| Enews you can use! |
|
HMPdiabetesWatch.com weekly Enews
Please signup today! |
|
|
|
|
|
|
|
|
Wound Infection
Without proper evaluation and treatment, diabetic wound infections can have severe ramifications and may potentially lead to amputation and death. Diabetes And NutritionSee below for related articles on topics ranging from methicillin resistant Staph aureus (MRSA) and antibiotics for diabetic wound infections to classification systems for diabetic foot infections.
Wound Infections in Repatriated Survivors of the Tsunami Disaster
Abstract: The tsunami of December 26, 2004, had an enormous death toll, and during the aftermath, numerous victims developed severe wound infections. The initial stream of victims was tremendous and had to be managed under extraordinary circumstances, often with too few staff, surgical equipment, and antibiotics, which posed challenges to the treatment of wounds. Wounds were often empirically treated with antibiotics without the support of culture results. The medical literature, Internet, and lay press carried reports of patients being at risk of deadly fungal infections and infections caused by waterborne and highly resistant pathogens. In most cases, these reports concerned only 1 or 2 repatriated travelers. The authors analyzed wound infections, culture results, and resistance patterns seen in 23 repatriated tsunami victims. Wound cultures showed a spectrum of pathogens different from those usually encountered in European hospitals. A combination of waterborne bacteria and a high prevalence of gram-negative bacteria and enteric commensals were found in wound and surveillance cultures. Most wound infections were polymicrobial, and bacteria were often multi-drug resistant. These results might influence the choice of empirical antibiotic treatment as adjunct to the surgical treatment of wound infections in tsunami or future flood victims. In such situations, strict quarantine of repatriated patients with appropriate microbiological assessment on admission is important.
Featured Content from Wounds Research
|
Wound Infections in Two Health Institutions in Ile-Ife, Nigeria: Results of a Cohort Study
The control of wound infections is increasingly complicated, yet treatment is not always guided by microbiological diagnosis. To describe the distribution of wound infections and causative agents, a prospective, 6-month cohort study involving 102 outpatients was conducted at the University Teaching Hospital and the Health Center in Ile-Ife, Nigeria. Location and type of infected wounds were recorded and bacterial isolates were identified by standard microbiological techniques. Almost half (40%) of all infected wounds were attributed to trauma and, in most cases, located on the extremities. Of the 162 bacterial isolates obtained from wound cultures, 39 were monomicrobial and 55 were polymicrobial; no bacterial isolate was obtained in eight cases. Staphylococcus aureus was the predominant micro-organism (25%), followed by Escherichia coli (12%), Pseudomonas aeruginosa (9%), and Staphylococcus epidermidis (9%). The diversity of micro-organisms and the high incidence of polymicrobic flora in this study give credence to the value of identifying one or more bacterial pathogens from wound cultures. The recognition of causative agents of wound infections can assist wound care practitioners in taking appropriate measures. Continuous dialogue between the microbiology department and wound care practitioners is strongly advised in order to improve treatment outcomes and slow the development of antibiotic-resistant bacteria.
Featured Content from Ostomy Wound Management
|
Surgical and Chronic Wound Infection Measurement Outcomes
Surgical and Chronic Wound Infection Measurement Outcomes Evidence Corner: Surgical and Chronic Wound Infection Measurement Outcomes - Laura Bolton, PhD Dear Readers: In this installment of the Evidence Corner, we venture into the world of the infected wound. Clinical Perspective While both surgical and chronic wound infection appear to have no gold standard for diagnosis, at least two symptoms, increasing pain and wound breakdown, were common core symptoms of infection in both surgical and ...
Featured Content from Wounds Research
|
Criteria for Identifying Wound Infection ? Revisited
The accurate identification of wound infection provides a clinical challenge to those involved in patient care and would appear to have not kept pace with other developments in the field of wound care. Attempts have been made to improve on the situation but diverse opinions together with lack of consensus prevail. The literature on infection criteria was reviewed and a set of criteria were collated; a number of criteria at the time were described as subtle in nature and have undergone validation studies. This article suggests a new perspective on the clinical identification of wound infection ? ie, the signs of infection are closely associated with the wound type. Infection criteria for six wound types are explored and presented. This approach is intended for consideration together with the results of an impending Delphi study that will raise awareness of this issue, promote discussion, and lead to validation of an accurate set of clinical criteria. KEYWORDS: clinical criteria, wound infection, Delphi, critical colonization, delayed healing
Featured Content from Ostomy Wound Management
|
Diagnosis of Wound Infections: Current Culturing Practices of U.S. Wound Care Professionals
Abstract: A 34-item questionnaire was distributed to U.S. members of the Association for the Advancement of Wound Care with a response rate of 43 percent (n = 345). Registered nurses, physical therapists, and physicians comprised 79 percent of the respondents. The respondents had an average of 11 years experience in wound care practice with 64 percent of their work time spent in direct wound care activities. Physical/clinical characteristics were the most commonly used method for determining wound infection, while only 39 of respondents (11%) reported they never culture wounds. Of the 306 who reported they do culture at least some wounds, only 12 percent indicated routinely culturing wounds prior to initiating treatment. A greater percentage (20%) did perform cultures after treatment failure. Most respondents reported that the final decision to culture was routinely made by physicians or podiatrists. When a wound is cultured, 54 percent indicated they routinely collect a swab only, while another 42 percent indicated they routinely collect both swab and biopsy specimens, depending on the nature of the wound. The most frequently isolated microorganisms sited by respondents were Pseudomonas aeruginosa, Staphylococcus aureus (S. aureus), Staphylococcus (species not specified), methicillin-resistant S. aureus (MRSA), and Streptococcus. As these organisms have a significant potential for being inherently resistant to antibiotics or developing antimicrobial resistance, determining the antimicrobial susceptibility patterns prior to beginning chemotherapy is recommended.
Featured Content from Wounds Research
|
Critical Colonization ? The Concept under Scrutiny
Infection in chronic wounds presents a major clinical challenge and is a cause of high morbidity rates. Much attention has been dedicated to identifying and managing this problem since the publication of the first article on chronic wound infection criteria in 1994. To illustrate how alteration in wound bioburden impacts pathology, the Wound Infection Continuum has been devised and subsequently modified. One stage in this continuum, critical colonization, is putatively described as a pivotal phase that occurs without inducing an overt host response. Critical colonization suggests that the concept is currently better explained from a microbiological than from a clinical perspective. The status of critically colonized wounds may change in one of several ways: 1) deteriorate to clinical infection, 2) remain in a critically colonized state, or 3) improve following appropriate intervention. Research to clearly define the term and clarify the role of bioburden in the chronic wound is needed to help clinicians recognize and implement appropriate treatment.
Featured Content from Ostomy Wound Management
|
Assessment of Wound Bioburden Development in a Rat Acute Wound Model: Quantitative Swab Versus Tissue Biopsy
Abstract: Controversy remains as to which technique is most appropriate for determining wound bioburden and potential wound infection. The purpose of this study was to determine if a one-point swab collection technique (rayon-tipped swab rotated clockwise three times in center of wound) and tissue biopsy culturing of wounds are comparable for quantifying potential wound flora in a rat wound model. Specimens were collected on the day of surgery and Days 2, 4, or 12 (n=6 or 7) post-surgery. Colony counts were obtained using standard microbiological quantification methods. The average colony count obtained on Day 4 by tissue biopsy sampling was 3.7x107/g and was 2.2x105 by swab culture, resulting in a two-log underestimation of bacterial numbers. A similar underestimation was obtained in Day 12 samples. The trend in colonization of the wound surface versus the wound bed indicated earlier stabilization of bacterial numbers within the wound bed. The average tissue colony count was approximately 107 on both Day 2 and Day 4, whereas swab (surface) counts increased from approximattely 102 to approximately105 from Day 2 to 4. Swab cultures yielded approximately 47-percent similarity in bacterial numbers, and biopsy yielded approximately 65-percent similarity on Days 4 and 12. The 18-percent difference may not be substantial enough difference to affect typical semiquantitative laboratory reports. Additionally, both methods detected the same types of bacteria. These findings indicate that quantitative swab culture techniques may provide useful guidance for initial treatment options, since the same microorganisms were detected regardless of colony counts.
Featured Content from Wounds Research
|
The Wound Infection Continuum and its Application to Clinical Practice
Four basic conditions exist in open wounds resulting from the level of bioburden present (bacterial contamination - normal but short-lived state, colonization - normal state, critical colonization - abnormal state, and infection - abnormal state). The two abnormal states have the potential to disrupt the orderly healing sequence, which results in the development of a chronic wound. In addition, the impact of the wound's anatomical position, duration, shape, or presentation; the patient's level of health and control of underlying pathologies; the presence of infection-potentiating factors such as foreign bodies, hematoma, and necrotic tissue; the sources and frequency of exogenous contamination; the considered virulence of the individual micro-flora species; and the potential synergism between different species all require consideration. This article discusses the states of bioburden and other aspects of microbiology relating to wound infection and their application to clinical practice.
Featured Content from Ostomy Wound Management
|
Bacterial Swabs and the Chronic Wound: When, How, and What Do They Mean
Determining when is far more important than determining how to culture a wound. A wound should be cultured after wound infection has been clinically diagnosed. Wound infection by definition implies that replicating micro-organisms within a wound are having a detrimental effect on the host.
Featured Content from Ostomy Wound Management
|
Bacterial Growth Guideline: Reassessing its Clinical Relevance in Wound Healing
The microbiology of wounds is a key determinant in healing and clinicians generally accept that a level of microbial (ie, bacterial) growth greater than 100,000 viable organisms per gram of tissue can be used to diagnose infection. Although other factors that predispose a wound to infection are widely recognized, today's wound care practitioners are influenced primarily by the 10 5 guideline, with treatment being based on the microbial count in deep or superficial tissue. However, to appropriately manage microbially challenged wounds (eg, heavily colonized and clinically infected), a more balanced awareness of the broader issues relating to micro-organisms and wounds is needed. The types of micro-organisms, their interactions with each other and with the wound environment, the local conditions, and host resistance are all key factors that collectively influence healing. From a microbiological perspective, successful wound healing is dependent on maintaining a host-manageable bioburden. If local conditions favor microbial growth, a wound may fail to heal and become infected, requiring topical antiseptics or antibiotics to supplement the host inflammatory response and restore balance in favor of the host. This paper provides a critical examination of the 10 5 guideline to enhance clinician understanding and utilization of a commonly applied diagnostic consideration.
Featured Content from Ostomy Wound Management
|
|
|
|
