIGN--Prospective randomised allocation to one of two prophylactic antibiotic regimens in a parallel group trial. Group sequential analyses of each 250 patients were performed. SETTING--14 District general and teaching
D C Rowe-Jones; A L Peel; R D Kingston; J F Shaw; C Teasdale; D S Cole
A bacterium, HKU30(T), was isolated from the infected tissue of a patient with woundinfection 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
Lau, Susanna K P; Curreem, Shirly O T; Lin, Cherry C N; Fung, Ami M Y; Yuen, Kwok-Yung; Woo, Patrick C Y
There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ‘magical dressings’. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.
Pressure sores (PSs) and wounds in immunocompromised children are rather rare conditions. No doubt, their management is often complex and difficult, even for experienced pediatric plastic surgeons. As there are no algorithms for standard care, the therapeutic approach is individual.Successful PS management always implies primary and secondary prevention. With a PS present, rapid relief of pressure is crucial. If local wound care fails to restore skin integrity within a short period of time, surgical defect closure is mandatory. Overall, full-thickness skin grafts and local flap surgery are the most suitable methods regarding result quality, procedure complexity, and risks. Negative pressure wound therapy (NPWT) plays an instrumental role in wound bed preparation before definitive coverage. Recurrence rate is high (the complication). It does not much depend on the surgical technique employed, but rather depends on whether the various pathogenic factors leading to PS can be eliminated or alleviated.In both temporarily and permanently immunocompromised children, wound healing is significantly impaired. At the same time, these patients have no or low host defense activity. Thus, they are at high risk not only for local woundinfection but also for potentially life threatening septic complications. Rapid and definitive wound closure is therefore essential. When conservative therapy fails, simple surgical techniques granting rapid and definitive wound closure should be used. PMID:24008551
Neuhaus, Kathrin; Meuli, Martin; Koenigs, Ingo; Schiestl, Clemens
Since 1997, the absence of a global, DoD public health laboratory system has been identified as a vulnerability in the U.S. military's effort to identify and quickly respond to emerging infections. The AFHSC Division of GEIS Operations has attempted to mitigate this vulnerability by supporting initiatives such as the DoD Global Influenza Surveillance Program and the DoD Directory of Public Health Laboratory Services. AFHSC continues to be engaged in identifying and addressing diagnostics needed to protect deployed forces. The GASI and the enhanced capability for identification of MDROs and threatening influenza strains in deployed areas are recent examples of GEIS utilizing its financial resources and position as a DoD organization to coordinate the efforts of the military services and other U.S. government organizations to improve preparedness for EID agents. However, the absence of a defined, comprehensive public health system that contains surveillance systems, reference laboratories, and public health communication systems functioning in unison to provide reach back and reference laboratory support to the global MHS remains a significant gap. PMID:22479910
Lindler, Luther; Lesho, Emil P; Harms, Dan E; Myers, Todd E; Gaydos, Joel C
Wound bed preparation is essential for the healing of wounds. The TIME framework (tissue, infection/inflammation, moisture balance, edge of wound) for wound bed preparation shows the importance of debridement in the treatment of chronic wounds. Debridement involves the removal of devitalised tissue from the wound bed. It also facilitates the removal of biofilms-complex microbial communities that are known to contribute to delayed wound healing and chronicity of wounds. Ultrasonic-assisted wound debridement (UAWD) is a lesser known debridement method that uses low-frequency ultrasound waves. There is evidence to show that the three clinical effects of atraumatic selective tissue debridement, wound stimulatory effects and antibacterial activity facilitate early healing of wounds, reducing the cost to the healthcare system and improving the patient's quality of life. PMID:23587975
The study aims to perform a comparative assessment of two types of burn wound treatment. To do the assessment, patients with partial thickness burn wounds with total body surface area <40% were simple randomised to treat with nanocrystalline silver nylon wound dressing or silver sulfadiazine cream. Efficacy of treatment, use of analgesics, number of wound dressing change, woundinfection and final hospitalisation cost were evaluated. The study showed silver nylon wound dressing significantly reduced length of hospital stay, analgesic use, woundinfection and inflammation compared with silver sulfadiazine. PMID:22734483
Abedini, Fereydoon; Ahmadi, Abdollah; Yavari, Akram; Hosseini, Vahid; Mousavi, Sarah
Background In infected incisional ventral hernias (IVHs), the use of a synthetic non-absorbable mesh is not recommended and biological meshes hold promise. However, the level of evidence for their safety and efficacy remains low. Methods The SIMBIOSE trial is a multicenter, phase III, randomized, controlled trial comparing the use of a biological mesh versus traditional wound care in patients with an IVH. The primary end point is 6-month infectious and/or wound morbidity. Secondary end points are woundinfection and recurrent hernia rates, post-operative pain, quality of life, time to heal, reoperation need, impact of the cross-linked mesh structure, and a medico-economic evaluation. One hundred patients need to be included. Results The main results expected with biological mesh use are a significant decrease of post-operative morbidity, hernia recurrence, time to heal, and costs with an improved quality of life. Conclusions For the first time, the impact of biological meshes in the treatment of IVHs will be evaluated in an academic, randomized, phase III trial to provide scientific evidence ( NCT01594450). Trial registration ClinicalTrial.gov, NCT01594450
Horse wounds have a high risk of becoming infected due to their environment. Infectedwounds harbour diverse populations of microorganisms, however in some cases these microorganisms can be difficult to identify and fail to respond to antibiotic treatment, resulting in chronic non-healing wounds. In human wounds this has been attributed to the ability of bacteria to survive in a biofilm
S. J. Westgate; S. L. Percival; D. C. Knottenbelt; P. D. Clegg; C. A. Cochrane
\\u000a Being elderly is a risk factor for delayed wound healing. In aged skin, epidermal turnover is decreased by about 50%. This\\u000a is accompanied by reductions in vascularization, granulation tissue, collagen, elastin, mast cells and fibroblasts. Age-related\\u000a changes occur which impact all phases of healing. In general, the elderly have increased rates of infection and wound dehiscence,\\u000a decreases in wound strength,
The ability to heal wounds is an ancient and conserved function of epidermal epithelial layers. The importance of skin wound healing to human life and biology has long been evident, however many of the molecular mechanisms underlying wound repair remain little understood. In the past several years, analysis of the C. elegans innate immune response to fungal infection of the epidermis has led to investigations of the ability of the C. elegans skin to respond to damage. In a recent paper we used live imaging to investigate the cell biological basis of wound repair in the adult C. elegans epidermis. We found that needle or laser injury of the skin triggers a large and sustained increase in epidermal calcium. Epidermal calcium signals appear to specifically promote actin-dependent processes of wound closure. The innate immune and wound closure responses act in parallel to promote survival after injury. Our findings indicate that wounding triggers multiple signals in the C. elegans skin. C. elegans offers a tractable model to dissect how epidermal epithelia activate coordinated responses to repair damage.
Xu, Suhong; Hsiao, Tiffany I.; Chisholm, Andrew D.
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
Background Postoperative woundinfections are a widespread and costly problem, especially in colorectal surgery. Despite their prevalence,\\u000a there are few data regarding appropriate management and prevention strategies.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial to gather\\u000a evidence in order to support data-driven protocol development, an e-mail
Katharine W. Markell; Ben M. Hunt; Paul D. Charron; Rodney J. Kratz; Jeffrey Nelson; John T. Isler; Scott R. Steele; Richard P. Billingham
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
To identify chemical resistant markers induced by fungal or mechanical injury, young trees of Scots pine (Pinus sylvestris) were subjected to inoculations of blue stain fungi associated with the pine shoot beetles Tomicus piniperda and T. minor. Among the 20 trees selected for chemical analyses, 16 were divided into four groups: one as control and three were pretreated by wounding
Jenny Fäldt; Halvor Solheim; Bo Långström; Anna-Karin Borg-Karlson
Introduction Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. Methods This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). Results Multiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. Conclusion Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.
Etiological factors of postoperative wound complications were studied in experiment on the models of surgical wounds in 1185 white Wistar rats, 28 mongrel dogs, 48 corpses, as well as the role of sutures and suture materials in development of eventrations and postoperative hernias. Morphological and microbiological studies have shown that the key role in etiology of wound complication belongs to morphofunctional substratem of the wound comprises, besides the type of the wound, the degree of traumatization and ischemia of paravulnar tissues, presence of devitalized tissue in the wound, the features and quantity of suture material, pattern and intensity of microbial dissemination, characteristics of sutures, etc. Isolated presence of only one from the mentioned factors in majority of cases does not result in development of wound complication. Thus, woundinfection even by critical doses of monocultures and their associations would not in alle cases cause the development of would infection. Thus, critical dose of microbes in fresh wounds could not be considered as an obligatory factor which results in suppuration. PMID:9791994
Median sternotomy woundsinfected after coronary artery bypass grafting with bilateral internal mammary arteries are generally poor in condition, cannot be debrided adequately, and are limited in flap selection for reconstruction. The authors treated 2 patients with two-stage reconstruction using a modified superior-based rectus abdominis musculocutaneous flap. First, simple debridement was performed with the goal of preserving the internal mammary artery grafts. Then, delayed reconstruction with the oblique rectus abdominis musculocutaneous flap supplied by the superior epigastric and seventh intercostal vessels was performed. Despite ligature of the bilateral internal mammary arteries at their full length, the large oblique skin paddle designed along the angiosome as far as the midaxillary line survived almost completely in both patients, resulting in cessation of pus discharge. The circulation to the superior epigastric and intercostal vessels might be reinforced because of the delay phenomenon. Two-stage reconstruction with a superior pedicled oblique rectus abdominis musculocutaneous flap presents a successful resolution of infected median sternotomy wounds after coronary artery bypass grafting with sacrifice of bilateral internal mammary arteries. PMID:14520073
Objective: Prospective studies show a 10% incidence of sternal woundinfection (SWI) after 90 days of follow-up, compared with infection rates of 5% reported by the National Nosocomial Infections Surveillance System after only 30 days of follow-up. This incidence increases 2–3 times in high-risk patients. Design: Prospective randomised double-blind controlled clinical trial.Setting: Cardiothoracic centre, UK.Patients: Patients were eligible if they
Kay Dhadwal; Sharif Al-Ruzzeh; Thanos Athanasiou; Marina Choudhury; Pynee Vuddamalay; Haifa Lyster; Mohamed Amrani; Shane George
\\u000a Equine wounds have a high risk of becoming infected due to their environment. Infectedwounds encompass diverse populations\\u000a of microorganisms that fail to respond to antibiotic treatment, resulting in chronic non-healing wounds. In human wounds this\\u000a has been attributed to the ability of bacteria to survive in a biofilm phenotypic state. Biofilms are known to delay wound\\u000a healing, principally due
Samantha J. Westgate; Steven L. Percival; Peter D. Clegg; Derek C. Knottenbelt; Christine A. Cochrane
On May 9-10, 2011, the Walter Reed Army Institute of Research, as the Army Center of Excellence for Infectious Disease, assembled over a dozen leaders in areas related to research into the communities of microorganisms which colonize and infect traumatic wounds. The objectives of the workshop were to obtain guidance for government researchers, to spur research community involvement in the field of traumatic wound research informed by a microbiome perspective, and to spark collaborative efforts serving the Wounded Warriors and similarly wounded civilians. During the discussions, it was made clear that the complexity of these infections will only be met by developing a new art of clinical practice that engages the numerous microbes and their ecology. It requires the support of dedicated laboratories and technologists who advance research methods such as community sequencing, as well as the kinds of data analysis expertise and facilities. These strategies already appear to be bearing fruit in the clinical management of chronic wounds. There are now funding announcements and programs supporting this area of research open to extramural collaborators. PMID:22622764
Kirkup, B C; Craft, D W; Palys, T; Black, C; Heitkamp, R; Li, C; Lu, Y; Matlock, N; McQueary, C; Michels, A; Peck, G; Si, Y; Summers, A M; Thompson, M; Zurawski, D V
Wounds are a hallmark of various skin diseases. Most patients with wounds suffer from chronic venous insufficiency or other vascular diseases. Autoimmune, infective, metabolic, malignant, some psychiatric and diseases caused by environmental factors like radiation, present with skin and mucosal erosions and ulcerations. Lichen planus, lichen sclerosus, toxic epidermal necrolysis, Kaposi sarcoma, genodermatoses like Hailey-Hailey and Darier's disease belong to different dermatological entities, they have different etiology, pathogenesis and clinical presentation, but at some stage ulcerations and erosions dominate through the disease course as a result of complications of untreated disease or as part of a complex clinical presentation. Wounds demand a different multidisciplinary therapeutic approach, sometimes even in intensive care unit, where special care is available. Most patients are followed-up to avoid fatal complications like sepsis, as well as a potential malignant transformation of cells in the environment of chronic inflammation. Wounds are found in female genital lichen planus and lichen sclerosus. Oral lichen planus has a potential for malignant transformation and is considered a precancerous disease. Toxic epidermal necrolysis is a life threatening disease similar to burns. Wounds cover most of the body surface as well as mucosa. The high mortality rate is due to complications like sepsis, loss of thermoregulation, electrolyte and fluid disbalance and shock. Chronic wounds are also a hallmark of skin tumors and other skin malignancies like Kaposi sarcoma and lymphoma. The primary treatment goal in genodermatoses like epidermolysis bullosa is wound care, and to a less extent in other inherited skin diseases like Hailey-Hailey and Darier's disease wound healing is important for sustaining a good quality of life in affected individuals. PMID:23193818
Background: To measure rates of incisional surgical site infection (ISSI) after cesarean section (CS) and to assess risks for infection. Methods: Prospective surveillance for ISSI at a 540-bed hospital in Saudi Arabia by using Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance (NNIS) system risk index. Results: Seven hundred thirty-five CSs were studied
Manuel W. Mah; Alison M. Pyper; Gbolahan A. Oni; Ziad A. Memish
‘Wound man’ refers to a stylised diagram used in early medical textbooks to illustrate the various injuries that the human body can sustain in battle. We have adapted this concept to create ‘Wound cat’, as a way to emphasise the type and location of injuries cats may inflict on one another during combat. We have further extended this concept to
Richard Malik; Jacqueline Norris; Joanna White; Bozena Jantulik
The adherence of bacterial pathogens to wounded skin is probably the first step in woundinfection. This report describes the development of a bioassay to simulate the adherence of bacteria to wounds. The adherence of bacteria was examined by exposing wounds to known quantities of pathogens, washing the wounds with distilled water, and quantitating the number of adherent bacteria per cm2 of tissue. Our studies focused on the effects of naturally occurring mediators of bacterial adherence, such as wound fluid, serum, and fibronectin. Bacterial adherence was shown to be challenge dependent. Addition of wound fluid, serum, and heat-inactivated serum was shown to reduce the adherence of Pseudomonas aeruginosa to the wound surface compared with that of a saline control. Additional fibronectin treatment of the wound had no effect on the adherence of Staphylococcus aureus. The ability to identify what affects the binding of bacteria to wounded skin can lead to a better understanding of woundinfection. Images
Mertz, P M; Patti, J M; Marcin, J J; Marshall, D A
Factor associated with neutral sphingomyelinase activity (FAN) is an adaptor protein that specifically binds to the p55 receptor for TNF (TNF-RI). Our previous investigations demonstrated that FAN plays a role in TNF-induced actin reorganization by connecting the plasma membrane with actin cytoskeleton, suggesting that FAN may impact on cellular motility in response to TNF and in the context of immune inflammatory conditions. In this study, we used the translucent zebrafish larvae for in vivo analysis of leukocyte migration after morpholino knockdown of FAN. FAN-deficient zebrafish leukocytes were impaired in their migration toward tail fin wounds, leading to a reduced number of cells reaching the wound. Furthermore, FAN-deficient leukocytes show an impaired response to bacterial infections, suggesting that FAN is generally required for the directed chemotactic response of immune cells independent of the nature of the stimulus. Cell-tracking analysis up to 3 h after injury revealed that the reduced number of leukocytes is not due to a reduction in random motility or speed of movement. Leukocytes from FAN-deficient embryos protrude pseudopodia in all directions instead of having one clear leading edge. Our results suggest that FAN-deficient leukocytes exhibit an impaired navigational capacity, leading to a disrupted chemotactic response.
BACKGROUND: Full-thickness burn wounds require excision and skin grafting. Multiple surgical procedures are inevitable in managing moderate to severe full-thickness burns. Wound bed preparations prior to surgery are necessary in order to prevent woundinfection and promote wound healing. Honey can be used to treat burn wounds. However, not all the honey is the same. This study aims to evaluate
Yan-Teng Khoo; Ahmad Sukari Halim; Kirnpal-Kaur B Singh; Noor-Ayunie Mohamad
Objectives: The primary objective of this study is to determine whether daily exit-site application of standardized antibacterial honey (Medihoney Antibacterial Wound Gel; Comvita, Te Puke, New Zealand) results in a reduced risk of catheter-associated infections in peritoneal dialysis (PD) patients compared with standard topical mupirocin prophylaxis of nasal staphylococcal carriers. Design: Multicenter, prospective, open label, randomized controlled trial. Setting: PD
David W. Johnson; Carolyn Clark; Nicole M. Isbel; Carmel M. Hawley; Elaine Beller; Alan Cass; Janak de Zoysa; Steven McTaggart; Geoffrey Playford; Brenda Rosser; Charles Thompson; Paul Snelling
We present a case of herpes simplex virus causing a superficial woundinfection. The patient suffered a recurrent prodromal burning sensation followed by small grouped vesicles on a erythematous base. We suggest that viral cultures be done in these cases to aid in this unusual diagnosis.
The S-adenosyl-l-methionine:pinosylvin-O-methyltransferase (PMT)2 gene was sequenced from Scots pine (Pinus sylvestris). The open reading frame is arranged in two exons spaced by one 102-bp intron. Promoter regulatory elements such as two “CAAT” boxes and one “TATA” box were identified. Several cis-regulatory elements were recognized: stress-responsive elements (Myb-responsive elements) as well as G, H, and GC boxes. Moreover, elicitor-responsive elements (W boxes) and a sequence resembling the simian virus 40 enhancer core were found. In phloem and needles of control trees, the transcripts of stilbene synthase (STS) and PMT were hardly detectable. Increased ozone fumigation up to 0.3 ?L L?1 enhanced the transcript level of STS and PMT in needles but not in healthy phloem. Wounding, e.g. mock inoculation, of stem-phloem was characterized by a transient increase in STS and PMT transcripts, which was more pronounced in the case of fungal inoculation. Combination of fungal-challenge or mock treatment with ozone resulted in a positive interaction at 0.3 ?L L?1. Scots pine stilbene formation appeared to be induced via STS and PMT gene expression upon ozone and fungal stress as well as wounding. The broad stress-responsiveness is in agreement with the range of various cis-acting elements detected in the STS and PMT promoters.
A receptor-like kinase, SRK, has been implicated in the autoincompatible response that leads to the rejection of self-pollen in Brassica plants. SRK is encoded by one member of a multigene family, which includes several receptor-like kinase genes with patterns of expression very different from that of SRK but of unknown function. Here, we report the characterization of a novel member of the Brassica S gene family, SFR2. RNA gel blot analysis demonstrated that SFR2 mRNA accumulated rapidly in response both to wounding and to infiltration with either of two bacteria: Xanthomonas campestris, a pathogen, and Escherichia coli, a saprophyte. SFR2 mRNA also accumulated rapidly after treatment with salicylic acid, a molecule that has been implicated in plant defense response signaling pathways. A SFR2 promoter and reporter gene fusion was introduced into tobacco and was shown to be induced by bacteria of another genus, Ralstonia (Pseudomonas) solanacearum. The accumulation of SFR2 mRNA in response to wounding and pathogen invasion is typical of a gene involved in the defense responses of the plant. The rapidity of SFR2 mRNA accumulation is consistent with SFR2 playing a role in the signal transduction pathway that leads to induction of plant defense proteins, such as pathogenesis-related proteins or enzymes of phenylpropanoid metabolism.
Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons, particularly in patients with compromised immune system or in case where the wound is heavy contaminated or poorly perfused. Molndal technique of wound dressing has proven to be effective in prevention of infection. In our study we wanted to describe the benefits of the application of Molndal technique wound dressing compared to traditional wound dressing technique at potentially contaminated and clean postoperative wounds. We examined postoperative wound after radical excision of pilonidal sinus and after implantation of partial endoprosthesis in hip fracture. Molndal technique consisted of wound dressing with Aquacel Ag - Hydrofiber. Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 50 patients after radical excision of pilonidal sinus. 25 patients were treated by Molndal technique and 25 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (4%) patient has revealed a woundinfection, proven by positive microbiological examination and suppuration. In the traditional technique group 4 (16%) patients developed woundinfection as inflammation and secretion as a sign of superficial infection. In the other group we analyzed the results of 50 patients after implantation of partial endoprosthesis after hip fracture. 20 patients were treated by Molndal technique and 30 patients by the traditional technique of wound dressing. In the group treated by Molndal technique no patient has revealed a woundinfection (0%). In the traditional technique group 4 (13%) patients developed woundinfection. All complication in both group were superficial incisional surgical infection (according to HPSC). There was no deep incisional surgical site infection or organ/space surgical site infection. Our results are clearly showing that Molndal technique is effective in preventing the postoperative woundinfection. PMID:22220414
Marinovi?, Marin; Cicvari?, Tedi; Grzalja, Nikola; Baci?, Giordano; Radovi?, Endi
Poly(vinyl alcohol)-borate complexes were evaluated as a potentially novel drug delivery platform suitable for in vivo use in photodynamic antimicrobial chemotherapy (PACT) of woundinfections. An optimised formulation (8.0%w/w PVA, 2.0%w/w borax) was loaded with 1.0 mg ml(-1) of the photosensitisers Methylene Blue (MB) and meso-tetra (N-methyl-4-pyridyl) porphine tetra tosylate (TMP). Both drugs were released to yield receiver compartment concentrations (>5.0 microg ml(-1)) found to be phototoxic to both planktonic and biofilm-grown methicillin-resistant Staphylococcus aureus (MRSA), a common cause of woundinfections in hospitals. Newborn calf serum, used to simulate the conditions prevalent in an exuding wound, did not adversely affect the properties of the hydrogels and had no significant effect on the rate of TMP-mediated photodynamic kill of MRSA, despite appreciably reducing the fluence rate of incident light. However, MB-mediated photodynamic kill of MRSA was significantly reduced in the presence of calf serum and when the clinical isolate was grown in a biofilm. Results support the contention that delivery of MB or TMP using gel-type vehicles as part of PACT could make a contribution to the photodynamic eradication of MRSA from infectedwounds. PMID:19651522
Donnelly, Ryan F; Cassidy, Corona M; Loughlin, Ryan G; Brown, Anthony; Tunney, Michael M; Jenkins, Mark G; McCarron, Paul A
BACKGROUND Laser therapy is a low cost, non-invasive procedure with good healing results. Doubts exist as to whether laser therapy action on microorganisms can justify research aimed at investigating its possible effects on bacteria-infectedwounds. OBJECTIVE To assess the effect of low intensity laser on the rate of bacterial contamination in infectedwounds in the skin of rats. METHODS An experimental study using 56 male Wistar rats. The animals were randomly divided into eight groups of seven each. Those in the "infected" groups were infected by Staphylococcus aureus MRSA in the dorsal region. Red laser diode (AlGaInP) 658nm, 5J/cm2 was used to treat the animals in the "treated" groups in scan for 3 consecutive days. Samples were drawn before inoculating bacteria and following laser treatment. For statistical analysis we used the nonparametric Wilcoxon (paired data) method with a significance level of p <0.05. RESULTS The statistical analysis of median values showed that the groups submitted to laser treatment had low bacterial proliferation. CONCLUSION The laser (AlGaInP), with a dose of 5J/cm2 in both intact skin and in wounds of rats infected with Staphylococcus aureus MRSA, is shown to reduce bacterial proliferation.
Silva, Daniela Conceicao Gomes Goncalves e; Plapler, Helio; da Costa, Mateus Matiuzzi; Silva, Silvio Romero Goncalves e; de Sa, Maria da Conceicao Aquino; Silva, Benedito Savio Lima e
Emergency physicians are often confronted with situations in which a patient with an acute injury is at high risk for an infection. Although most traumatic wounds have a low risk for developing infection, certain types of high-risk trauma justify antimicrobial prophylaxis. This article reviews antimicrobial woundinfection prophylaxis for high-risk traumatic wounds, including the prevention of rabies and tetanus. Prophylaxis to prevent infections related to invasive procedures in the emergency department is also addressed. PMID:18295686
Moran, Gregory J; Talan, David A; Abrahamian, Fredrick M
The state of wound oxygenation is a key determinant of healing outcomes. From a diagnostic standpoint, measurements of wound oxygenation are commonly used to guide treatment planning such as amputation decision. In preventive applications, optimizing wound perfusion and providing supplemental O2 in the peri-operative period reduces the incidence of post-operative infections. Correction of wound pO2 may, by itself, trigger some healing responses. Importantly, approaches to correct wound pO2 favorably influence outcomes of other therapies such as responsiveness to growth factors and acceptance of grafts. Chronic ischemic wounds are essentially hypoxic. Primarily based on the tumor literature, hypoxia is generally viewed as being angiogenic. This is true with the condition that hypoxia be acute and mild to modest in magnitude. Extreme near-anoxic hypoxia, as commonly noted in problem wounds, is not compatible with tissue repair. Adequate wound tissue oxygenation is required but may not be sufficient to favorably influence healing outcomes. Success in wound care may be improved by a personalized health care approach. The key lies in our ability to specifically identify the key limitations of a given wound and in developing a multifaceted strategy to specifically address those limitations. In considering approaches to oxygenate the wound tissue it is important to recognize that both too little as well as too much may impede the healing process. Oxygen dosing based on the specific need of a wound therefore seems prudent. Therapeutic approaches targeting the oxygen sensing and redox signaling pathways are promising.
Soldiers have been killed and wounded in wars throughout history. With new medical technologies, more soldiers survive their injuries and return home. Unfortunately, those injuries often include permanent disabilities either through loss of limb(s) or brain injury or post-traumatic stress disorder, among other possibilities. Perhaps equally unfortunate is the way that soldiers with disabilities and persons with disabilities generally are
OBJECTIVE To compare the effects of different skin preparation solutions on surgical-site infection rates. DESIGN Three skin preparations were compared by means of a sequential implementation design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner. SETTING Single large academic medical center. PATIENTS All adult general surgery patients. RESULTS The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001). CONCLUSIONS Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to chlorhexidine for this purpose in general surgery patients.
Swenson, Brian R.; Hedrick, Traci L.; Metzger, Rosemarie; Bonatti, Hugo; Pruett, Timothy L.; Sawyer, Robert G.
Optimal wound healing requires adequate nutrition. Nutrition deficiencies impede the normal processes that allow progression through stages of wound healing. Malnutrition has also been related to decreased wound tensile strength and increased infection rates. Malnourished patients can develop pressure ulcers, infections, and delayed wound healing that result in chronic nonhealing wounds. Chronic wounds are a significant cause of morbidity and mortality for many patients and therefore constitute a serious clinical concern. Because most patients with chronic skin ulcers suffer micronutrient status alterations and malnutrition to some degree, current nutrition therapies are aimed at correcting nutrition deficiencies responsible for delayed wound healing. This review provides current information on nutrition management for simple acute wounds and complex nonhealing wounds and offers some insights into innovative future treatments. PMID:20130158
. Severe injury or infection is associated with a hypermetabolic response that, when excessive, results in impaired wound healing\\u000a and as a consequence increased morbidity and mortality. The objective examination of wound healing in humans is difficult\\u000a and generally requires the use of models. Evidence is accumulating that nutritional and growth factors play important roles\\u000a in improving the wound healing
Matthew A. Clark; Lindsay D. Plank; Graham L. Hill
Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infectedwounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier's gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis. With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon.
Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infectedwounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier's gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis. With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon. PMID:23162231
Negative pressure wound therapy (NPWT) is in widespread use and its role in wound care is expanding worldwide. It is estimated that 300 million acute wounds are treated globally each year. Currently, sporadic data exist to support NPWT in acutely contaminated wounds. Despite lack of data, use of negative pressure wound therapy in such cases is increasing across the globe. We retrospectively reviewed 86 consecutive patients, totalling 97 contaminated wounds. All wounds were Class IV based on US Center for Disease Control criteria. Sepsis criteria were present in 78/86 (91%) of patients. All patients were managed with NPWT. Wound type, degree of tissue destruction, presence of infection, wound dimension, timing of initial NPWT, type and timing of wound closure and patient comorbidities were recorded. Outcome endpoints included durability of wound closure and death. Wound location was 41/97 (42%) in the torso; 56/97 (58%) at the extremities. Tissue necrosis was present in 84/97 (87%) of wounds. Infection was present in 86/97 (89%) of wounds. Average wound size was 619 cm(2) when square surface area measured; 786 cm(3) when volume measurements taken. Mean time to wound closure was 17 days, median 10 days and mode 6 days. Durability of wound closure 73/79 (92%). Deaths were noted in 6/86 (7%) of patients. No deaths appeared related to NPWT. Contemporary NPWT related acute wound care is expanding empirically, in quantity and scope across the globe. However, several areas of concern are known regarding this contemporary use of NPWT in acute wounds. Thus, it is important to assess the safety and efficacy of such expanded empiric NPWT practice. Based on our findings with NPWT in the largest known patient cohort of this type, NPWT appears safe and effective in managing acute, contaminated wounds including patients meeting sepsis criteria. These findings provide evidence-based support for current worldwide empiric NPWT-related acute wound care. PMID:22420782
Wound repair on the cellular and multicellular levels is essential to the survival of complex organisms. In order to avoid further damage, prevent infection, and restore normal function, cells and tissues must rapidly seal and remodel the wounded area. The cytoskeleton is an important component of wound repair, needed for actomyosin contraction, recruitment of repair machineries, and cell migration. Recent use of model systems and high-resolution microscopy has provided new insight into molecular aspects of the cytoskeletal response during wound repair. Here we discuss the role of the cytoskeleton in single cell, embryonic, and adult repair, as well as the striking resemblance of these processes to normal developmental events and many diseases.
Abreu-Blanco, Maria Teresa; Watts, James J.; Verboon, Jeffrey M.; Parkhurst, Susan M.
Wound bed preparation has been performed for over two decades, and the concept is well accepted. The ‘TIME’ acronym, consisting of tissue debridement, infection or inflammation, moisture balance and edge effect, has assisted clinicians systematically in wound assessment and management. While the focus has usually been concentrated around the wound, the evolving concept of wound bed preparation promotes the treatment of the patient as a whole. This article discusses wound bed preparation and its clinical management components along with the principles of advanced wound care management at the present time. Management of tissue necrosis can be tailored according to the wound and local expertise. It ranges from simple to modern techniques like wet to dry dressing, enzymatic, biological and surgical debridement. Restoration of the bacterial balance is also an important element in managing chronic wounds that are critically colonized. Achieving a balance moist wound will hasten healing and correct biochemical imbalance by removing the excessive enzymes and growth factors. This can be achieved will multitude of dressing materials. The negative pressure wound therapy being one of the great breakthroughs. The progress and understanding on scientific basis of the wound bed preparation over the last two decades are discussed further in this article in the clinical perspectives.
Cleansing is a vital component of wound management. However, there is limited research to inform protocols. Although research has focussed on types of dressings, little attention has been given to the solutions and techniques to be used for cleansing purposes. The available evidence about the effectiveness of solutions and techniques in the prevention of woundinfection and the promotion of
Trauma to the genital region and perineum can leave behind lifelong sequelae and pose significant challenges to surgeons in the restoration of functional ability and aesthetic status. Effective methods and techniques are indispensable during the treatment period. Negative pressure wound therapy (NPWT) is a widely accepted technique that is becoming a commonplace treatment in many clinical settings. The purpose of this case report was to introduce the efficacy of the concurrent usage of NPWT and split-thickness skin grafting (STSG) in the reconstruction of genital injuries. A man suffered a traffic accident that caused necrosis of the scrotum and penis associated with a severe infection caused by Pseudomonas aeruginosa and Enterobacter cloacea. After debridement, we adopted NPWT during the postoperative dressing changes and the application of meshed STSG. The outcomes showed that combination of NPWT and split-thickness skin grafts is safe, well-tolerated and efficient in the reconstruction of penoscrotal defects. This could be a versatile tool for reconstruction after perineal and penoscrotal trauma. PMID:22672131
Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai
Foot infections are the most common infectious complication of diabetes. Moderate to severe diabetic foot infections (DFI) are typically polymicrobial with both aerobic and anaerobic organisms. The role of MRSA in these wounds has become an increasing concern. To determine if the addition of avibactam, a novel non-beta-lactam beta-lactamase inhibitor, to ceftaroline would be more active than ceftaroline alone, we tested 316 aerobic pathogens and 154 anaerobic recovered from patients with moderate to severe DFI, and compared ceftaroline with and without avibactam to other agents. Testing on aerobes was done by broth microdilution and by agar dilution for anaerobes, according to CLSI M11-A8, and M7-A8 standards. Ceftaroline-avibactam MIC90 for all Staphylococcus spp. including MRSA was 0.5 ?g/mL, and for enterococci was 1 ?g/mL. The MIC90s for enteric Gram-negative rods was 0.125 ?g/mL. The addition of avibactam to ceftaroline reduced the ceftaroline MICs for 2 strains of resistant Enterobacter spp. and for 1 strain of Morganella. Against anaerobic Gram-positive cocci ceftaroline-avibactam had an MIC90 0.125 ?g/mL and for clostridia 1 ?g/mL. Avibactam improved ceftaroline's MIC90s for Bacteroides fragilis from >32 to 2 ?g/mL and for Prevotella spp. from >32 to 1 ?g/mL. Ceftaroline alone demonstrates excellent in vitro activity against most of the aerobes found in moderate to severe DFI. The addition of avibactam provides an increased spectrum of activity including the beta-lactamase producing Prevotella, Bacteroides fragilis and ceftaroline resistant gram-negative enteric organisms. PMID:23623385
Goldstein, Ellie J C; Citron, Diane M; Merriam, C Vreni; Tyrrell, Kerin L
Phytophthora parasitica have caused severe damage in Citrus nurseries and orchards worldwide. The purpose of these experiments was to determine how plant defense pathways are induced by P. parasitica and if induction differs in susceptible (Citrus sunki) and resistant (Poncirus trifoliata) interactions. Furthermore, to test the effect of simple wounding on the induction of defense-related genes, plants were mechanically wounded and
Leonardo P. Boava; Mariângela Cristofani-Yaly; Rodrigo M. Stuart; Marcos A. Machado
BackgroundThe dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured
Mark T M van den Baar; Job van der Palen; Marianne I Vroon; Paul Bertelink; Ron Hendrix
Study objective: Irrigation, a critical component of wound management, is commonly performed with sterile normal saline solution. The purpose of this study was to compare the infection rates of wounds irrigated with normal saline solution versus those of wounds irrigated with running tap water. Methods: A prospective trial was conducted in an urban pediatric emergency department. Tap water pressure and
Jonathan H. Valente; Rene J. Forti; Lawrence F. Freundlich; Stephanie O. Zandieh; Ellen F. Crain
Delivery of therapeutic genes represents an appealing possibility to accelerate healing of wounds that are otherwise difficult to treat, such as those in patients with metabolic disorders or infections. Experimental evidence indicates that in such conditions potentiation of neo-angiogenesis at the wound site might represent an important therapeutic target. Here we explore the efficacy of gene therapy of wound healing
B Deodato; N Arsic; L Zentilin; M Galeano; D Santoro; V Torre; D Altavilla; D Valdembri; F Bussolino; F Squadrito; M Giacca
Host defense peptides are effector molecules of the innate immune system. They show broad antimicrobial action against gram-positive and -negative bacteria, and they likely play a key role in activating and mediating the innate as well as adaptive immune response in infection and inflammation. These features make them of high interest for wound healing research. Non-healing and infectedwounds are a major problem in patient care and health care spending. Increasing infection rates, growing bacterial resistance to common antibiotics, and the lack of effective therapeutic options for the treatment of problematic wounds emphasize the need for new approaches in therapy and pathophysiologic understanding. This review focuses on the current knowledge of host defense peptides affecting wound healing and infection. We discuss the current data and highlight the potential future developments in this field of research.
Hand wounds represent a major problem in regard of the number of patients as well as the economic burden associated with it. The close relationship of the different anatomical structures increase the probability of involvement of multiple structures, which require a multidisciplinary approach. Paucity of clinical signs of certain lesions render surgical exploration necessary. Regarding replantation, multiple factors need to be taken into consideration, principally the condition of the amputated part, which is influenced by the trauma but also by the initial care applied to the severed part. Transfer delay to a specialized center should be minimize. PMID:20085204
Wound bed assessment and optimum local wound care are essential to facilitate the wound healing process. The presence of devitalized tissue, for instance necrotic tissue or slough, is common in hard-to-heal wounds and acts as a barrier to healing. There are several debridement options available to the practitioner with the choice of wound debridement technique being made following a holistic assessment of the patient and the wound. The method of debridement should be discussed with the patient and family where appropriate and consent to treatment obtained prior to the procedure being undertaken. PMID:20220634
This article builds and expands upon the concept of wound bed preparation introduced by Sibbald et al in 2000 as a holistic approach to wound diagnosis and treatment of the cause and patient-centered concerns such as pain management, optimizing the components of local wound care: Debridement, Infection and persistent Inflammation, along with Moisture balance before Edge effect for healable but stalled chronic wounds. PMID:21860264
Sibbald, R Gary; Goodman, Laurie; Woo, Kevin Y; Krasner, Diane L; Smart, Hiske; Tariq, Gulnaz; Ayello, Elizabeth A; Burrell, Robert E; Keast, David H; Mayer, Dieter; Norton, Linda; Salcido, Richard Sal
Nearly all wounds are at risk for compromised healing due to excessive exudation, oedema, contaminants and presence of inflammatory mediators. Compromised wounds have the potential to develop complications, such as infection, which may lead to delayed wound healing, prolonged hospitalisation and more frequent readmissions. It is generally believed that the wound advances from contamination to colonisation when the bacteria on the wound's surface begin to replicate and increase their metabolic activity. Heavy bacterial bioburden increases the metabolic requirements, stimulates a proinflammatory environment and encourages the in-migration of monocytes, macrophages and leukocytes - all of which can negatively impact wound healing. Bacteria also secrete harmful cytokines which can lead to vasoconstriction and decreased blood flow. Thus, controlling or preventing infections is essential for normal wound healing process to occur. While the mainstay of treating woundinfection has historically included intravenous, oral and/or topical antimicrobials in addition to frequent gauze dressing changes, a shift towards wound management with advanced modalities, such as negative pressure wound therapy (NPWT), has occurred during the past decade. This review will provide expert opinion and scientific support for the use of NPWT with instillation (NPWTi; V.A.C. Instill® Wound Therapy and V.A.C. VeraFlo™ Therapy, KCI USA, Inc., San Antonio, TX) for the treatment of at-risk and complicated wounds. PMID:22727137
Wound care skills are essential for patients in stable condition after surgery. A nurse must teach wound care skills and explain infection symptoms and signs to patients or their families before discharge to help wound healing. The purpose of this study is to investigate the influence of group teaching with multimedia materials on wound care skills of surgical patients. This
Shu-Ling Tu; Yue-Der Lin; I-Chen Chiu; Yaw-Jen Lin
Wounds are the result of injuries to the skin that disrupt the other soft tissue. Healing of a wound is a complex and protracted process of tissue repair and remodeling in response to injury. Various plant products have been used in treatment of wounds over the years. Wound healing herbal extracts promote blood clotting, fight infection, and accelerate the healing of wounds. Phytoconstituents derived from plants need to be identified and screened for antimicrobial activity for management of wounds. The in vitro assays are useful, quick, and relatively inexpensive. Small animals provide a multitude of model choices for various human wound conditions. The study must be conducted after obtaining approval of the Ethics Committee and according to the guidelines for care and use of animals. The prepared formulations of herbal extract can be evaluated by various physicopharmaceutical parameters. The wound healing efficacies of various herbal extracts have been evaluated in excision, incision, dead space, and burn wound models. In vitro and in vivo assays are stepping stones to well-controlled clinical trials of herbal extracts.
Surgeons often care for patients with conditions of abnormal wound healing, which include conditions of excessive wound healing, such as fibrosis, adhesions, and contractures, as well as conditions of inadequate wound healing, such as chronic nonhealing ulcers, recurrent hernias, and wound dehiscences. Despite many recent advances in the field, which have highlighted the importance of adjunct therapies in maximizing the healing potential, conditions of abnormal wound healing continue to cause significant cost, morbidity, and mortality. To understand how conditions of abnormal wound healing can be corrected, it is important to first understand the basic principles of wound healing. PMID:21074032
Both chronic and acute dermal wounds are susceptible to infection due to sterile loss of the innate barrier function of the skin and dermal appendages, facilitating the development of microbial communities, referred to as biofilms, within the wound environment. Microbial biofilms are implicated in both the infection of wounds and failure of those wounds to heal. The aim of this review is to provide a summary of published papers detailing biofilms in wounds, the effect they have on infection and wound healing, and detailing methods employed for their detection. The studies highlighted within this paper provide evidence that biofilms reside within the chronic wound and represent an important mechanism underlying the observed, delayed healing and infection. The reasons for this include both protease activity and immunological suppression. Furthermore, a lack of responsiveness to an array of antimicrobial agents has been due to the biofilms' ability to inherently resist antimicrobial agents. It is imperative that effective strategies are developed, tested prospectively, and employed in chronic wounds to support the healing process and to reduce infection rates. It is increasingly apparent that adoption of a biofilm-based management approach to wound care, utilizing the "antibiofilm tool box" of therapies, to kill and prevent reattachment of microorganisms in the biofilm is producing the most positive clinical outcomes and prevention of infection. PMID:22985037
Percival, Steven L; Hill, Katja E; Williams, David W; Hooper, Samuel J; Thomas, Dave W; Costerton, John W
Penetrating chest trauma can cause a wide variety of cardiac injuries, including myocardial contusion, damage to the interventricular septum, laceration of the coronary arteries, and free-wall rupture. Herein, we describe the case of a 21-year-old man who presented with congestive heart failure, which was secondary to an old myocardial infarction and complicated by the delayed formation of a ventricular septal defect. All of these conditions were attributable to multiple gunshot wounds that the patient had sustained 6 months earlier. Left ventricular angiography showed an apical aneurysm; a large, muscular, ventricular septal defect; and 19 gunshot pellets in the chest wall. Three months after aneurysmectomy and surgical closure of the septal defect, the patient had recovered fully and was asymptomatic. This case reaffirms the fact that substantial cardiac injuries can appear months after chest trauma. The possibility of traumatic ventricular septal defect should be considered in all multiple-trauma patients who develop a new heart murmur, even when overt chest-wall injury is absent.
Background:Chronic wounds cause significant morbidity and mortality and cost our health care system millions of dollars each year. A major impediment to wound healing is the formation of bacterial biofilms. Biofilms are communities of bacteria associated with chronic infections.Objective:This article reviews the literature on chronic wounds and biofilms. The role of biofilms in chronic wounds is not widely known. The purpose is to increase awareness of their role and to discuss research into novel therapeutic options.Methods:PubMed searches were performed to identify publications on chronic wounds and biofilms.Results:Biofilms contribute to chronic wound nonhealing. There is an abundance of research into novel antibiofilm strategies for chronic wounds.Conclusion:Current research is being targeted at antibiofilm strategies needed to restore an optimal wound-healing environment. A combined treatment approach involving aggressive débridement and the addition of antibiofilm agents is needed. PMID:24138971
It is suggested that the internal thoracic artery (ITA) harvesting technique influences the incidence of sternal woundinfection (SWI) after coronary artery bypass graft (CABG). To determine if there is any real difference between skeletonized vs pedicled ITA, we performed a meta-analysis to determine if there is any real difference between these two established techniques in terms of SWI. We performed a systematic review using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for studies that compared the incidence of SWI after CABG between skeletonized vs pedicled ITA until June 2012. The principal summary measures were odds ratio (OR) with 95% confidence interval (CI) and P values (statistically significant when <0.05). The ORs were combined across studies using the weighted DerSimonian-Laird random effects model and weighted Mantel-Haenszel fixed effects. Meta-analysis, sensitivity analysis and meta-regression were completed using the software Comprehensive Meta-Analysis version 2 (Biostat, Inc., Englewood, NJ, USA). Twenty-two studies involving 4817 patients (2424 skeletonized; 2393 pedicled) met the eligibility criteria. There was no evidence for important heterogeneity of effects among the studies. The overall OR (95% CI) of SWI showed a statistically significant difference in favour of skeletonized ITA (fixed effect model: OR 0.443, 95% CI 0.323-0.608, P < 0.001; random effect model: OR 0.443, 95% CI 0.323-0.608, P < 0.001). In the sensitivity analysis, the difference in favour of skeletonized ITA was also observed in subgroups such as diabetic, bilateral ITA and diabetic with bilateral ITA; we also observed that there was a difference in the type of study, since non-randomized studies together demonstrated the benefit of skeletonized ITA in comparison with pedicled ITA, but the randomized studies together did not show this difference (although close to statistical significance and with the tendency to favour the skeletonized group). In meta-regression, we observed a statistically significant coefficient for SWI and proportion of diabetic patients (coefficient -0.02, 95% CI -0.03 to -0.01, P = 0.016). In conclusion, skeletonized ITA appears to reduce the incidence of postoperative SWI in comparison with pedicled ITA after CABG, with this effect being modulated by the presence of diabetes. PMID:23446674
Sá, Michel Pompeu Barros de Oliveira; Ferraz, Paulo Ernando; Escobar, Rodrigo Renda; Vasconcelos, Frederico Pires; Ferraz, Alvaro Antonio Bandeira; Braile, Domingo Marcolino; Lima, Ricardo Carvalho
Background: Fungal infections of burn wounds have become an important cause of burn-associated morbidity and mortality. The nature of fungal infections dictates aggressive treatment to minimize the morbidity associated with these infections. Persons with large total body surface area burns are particularly susceptible to fungal infections and are treated in such a manner as to minimize their risk of infection.
Intentional penetrating wounds, self inflicted or inflicted by others, are increasingly common. As a result, it can be difficult for the forensic examiner to determine whether the cause is self-inflicted or not. This type of trauma has been studied from a psychological perspective and from a surgical perspective but the literature concerning the forensic perspective is poorer. The objective of this study was to compare the epidemiology of abdominal stab wounds so as to distinguish specific features of each type. This could help the forensic scientist to determine the manner of infliction of the wound. We proposed a retrospective monocentric study that included all patients with an abdominal wound who were managed by the visceral surgery department at Angers University Hospital. Demographic criteria, patient history, circumstances and location of the wound were noted and compared. A comparison was drawn between group 1 (self inflicted wound) and group 2 (assault). This study showed that the only significant differences are represented by the patient's prior history and the circumstances surrounding the wound, i.e. the scene and time of day. In our study, neither the site, nor the injuries sustained reveal significant clues as to the origin of the wound. According to our findings, in order to determine the cause, the forensic examiner should thus carefully study the circumstances and any associated injuries. PMID:23622473
Over the past two decades a body of evidence has been generated to support the traditional use of water in cleansing wounds, with studies showing that the use of clean water does not increase the risk of infection or delay healing. However, recent advances in the understanding of wound management have encouraged reforms and led to the development of wound cleansing agents that have the potential to improve clinical outcomes. This article draws on in vitro and in vivo evidence including comparative studies of patients with acute and chronic wounds to consider the evidence supporting alternatives to water in wound cleansing. PMID:20622786
Clinical data of a single case of functional recovery and regeneration in pathologically altered foot tissue with extensive necrosis in during the course of therapy with the use of dietary supplement "Leiurus Arctica +" Clinical data indicates that the dietary supplement "Leiurus Arctica +" can be used as a wound healing agent. PMID:23786021
Gunshot wounds are among the most complex traumatic lesions encountered in forensic pathology. At the time of autopsy, careful scrutiny of the wounds is essential for correct interpretation of the lesions. Complementary pathological analysis has many interests: differentiation between entrance and exit wounds, estimation of firing distance, differentiation between vital and post mortem wounds and wounds dating. In case of multiple headshots, neuropathological examination can provide arguments for or against suicide. Sampling of gunshot wounds at autopsy must be systematic. Pathological data should be confronted respectively to autopsy and death scene investigation data and also ballistic studies. Forensic pathologist must be aware of the limits of optic microscopy. PMID:22325312
Wound examination is indispensable in forensic practice. It is always necessary to determine wound vitality or wound age to correctly evaluate the relationship between death and any wounds. Thus, the determination of wound vitality or wound age is a classic but still modern theme in forensic pathology. Skin wound healing is a primitive but well orchestrated biological phenomena consisting of three sequential phases, inflammation, proliferation, and maturation. Many biological substances are involved in the process of wound repair, and this short and simplified overview of wound healing can be adopted to determine wound vitality or wound age in forensic medicine. With the development of immunohistochemistry and chemical analyses, the scientific field of wound age determination has advanced progressively during recent years. In particular, it has been demonstrated that collagens, cytokines, and growth factors are useful candidates and markers for the determination of wound vitality or age. In this review article, some interesting and instructive results are presented, contributing to the future practice of every forensic pathologist. PMID:17275383
Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons. Colonized and infectedwounds are a potential source for cross-infection. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag--Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (2%) patient has revealed a woundinfection, proven by positive microbiological examination and suppuration, mostly in the subumbilical incision. In the traditional technique group 7 (14%) patients developed woundinfection also predominantly in the subumbilical incision. The difference was statistically significant (p < 0.01). Our results are clearly showing that Molndal technique is effective in preventing the infection of subumbilical incision wound and is to by recommend for regular use at designated site after laparoscopic cholecistectomy. PMID:21305739
Patients prescribed morphine for the management of chronic pain, and chronic heroin abusers, often present with complications such as increased susceptibility to opportunistic infections and inadequate healing of wounds. We investigated the effect of morphine on wound-healing events in the presence of an infection in an in vivo murine model that mimics the clinical manifestations seen in opioid user and abuser populations. We show for the first time that in the presence of an inflammatory inducer, lipopolysaccharide, chronic morphine treatment results in a marked decrease in wound closure, compromised wound integrity, and increased bacterial sepsis. Morphine treatment resulted in a significant delay and reduction in both neutrophil and macrophage recruitment to the wound site. The delay and reduction in neutrophil reduction was attributed to altered early expression of keratinocyte derived cytokine and was independent of macrophage inflammatory protein 2 expression, whereas suppression of macrophage infiltration was attributed to suppressed levels of the potent macrophage chemoattractant monocyte chemotactic protein-1. When the effects of chronic morphine on later wound healing events were investigated, a significant suppression in angiogenesis and myofibroblast recruitment were observed in animals that received chronic morphine administration. Taken together, our findings indicate that morphine treatment results in a delay in the recruitment of cellular events following wounding, resulting in a lack of bacterial clearance and delayed wound closure.
Wound profiles made under controlled conditions in the wound ballistics laboratory using gelatin tissue simulant that has been calibrated against living animal soft tissue show the location along the tissue path and amount of both crush (permanent cavity)...
... frustrating having to hold back on activities like sports while a wound heals. But if you take ... Dealing With Cuts and Wounds Dealing With Falls Sports and Exercise Safety Contact Us Print Additional resources ...
Impaired wound healing in the elderly presents a major clinical and economic problem. With the aging population growing in both number and percentage, the importance of understanding the mechanisms underlying age-related impairments in healing is increased. Normal skin exhibits characteristic changes with age that have implications for wound healing. Additionally, the process of wound healing is altered in aged individuals.
Burst abdomen, incisional herniation, sinus formation and post-operative woundinfection continue to bedevil the surgeon. A prospective study of 1129 laparotomy wounds defined the extent of the problem; 1.7% incidence of dehiscence, 7.4% herniation and 6.7% sinus formation, all significantly associated with woundinfection. Mass closure reduced the dehiscence rate from 3.8% to 0.76%. Infection reduced wound strength in a rat laparotomy model due to a decrease in fibroblast concentration and activity. A monofilament non-absorbable suture was shown experimentally to be the most suitable suture for closing infected abdominal wounds. Electron microscopy demonstrated bacteria in the interstices of infected multifilament sutures. A randomised clinical trial comparing polyglycolic acid and monofilament nylon in the closure of abdominal wounds confirmed the experimental findings; polyglycolic acid resulted in a significantly higher wound failure rate with no decrease in sinus formation. A mass closure technique using monofilament nylon is recommended for laparatomy closure and efforts should continue to reduce wound sepsis. Images Fig. 1 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 10 Fig. 11 Fig. 12
This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate. PMID:18578357
Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely\\u000a used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This\\u000a case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started\\u000a from
\\u000a There are various wounds with tissue loss. These include burn wounds, wounds caused as a result of trauma, diabetic ulcers\\u000a and pressure sores. Every year in the United States more than 1.25 million people experience burns and 6.5 million experience\\u000a various chronic skin ulcers. In burns, infection is the major complication after the initial period of shock and it is
Jonathan J. Elsner; Israela Berdicevsky; Adaya Shefy-Peleg; Meital Zilberman
Wound examination is of prime importance in forensic pathology, and it is desirable to establish a wound examination system in order to evaluate and record the nature of wound more accurately and objectively. Modern diagnostic techniques and devices as well as advanced cell-biological methods should be introduced as the means for this aim. For example, radiological, endoscopic or magnetic resonance imaging (MRI) examination have been used in addition to examination with the naked eye. In our department, a binocular surgical operating microscope is routinely employed at forensic autopsy, which is useful for elucidating the nature of wound in more detail. It is also necessary to determine whether a wound has vitality, and, if antemortem, how long before death the wound has been sustained. For the determination of wound age including vitality, various biological factors such as cytokines and extracellular matrix components involved in wound healing have been examined by histopathological methods. Our studies have shown that interleukin (IL)-1alpha, IL-1 b, IL-6, IL-10 and tumor necrosis factor-alpha are possibly useful markers for wound age determination as well as cell-biological indicators of vitality. Furthermore, molecular biological techniques have been intended to be applied to wound examination; our experimental study has shown that even mRNA of cytokines mentioned above can be histologically detected by reverse transcriptase-polymerase chain reaction or in situ hybridization. A trial of forensic wound examination from macroscopic to molecular level is discussed. PMID:10978618
The phases of wound healing--inflammatory, fibroblastic, and maturation--are continuous, though they overlap and do not always occur in an orderly fashion. Wound healing may be retarded by age, diabetes, smoking, immunosuppression, poor nutrition, cell hypoxia, dehydration, bacteria, and other factors. Bacteria and pus may be so great at the inflammatory phase that the wound remains at that phase. It is important that the nurse recognize when pus is a major factor in an unhealed wound and initiate local care to assist in cleaning the wound bed. It is also important to recognize a clean wound and to initiate appropriate local care that facilitates wound healing. New information about wound healing at the cellular level continues to become available. Epidermal growth factors, platelet-derived growth factors, and the growth hormone somatomedin are being studied, and new methods based on these studies may change local wound care measures. It is essential to understand the phases of wound healing to determine appropriate wound care measures for individual patients. PMID:1823567
Nonhealing wounds represent a significant cause of morbidity and mortality for a large portion of the population. One of the underlying mechanisms responsible for the failure of chronic wounds to heal is an out-of-control inflammatory response that is self-sustaining. Underappreciation of the inherent complexity of the healing wound has led to the failure of monotherapies, with no significant reduction in wound healing times. A model of the inflammatory profile of a nonhealing wound is one in which the equilibrium between synthesis and degradation has been shifted toward degradation. This review summarizes the current information regarding acute wound healing responses as contrasted to the delayed response characteristic of chronic wounds. In addition, some initial complexity theoretical models are proposed to define and explain the underlying pathophysiology. PMID:17276197
Menke, Nathan B; Ward, Kevin R; Witten, Tarynn M; Bonchev, Danail G; Diegelmann, Robert F
Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds. PMID:23868624
Leelavathi, M; Siti Aishah, M A; Wong, Y P; Jamil, A
BACKGROUND: The purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infectedwound. METHODS: Four porcine samples were scored then infected with a broth culture containing a variety of organisms and incubated at 37°C for 24 hours. The
Frank L Bowling; Daryl S Stickings; Valerie Edwards-Jones; David G Armstrong; Andrew JM Boulton
Introduction Negative pressure wound therapy (NPWT) and vessel loop assisted closure are two common methods used to assist with the closure of fasciotomy wounds. This retrospective review compares these two methods using a primary outcome measurement of skin graft requirement. Methods A retrospective search was performed to identify patients who underwent fasciotomy at our institution. Patient demographics, location of the fasciotomy, type of assisted closure, injury characteristics, need for skin graft, length of stay and evidence of infection within 90 days were recorded. Results A total of 56 patients met the inclusion criteria. Of these, 49 underwent vessel loop closure and seven underwent NPWT assisted closure. Patients who underwent NPWT assisted closure were at higher risk for requiring skin grafting than patients who underwent vessel loop closure, with an odds ratio of 5.9 (95% confidence interval 1.11 to 31.24). There was no difference in the rate of infection or length of stay between the two groups. Demographic factors such as age, gender, fracture mechanism, location of fasciotomy and presence of open fracture were not predictive of the need for skin grafting. Conclusion This retrospective descriptive case series demonstrates an increased risk of skin grafting in patients who underwent fasciotomy and were treated with NPWT assisted wound closure. In our series, vessel loop closure was protective against the need for skin grafting. Due to the small sample size in the NPWT group, caution should be taken when generalising these results. Further research is needed to determine if NPWT assisted closure of fasciotomy wounds truly leads to an increased requirement for skin grafting, or if the vascular injury is the main risk factor.
Fowler, J. R.; Kleiner, M. T.; Das, R.; Gaughan, J. P.; Rehman, S.
Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound's environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic woundinfection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review.
Introduction Starting from January 2009, we systematically irrigated the surgical wounds of patients undergoing spine surgery with a solution\\u000a of povidone–iodine (PVP–I) and hydrogen peroxide (H2O2).\\u000a \\u000a \\u000a \\u000a \\u000a Method We prospectively recorded the clinical data of patients who underwent spine surgery during 2009 and we compared the results\\u000a with retrospectively reviewed clinical records of patients operated during 2008. Patients were analyzed for preoperative risk
Simone Ulivieri; Stefano Toninelli; Carlo Petrini; Antonio Giorgio; Giuseppe Oliveri
Background Wounding following whole-body ?-irradiation (radiation combined injury, RCI) increases mortality. Wounding-induced increases in radiation mortality are triggered by sustained activation of inducible nitric oxide synthase pathways, persistent alteration of cytokine homeostasis, and increased susceptibility to bacterial infection. Among these factors, cytokines along with other biomarkers have been adopted for biodosimetric evaluation and assessment of radiation dose and injury. Therefore, wounding could complicate biodosimetric assessments. Results In this report, such confounding effects were addressed. Mice were given 60Co ?-photon radiation followed by skin wounding. Wound trauma exacerbated radiation-induced mortality, body-weight loss, and wound healing. Analyses of DNA damage in bone-marrow cells and peripheral blood mononuclear cells (PBMCs), changes in hematology and cytokine profiles, and fundamental clinical signs were evaluated. Early biomarkers (1 d after RCI) vs. irradiation alone included significant decreases in survivin expression in bone marrow cells, enhanced increases in ?-H2AX formation in Lin+ bone marrow cells, enhanced increases in IL-1?, IL-6, IL-8, and G-CSF concentrations in blood, and concomitant decreases in ?-H2AX formation in PBMCs and decreases in numbers of splenocytes, lymphocytes, and neutrophils. Intermediate biomarkers (7 – 10 d after RCI) included continuously decreased ?-H2AX formation in PBMC and enhanced increases in IL-1?, IL-6, IL-8, and G-CSF concentrations in blood. The clinical signs evaluated after RCI were increased water consumption, decreased body weight, and decreased wound healing rate and survival rate. Late clinical signs (30 d after RCI) included poor survival and wound healing. Conclusion Results suggest that confounding factors such as wounding alters ionizing radiation dose assessment and agents inhibiting these responses may prove therapeutic for radiation combined injury and reduce related mortality.
Patients may experience wounds at or near the end of life that are difficult to treat and may not be amenable to healing. In these cases, hospice and palliative care may be considered. Palliative care approaches include stabilization of existing wounds, prevention of new wounds, and symptom management with a focus on quality of life. Treatment goals for nonhealing wounds at the end of life include managing exudate, controlling odor, maximizing mobility and function, preventing infection, and controlling pain and other symptoms. Complementary components of palliative care are also instituted including communication and psychosocial support for patients and families. PMID:20463544
Letizia, MariJo; Uebelhor, Jonathan; Paddack, Elizabeth
Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45?days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n?=?258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010
Background: Debridement is essential for successful wound management. Enzymatic debridement is commonly utilized in wound care but has been reported to be unsafe in wounds with significant bacterial bioburden, unless used in conjunction with topical antimicrobials. We examine this hypothesis with 2 commercially available, commonly used preparations of enzymatic debriding agents. Materials and Methods: Using a standard rodent model of a chronically infected granulating wound with bacterial levels greater than 1 × 105 Colony Forming Units per gram of tissue, commercially available preparations of collagenase and papain-urea were utilized to investigate the response of infectedwounds to these preparations, and to evaluate their ability to overcome the inhibition of infection on wound healing. Quantitative bacteriology of tissue biopsies and wound healing trajectories were used to compare the preparations to saline-treated negative controls. Results: Collagenase- and papain-urea-treated wounds demonstrated a reduction in bacterial burden of wounds to < 105 colony forming units/gram of tissue (P < .05). This decrease in bacterial bioburden occurred rapidly, allowing wounds to achieve bacterial balance in a short period of time. Wounds treated with enzymatic debriding agents healed significantly faster and to greater extent than saline-treated controls (P < .01); a direct reflection of the decreasing bacterial load of the wound. Conclusions: Collagenase and papain-urea appear beneficial and safe even in wounds with high bacterial loads, and appear to significantly aid extent and rate of healing, probably by lowering bacterial burden through their positive enzymatic actions on bacteria and necrotic tissue.
Payne, Wyatt G.; Salas, R. Emerick; Ko, Francis; Naidu, Deepak K.; Donate, Guillermo; Wright, Terry E.; Robson, Martin C.
Cutaneous wound healing is a complex process encompassing a number of overlapping events including leukocyte recruitment,\\u000a matrix deposition, epithelialization, and ultimately resolution of inflammation with the formation of a mature scar. Morbidity\\u000a associated with age-related delayed wound healing imposes an enormous social and financial burden; unless improved wound care\\u000a strategies are developed the projected relative and absolute increase in the
Gillian S. Ashcroft; Stuart J. Mills; Jason J. Ashworth
Skin wound healing is a vital process that is important for re-establishing the epithelial barrier following disease or injury. Aberrant or delayed skin wound healing increases the risk of infection, causes patient morbidity, and may lead to the formation of scar tissue. One of the most important events in wound healing is coverage of the wound with a new epithelial layer. This occurs when keratinocytes at the wound periphery divide and migrate to re-populate the wound bed. Many approaches are under investigation to promote and expedite this process, including the topical application of growth factors and the addition of autologous and allogeneic tissue or cell grafts. The mechanical environment of the wound site is also of fundamental importance for the rate and quality of wound healing. It is known that mechanical stress can influence wound healing by affecting the behaviour of cells within the dermis, but it remains unclear how mechanical forces affect the healing epidermis. Tensile forces are known to affect the behaviour of cells within epithelia, however, and the material properties of extracellular matrices, such as substrate stiffness, have been shown to affect the morphology, proliferation, differentiation and migration of many different cell types. In this review we will introduce the structure of the skin and the process of wound healing. We will then discuss the evidence for the effect of tissue mechanics in re-epithelialisation and, in particular, on stem cell behaviour in the wound microenvironment and in intact skin. We will discuss how the elasticity, mechanical heterogeneity and topography of the wound extracellular matrix impact the rate and quality of wound healing, and how we may exploit this knowledge to expedite wound healing and mitigate scarring. PMID:23746929
Evans, Nicholas D; Oreffo, Richard O C; Healy, Eugene; Thurner, Philipp J; Man, Yu Hin
Horse wounds have a high risk of becoming infected due to their environment. Infectedwounds harbour diverse populations of microorganisms, however in some cases these microorganisms can be difficult to identify and fail to respond to antibiotic treatment, resulting in chronic non-healing wounds. In human wounds this has been attributed to the ability of bacteria to survive in a biofilm phenotypic state. Biofilms are known to delay wound healing, principally due to their recalcitrance towards antimicrobial therapies and components of the innate immune response. This study describes the presence of bacterial biofilms within equine wounds. Thirteen 8-mm diameter tissue samples were collected from (n=18) chronic wounds. Following histological staining, samples were observed for evidence of biofilms. Fifty one wounds and control skin sites were sampled using sterile swabs. Control skin sites were on the uninjured side of the horse at the same anatomical location as the wound. The isolated bacteria were cultured aerobically and anaerobically. The biofilm forming potential of all the isolated bacteria was determined using a standard crystal violet microtitre plate assay. Stained tissue samples provided evidence of biofilms within 61.5% (8 out of 13) equine wounds. In total 340 bacterial isolates were identified from all the equine wound and skin samples. Pseudomonas aeruginosa and Enterococcus faecium were the most predominantly isolated bacterial species from equine wound and skin samples respectively. Staphylococcus was the most commonly isolated genus in both environments. Bacteria cultured from chronic and acute wounds showed significantly (P<0.05) higher biofilm forming potential than bacteria isolated from skin. This paper highlights preliminary evidence supporting the presence of biofilms and a high microbial diversity in equine chronic wounds. The presence of biofilms in equine wounds partly explains the reluctance of many lower limb wounds to heal. Non-healing limb wounds in horses are a well documented welfare and economic concern. This knowledge can be used to shape future treatments in order to increase the healing rate and decrease the costs and suffering associate with equine wounds. PMID:21273008
Westgate, S J; Percival, S L; Knottenbelt, D C; Clegg, P D; Cochrane, C A
Many small animals succumb to complications of serious wounds. Sometimes infection and sepsis overwhelm the animal; sometimes the costs of intensive care overwhelm the owner. Maggot therapy, a method of wound debridement using live fly larvae, could provide effective, simple, low cost wound care. All eight US veterinarians who had been provided with medicinal maggots were surveyed to determine if
Ronald A. Sherman; Howard Stevens; David Ng; Eve Iversen
This article presents a general overview of maggot debridement therapy, as used in the management of chronic infectedwounds. Much has been written about this treatment method, both historically and in the past decade. Current clinical practice is discussed and clinical and laboratory research are reviewed, with attention to the inherent challenges of such research. The nature of microbial and
Oxygen is essential for all stages of wound healing. Previous research has shown topical administration of oxygen to have positive effects on wound healing. In this study, the application of transdermal continuous topical oxygen therapy (TCOT) was evaluated for its effect on chronic wound healing in 9 patients. After 4 weeks of treatment, mean wound surface area and woundinfection checklist scores were significantly reduced. Signs of bacterial damage were also reduced. Findings from this study suggest TCOT may be beneficial in promoting chronic wound healing. PMID:23151764
The increasing incidence and complications arising from combat wounds has necessitated a reassessment of methods for effective treatment. Infection, excessive inflammation, and incidence of drug-resistant organisms all contribute toward negative outcomes for afflicted individuals. The organisms and host processes involved in wound progression, however, are incompletely understood. We therefore set out, using our unique technical resources, to construct a profile of combat wounds which did or did not successfully resolve. We employed the Lawrence Livermore Microbial Detection Array and identified a number of nosocomial pathogens present in wound samples. Some of these identities corresponded with bacterial isolates previously cultured, while others were not obtained via standard microbiology. Further, we optimized proteomics protocols for the identification of host biomarkers indicative of various stages in wound progression. In combination with our pathogen data, our biomarker discovery efforts will provide a profile corresponding to wound complications, and will assist significantly in treatment of these complex cases.
Recently, photodynamic therapy (PDT) has been used for the treatment of festering wounds and trophic ulcers. An important advantage of PDT is its ability to affect bacterial cultures that are resistant to antibiotics. However the use of PDT alone does not usually guarantee a stable antiseptic effect and cannot prevent an external infection of wounds and burns. In this work attention is focused on the healing of the extensive soft tissues wounds with combined laser therapy (LT) and PDT treatment. At the first stage of this process festering tissues (for example spacious purulent wounds with area more than 100 cm2) were illuminated with high-energy laser beam (with power 20 W) in continues routine. The second stage involves “softer” PDT affect, which along with the completion stages of destruction pathological cells, stimulating the process of wound granulation and epithelization. Also, according to our previous results, photosensitizer (photoditazin) is introduced inside the wound with different amphiphilic polymers for increasing the PDT efficacy.
Solovieva, A. B.; Tolstih, P. I.; Melik-Nubarov, N. S.; Zhientaev, T. M.; Kuleshov, I. G.; Glagolev, N. N.; Ivanov, A. V.; Karahanov, G. I.; Tolstih, M. P.; Timashev, P. S.
Across Europe, wound care management is organized differently, and in some countries such as the UK or Denmark, wound healing centres have been implemented. In France, a large number of health professionals are not sufficiently educated in wound care management during their vocational training. The rapid evolution of dressings has changed wound management practices and has given rise to new professional recommendations. This national survey was carried out in France in 2009, including 465 health professionals, to determine the criteria they use to choose a dressing and their habits of care with acute or chronic wounds. Around 73% of respondents were nurses and, on average, participants took care of 43 wounds per month. It was also found that 89% of the health professionals who took part prefer the sequential treatment of the wound based on its appearance. Regardless of whether the wound is acute or chronic, the priorities for wound care and the choice of dressing are the management of the exudate and the prevention or treatment of infection. These results put into evidence the adequacy of the recommendations by these practitioners and the good correlation between the choice of dressing and the local therapeutic goal. To reach the same level of expertise, the professional training for health professionals who are less frequently involved in wound care is necessary. PMID:22067931
Background: Aerosols are defined as the mixture of liquid or solid particles/droplets that are stably suspending in air. When carrying a certain amount of negative charge, they will be defined as negatively-charged aerosol. This report investigates the effect of negatively-charged aerosol on the healing of chronic wound. Methods: 140 patients with chronic wound were assigned randomly into two groups. Normal, routine treatment was applied on chronic wounds of 73 patients depending on wounds situation (control group). While another 67 similar patients received negatively-charged aerosol therapy (2 hours per time, twice a day) and were used as experimental group. Wound healing assessment including the patients’ complication, detection of bacteria in wound secretions, and evaluation of wound healing. Results: The results of our study showed that after the application of negatively-charged aerosols, and condition and infection rate of wounds from experiment group were better and lower than that of control group. In comparison with control group, the relative size of wounds from experiment group was significantly smaller (P<0.05) at post-treatment day 0, 7, 14, 21 and 28. Also, the time required for wound healing in the experimental group was significantly shorter (P<0.05) than that in the control group. Conclusion: Negatively-charged aerosol therapy can accelerate wound healing speed and improve the healing of chronic wounds. Thus, we wound recommend the consideration of Negatively-charged aerosol therapies in addition to normal wound treatment in cases of chronic wound.
Objectives: We are often confused on selecting a suitable wound dressing for the treatment of infectedwounds from huge number of available wound dressings. Then, to help clinicians easily select a wound dressing, we compared the antibacterial effects and bacterial retentivity (ie, potency of keeping absorbed bacteria inside wound dressings and preventing them from leaking out) of wound dressings. Methods: Five wound dressings with antibacterial constituents were compared to research antibacterial effects against nonpathogenic Escherichia coli using an in vitro model. The 5 other wound dressings with no antibacterial constituent were compared to research bacterial retentivity. The relative amount of E coli was determined using cell proliferation reagent WST-1 (11644807001, Roche Applied Science, United States) with time. Results: The results have shown that the antibacterial effects and bacterial retentivity differed among various wound dressings. Silver ions quickly exerted a very strong antibacterial effect, and hydrofibers had a high potency of bacterial retentivity by gelling the absorbed bacteria in wound dressings. Conclusions: The present study indicated the differences of antibacterial strength, time of onset and duration of the antibacterial effect, and bacterial retentivity between each wound dressing. Clinicians should use appropriate wound dressings according the wound condition in consideration of the different characteristics of wound dressings. The present results are helpful for clinicians to select appropriate wound dressing.
The majority of war wounds are caused by antipersonnel fragments from munitions such as mortars and bomblets. Modern munitions aim to incapacitate soldiers with multiple wounds from very small fragments of low available kinetic energy. Many of these fragments may be stopped by helmets and body armour and this has led to a predominance of multiple wounds to limbs in those casualties requiring surgery. The development of an appropriate management strategy for these multiple wounds requires knowledge of the contamination and extent of soft tissue injury; conservative management may be appropriate. The extent of skin and muscle damage associated with a small fragment wound, the way in which these wounds may progress without intervention and their colonisation by bacteria has been determined in an experimental animal model. Results from 12 animals are presented. There was a very small (approximately 1 mm) margin of nonviable skin around the entrance wound. The amount of devitalised muscle in the wound tract was a few hundred milligrams. Some muscles peripheral to the wound track also showed signs of damage 1 h after wounding, but this improved over 24 h; the proportion of fragmented muscle fibres in the tissue around the track decreased as time went on. There was no clinical sign or bacteriological evidence of the track becoming infected up to 24 h after wounding. This preliminary work suggests that, in the absence of infection, the amount of muscle damage caused by small fragment wounds begins to resolve in the first 24 h after injury, even without surgical intervention. Images Figure 1 Figure 2
Sulfur mustard is a chemical warfare agent that causes vesication in human skin. These blisters make the victims more susceptible to infection and delay healing of the skin. The first step in treating wounds is to cleanse the wound to prevent infection. M...
A. H. Chuang A. L. Adkins C. L. Henemyre-Harris J. S. Graham
This case series presents two females, 53 and 33 years old, with thyroidectomy wounds that failed to heal, 16 and 18 weeks, respectively, following the operation. The wounds were explored with removal of gauze and catgut suture. The patients made remarkable improvement and the wounds healed satisfactorily within seven days. Surgical materials forgotten intraoperatively, wrong use of and / or infected surgical materials should be considered when surgical wounds fail to heal. PMID:23066459
This case series presents two females, 53 and 33 years old, with thyroidectomy wounds that failed to heal, 16 and 18 weeks, respectively, following the operation. The wounds were explored with removal of gauze and catgut suture. The patients made remarkable improvement and the wounds healed satisfactorily within seven days. Surgical materials forgotten intraoperatively, wrong use of and / or infected surgical materials should be considered when surgical wounds fail to heal.
Since its discovery approximately 200 years ago, chitosan, as a cationic natural polymer, has been widely used as a topical dressing in wound management owing to its hemostatic, stimulation of healing, antimicrobial, nontoxic, biocompatible and biodegradable properties. This article covers the antimicrobial and wound-healing effects of chitosan, as well as its derivatives and complexes, and its use as a vehicle to deliver biopharmaceuticals, antimicrobials and growth factors into tissue. Studies covering applications of chitosan in wounds and burns can be classified into in vitro, animal and clinical studies. Chitosan preparations are classified into native chitosan, chitosan formulations, complexes and derivatives with other substances. Chitosan can be used to prevent or treat wound and burn infections not only because of its intrinsic antimicrobial properties, but also by virtue of its ability to deliver extrinsic antimicrobial agents to wounds and burns. It can also be used as a slow-release drug-delivery vehicle for growth factors to improve wound healing. The large number of publications in this area suggests that chitosan will continue to be an important agent in the management of wounds and burns.
Dai, Tianhong; Tanaka, Masamitsu; Huang, Ying-Ying; Hamblin, Michael R
The repair of wounds is one of the most complex biological processes that occur during human life. After an injury, multiple biological pathways immediately become activated and are synchronized to respond. In human adults, the wound repair process commonly leads to a non-functioning mass of fibrotic tissue known as a scar. By contrast, early in gestation, injured fetal tissues can
Geoffrey C. Gurtner; Sabine Werner; Yann Barrandon; Michael T. Longaker
Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. Presenting 3 case reports, this article aims to show the danger of stab wounds and how easily sharp objects can penetrate human tissue. In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision. PMID:22746076
A wound biofilm model was created by adapting a superficial infection model. Partial-thickness murine wounds were inoculated with methicillin-resistant Staphylococcus aureus (MRSA). Dense biofilm communities developed at the wound surface after 24 h as demonstrated by microscopy and quantitative microbiology. Common topical antimicrobial agents had reduced efficacy when treatment was initiated 24 h after inoculation compared to 4 h after inoculation. This model provides a rapid in vivo test for new agents to treat wound biofilm infections.
Renick, Paul J.; Tetens, Shannon P.; Carson, Dennis L.
Active regions are open wounds in the Sun's surface. Seismic oscillations from the interior pass through them into the atmosphere, changing their nature in the process to fast and slow magneto-acoustic waves. The fast waves then partially reflect and partially mode convert to upgoing and downgoing Alfvén waves. The reflected fast and downgoing Alfvén waves then re-enter the interior through the active regions that spawned them, infecting the surface seismology with signatures of the atmosphere. Using numerical simulations of waves in uniform magnetic fields, we calculate the upward acoustic and Alfvénic losses in the atmosphere as functions of field inclination and wave orientation as well as the time-distance `travel time' perturbations, and show that they are related. Travel time perturbations relative to quiet Sun can exceed 40 s in 1 kG magnetic field. It is concluded that active region seismology is indeed significantly infected by waves leaving and re-entering the interior through magnetic wounds, with differing travel times depending on the orientation of the wave vector relative to the magnetic field. This presages a new directional-time-distance seismology.
The developing fetus has the ability to heal wounds by regenerating normal epidermis and dermis with restoration of the extracellular matrix (ECM) architecture, strength, and function. In contrast, adult wounds heal with fibrosis and scar. Scar tissue remains weaker than normal skin with an altered ECM composition. Despite extensive investigation, the mechanism of fetal wound healing remains largely unknown. We do know that early in gestation, fetal skin is developing at a rapid pace and the ECM is a loose network facilitating cellular migration. Wounding in this unique environment triggers a complex cascade of tightly controlled events culminating in a scarless wound phenotype of fine reticular collagen and abundant hyaluronic acid. Comparison between postnatal and fetal wound healing has revealed differences in inflammatory response, cellular mediators, cytokines, growth factors, and ECM modulators. Investigation into cell signaling pathways and transcription factors has demonstrated differences in secondary messenger phosphorylation patterns and homeobox gene expression. Further research may reveal novel genes essential to scarless repair that can be manipulated in the adult wound and thus ameliorate scar. PMID:19803418
Buchanan, Edward P; Longaker, Michael T; Lorenz, H Peter
With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings.
Gist, Steve; Tio-Matos, Iris; Falzgraf, Sharon; Cameron, Shirley; Beebe, Michael
Since the wound is the most common focus of infection in the surgical patient, adequate levels of antibiotic within the wound ar essential. This study examines the concentrations of antibiotic achieved in human wounds. Fluid was collected at timed intervals on the first postoperative day from the wounds of 56 patients receiving antibiotics after regional lymph node dissection. Antibiotic concentration was determined by bioassay. Six antibiotics were studied: cephalothin, cefazolin, cephapirin, oxacillin, ampicillin and clindamycin. The cephalosporins and penicillins showed similar patterns of appearance in the wound fluid. The peak level occurred early (1--1 1/2 hours) with subsequent slow decrease. Clindamycin produced nearly constant levels in wound fluid. The concentration of each antibiotic in wound fluid surpassed the serum levels after 2.5 hours. At the dosages studied each antibiotic produced wound fluid concentrations greater than the MIC for most susceptible organisms. Higher doses provided higher wound fluid levels. The rate of appearance and the levels achieved should be considered in the choice of antibiotics in the surgical subject. Images Fig. 1.
Bagley, D H; Mac Lowry, J; Beazley, R M; Gorschboth, C; Ketcham, A S
Multidrug-resistant organisms (MDROs) are increasingly implicated in both acute and chronic woundinfections. The limited therapeutic options are further compromised by the fact that wound bacteria often co-exist within a biofilm community which enhances bacterial tolerance to antibiotics. As a consequence, topical antiseptics may be an important consideration for minimising the opportunity for woundinfections involving MDROs. The objective of this research was to investigate the antimicrobial activity of a silver-containing gelling fibre dressing against a variety of MDROs in free-living and biofilm states, using stringent in vitro models designed to simulate a variety of wound conditions. MDROs included Acinetobacter baumannii, community-associated methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase-producing bacteria. Clostridium difficile was also included in the study because it carries many of the characteristics seen in MDROs and evidence of multidrug resistance is emerging. Sustained in vitro antimicrobial activity of the silver-containing dressing was shown against 10 MDROs in a simulated wound fluid over 7 days, and inhibitory and bactericidal effects against both free-living and biofilm phenotypes were also consistently shown in simulated colonised wound surface models. The in vitro data support consideration of the silver-containing gelling fibre dressing as part of a protocol of care in the management of wounds colonised or infected with MDROs. PMID:22640181
Bowler, Philip G; Welsby, Sarah; Towers, Victoria; Booth, Rebecca; Hogarth, Andrea; Rowlands, Victoria; Joseph, Alexis; Jones, Samantha A
Quickly evolutive skin necrosis and deep infection after total knee arthroplasty (TKA) are not uncommon. Several predisposing factors, such as immunosuppression, malnutrition, steroid use, rheumatoid arthritis, multiple scars, and vascular disease can be involved in the onset of wound complications, as well as long tourniquet time and early knee flexion. Skin necrosis after TKA can be treated in different ways, including local wound care, debridement, and soft tissue coverage with muscle or skin grafts. This article presents a rare case of skin necrosis occurring in a patient without any other apparent risk factor after TKA. A 78-year-old woman affected by primary osteoarthritis of the right knee who had no comorbidities and who had already undergone TKA for primary osteoarthritis on the left knee underwent a cemented TKA. Three days postoperatively, she developed a fever and wound problems, which soon after turned into skin necrosis. This complication was first treated surgically with a debridement of the wound with antibiotic therapy and local wound care, then with vacuum-assisted closure (Kinetic Concepts Inc, San Antonio, Texas) therapy and soft tissue coverage using skin grafting. She had a complete recovery in the next 3 months; the skin grafting was well tolerated and the range of motion and functional outcome were good. PMID:19292412
The maggots of Lucilia sericata are especially indicated for severe, infectedwounds that need debridement. Maggot Debride- ment Therapy (MDT) was a well-known therapy in ancient war times and was successfully reintroduced in the 1990s for treat- ment of infectedwounds. MDT was approved by the FDA in 2004 (510(k) #33391. The exact mechanism of action of MDT is unk-
This research seeks to develop non-invasive techniques for evaluating burn depth based upon non-contacting visible and near-infrared spectroscopic measurement of the wounds. In previous years, we demonstrated that features of the optical reflection spectr...
This research seeks to develop non-invasive burn depth evaluation from non-contacting visible and near-infrared spectroscopic measurements. In previous years, we demonstrated that features of the optical reflection spectra of burn wounds can be correlated...
The US Department of Energy reports of events that occurred in the chemical processing 200 Areas of the Hanford Site during the period from 1972 through 1986 were reviewed to identify the causes of contaminated wounds. Contaminated wounds were reported in 19 events involving 20 workers. The causal agents (high risk operations) and the root causes were characterized. Emergency actions taken and their efficacy were noted. The 19 wound events were compared with 17 events with the potential for inhalation. It was found that the wound events involve a single worker and frequently result in an internal contamination and its resulting dose. Inhalation events involve groups of workers and rarely resulted in detectable internal contamination. The difference is attributed to anticipation of an inhalation event and use of respiratory protection and continuous air monitors to mitigate its effects.
The US Department of Energy reports of events that occurred in the chemical processing 200 Areas of the Hanford Site during the period from 1972 through 1986 were reviewed to identify the causes of contaminated wounds. Contaminated wounds were reported in 19 events involving 20 workers. The causal agents (high risk operations) and the root causes were characterized. Emergency actions taken and their efficacy were noted. The 19 wound events were compared with 17 events with the potential for inhalation. It was found that the wound events involve a single worker and frequently result in an internal contamination and its resulting dose. Inhalation events involve groups of workers and rarely resulted in detectable internal contamination. The difference is attributed to anticipation of an inhalation event and use of respiratory protection and continuous air monitors to mitigate its effects.
Radiation wounds caused by newer high-voltage radiotherapy techniques are very difficult to manage. Recent developments in flap design and transfer aid the surgeon in successfully treating these difficult problems.
Against 182 anaerobe and 241 aerobe strains obtained from diabetic foot infections, doripenem was the most active carbapenem against Pseudomonas aeruginosa (MIC90, 2 ?g/ml), more active than imipenem against Proteus mirabilis, and ertapenem was more active against Escherichia coli and Klebsiella spp. The MIC50 and MIC90 values were ?0.125 ?g/ml for methicillin-sensitive Staphylococcus aureus and all streptococci and 0.25/1 for Bacteroides fragilis.
Goldstein, Ellie J. C.; Citron, Diane M.; Merriam, C. Vreni; Warren, Yumi A.; Tyrrell, Kerin L.; Fernandez, Helen T.
This study evaluated the ability of the probiotic organism Lactobacillus plantarum to inhibit the pathogenic activity of Pseudomonas aeruginosa, both in vitro and in vivo, and investigated the mechanisms involved in such protection. L. plantarum whole cultures, culture filtrates (acid filtrate and neutralised acid filtrate) and isolated, washed cells were tested in vitro for their effects on the production of the P. aeruginosa quorum-sensing signal molecules, acyl-homoserine-lactones (AHLs), and two virulence factors controlled by these signal molecules, elastase and biofilm. All were inhibited by L. plantarum cultures and filtrates, but not by isolated, washed cells. The acid L. plantarum growth medium itself had some inhibitory activity, but the greatest activity was exerted by the whole culture. To test the in-vivo activity of L. plantarum, a burned-mouse model was used in which burns infected with P. aeruginosa were treated with L. plantarum at 3, 4, 5, 7 and 9 days post-infection. Samples from skin, liver and spleen taken after 5, 10 and 15 days demonstrated inhibition of P. aeruginosa colonisation by L. plantarum. There was also an improvement in tissue repair, enhanced phagocytosis of P. aeruginosa by tissue phagocytes, and a decrease in apoptosis at 10 days. These results indicate that L. plantarum and/or its by-products are potential therapeutic agents for the local treatment of P. aeruginosa burn infections. PMID:15882197
Valdéz, J C; Peral, M C; Rachid, M; Santana, M; Perdigón, G
The healing wound offers a variety of potential end results. The surgeon's responsibility is to define what he wants and then\\u000a arrange to get it. History has proved that technical improvements can eliminate disorders such as dehiscence and incisional\\u000a hernias. Technical improvements should diminish the frequency of failed tendon repairs.\\u000a \\u000a When the author first became interested in wound healing and
Little research or attention has been paid to finding out whether wound closure with sutures or staples attains the best outcomes after saphenous vein harvest for coronary artery bypass grafting. We undertook a quality improvement project to compare the prevalence of leg wound complications (eg, infection, seroma, hematoma, dehiscence) between two types of skin closure (ie, staples, subcuticular sutures) after conventional open surgery with bridging between incisions and vein harvesting during coronary revascularization to determine the need for practice changes. We found no significant differences between patients with wound complications and those without. However, in this project, the risk for infections was greater for patients with diabetes whose wounds were closed by using subcuticular sutures. These findings have led to practice changes for reducing leg wound complications within our institution: clinicians now assess patients for increased risk of leg wound complications preoperatively and opt to close wounds with staples for patients who have diabetes. PMID:24075335
East, Susan A; Lorenz, Rebecca A; Armbrecht, Eric S
\\u000a The normal wound healing response can be divided into (1) inflammatory, (2) proliferative, and (3) tissue remodeling (i.e.,\\u000a fibroplasia and maturation) phases that involve complex interactions between various cutaneous-derived and inflammatory cells,\\u000a cytokines, and the extracellular matrix (ECM) [1–6]. Numerous studies continue to uncover the genetic, epigenetic (i.e., microRNA),\\u000a cellular (including stem cells), molecular, and biochemical mechanisms underlying this process
The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care. PMID:23634474
Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M
Arginine metabolism in wounds was investigated in the rat in 1) lambda-carrageenan-wounded skeletal muscle, 2) Schilling chambers, and 3) subcutaneous polyvinyl alcohol sponges. All showed decreased arginine and elevated ornithine contents and high arginase activity. Arginase could be brought to the wound by macrophages, which were found to contain arginase activity. However, arginase was expressed by macrophages only after cell lysis and no arginase was released by viable macrophages in vitro. Thus the extracellular arginase of wounds may derive from dead macrophages within the injured tissue. Wound and peritoneal macrophages exhibited arginase deiminase activity as demonstrated by the conversion of (guanido-/sup 14/C)arginine to radiolabeled citrulline during culture, the inhibition of this reaction by formamidinium acetate, and the lack of prokaryotic contamination of the cultures. These findings and the known metabolic fates of the products of arginase and arginine deiminase in the cellular populations of the wound suggest the possibility of cooperativity among cells for the production of substrates for collagen synthesis.
Cell wounding is a common event in the life of many cell types, and the capacity of the cell to repair day-to-day wear-and-tear injuries, as well as traumatic ones, is fundamental for maintaining tissue integrity. Cell wounding is most frequent in tissues exposed to high levels of stress. Survival of such plasma membrane disruptions requires rapid resealing to prevent the loss of cytosolic components, to block Ca2+ influx and to avoid cell death. In addition to patching the torn membrane, plasma membrane and cortical cytoskeleton remodeling are required to restore cell function. Although a general understanding of the cell wound repair process is in place, the underlying mechanisms of each step of this response are not yet known. We have developed a model to study single cell wound repair using the early Drosophila embryo. Our system combines genetics and live imaging tools, allowing us to dissect in vivo the dynamics of the single cell wound response. We have shown that cell wound repair in Drosophila requires the coordinated activities of plasma membrane and cytoskeleton components. Furthermore, we identified an unexpected role for E-cadherin as a link between the contractile actomyosin ring and the newly formed plasma membrane plug.
Wound healing is a critical process involved in the recovery from injury and surgical procedures. Poor healing increases the risk for woundinfections or complications, lengthens hospital stays, magnifies patient discomfort, and slows return to activities of daily living. Converging evidence from different research paradigms suggests that psychological stress and other behavioral factors can affect wound healing. A meta-analytical study using diverse wound-healing models and outcomes found that across studies there was an average correlation of ?0.42 between psychological stress and wound healing.1 This result suggests that the relationship between stress and wound repair is not only statistically significant but also clinically relevant. This review presents data and methods from observational, experimental, and interventional studies corroborating the impact of stress on wound healing. Potential behavioral and physiologic mechanisms explaining the association between stress and impaired wound healing are also discussed.
In diabetic patients, there is impairment in angiogenesis, neovascularisation and failure in matrix metalloproteineases (MMPs), keratinocyte and fibroblast functions, which affects wound healing mechanism. Hence, diabetic patients are more prone to infections and ulcers which finally result in gangrene. Ferulic acid (FA) is a natural antioxidant found in fruits and vegetables, such as tomatoes, rice bran and sweet corn. In this study, wound healing activity of FA was evaluated in streptozotocin-induced diabetic rats using excision wound model. FA-treated wounds were found to epithelise faster as compared to diabetic wound control group. The hydroxyproline and hexosamine content increased significantly when compared to diabetic wound control. FA effectively inhibited the lipid peroxidation and elevated the catalase, superoxide dismutase, glutathione, nitric oxide levels along with the increase in the serum zinc and copper levels probably aiding the wound healing process. Hence, the results indicate that FA significantly promotes wound healing in diabetic rats. PMID:23236955
Ghaisas, Mahesh M; Kshirsagar, Shashank B; Sahane, Rajkumari S
A 39-year-old patient suffered a stab wound of the right thenar prominence after an accident with a screwdriver. In the first hospital the deep wound was irrigated with octenidine dihydrochloride/2-phenoxyethanol and closed by suture. During the further course pressure pain and numbness of the right thenar and swelling of the right hand occurred. Three weeks after the accident an operative revision of the wound in a second hospital was performed. The intraoperative findings showed inflammation and necrosis of the right m. abductor pollicis brevis, but no infection with pus.The patient accused the first hospital of irrigating the tissue of his right hand with Octenisept®. The expert option of the Arbitration Board identified improper care in the first hospital with insufficient excision of the wound and incorrect use of the Octenisept® solution. Against the explicit advice of the manufacturing company the wound had been sutured without the possibility of drainage for the Octenisept® solution. PMID:21229225
After radical vulvectomy, infection and wound breakdown occurs in approximately 40–60% of patients resulting in significant morbidity and increased hospital stay. Wound breakdown is primarily due to infection of and tension on the wound. Post-operative defects in the immune system and neutrophil dysfunction may contribute to the high rate of this complication. To investigate this phenomenon in patients with a
A. C. M. van Lindert; E. A. Symons; B. F. M. Damen; A. P. M. Heintz
In the experiments on rabbits with bilateral musculocutaneous wound of a thigh, it is shown that the early use of the "Dnepr MN" activated carbon fibrous material (ACFM) intended for medical purposes provides timely haemostasis in the damaged tissues, reduces blood loss, prevents the development of traumatic edema, decreases the intensity of inflammatory process in a wound, facilitates rapid and uncomplicated healing of wounds under the artificial crust. The treatment-and-prophylactic effectiveness of ACFM is associated with its ability for rapid and irreversible sorption of biologically active substances forming in the wound tissues, and as well with protection of a wound against secondary infection. PMID:2739244
Eretskaia, E V; Sakhno, L A; Vovianko, S I; U?chenko, V Iu
For hundreds of years poor and chronic nonhealing wounds have constituted a serious problem to medicine. What is more, treating such wounds is an expensive let alone a long-lasting process. The following paper describes Professor Scheller's achievements in using propolis for poor and chronic non-healing wounds. The authors' intention was to present the results connected with the use of the ethanolic extract propolis, in the treatment of patients suffering from burns, venous crural ulceration, local sacral bone pressure ulcers, suppurative osteitis and arthritis, suppurative postoperative local wound complications, and infected traumatic wounds.
Kucharzewski, M.; Kubacka, S.; Urbanek, T.; Wilemska-Kucharzewska, K.; Morawiec, T.
Introduction. Medications used to treat rheumatoid arthritis, such as corticosteroids, disease-modifying agents (DMARDs), and injectable biological agents (anti-TNF?), may have widespread effects on wound healing. In hand surgery, it is important to balance the risks of poor wound healing from continuing a medication against the risks of a flare of rheumatoid arthritis if a drug is temporarily discontinued. Materials and Methods. A United Kingdom (UK) group of 28 patients had metacarpophalangeal joint replacement surgery in 35 hands (140 wounds). All medication for rheumatoid arthritis was continued perioperatively, except for the injectable biological agents. Results. There were no instances of wound dehiscence or deep infection and only one episode of minor superficial infection. Conclusions. We conclude that provided care is taken to identify and treat any problems promptly, it is appropriate to continue most antirheumatoid medications in the perioperative period during hand surgery to reduce the risk of destabilising the patients' overall rheumatoid disease control.
Barnard, A. R.; Regan, M.; Burke, F. D.; Chung, K. C.; Wilgis, E. F. S.
Existing literatures indicate that wounds in plant tissues provide the entry to A. flavus. and fungi. By mechanically wounding pistachio nut-fruits, sufficient number of nut-fruits conducive to A. flavus and fungal infection are generated. The wounded nut-fruits are easily recognized for sampling. ...
Despite innovation in the design and functionalization of polymer nanofiber wound healing materials, information on their interaction with the biochemical wound environment is lacking. In an earlier study, we have reported the interaction of fusidic acid-loaded PLGA ultrafine fibers (UFs) with wound bacteria. Massive bacterial colonization and the formation of a dense biofilm throughout the mat were demonstrated. This was associated with a marked enhancement of initial drug release at concentrations allowing eradication of planktonic bacteria and considerable suppression of biofilm. The present study aimed at extending earlier findings to gain more mechanistic insights into the potential response of the fusidic acid-laden UFs under study to controlled microbial bioburden. Initial drug release enhancement was shown to involve surface erosion of the ultrafibrous mats likely mediated by microbial esterase activity determined in the study. Release data could be correlated with microbial bioburden over the inoculum size range 10³-10? CFU/ml, suggesting a bioburden-triggered drug release enhancement mechanism. Moreover, the effectiveness of fusidic acid-laden UFs in the healing of either lightly contaminated or Staphylococcus aureus heavily infectedwounds in a rat model suggested in-use relevant antimicrobial release patterns. Findings indicated active participation of polymer ultrafine wound dressings in a dynamic interaction with the wound milieu, which affects their structure-function relationship. Understanding such an interaction is fundamental to the characterization and performance assessment of wound materials under biorelevant conditions and the design of polymer-based infection-responsive biomaterials. PMID:21924354
Said, Somiraa S; El-Halfawy, Omar M; El-Gowelli, Hanan M; Aloufy, Affaf K; Boraei, Nabila A; El-Khordagui, Labiba K
Summary Background Data Mechanical forces play an important role in tissue neovascularisation and are a constituent part of modern wound therapies. The mechanisms by which Vacuum Assisted Closure (VAC) modulates wound angiogenesis are still largely unknown. Objective To investigate how VAC treatment affects wound hypoxia and related profiles of angiogenic factors as well as to identify the anatomical characteristics of the resultant, newly formed vessels. Methods Wound neovascularization was evaluated by morphometric analysis of CD31- stained wound cross sections as well as by corrosion casting analysis. Wound hypoxia and mRNA expression of HIF-1? and associated angiogenic factors were evaluated by pimonidazole hydrochloride staining and quantitative RT-PCR, respectively. VEGF protein levels were determined by western blot analysis. Results VAC-treated wounds were characterized by the formation of elongated vessels aligned in parallel and consistent with physiologically function, compared to occlusive dressing control wounds that showed formation of tortuous, disoriented vessels. Moreover, VAC-treated wounds displayed a well-oxygenated wound bed, with hypoxia limited to the direct proximity of the VAC-foam interface, where higher VEGF levels were found. By contrast, occlusive dressing control wounds showed generalized hypoxia, with associated accumulation of HIF-1? and related angiogenic factors. Conclusions The combination of established gradients of hypoxia and VEGF expression along with mechanical forces exerted by VAC therapy was associated with the formation of more physiological blood vessels compared to occlusive dressing control wounds. These morphological changes are likely a necessary condition for better wound healing.
Erba, Paolo; Ogawa, Rei; Ackermann, Maximilian; Adini, Avner; Miele, Lino F; Dastouri, Pouya; Helm, Doug; Mentzer, Steven J; D'Amato, Robert J; Murphy, George F; Konerding, Moritz A; Orgill, Dennis P
As research techniques in wound care management improve, treatment protocols for the care of wounds must also change to ensure safe and optimal healing. In this study, I surveyed current practices of athletic trainers regarding the care of athletic wounds and compared the findings to current literature. I contacted 501 athletic trainers, including all NATA curricular undergraduate directors. Overall response rate was 58%; 78% of the athletic trainers from the curricular schools responded. Wet-to-dry, irrigation, and soaks were the three most common methods used to debride and cleanse a wound. Povidone-iodine (Betadine) and hydrogen peroxide were the two most popular cleansing agents. Conventional gauze was the primary dressing used by 67% of the athletic trainers, while 20% of those surveyed used occlusive dressings. Although povidone-iodine and hydrogen peroxide are commonly used, both are toxic to cells involved in the wound-healing process and delay healing. Research indicates that the best method of cleansing and debriding a wound is to irrigate it with saline. Occlusive dressings have a lower infection rate, are viral barriers, and are associated with faster wound healing and less pain than gauze dressings. Athletic trainers need to assess their wound care protocols so that they give the best possible care to their athletes.
This study was a randomized-controlled trial comparing the standard type of dry dressing, Mepore, with moist wound healing, using a hydrofiber dressing, Aquacel, in primary closed wounds after vascular surgery. The endpoints were patient comfort, cost-effectiveness, infections, wound complications, and length of hospital stay. One hundred and sixty patients were randomized to receive either Mepore or Aquacel dressing. There was no significant difference in patient comfort between the two groups, but a higher cost in the Aquacel group despite significantly fewer changes of dressings in these patients. No difference in the infection rate (13% vs. 11%, p=0.73), length of hospital stay, or wound complications was noted between the two groups. We conclude that although the Aquacel dressing needed significantly fewer changes than the conventional dressing, this did not influence the patient comfort. Moreover, the traditional dressing scheme was significantly less expensive. PMID:17971007
Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed. PMID:23507692
Objective Prospective studies show a 10% incidence of sternal woundinfection (SWI) after 90?days of follow?up, compared with infection rates of 5% reported by the National Nosocomial Infections Surveillance System after only 30?days of follow?up. This incidence increases 2–3 times in high?risk patients. Design Prospective randomised double?blind controlled clinical trial. Setting Cardiothoracic centre, UK. Patients Patients were eligible if they were undergoing median sternotomy for primary isolated coronary artery bypass grafting, with at least one internal thoracic artery used for coronary grafting and having one or more of the following three risk factors: (1) obesity, defined as body mass index 30?kg/m2; (2) diabetes mellitus; or (3) bilateral internal thoracic artery grafts (ie, the use of the other internal thoracic artery). Interventions The study group received a single dose of gentamicin 2?mg/kg, rifampicin 600?mg and vancomycin 15?mg/kg, with three further doses of 7.5?mg/kg at 12?hour intervals. The control group received cefuroxime 1.5?g at induction and three further doses of 750?mg at 8?hour intervals. Main outcome measures The primary end point was the incidence of SWI at 90?days. The secondary end point was the antibiotic and hospital costs. Results During the study period, 486 patients underwent isolated coronary artery bypass grafting with a 30?day SWI of 7.6%. 186 high?risk patients were recruited and analysed: 87 in the study group and 99 in the control group. 90?day SWI was significantly reduced in 8 patients in the study group (9.2%; 95% CI 3.5% to 15.3%) compared with 25 patients in the control group (25.2%; 95% CI 19.5% to 39.4%; p?=?0.004). The study group had a significantly lower cost of antibiotics (21.2% reduction—US$96/patient; p<0.001), and a significantly lower hospital cost (20.4% reduction in cost—US$3800/patient; p?=?0.04). Conclusions Longer and broader?spectrum antibiotic prophylaxis significantly reduces the incidence of SWI in high?risk patients, with a significant economic benefit in costs of antibiotics as well as hospital costs.
CDC group DF-2 is the vernacular name given to a slow-growing gram-negative bacterium that causes septicemia and meningitis in humans. Infections frequently (one-third of cases) occur following dog bites or close contact with dogs or occasionally with cats. Splenectomy and alcoholism appear to be strong predisposing factors for DF-2 infection. In addition to 150 DF-2 strains received for identification, we received 9 DF-2-like strains; 6 were isolated from wound or eye infections, 3 of which were associated with dog bites and 1 of which was associated with a cat scratch, and 3 were isolated from dog mouths. The major characteristics of DF-2 include production of acid but no gas from lactose and maltose and usually D-glucose; positive reactions for oxidase, catalase, arginine dihydrolase, gliding motility, and o-nitrophenyl-beta-D-galactopyranoside; growth enhanced by serum and by incubation in a candle jar atmosphere; and negative reactions for sucrose, raffinose, inulin, melibiose, nitrate reduction, indole, and growth on MacConkey agar. DF-2-like strains had the same characteristics, except that acid was formed from sucrose, raffinose, inulin, and melibiose. By the hydroxyapatite method, DNAs from 12 DF-2 strains were 88% related in 60 degrees C reactions and 84% related in 75 degrees C reactions. Related sequences contained 0.5 to 1.5% unpaired bases (divergence). Three DF-2-like strains were 73 to 80% related at 60 degrees C (with 2.0 to 2.5% divergence) and 68 to 75% related at 75 degrees C. The relatedness of DF-2 and DF-2-like strains was 19 to 31% at 60 degrees Celsius and 13 to 19% at 75 degrees Celsius. The relatedness of DF-2 and DF-2-like strains to Capnocytophaga species was 4 to 7%. The DNA relatedness date indicate that eh DF-2 and the DF-2-like strains are separate, previously undescribed species. Both groups are phenotypically and genetically distinct from Capnocytophaga species, although they do share several characteristics with Capnocytophaga species, including cellular morphology, gliding motility, cellular fatty acid composition, enhancement of growth in a candle jar atmosphere, and G+C content. The new species differ from Capnocytophaga species by their positive oxidase and catalase reactions. We chose to avoid creating a new genus and proposed the names Capnocytophaga canimorsus sp. nov. for group DF-2 and C. cynodegmi sp. nov. for the DF-2-like strains.
Brenner, D J; Hollis, D G; Fanning, G R; Weaver, R E
Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currently
Role of negative pressure dressing and moist wound healing are well established in the treatment of both acute and chronic wounds with certain advantages and disadvantages in both the techniques. Both these techniques prevents wound colonization, but the negative pressure dressing method has proved to have a greater potency to remove secretions, prevent wound invasion and eradication established infection. In both these techniques there is no accessibility to wound environment. Limited access dressing (LAD) is a moist wound dressing with negative pressure. It provides limited access to the wound through two small ports for both dressers and pathogens. The LAD design has notable advantages like wound isolation that reduces chance of wound colonization and safe disposal of infected materials (important factor to reduce hospital-acquired infections), while avoiding some major disadvantages such as opacity of dressing materials, inaccessible offensive smelling wound environment, and relatively high treatment costs. In LAD a definite intermittent negative pressure regimen is followed. The intermittent negative pressure (cycle of 30 minutes suction and 3½ hours rest) is effective. Overall, the LAD is a safe and effective alternative to conventional dressing methods. LAD is an excellent research tool for wound healing as frequent/continuous record of wound healing is possible without disturbing the wound healing process. LAD is an effective dressing for limb salvage in cases of acute and chronic complex wounds. Leech effect prevents wound related systematic response syndrome and sepsis. Suction-assisted dressing (SAD) is a combination of semiocclusive dressing with negative pressure. It works by removal of fluids by intermittent (like LAD) negative pressure and preventing bacterial invasion. SAD is especially advantageous where soakage is less, there is no dead tissue covering the wound (e.g., following skin grafting), superficial skin wounds (e.g., donor area) and also where LAD is technically difficult to apply over circumferential trunk and neck dressings under anesthesia.
Skin-wound healing is an orchestrated biological phenomena consisting of three sequential phases, inflammation, proliferation, and maturation. Many biological substances are involved in the process of wound repair, and this short and simplified overview of wound healing can be adopted to determine wound vitality or wound age in forensic medicine. With the development of genetically engineered animals, essential molecules for skin-wound healing have been identified. Especially, cytokines, and growth factors are useful candidates and markers for the determination of wound vitality or age. Moreover, bone marrow-derived progenitor cells would give significant information to wound age determination. In this review article, some interesting observations are presented, possibly contributing to the future practice of forensic pathologists. PMID:20739128
Background Activin B has been reported to promote the proliferation and migration of keratinocytes in vitro via the RhoA-JNK signaling pathway, whereas its in vivo role and mechanism in wound healing process has not yet been elucidated. Principal Findings In this study, we explored the potential mechanism by which activin B induces epithelial wound healing in mice. Recombinant lentiviral plasmids, with RhoA (N19) and RhoA (L63) were used to infectwounded KM mice. The wound healing process was monitored after different treatments. Activin B-induced cell proliferation on the wounded skin was visualized by electron microscopy and analyzed by 5?-bromodeoxyuridine (BrdU) incorporation assay. Protein expression of p-JNK or p-cJun was determined by immunohistochemical staining and immunoblotting analysis. Activin B efficiently stimulated the proliferation of keratinocytes and hair follicle cells at the wound area and promoted wound closure. RhoA positively regulated activin B-induced wound healing by up-regulating the expression of p-JNK and p-cJun. Moreover, suppression of RhoA activation delayed activin B-induced wound healing, while JNK inhibition recapitulated phenotypes of RhoA inhibition on wound healing. Conclusion These results demonstrate that activin B promotes epithelial wound closure in vivo through the RhoA-Rock-JNK-cJun signaling pathway, providing novel insight into the essential role of activin B in the therapy of wound repair.
Wound problems can often be prevented with careful planning. When transverse incisions are used for knee surgery many years prior to any anticipated knee arthroplasty, no major problems are typically encountered with a conventional, anterior longitudinal incision. We recommend lateral incisions (eg, after a previous lateral tibial plateau fracture) be reused for TKA. When confronted with multiple previous incisions, surgeons would best use the most recently healed or the most lateral. We prefer soft tissue reconstruction with expanders or a gastrocnemius flap if there are multiple incisions, if the skin and scar tissue are adherent to underlying tissue, or if wound healing seems questionable. Deep infection must be determined by aspiration. When present, we believe treatment must include irrigation, débridement, polyethylene exchange if acute, and resection arthroplasty if chronic. Poor wound healing is a potentially devastating complication that may result in multiple reconstructive procedures and even amputation. Early recognition followed by expeditious débridement and soft tissue reconstruction should be used for managing wound complications after TKA. PMID:17079990
The review is based on 34 recent publications. Bullet-wounds by military weapons either in drill or war are to be regarded as special kinds of wounds, needing profound knowledge of wound ballistic. However, the therapy of late developing complications may lead to problems. PMID:437659
Wound management encompasses a number of disciplines. As new concepts and innovative technologies develop within this exciting field, it is important to share them in spite of the divergence of clinical perspectives between the expert disciplines. One such divergence exists between surgeons and nonsurgical wound specialists. As a result, there is a need to develop a common language between these two groups. How can we develop a common language that unites surgical expertise within medical wound management? One route may be through the principles of wound bed preparation, which we believe have great potential for the communication of effective surgical techniques. Another is through sharing our concepts of surgical debridement as it is applied to different wounds by a variety of surgical disciplines. In this monograph, we try to bring these two themes together. We discuss how wound bed preparation has added to our understanding of the pathophysiology of the nonhealing wound and has provided us with some general clinical concepts. We discuss what role debridement, and then specifically surgical debridement, has to play within wound bed preparation, before analyzing the importance of surgical debridement in tissue preservation and the control of infection. We finally look at ongoing work that examines the cost of various surgical debridement techniques. We will also review a new hydrosurgery system (VERSAJET, Smith and Nephew, Hull, UK), which we believe has an important role to play in the surgical preparation of the wound. We also expect that this paper will remind our medical colleagues about the critical role played by surgery in wound management. PMID:16939471
This research seeks to develop non-invasive burn depth evaluation methods from non-contacting visible and near-infrared spectroscopic measurements. In previous years, we demonstrated that features of the optical reflection spectra of burn wounds can be co...
Scarring results from injuries and disease in mammalian adults and can cause pain and loss of function in the afflicted tissues. This negative aspect of wound repair is not always true for certain amphibians and during fetal development of mammals. Based on this knowledge, scientists and clinicians are investigating the mechanisms and growth factors that contribute to or deter a
The article describes main principles of treatment of civilian gunshot wounds: rational organization of medical care to wounded at the prehospital stage, combination of diagnostic and medical process in specialized centers, early detection and eradication of menacing to life consequences of the wound, valuable intensive therapy at all stages of medical care and treatment, the shortest in time and full in volume specialized surgical care. Results of treatment of 507 patients with gunshot injuries of different localization in the clinic of military surgery for the last 15 years show that during this period the amount of such patients rose from 6.4% to 12.2% of all patients with different injuries, slight wounds taking place in 30.8%, of mean gravity--in 7.1%, grave--in 46.4%, critically grave--in 14.9%. Lethality made up 17.2%, incidence of complications--31.2%, duration of hospital treatment was 33 +/- 1.8 days. PMID:9915060
... wash the cut thoroughly with mild soap and water. Use direct pressure to stop the bleeding. Apply antibacterial ointment and a clean bandage that will not stick to the wound. FOR MINOR PUNCTURES ... under running water. Then wash with soap. Look (but do not ...
BACKGROUND: Human chronic liver diseases (CLDs) with different aetiologies rely on chronic activation of wound healing that represents the driving force for fibrogenesis progression (throughout defined patterns of fibrosis) to the end stage of cirrhosis and liver failure. ISSUES: Fibrogenesis progression has a major worldwide clinical impact due to the high number of patients affected by CLDs, increasing mortality rate,
In a consecutive series of 1085 open fractures treated from May 1983 to July 1992, 381 severe compound fractures in 335 patients were managed with the antibiotic bead pouch technique. There were 27 grade I (marked swelling, compartment syndrome), 115 grade II, and 239 grade III open fractures (94 type IIIA, 114 type IIIB, and 31 type IIIC). These fractures were managed with early administration of broad spectrum antibiotics, copious wound irrigation, serial debridements, and external skeletal stabilization. Tobramycin-PMMA beads were placed in the wound, and porous plastic film (Opsite, Smith and Nephew Medical, Limited, Hall, England) covered the soft tissue defect. This dressing was changed every 48 to 72 hours until wound coverage/closure could be obtained. Infection rate, either on an acute or chronic basis, was 2.6% in grade II open fractures and 8.4% in grade III compound fractures. There was no infectedwound or bone in the grade I category. Those fractures that did not develop an infection were closed at a mean time of 7.6 days; those that developed an infection were closed at a mean time of 17.9 days. The difference was statistically significant (P < 0.001). When severe open fractures are managed with the antibiotic bead pouch technique, wound closure should be obtained within 1 week to prevent infectious complications. PMID:8036183