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Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner T, Renata F, Naik-Mathuria B, Liu P, Ead KJ, Adedayo T, Armstrong DG, McMullin N, Balch Samora J, Akingba AG. Management of Acute Wounds - Expert Panel Consensus Statement. Adv Wound Care (New Rochelle) 2024. [PMID: 38618741 DOI: 10.1089/wound.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
SIGNIFICANCE The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. As a first step, a consensus on the treatment of chronic wounds was developed and published in 2022.(1) The current publication on acute wounds represents the second step in this process. Acute wounds may result from any number of conditions, including burns, military and combat operations, and trauma to specific areas of the body. The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis and therapeutic management of acute wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. RECENT ADVANCES Recent advances in the management of acute wounds have centered on stabilization and treatment in the military and combat environment, Specifically advancements in hemostasis, resuscitation, and the mitigation of infection risk through timely initiation of antibiotics and avoidance of high pressure irrigation in contaminated soft tissue injury. . CRITICAL ISSUES Critical issues include infection control, pain management and the unique considerations for the management of acute wounds in pediatric patients. FUTURE DIRECTIONS Future directions include new approaches to preventing the progression and conversion of burns through the use of the microcapillary gel, a topical gel embedded with the anti-inflammatory drug infliximab.(38) Additionally, the use of three-dimensional bioprinting and photo-modulation for skin reconstruction following burns is a promising area for continued discovery.
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Affiliation(s)
- Oluyinka O Olutoye
- Nationwide Children's Hospital, 2650, Surgery, 700 Children's Drive, T6 Administration, Columbus, Columbus, Ohio, United States, 43205
- The Ohio State University, 2647, Surgery, 700 Children's Drive, T6 Administration, Columbus, Ohio, United States, 43210-1132;
| | - Elof Eriksson
- Harvard Medical School, 1811, Plastic & Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Alicia D Menchaca
- Nationwide Children's Hospital, 2650, Pediatric Surgery, 575 Children's Crossroad, Rm 4143, Columbus, Ohio, United States, 43205-2664;
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, United States;
| | - Rica Tanaka
- Juntendo University School of Medicine Graduate School of Medicine, 73362, Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Bunkyo-ku, Tokyo, Japan;
| | - Gregory Schultz
- Institute for Wound Research, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, United States, 32610-0294;
| | - Dot Weir
- Saratoga Hospital for Wound Healing and Hyperbaric Medicine, Saratoga Springs, United States;
| | - Tracey Wagner
- Nationwide Children's Hospital, 2650, Emergency Medicine, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Fabia Renata
- Nationwide Children's Hospital, 2650, Pediatric Surgery , Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Bindi Naik-Mathuria
- The University of Texas Medical Branch at Galveston, 12338, Pediatric Surgery, Galveston, Texas, United States;
| | - Paul Liu
- Brown University/Rhode Island Hospital, Plastic Surgery, 225 Plain Street, Providence, Rhode Island, United States, 02905;
| | - Karim J Ead
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Temitope Adedayo
- Temple University School of Podiatric Medicine, 70068, Philadelphia, Pennsylvania, United States;
| | - David G Armstrong
- University of Southern California Keck School of Medicine, 12223, Los Angeles, California, United States;
| | - Neil McMullin
- Evans Army Community Hospital, 19909, Plastic Surgery, Fort Carson, Colorado, United States;
| | - Julie Balch Samora
- Nationwide Children's Hospital, 2650, Orthopedic Surgery, Columbus, Ohio, United States
- The Ohio State University College of Medicine, 12305, Columbus, Ohio, United States;
| | - Ajibola G Akingba
- VA, 8267, Vascular Surgery , Washington, District of Columbia, United States;
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Abstract
Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.
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Affiliation(s)
- Stéphanie F. Bernatchez
- 3M Health Care, St. Paul, Minnesota, USA.,Correspondence: 3M Health Care, St. Paul, MN 55144-1000, USA
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Abstract
Debridement of devitalised tissue and wound biofilm is vital to promote healing. This article introduces an innovative debridement product, ChloraSolv Wound Debridement Gel, which is as effective as a blade but also selective, atraumatic and fast-acting and does not require specialist training. Its ease of use makes it suitable for all settings and staff.
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Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust and University of Huddersfield
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Gupta P, Mishra P, Mehra L, Rastogi K, Prasad R, Mittal G, Poluri KM. Eugenol-acacia gum-based bifunctional nanofibers as a potent antifungal transdermal substitute. Nanomedicine (Lond) 2021; 16:2269-2289. [PMID: 34569268 DOI: 10.2217/nnm-2021-0274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: Fungal biofilms interfere with the wound healing processes. Henceforth, the study aims to fabricate a biomaterial-based nano-scaffold with the dual functionalities of wound healing and antibiofilm activity. Methods: Nanofibers comprising acacia gum, polyvinyl alcohol and inclusion complex of eugenol in β-cyclodextrin (EG-NF) were synthesized using electrospinning. Antibiofilm studies were performed on Candida species, and the wound-healing activity was evaluated through an in vivo excision wound rat model. Results: The EG-NF potentially eradicated the mature biofilm of Candida species and their clinical isolates. Further, EG-NF also enhanced the re-epithelization and speed of wound healing in in vivo rat experiments. Conclusion: The study established the bifunctional applications of eugenol nanofibers as a transdermal substitute with antifungal potency.
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Affiliation(s)
- Payal Gupta
- Department of Biosciences & Bioengineering, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Purusottam Mishra
- Department of Biosciences & Bioengineering, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Lalita Mehra
- Department of Combat Sciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organisation, Timarpur, 110054, Delhi, India
| | - Kartikey Rastogi
- Department of Combat Sciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organisation, Timarpur, 110054, Delhi, India
| | - Ramasare Prasad
- Department of Biosciences & Bioengineering, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Gaurav Mittal
- Department of Combat Sciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research & Development Organisation, Timarpur, 110054, Delhi, India
| | - Krishna Mohan Poluri
- Department of Biosciences & Bioengineering, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India.,Centre for Nanotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
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A Novel Biofilm-Disrupting Wound Care Technology for the Prevention of Surgical Site Infections Following Total Joint Arthroplasty: A Conceptual Review. Surg Technol Int 2021. [PMID: 34005832 DOI: 10.52198/21.sti.38.os1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgical site infections (SSIs) are a major driver for increased costs following lower extremity joint arthroplasty procedures. It has been estimated that these account for over $2 billion in annual costs in the United States. While many of the current strategies for the prevention and treatment of SSIs target planktonic bacteria, 80 to 90% of bacterial pathogens exist in a sessile state. These sessile bacteria can produce extracellular polymeric substance (EPS) as protective barriers from host immune defenses and antimicrobial agents and thus, can be exceedingly difficult to eradicate. A novel wound care gel that disrupts the EPS and destroys the inciting pathogens has been developed for the treatment and prevention of biofilm-related infections. This is achieved by the simultaneous action of four key ingredients: (1) citric acid; (2) sodium citrate; (3) benzalkonium chloride; and (4) polyethylene glycol. Together, these constituents create a high osmolarity, pH-controlled environment that deconstructs and prevents biofilm formation, while destroying pathogens and promoting a moist environment for optimal wound healing. The available clinical evidence demonstrating the efficacy of this technology has been summarized, as well as the economic implications of its implementation and the authors' preferred method of its use. Due to the multifaceted burden associated with biofilm-producing bacteria in arthroplasty patients, this technology may prove to be beneficial for patients who have higher risks for infection, or perhaps, as a prophylactic measure to prevent infections for all patients.
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Maillard JY, Kampf G, Cooper R. Antimicrobial stewardship of antiseptics that are pertinent to wounds: the need for a united approach. JAC Antimicrob Resist 2021; 3:dlab027. [PMID: 34223101 PMCID: PMC8209993 DOI: 10.1093/jacamr/dlab027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Long before the nature of infection was recognized, or the significance of biofilms in delayed healing was understood, antimicrobial agents were being used in wound care. In the last 70 years, antibiotics have provided an effective means to control wound infection, but the continued emergence of antibiotic-resistant strains and the documented antibiotic tolerance of biofilms has reduced their effectiveness. A range of wound dressings containing an antimicrobial (antibiotic or non-antibiotic compound) has been developed. Whereas standardized methods for determining the efficacy of non-antibiotic antimicrobials in bacterial suspension tests were developed in the early twentieth century, standardized ways of evaluating the efficacy of antimicrobial dressings against microbial suspensions and biofilms are not available. Resistance to non-antibiotic antimicrobials and cross-resistance with antibiotics has been reported, but consensus on breakpoints is absent and surveillance is impossible. Antimicrobial stewardship is therefore in jeopardy. This review highlights these difficulties and in particular the efficacy of current non-antibiotic antimicrobials used in dressings, their efficacy, and the challenges of translating in vitro efficacy data to the efficacy of dressings in patients. This review calls for a unified approach to developing standardized methods of evaluating antimicrobial dressings that will provide an improved basis for practitioners to make informed choices in wound care.
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Affiliation(s)
- Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Günter Kampf
- Institute of Hygiene and Environmental Medicine, University of Greifswald, Germany
| | - Rose Cooper
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
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Cook J, Holmes CJ, Wixtrom R, Newman MI, Pozner JN. Characterizing the Microbiome of the Contracted Breast Capsule Using Next Generation Sequencing. Aesthet Surg J 2021; 41:440-447. [PMID: 32291435 DOI: 10.1093/asj/sjaa097] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent work suggests that bacterial biofilms play a role in capsular contracture (CC). However, traditional culture techniques provide only a limited understanding of the bacterial communities present within the contracted breast. Next generation sequencing (NGS) represents an evolution of polymerase chain reaction technology that can sequence all DNA present in a given sample. OBJECTIVES The aim of this study was to utilize NGS to characterize the bacterial microbiome of the capsule in patients with CC following cosmetic breast augmentation. METHODS We evaluated 32 consecutive patients with Baker grade III or IV CC following augmentation mammoplasty. Specimens were obtained from all contracted breasts (n = 53) during capsulectomy. Tissue specimens from contracted capsules as well as intraoperative swabs of the breast capsule and implant surfaces were obtained. Samples were sent to MicroGenDX Laboratories (Lubbock, TX) for NGS. RESULTS Specimens collected from 18 of 32 patients (56%) revealed the presence of microbial DNA. The total number of positive samples was 22 of 53 (42%). Sequencing identified a total of 120 unique bacterial species and 6 unique fungal species. Specimens with microbial DNA yielded a mean [standard deviation] of 8.27 [4.8] microbial species per patient. The most frequently isolated species were Escherichia coli (25% of all isolates), Diaphorobacter nitroreducens (12%), Cutibacterium acnes (12%), Staphylococcus epidermidis (11%), fungal species (7%), and Staphylococcus aureus (6%). CONCLUSIONS NGS enables characterization of the bacterial ecosystem surrounding breast implants in unprecedented detail. This is a critical step towards understanding the role this microbiome plays in the development of CC. LEVEL OF EVIDENCE: 4
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Treatment with the Pseudomonas aeruginosa Glycoside Hydrolase PslG Combats Wound Infection by Improving Antibiotic Efficacy and Host Innate Immune Activity. Antimicrob Agents Chemother 2019; 63:AAC.00234-19. [PMID: 30988141 DOI: 10.1128/aac.00234-19] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/04/2019] [Indexed: 12/25/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic, nosocomial bacterial pathogen that forms persistent infections due to the formation of protective communities, known as biofilms. Once the biofilm is formed, the bacteria embedded within it are recalcitrant to antimicrobial treatment and host immune defenses. Moreover, the presence of biofilms in wounds is correlated with chronic infection and delayed healing. The current standard of care for chronic wound infections typically involves physical disruption of the biofilm via debridement and subsequent antimicrobial treatment. The glycoside hydrolases PelAh and PslGh have been demonstrated in vitro to disrupt biofilm integrity through degradation of the key biofilm matrix exopolysaccharides Pel and Psl, respectively. Herein, we demonstrate that PslGh hydrolase therapy is a promising strategy for controlling P. aeruginosa wound infections. Hydrolase treatment of P. aeruginosa biofilms resulted in increased antibiotic efficacy and penetration into the biofilm. PslGh treatment of P. aeruginosa biofilms also improved innate immune activity leading to greater complement deposition, neutrophil phagocytosis, and neutrophil reactive oxygen species production. Furthermore, when P. aeruginosa-infected wounds were treated with a combination of PslGh and tobramycin, we observed an additive effect leading to greater bacterial clearance than treatments of tobramycin or PslGh alone. This study demonstrates that PelAh and PslGh have promising therapeutic potential and that PslGh may aid in the treatment of P. aeruginosa wound infections.
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9
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Geraghty T, LaPorta G. Current health and economic burden of chronic diabetic osteomyelitis. Expert Rev Pharmacoecon Outcomes Res 2019; 19:279-286. [PMID: 30625012 DOI: 10.1080/14737167.2019.1567337] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) prevalence is as high as 25% and 40-80% of DFUs become infected (DFI). About 20% of infected ulcers will spread to bone causing diabetic foot osteomyelitis (DFO). DFU costs Medicare $9-13 billion/year. The most expensive costs associated with DFU are inpatient costs and hospital admissions. DFO costs are driven mostly by surgical procedures. DFU patients have a 3-year cumulative mortality rate of 28% and rates approaching 50% in amputated patients. AREAS COVERED This review will summarize the current health and economic burden of DFO covering management, epidemiology, and copious costs associated with DFO. The review began by searching PubMed and Cochrane databases for various terms including, 'diabetic osteomyelitis costs,' 'diabetic foot infection,' and 'diabetes and antibiotics.' Additionally, references from retrieved publications were reviewed. The global burden of DFU calls for investigating new therapeutic options. EXPERT OPINION For DFI, anti-biofilm agents have had success because they directly deliver antimicrobials to the infection site. For DFO, intraosseous (I/O) antibiotic therapy similarly bypasses the issue of vascular disease, will likely have improved therapeutic efficacy, and reduced costs for DFO patients. I/O antibiotic therapy has had clinical success in one case report already, and may significantly improve the lives of those afflicted with DFO.
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Affiliation(s)
- Terese Geraghty
- a Department of Microbial Pathogens & Immunity , Rush University Medical Center , Chicago , IL , USA
| | - Guido LaPorta
- b Department of Foot and Ankle Surgery , Geisinger Community Medical Center , Scranton , PA , USA
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10
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Marson BA, Deshmukh SR, Grindlay DJC, Ollivere BJ, Scammell BE. A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics. Bone Joint J 2018; 100-B:1409-1415. [PMID: 30418057 DOI: 10.1302/0301-620x.100b11.bjj-2018-0720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. MATERIALS AND METHODS Databases were searched to identify eligible studies and 13 were identified for inclusion. RESULTS Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. CONCLUSION There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409-15.
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Affiliation(s)
- B A Marson
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - S R Deshmukh
- Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J C Grindlay
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B J Ollivere
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK and Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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11
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Kalan L, Grice EA. Fungi in the Wound Microbiome. Adv Wound Care (New Rochelle) 2018; 7:247-255. [PMID: 29984114 DOI: 10.1089/wound.2017.0756] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/10/2017] [Indexed: 02/06/2023] Open
Abstract
Significance: Culture-independent methods have revealed the diverse and dynamic bacterial communities that colonize chronic wounds. Only recently have studies begun to examine fungal colonization and interactions with the bacterial component of the microbiome, their relationship with the host, and influence on wound outcomes. Recent Advances: Studies using culture-independent sequencing methods reveal that fungi often go undetected in wounds. Candida spp. and Cladosporidium spp. are the most commonly identified fungi in wounds. The wound environment may promote multispecies biofilm formation between bacteria and fungi in wounds, with implications for pathogenicity, treatment, and outcomes. Critical Issues: Identifying microorganisms that are problematic for healing will require a comprehensive understanding of all members of the polymicrobial wound community, including fungi and bacteria. Improved reference databases and bioinformatics tools for studying fungal communities will stimulate further research into the fungal microbiome. Future Directions: Continued study of polymicrobial wound communities using culture-independent methods will further our understanding of the relationships between microbial bioburden, the host response, and impact on healing, complications, and patient outcomes. Future studies should encompass all types of microbiota, including fungi, and focus on potential multi-kingdom interactions that contribute to pathogenicity, biofilm formation, and poor outcomes.
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Affiliation(s)
- Lindsay Kalan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth A. Grice
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
BACKGROUND As the population grows older, the incidence and prevalence of conditions that lead to a predisposition for poor wound healing also increase. Ultimately, this increase in nonhealing wounds has led to significant morbidity and mortality with subsequent huge economic ramifications. Therefore, understanding specific molecular mechanisms underlying aberrant wound healing is of great importance. It has and will continue to be the leading pathway to the discovery of therapeutic targets, as well as diagnostic molecular biomarkers. Biomarkers may help identify and stratify subsets of nonhealing patients for whom biomarker-guided approaches may aid in healing. METHODS A series of literature searches were performed using Medline, PubMed, Cochrane Library, and Internet searches. RESULTS Currently, biomarkers are being identified using biomaterials sourced locally from human wounds and/or systemically using high-throughput "omics" modalities (genomic, proteomic, lipidomic, and metabolomic analysis). In this review, we highlight the current status of clinically applicable biomarkers and propose multiple steps in validation and implementation spectrum, including those measured in tissue specimens, for example, β-catenin and c-myc, wound fluid, matrix metalloproteinases and interleukins, swabs, wound microbiota, and serum, for example, procalcitonin and matrix metalloproteinases. CONCLUSIONS Identification of numerous potential biomarkers using different avenues of sample collection and molecular approaches is currently underway. A focus on simplicity and consistent implementation of these biomarkers, as well as an emphasis on efficacious follow-up therapeutics, is necessary for transition of this technology to clinically feasible point-of-care applications.
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Trivedi U, Madsen JS, Rumbaugh KP, Wolcott RD, Burmølle M, Sørensen SJ. A post-planktonic era of in vitro infectious models: issues and changes addressed by a clinically relevant wound like media. Crit Rev Microbiol 2016; 43:453-465. [PMID: 27869519 DOI: 10.1080/1040841x.2016.1252312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Medical science is pitted against an ever-increasing rise in antibiotic tolerant microorganisms. Concurrently, during the past decade, biofilms have garnered much attention within research and clinical practice. Although the significance of clinical biofilms is becoming very apparent, current methods for diagnostics and direction of therapy plans in many hospitals do not reflect this knowledge; with many of the present tools proving to be inadequate for accurately mimicking the biofilm phenomenon. Based on current findings, we address some of the fundamental issues overlooked by clinical labs: the paradigm shifts that need to occur in assessing chronic wounds; better simulation of physiological conditions in vitro; and the importance of incorporating polymicrobial populations into biofilm models. In addition, this review considers using a biofilm relevant in vitro model for cultivating and determining the antibiotic tolerance and susceptibility of microorganisms associated with chronic wounds. This model presents itself as a highly rapid and functional tool that can be utilized by hospitals in an aim to improve bedside treatments.
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Affiliation(s)
- Urvish Trivedi
- a Department of Biology, Faculty of Science , Section of Microbiology, University of Copenhagen , Copenhagen , Denmark
| | - Jonas S Madsen
- a Department of Biology, Faculty of Science , Section of Microbiology, University of Copenhagen , Copenhagen , Denmark
| | - Kendra P Rumbaugh
- b Department of Surgery , Texas Tech University Health Sciences Center , Lubbock , TX , USA
| | | | - Mette Burmølle
- a Department of Biology, Faculty of Science , Section of Microbiology, University of Copenhagen , Copenhagen , Denmark
| | - Søren J Sørensen
- a Department of Biology, Faculty of Science , Section of Microbiology, University of Copenhagen , Copenhagen , Denmark
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14
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Affiliation(s)
- R Cooper
- Professor of Microbiology, Centre for Biomedical, Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Western Avenue, Cardiff
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15
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Coakley DN, Shaikh FM, O'Sullivan K, Kavanagh EG, Grace PA, McGloughlin TM. In vitro evaluation of acellular porcine urinary bladder extracellular matrix – A potential scaffold in tissue engineered skin. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.wndm.2015.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Liu J, Zhang P, Tian J, Li L, Li J, Tian JH, Yang K. Ozone therapy for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev 2015; 2015:CD008474. [PMID: 26505864 PMCID: PMC8246444 DOI: 10.1002/14651858.cd008474.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It has been reported that ozone therapy might be helpful in treating foot ulcers in people with diabetes mellitus (DM). OBJECTIVES To assess the effects of ozone therapy on the healing of foot ulcers in people with DM. SEARCH METHODS In March 2015 we searched: The Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Science Citation Index, Chinese Biomedical Literature Database and The Chinese Clinical Registry. There were no restrictions based on language, date or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared ozone therapy with sham ozone therapy or any other interventions for foot ulcers in people with DM, irrespective of publication date or language. DATA COLLECTION AND ANALYSIS Two reviewers independently screened all retrieved citations, selected relevant citations and extracted data. Disagreements were resolved by discussion with a third reviewer. The methodological quality of included studies and the evidence level of outcomes were assessed using the Cochrane risk of bias tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach respectively. Data were expressed using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with their 95% confidence interval (95% CI). Review Manager (RevMan) software was used to analyse the data. MAIN RESULTS Three studies (212 participants) were included in this review. The overall risk of bias was high for two trials and unclear for one.One trial (101 participants) compared ozone treatment with antibiotics for foot ulcers in people with DM. The study had a follow-up period of 20 days. This study showed that ozone treatment was associated with a greater reduction in ulcer area from baseline to the end of the study than treatment with antibiotics (MD -20.54 cm(2), 95% CI -20.61 to -20.47), and a shorter duration of hospitalisation (MD -8.00 days, 95% CI -14.17 to -1.83), but did not appear to affect the number of ulcers healed over 20 days (RR 1.10, 95% CI 0.87 to 1.40). No side effects were observed in either group.The other two trials (111 participants) compared ozone treatment plus usual care with usual care for foot ulcers in people with DM. The meta-analysis results did not show evidence of a difference between groups for the outcomes of reduction of ulcer area (MD -2.11 cm(2), 95% CI -5.29 to 1.07), the number of ulcers healed (RR 1.69, 95% CI 0.90 to 3.17), adverse events (RR 2.27, 95% CI 0.48 to 10.79), or amputation rate (RR 2.73, 95%CI 0.12, 64.42). AUTHORS' CONCLUSIONS The available evidence was three small RCTs with unclear methodology, so we are unable to draw any firm conclusions regarding the effectiveness of ozone therapy for foot ulcers in people with DM.
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Affiliation(s)
- Jian Liu
- The First Hospital of Lanzhou UniversityCritical Care Medicine DepartmentNo 1 Donggang West RoadLanzhou CityGansuChina730000
| | - Peng Zhang
- Nanyang Central HospitalDepartment of Pediatric SurgeryNanyangHenanChina473000
| | - Jing Tian
- Nanyang Central HospitalNanyangHenanChina473000
| | - Lun Li
- The Second Xiangya Hospital of Central South UniversityDepartment of Breast‐Thyroid SurgeryChangshaChina
| | - Jun Li
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - Jin Hui Tian
- Lanzhou UniversityEvidence‐Based Medicine Center, School of Basic Medical SciencesNo. 199, Donggang West RoadLanzhou CityGansuChina730000
| | - KeHu Yang
- Lanzhou UniversityKey Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu ProvinceNo. 199, Donggang West RoadLanzhou CityGansuChina730000
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