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Marcolina M, Williams ZJ, Hendrickson D, Pezzanite LM. Evaluation of Sterility of Saline Formulations Manufactured for Wound Care in Veterinary Practice. Vet Sci 2025; 12:431. [PMID: 40431524 PMCID: PMC12115887 DOI: 10.3390/vetsci12050431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Revised: 04/20/2025] [Accepted: 04/28/2025] [Indexed: 05/29/2025] Open
Abstract
The discontinuation of commercially available saline and hypertonic saline wound dressings for the veterinary market has restricted options available to veterinary practitioners treating contaminated and infected wounds. Clinicians may manufacture their own homemade solutions in clinics or field settings to treat equine or livestock species; however, information is limited on whether autoclave sterilization is necessary or sufficient to eliminate bacterial growth in isotonic and concentrated salt solutions and how long they may subsequently be stored prior to use. The purpose of this study was to assess sterility of saline (0.9%) and hypertonic saline (20%) solutions manufactured three ways (1-autoclaved glass bottle that was autoclaved again following solution preparation; 2-autoclaved glass bottle, not autoclaved again following preparation; 3-non-autoclaved plastic bottle, not autoclaved following preparation). Solutions were stored two different ways (1-solution in sealed bottle or 2-soaked gauze in vacuum-sealed plastic packets). Products were assessed for bacterial growth at four time points (baseline, one week, one month, six months). At each time point, samples of each solution were plated on Luria-Bertani (LB) agar plates and assessed for bacterial growth at 24 h. Vacuum-sealed soaked gauze was placed in antibiotic-free growth media for 24 h, and then media were plated on LB agar plates and assessed for bacterial growth at 24 h. If bacterial growth was detected, qualitative culture with sensitivity was performed to identify bacterial isolates. No bacterial growth was detected in stored solutions for any preparation method, concentration or time point assessed. Bacterial growth was detected from 0.9% saline-soaked gauze at 1 week, 1 month and 6 months in all container types for at least one time point. Bacterial culture revealed Ralstonia, Bacillus, Sphingomonas and Staphylococcus species. Environmental controls (water, containers, salt, biosafety cabinet and benchtop) were submitted for culture to identify the source of contamination, yielding light mixed growth from tap water and no growth from any other locations. These findings provide clinicians with practical information to guide preparation and storage of homemade saline-based products for wound care.
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Affiliation(s)
| | | | - Dean Hendrickson
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Lynn M. Pezzanite
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Li Y, Cai M, Li N, Zhang H, Huang E, Zhao J, Jin M, Zhang L. The value of slough in wounds for the diagnosis of microbiology cultivation. Wound Repair Regen 2025; 33:e70002. [PMID: 39924720 DOI: 10.1111/wrr.70002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 01/05/2025] [Accepted: 01/31/2025] [Indexed: 02/11/2025]
Abstract
Slough is not currently a recommended microbiology culture specimen. The aim of our work is to analyse the concordance of results between slough and swab samples for cultures. A single-centre, retrospective, cross-sectional study involving patients (n = 131) with hard to heal wounds was conducted from October 2022 to October 2023. Pairs of slough and swab samples were collected for microbiological analysis and subdivided depending on whether a relatively clean wound bed was obtained. Swab samples were collected using the Levine and deep pus methods, Cohen's κ coefficients calculated to evaluate concordance, and microbiological agreement analysed. Gram-stain results did not differ significantly between slough and swab samples (𝜒2 = 329.287, p = 0.688; concordance, κ = 0.879, p < 0.001); microbiological agreement was 90.1%. Samples from 87 patients with relatively clean wound beds generated excellent concordance between slough and Levine technique (κ = 0.867, p < 0.001; microbiological agreement, 89.7%). In 44 patients with slough and deep pus swab where a relatively clean wound bed could not be obtained, Gram-stain also demonstrated excellent concordance (κ = 0.898, p < 0.001; microbiology agreement, 90.9%). Our data provide evidence that slough is a reliable wound specimen from hard to heal wounds for microbiology culture.
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Affiliation(s)
- Yunfeng Li
- Department of Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Meng Cai
- Department of Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Ershun Huang
- Department of Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Jinghui Zhao
- Department of Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Mei Jin
- Department of Wound Healing Center, Peking University Third Hospital, Beijing, China
| | - Long Zhang
- Department of Wound Healing Center, Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
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Karaubayeva AA, Bekezhanova T, Zhaparkulova K, Susniak K, Sobczynski J, Kazimierczak P, Przekora A, Skalicka-Wozniak K, Kulinowski Ł, Glowniak-Lipa A, Sakipova ZB, Korona-Głowniak I. Antimicrobial Mixture Based on Micronized Kaolinite and Ziziphora Essential Oil as a Promising Formulation for the Management of Infected Wounds. Int J Mol Sci 2024; 25:13192. [PMID: 39684902 DOI: 10.3390/ijms252313192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 12/02/2024] [Accepted: 12/05/2024] [Indexed: 12/18/2024] Open
Abstract
Kaolinite stands out as a promising natural geomaterial for developing new therapeutic systems aimed at addressing global health challenges, such as multidrug-resistant infections. In this study, we report on the formulation and biological activity of a therapeutic mixture composed of white micronized kaolinite (KAO) and Ziziphora essential oil (ZEO), intended for topical application on infected wounds. GC-MS analysis revealed that the primary component of ZEO is pulegone, constituting 72.98% of the oil. ZEO demonstrated good bioactivity against bacterial and fungal strains (MIC 1.25-5 mg/mL). Additionally, ZEO at a concentration of 0.0156% (0.156 mg/mL) was found to significantly stimulate collagen synthesis. The antimicrobial activity of the tested KAO-ZEO mixture formulation (30% KAO/0.25% ZEO in an excipient base) showed the highest effectiveness against Candida spp. (MIC 0.08-25 mg/mL) and Gram-positive bacteria (MIC 0.16-25 mg/mL), with lower activity against Gram-negative bacteria (MIC 25-50 mg/mL). Moreover, the KAO-ZEO mixture was nontoxic (cell viability near 100%) to human skin fibroblasts according to the ISO 10993-5 standard and promoted collagen synthesis by skin cells. This is the first documented formulation combining KAO and ZEO, demonstrating significant antimicrobial properties along with the ability to stimulate collagen production in fibroblasts. These properties highlight KAO-ZEO as a promising novel treatment, which may synergize with current care standards and improve wound healing outcomes.
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Affiliation(s)
- Aigerim A Karaubayeva
- School of Pharmacy, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan
| | - Tolkyn Bekezhanova
- School of Pharmacy, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan
| | - Karlygash Zhaparkulova
- School of Pharmacy, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan
| | - Katarzyna Susniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jan Sobczynski
- Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Lublin, Chodźki St. 7, 20-093 Lublin, Poland
| | - Paulina Kazimierczak
- Department of Tissue Engineering and Regenerative Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Agata Przekora
- Department of Tissue Engineering and Regenerative Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | | | - Łukasz Kulinowski
- Department of Natural Products Chemistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Anna Glowniak-Lipa
- Department of Cosmetology, University of Information Technology and Management in Rzeszów, Sucharskiego 2, 35-225 Rzeszow, Poland
| | - Zuryiadda B Sakipova
- School of Pharmacy, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland
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Münter KC, Lázaro-Martínez JL, Kanya S, Sawade L, Schwenke C, Pegalajar-Jurado A, Swanson T, Leaper D. Clinical efficacy and safety of a silver ion-releasing foam dressing on hard-to-heal wounds: a meta-analysis. J Wound Care 2024; 33:726-736. [PMID: 39388210 DOI: 10.12968/jowc.2024.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
OBJECTIVE Delayed or stalled healing in open wounds can result from persisting chronic inflammation related to infection and/or persistent bacterial colonisation and biofilm. Treatment of hard-to-heal wounds focuses on debridement and exudate management, but also on infection prevention and control. Silver dressings have been evaluated in randomised clinical trials (RCTs); this meta-analysis evaluated the efficacy and safety of a silver ion-releasing foam dressing (Biatain Ag; Coloplast A/S, Denmark) to treat hard-to-heal wounds. METHOD Literature databases (PubMed and Cochrane Library) were searched for studies on silver ion-releasing foam dressings in the treatment of hard-to-heal wounds. Individual patient data from four RCTs were obtained and included in the meta-analysis. RESULTS Findings showed that treatment with the silver ion-releasing foam dressing was associated with a significantly higher relative reduction in wound area after four (least squares-mean difference (LS-MD): -12.55%, 95% confidence interval (CI): (-15.95, -9.16); p<0.01) and six weeks of treatment (LS-MD: -11.94%, 95%CI: (-17.21, -6.68); p<0.01) compared with controls. Significant benefits were also observed for time to disappearance of odour (hazard ratio: 1.61, 95%CI: (1.31, 1.98); p<0.01), relative reduction of exudate (LS-MD: -5.15, 95%CI: (-7.36, -2.94); p<0.01), proportion of patients with periwound erythema (relative risk (RR): 0.81, 95%CI: (0.69; 0.94); p<0.01), and less pain at dressing removal (LS-MD: -0.35, 95%CI: (-0.63, -0.06); p=0.02). No differences regarding safety outcomes were identified. CONCLUSION This meta-analysis has demonstrated beneficial outcomes and a good tolerability profile for silver ion-releasing foam dressings in the treatment of moderate-to-highly exuding wounds with delayed healing compared with control dressings.
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Affiliation(s)
| | | | - Susanne Kanya
- Wound and Skin Care Region DACH, Coloplast GmbH, Hamburg, Germany
| | | | | | | | - Terry Swanson
- South West Healthcare, Warrnambool, Victoria, Australia
| | - David Leaper
- University of Newcastle, UK
- University of Huddersfield, UK
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Mayer P, Smith AC, Hurlow J, Morrow BR, Bohn GA, Bowler PG. Assessing Biofilm at the Bedside: Exploring Reliable Accessible Biofilm Detection Methods. Diagnostics (Basel) 2024; 14:2116. [PMID: 39410520 PMCID: PMC11475494 DOI: 10.3390/diagnostics14192116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 10/20/2024] Open
Abstract
INTRODUCTION Biofilm is linked through a variety of mechanisms to the pathogenesis of chronic wounds. However, accurate biofilm detection is challenging, demanding highly specialized and technically complex methods rendering it unapplicable for most clinical settings. This study evaluated promising methods of bedside biofilm localization, fluorescence imaging of wound bacterial loads, and biofilm blotting by comparing their performance against validation scanning electron microscopy (SEM). METHODS In this clinical trial, 40 chronic hard-to-heal wounds underwent the following assessments: (1) clinical signs of biofilm (CSB), (2) biofilm blotting, (3) fluorescence imaging for localizing bacterial loads, wound scraping taken for (4) SEM to confirm matrix encased bacteria (biofilm), and (5) PCR (Polymerase Chain Reaction) and NGS (Next Generation Sequencing) to determine absolute bacterial load and species present. We used a combination of SEM and PCR microbiology to calculate the diagnostic accuracy measures of the CSB, biofilm blotting assay, and fluorescence imaging. RESULTS Study data demonstrate that 62.5% of wounds were identified as biofilm-positive based on SEM and microbiological assessment. By employing this method to determine the gold truth, and thus calculate accuracy measures for all methods, fluorescence imaging demonstrated superior sensitivity (84%) and accuracy (63%) compared to CSB (sensitivity 44% and accuracy 43%) and biofilm blotting (sensitivity 24% and accuracy 40%). Biofilm blotting exhibited the highest specificity (64%), albeit with lower sensitivity and accuracy. Using SEM alone as the validation method slightly altered the results, but all trends held constant. DISCUSSION This trial provides the first comparative assessment of bedside methods for wound biofilm detection. We report the diagnostic accuracy measures of these more feasibly implementable methods versus laboratory-based SEM. Fluorescence imaging showed the greatest number of true positives (highest sensitivity), which is clinically relevant and provides assurance that no pathogenic bacteria will be missed. It effectively alerted regions of biofilm at the point-of-care with greater accuracy than standard clinical assessment (CSB) or biofilm blotting paper, providing actionable information that will likely translate into enhanced therapeutic approaches and better patient outcomes.
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Affiliation(s)
- Perry Mayer
- The Mayer Institute (TMI), Hamilton, ON L8R 2R3, Canada
| | - Allie Clinton Smith
- Department of Honors Studies, Texas Tech University, Lubbock, TX 79409, USA;
| | - Jennifer Hurlow
- Consultant Wound Care Specialized Nurse Practitioner, Memphis, TN 38120, USA;
| | - Brian R. Morrow
- College of Dentistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Gregory A. Bohn
- The American Professional Wound Care Association (APWCA), American Board of Wound Healing, Milwaukee, WI 53214, USA
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Trafelet N, Johnson S, Schroder J, Serena TE. Audit of Antimicrobial Prescribing Trends in 1447 Outpatient Wound Assessments: Baseline Rates and Impact of Bacterial Fluorescence Imaging. Diagnostics (Basel) 2024; 14:2034. [PMID: 39335713 PMCID: PMC11431003 DOI: 10.3390/diagnostics14182034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: In the field of wound care, the prescription of antibiotics and antimicrobials is haphazard and irrational, which has led to unchecked overprescribing. Recent Joint Commission guidelines mandate that hospital outpatient clinics develop and implement antimicrobial stewardship programs (ASPs). Yet few ASPs exist in wound clinics across the United States (US). Understanding baseline prescribing practices and rates in the US is a critical first step toward rational antimicrobial use and effective ASPs. Methods: This prospective study was conducted across eight outpatient wound clinics from January-December 2022. Data from consecutive patients attending single-time-point initial visits were recorded, including clinical findings, antimicrobial prescribing trends, and sampling practices. Results: A total of 1438 wounds were included; 964 were assessed by clinical examination (standard of care, SoC), and 474 by clinical examination plus fluorescence imaging. SoC patients were prescribed more concurrent medications on average than fluorescence patients (1.4 vs. 1 per patient). Prescriptions were preferentially topical in the fluorescence group (92% vs. 64%, p > 0.0001), and systemic antibiotics represented 36% of the single items prescribed under SoC (vs. 8% in fluorescence group p < 0.0001). Conclusions: Fluorescence imaging provided objective and actionable information at the bedside, which led to a decrease in the use of antibiotics. Real-time diagnostic technologies are essential in establishing a meaningful ASP.
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Affiliation(s)
- Nancy Trafelet
- SerenaGroup® Inc., 125 Cambridge Park Drive Suite 301, Cambridge, MA 02140, USA
| | - Scott Johnson
- Ascension Via Christi Wound Center, Wichita, KS 67214, USA
| | - Jill Schroder
- SerenaGroup® Inc., 125 Cambridge Park Drive Suite 301, Cambridge, MA 02140, USA
| | - Thomas E Serena
- SerenaGroup® Inc., 125 Cambridge Park Drive Suite 301, Cambridge, MA 02140, USA
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Pham E, Reynolds-Reber L, Navarro S, Hamood A, Jones-Donaldson LM, Smith AC. Determination of the Course of Cyan Fluorescence of Pseudomonas aeruginosa with a Handheld Bacterial Imaging Device. Diagnostics (Basel) 2024; 14:1474. [PMID: 39061611 PMCID: PMC11276341 DOI: 10.3390/diagnostics14141474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
Chronic wound infections are of clinical concern as they often lead to high rates of mortality and morbidity. A point-of-care handheld bacterial fluorescence imaging has been designed to detect the auto-fluorescent characteristics of most clinically relevant species of bacteria. This device causes most species of bacteria to exhibit red fluorescence due to the production of exoproduct porphyrins. One of the most significant contributors to the pathogenicity of chronic wounds is the pathogen Pseudomonas aeruginosa, and interestingly, this organism exhibits an additional unique cyan fluorescence signature. There is an over 90% positive predictive value that, when a chronic wound exhibits cyan fluorescence with the bacterial fluorescence imaging device, the wound will harbor P. aeruginosa. This project seeks to understand what genetic factor(s) contribute to the cyan phenotype observed.
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Affiliation(s)
- Emily Pham
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA;
| | | | - Stephany Navarro
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (S.N.); (A.H.)
| | - Abdul Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; (S.N.); (A.H.)
| | | | - Allie Clinton Smith
- Department of Honors Studies, Texas Tech University, Lubbpock, TX 79409, USA
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Bhatt P, Sharpe A, Staines K, Wallace N, Withers A. Topical desiccating agent (DEBRICHEM): an accessible debridement option for removing biofilm in hard-to-heal wounds. J Wound Care 2024; 33:S4-S11. [PMID: 38752844 DOI: 10.12968/jowc.2024.33.sup5b.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
It is now assumed that all hard-to-heal wounds contain biofilm. Debridement plays a key role in wound-bed preparation, as it can remove biofilm along with the devitalised tissue, potentially leaving a clean wound bed that is more likely to progress towards healing. The gold standard methods of debridement (surgical and sharp) are the least used, as they require specialist training and are often not readily available at the point of need. Most other methods can be used by generalists but are slower. They all need regular applications. The topical desiccating agent DEBRICHEM is an innovative alternative, as it is fast, effective and can be used in all clinical settings, as well as typically requiring only a single use. This article describes best practice for achieving optimal outcomes with its use.
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Affiliation(s)
- Priti Bhatt
- Community Tissue Viability Lead, Guy's and St Thomas' NHS Foundation Trust
| | - Andrew Sharpe
- Advanced Podiatrist, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust
| | | | - Nicola Wallace
- Leg Ulcer Clinical Nurse specialist, Central London Community Healthcare NHS Trust
| | - Amy Withers
- Lead Tissue Viability Nurse, Acute Services, Manchester University NHS Foundation Trust
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Mihai MM, Popa MI, Holban AM, Gheorghe-Barbu I, Popa LG, Chifiriuc MC, Giurcăneanu C, Bleotu C, Cucu CI, Lazăr V. Clinical and microbiological features of host-bacterial interplay in chronic venous ulcers versus other types of chronic skin ulcers. Front Microbiol 2024; 14:1326904. [PMID: 38375067 PMCID: PMC10875999 DOI: 10.3389/fmicb.2023.1326904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Chronic venous ulcers of the lower limbs develop in the context of advanced venous disease and have a significant impact on the patient's quality of life, being associated with depression and worrisome suicide rates, as well as with an economic burden caused by increased medical care costs and high epidemiological risks of healthcare associated infections and emergence of strains resistant to multiple classes of antibiotics and/ or antiseptics. Although numerous studies have investigated the composition of the chronic wounds microbiome, either by culture-dependent or independent methods, there are no data on the association between virulence and resistance profiles of strains isolated from venous ulcers and the clinical picture of this pathology. The elucidation of pathogenic mechanisms, at both phenotypic and molecular level, is crucial in the fight against these important human microbial agents, in order to develop novel biomarkers and discover new therapeutic targets. Methods In this study we aimed to characterize the phenotypic virulence profiles (including the ability to develop biofilms) of microorganisms isolated from chronic skin wounds and to correlate them with the clinical symptomatology. Considering the high incidence of Staphylococcus aureus infections in chronic ulcers, but also the ability of this species to develop multi-drug resistance, we performed an more in-depth study of the phenotypic and genotypic virulence profiles of methicillin-resistant Staphylococcus. Results The study revealed important differences regarding the clinical evolution and virulence profiles of microorganisms isolated from lower limb wounds, as well as between patients diagnosed with chronic venous ulcers and those with lesions of different etiology.
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Affiliation(s)
- Mara Mădălina Mihai
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Mircea Ioan Popa
- Department of Microbiology—“Cantacuzino” Institute, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Maria Holban
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Irina Gheorghe-Barbu
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mariana-Carmen Chifiriuc
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Coralia Bleotu
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
- Cellular and Molecular Department, “Ştefan S. Nicolau” Institute of Virology, Bucharest, Romania
| | - Corina Ioana Cucu
- Department of Oncologic Dermatology–“Elias” University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Veronica Lazăr
- Department of Botany-Microbiology, Faculty of Biology, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
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Algharib A, van Dortmont LMC, Hendrix MGR, Riedel S, Möller R, Koning GG. Innovative biochemisurgical treatment for stabilisation of an end-stage chronic wound in a complex vascular compromized patient. Int J Surg Case Rep 2024; 114:109103. [PMID: 38103319 PMCID: PMC10770582 DOI: 10.1016/j.ijscr.2023.109103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Treating advanced peripheral arterial occlusive disease (e.g. PAOD IV) poses a significant challenge, as conventional treatments quite often fall short at this stage. However, a range of interventions can be considered to postpone amputation. This study presents an example of advanced stage of Peripheral Artery Occlusive Disease (PAOD) stage IV, encompassing a history of a high thigh amputation on the left side, coupled with pronounced wound healing disorders. PRESENTATION OF CASE Our patient, 55 years old, smoker and ASA Class III is in a left sided above-the knee-amputation situation. He presented to our outpatient clinic with blistering in the stump area, caused by non-proportinate pressure from the prosthesis. With an emerging septic course and advanced peripheral arterial occlusive disease (PAOD) at Fontaine class IV, revascularization was unfeasible in the left iliac artery axis and groin arteries. Additionally, a stage PAOD IV presents itself with poorly healing wounds on the right side which our patient still uses to support his transfers in and out bed and his wheelchair. Multiple surgical stump revisions and femur shortenings and diverse wound treatments were performed all were unsatisfying for patient and practitioners. We introduced a novel biochemisurgical treatment in our teaching hospital. DISCUSSION Desiccating-agent-A is an innovative dehydrating agent with potent desiccating characteristics upon application to organic substances. Its formulation involves blending 83% methane sulfonic acid with proton acceptors and dimethyl sulfoxide, as outlined in patent application. The case description results in an illustrated follow up period of 16 months and is presented in line with the recommendations of the consensus-based surgical case reporting guideline development. CONCLUSION The goal of achieving a secondary healing trend is to establish stability within the wound area or achieve complete healing. This endeavor becomes particularly intricate when severe blood circulation compromise exists. Nonetheless, progress in wound treatment measures has made it feasible to achieve this aim by fostering the formation of dry and clean necrotic tissue. This dry and clean wound is now manageable in a patient's home situation, allowing for effective care and a better chance at preventing further severe complications.
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Affiliation(s)
- A Algharib
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany.
| | - L M C van Dortmont
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - M G R Hendrix
- Department of Medical Microbiology, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - S Riedel
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - R Möller
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
| | - G G Koning
- Department of Vascular & Endovascular Surgery, EUREGIO Hospital, Albert-Schweitzer-Straße 10, 48527 Nordhorn, Niedersachsen, Germany
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Liu R, Zhai L, Feng S, Gao R, Zheng J. Research frontiers and hotspots in bacterial biofilm wound therapy: bibliometric and visual analysis for 2012-2022. Ann Med Surg (Lond) 2023; 85:5538-5549. [PMID: 37915709 PMCID: PMC10617850 DOI: 10.1097/ms9.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023] Open
Abstract
Background Bacterial biofilms, which can protect bacteria from host immune response and drug attack, are an important factor in the difficult healing of chronic wound infection, which has become a major problem in medical development. This paper aimed to analyze literature related to bacterial biofilm wound treatment published between 2012 and 2022 using bibliometric and visual analysis. Methods Publications related to bacterial biofilm wound treatment from 2012 to 2022 were selected from the Web of Science Core Collection. Microsoft Excel 2021, bibliometrics, CiteSpace6.1, and VOSviewer1.6.18 were used to extract and analyze data. Results A total of 940 articles were published between 2012 and 2022, with the United States being the leading country (with 302 papers, 32.13%) and the University of Copenhagen in Denmark being the leading institution (with 26 published articles) in the field. Steven L Percival, a British academic, published the most articles (14). In the field of bacterial biofilm wound treatment, keywords suggested that the research gradually transitioned from lower limb venous ulcer, negative pressure-assisted healing to chronic wound, in-vitro bacterial biological model research, and then to the development of more microscopic and more advanced technologies such as antibacterial activity and nanomaterials. "Nanoparticles", "inhibition/antibacterial", "delivery", "gold nanoparticles", "hydrogel", "wound healing", etc., may become new research hotspots in this field. Conclusion There is a lack of specific and effective treatment methods for diagnosing and treating bacterial biofilms in wounds. Through the development of multidisciplinary cooperation, early diagnosis and treatment of bacterial biofilms in wounds can be achieved. These data may provide a useful reference for scholars studying more effective bacterial biofilm wound treatment.
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Affiliation(s)
| | | | | | | | - Jie Zheng
- Department of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
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12
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Lu Z, Yu D, Nie F, Wang Y, Chong Y. Iron Nanoparticles Open Up New Directions for Promoting Healing in Chronic Wounds in the Context of Bacterial Infection. Pharmaceutics 2023; 15:2327. [PMID: 37765295 PMCID: PMC10537899 DOI: 10.3390/pharmaceutics15092327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Metal nanoparticles play an outstanding role in the field of wound healing due to their excellent properties, and the significance of iron, one of the most widely used metals globally, cannot be overlooked. The purpose of this review is to determine the importance of iron nanoparticles in wound-healing dressings. Prolonged, poorly healing wounds may induce infections; wound infections are a major cause of chronic wound formation. The primary components of iron nanoparticles are iron oxide nanoparticles, which promote wound healing by being antibacterial, releasing metal ions, and overcoming bacterial resistance. The diameter of iron oxide nanoparticles typically ranges between 1 and 100 nm. Magnetic nanoparticles with a diameter of less than 30 nm are superparamagnetic and are referred to as superparamagnetic iron oxide nanoparticles. This subset of iron oxide nanoparticles can use an external magnetic field for novel functions such as magnetization and functionalization. Iron nanoparticles can serve clinical purposes not only to enhance wound healing through the aforementioned means but also to ameliorate anemia and glucose irregularities, capitalizing on iron's properties. Iron nanoparticles positively impact the healing process of chronic wounds, potentially extending beyond wound management.
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Affiliation(s)
- Zhaoyu Lu
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China; (Z.L.); (D.Y.); (F.N.)
- Department of General Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
| | - Dong Yu
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China; (Z.L.); (D.Y.); (F.N.)
- Department of General Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
| | - Fengsong Nie
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China; (Z.L.); (D.Y.); (F.N.)
- Department of General Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
| | - Yang Wang
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225000, China
| | - Yang Chong
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China; (Z.L.); (D.Y.); (F.N.)
- Department of General Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225000, China
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13
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Holubová A, Chlupáčová L, Krocová J, Cetlová L, Peters LJF, Cremers NAJ, Pokorná A. The Use of Medical Grade Honey on Infected Chronic Diabetic Foot Ulcers-A Prospective Case-Control Study. Antibiotics (Basel) 2023; 12:1364. [PMID: 37760661 PMCID: PMC10525154 DOI: 10.3390/antibiotics12091364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Non-healing wounds are usually colonised and contaminated by different types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical grade honey (MGH). MGH has antioxidant, antimicrobial, anti-inflammatory, and immunomodulatory features. This study aims to evaluate the effect of MGH therapy on infected non-healing wounds, especially for diabetic foot syndrome. Prospective, observational case series (n = 5) of patients with wounds of diabetic foot syndrome are presented. There were five males with an average age of 61.6 years. All wounds were treated with MGH, and the healing trajectory was rigorously and objectively monitored. In all cases, there was a gradual disappearance of odour, pain, and exudation. Moreover, the wound areas significantly reduced within 40 days and there was a decrease in glycated haemoglobin and glycaemia values. All these outcomes resulted in improved quality of life of the patients. Despite bacterial colonisation, antibiotic treatment was not necessary. All wounds were completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in diabetic foot syndrome wounds, does not increase glycated haemoglobin or glycaemia levels, and thus constitutes an effective alternative to the use of antibiotics in the treatment of locally infected wounds.
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Affiliation(s)
- Adéla Holubová
- Faculty of Health and Social Sciences, University of South Bohemia, 370 11 České Budějovice, Czech Republic;
- DiaPodi Care, spol. s r.o., 392 01 Soběslav, Czech Republic;
| | | | - Jitka Krocová
- Department of Nursing and Midwifery, Faculty of Health Studies, University of West Bohemia, 301 00 Pilsen, Czech Republic;
| | - Lada Cetlová
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
| | | | - Niels A. J. Cremers
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, The Netherlands;
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Andrea Pokorná
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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14
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Hermans M. Introducing a desiccant debridement agent: as effective as a blade, as easy as a pad. J Wound Care 2023; 32:S11-S12. [PMID: 36971482 DOI: 10.12968/jowc.2023.32.sup3b.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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15
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Ousey K, Ovens L. Comparing methods of debridement for removing biofilm in hard-to-heal wounds. J Wound Care 2023; 32:S4-S10. [PMID: 36971485 DOI: 10.12968/jowc.2023.32.sup3b.s4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Karen Ousey
- Professor and Director of the Institute of Skin Integrity and Infection Prevention, University of Huddersfield
| | - Liz Ovens
- Independent Tissue Viability Specialist Nurse
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16
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Esin S, Kaya E, Maisetta G, Romanelli M, Batoni G. The antibacterial and antibiofilm activity of Granudacyn in vitro in a 3D collagen wound infection model. J Wound Care 2022; 31:908-922. [DOI: 10.12968/jowc.2022.31.11.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: It is widely agreed that infection and the formation of biofilms play a major role in increasing inflammation and delaying wound healing. The aim of this study was to evaluate, in vitro, the antimicrobial activity of the wound irrigation solution, Granudacyn (Mölnlycke Health Care AB, Sweden) against planktonic bacteria and mature biofilms of clinically relevant bacterial species. Method: Quantitative evaluation of bacterial numbers and confocal and/or scanning electron microscopy were used to evaluate the wound irrigation solution's antimicrobial/antibiofilm activity in standard laboratory conditions as well as in a three-dimensional (3D) collagen wound infection model. Results: The wound irrigation solution exhibited a rapid and strong antibacterial activity against both Gram-positive and Gram-negative strains isolated from infected wounds in planktonic form, with a reduction in bacterial number of >4 Logs after as little as one minute of treatment. The wound irrigation solution also exerted an evident activity against preformed biofilms of Pseudomonas aeruginosa and Staphylococcus aureus (>3 Log and >1 Log reduction in colony forming unit number, respectively, after 15 minutes of incubation). Although the wound irrigation solution was partially inhibited in the presence of simulated wound fluid, it maintained a marked antibiofilm activity in in vivo-like conditions (ie. in a 3D collagen wound infection model) with a strong killing and a mild debridement effect, which was superior to standard saline. Conclusion: The results obtained in this study suggest that although the wound irrigation solution used might be partially inhibited by wound exudate, it has the potential to effectively kill wound infecting planktonic as well as biofilm bacteria.
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Affiliation(s)
- Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Esingül Kaya
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppantonio Maisetta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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17
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Cogo A, Bignozzi AC, Hermans MHE, Quint BJ, Snels JP, Schultz G. A desiccation compound as a biofilm- and necrosis-removing agent: a case series. J Wound Care 2022; 31:816-822. [DOI: 10.12968/jowc.2022.31.10.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objective: A new compound, Debrichem (DEBx Medical BV, the Netherlands), a topical desiccation agent (TDA), is an active gel that contains an acidic species with a potent hygroscopic action. When in contact with microorganisms and necrosis, rapid desiccation and carbonisation of the proteins in these microorganisms, as well as of the extracellular matrix of biofilms and necrosis, occurs. The resulting ‘precipitate’ rapidly dislodges from the wound bed, resulting in a clean wound which granulates, which is a prerequisite for healing by secondary intention. Method: In a retrospective study, a series of mostly large and hard-to-heal lesions of different aetiologies were treated with a one-time application of the TDA, followed by weekly dressing changes. Results: Of the total of 54 lesions included in this case series, 22 were diagnosed as venous leg ulcers (VLUs), 20 as diabetic foot ulcers (DFUs), nine as post-traumatic, hard-to-heal lesions, two as vascular ulcers and one as an ischaemic ulcer. All of the VLUs, 75% of the DFUs and all of the other lesions reached complete granulation. Conclusion: The use of a TDA may contribute to the consistent, fast and easy removal of both biofilms and necrosis, and hence to wound healing.
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18
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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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19
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Aisa J, Parlier M. Local wound management: A review of modern techniques and products. Vet Dermatol 2022; 33:463-478. [PMID: 35876262 DOI: 10.1111/vde.13104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/01/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.
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Affiliation(s)
- Josep Aisa
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Mark Parlier
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
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20
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Monaco D, Zaghini F, Fiorini J, Venturini G, Iovino P, Vellone E, Alvaro R, Sili A. Effect of a wound healing protocol on patients with stage III and IV pressure ulcers: a preliminary observational study. J Wound Care 2022; 31:322-328. [DOI: 10.12968/jowc.2022.31.4.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To evaluate the influence of a wound healing protocol for stage III and IV pressure ulcers (PUs), and to determine the predictive power of specific sociodemographic and clinical characteristics on wound healing and infection. Method: This longitudinal study included participants with stage III and IV PUs who were recruited from 10 acute care settings of an Italian university hospital, and who were managed with a protocol inspired by the TIMECare model. Data were collected between October 2018 and March 2019. The National Pressure Ulcer Advisory Panel Staging System was used to stage the PUs. Wound healing was assessed with the Pressure Ulcer Scale for Healing (PUSH). Nutritional status was assessed with the Mini Nutritional Assessment Index. Data collection took place at admission and every seven days thereafter—a total of six times before discharge. The outcome and predictors of wound healing were assessed with Student's paired t-tests and multiple linear regressions, respectively. Results: Patients (n=126) were almost equally split between male and female, with a mean age of 78.17 years and who were all retired. Stage III and IV PUs were most prevalent at the sacrum (65.5% and 73.2%, respectively). PUSH wound healing scores improved significantly after six weeks in both stage III and IV PUs (p<0.001). Nutritional status was predictive of wound healing (R2=0.12). Conclusion: Our results showed that a good nutritional status and a protocol inspired by the TIMECare model were associated with wound healing improvements in stage III and IV PUs. We recommend this protocol in older patients with stage III and IV PUs.
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Affiliation(s)
- Dario Monaco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Jacopo Fiorini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Australian Catholic University, Melbourne, Australia
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Sili
- Nursing Department, Tor Vergata University Hospital, Rome, Italy
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21
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Hearne CLJ, Patton D, Moore ZE, Wilson P, Gillen C, O'Connor T. Effectiveness of combined modulated ultrasound and electric current stimulation to treat diabetic foot ulcers. J Wound Care 2022; 31:12-20. [PMID: 35077215 DOI: 10.12968/jowc.2022.31.1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The use of combined ultrasound and electrostimulation (CUSECS) as an adjunct therapy for diabetic foot ulcers (DFUs) is a relatively new concept. This study aimed to investigate if combined ultrasound and electrostimulation is an effective adjunctive treatment for hard-to-heal DFUs when compared with standard wound care. METHODS A randomised controlled pilot study design was used. Patients with hard-to-heal DFUs from two centres were sequentially randomised. For 8 weeks, the experimental group received CUSECS and standard wound care treatment twice a week. The control group received standard wound care treatment once a week. Wound changes were documented using photography, which also facilitated wound size measurement. Self-efficacy, economic cost, quality of life and reoccurrence rates were analysed as secondary objectives. RESULTS The experimental group (n=6) achieved a higher rate of mean wound healing (mean difference (MD): 0.49) when compared to the control group (n=5, MD: 0.01). Two participants completed full healing in the experimental group and one in the control group. There were no statistically significant findings because of the small sample size. There were no direct adverse reactions to this therapy. Quality of life scores improved in the treatment group. There was no significant change in self-efficacy scores. Costs were higher in the experimental group; however, the healing rate was quicker, which could be extrapolated to cost reductions over time. CONCLUSION Results suggest that CUSECS may be a useful adjunctive therapy for treatment of hard-to-heal DFUs. Further large-scale studies are needed to ascertain the effectiveness of CUSECS. The findings here are inconclusive but indicate that CUSECS may offer promise as a treatment.
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Affiliation(s)
- Caoimhe L Joyce Hearne
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,SWaT Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,SWaT Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Zena E Moore
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,SWaT Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Lida Institute, Shanghai, China.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Pauline Wilson
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,SWaT Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,St James's Hospital, Dublin, Ireland
| | | | - Tom O'Connor
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,SWaT Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Lida Institute, Shanghai, China
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22
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Davis SC, Gil J, Solis M, Higa A, Mills A, Simms C, Pena PV, Li J, Raut V. Antimicrobial effectiveness of wound matrices containing native extracellular matrix with polyhexamethylene biguanide. Int Wound J 2022; 19:86-99. [PMID: 33955663 PMCID: PMC8684887 DOI: 10.1111/iwj.13600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of wound matrix materials that are designed to help heal both acute and chronic wounds are currently available. Because wounds often encounter opportunistic microbes that can delay healing, the effectiveness of these materials is often suboptimal, resulting in delayed or compromised wound healing. The importance of reducing and controlling wound microbes is well recognised and there are several antimicrobial options available to address this unmet clinical need. This study compares the antimicrobial and wound healing capabilities, both in vivo and in vitro against methicillin-resistant Staphylococcus aureus (MRSA) USA 300, for the following compounds: Collagen Wound Matrix-Anti Microbial (CWM-AM); Collagen Wound Matrix-Anti Microbial XT (CWM-AM XT); Antimicrobial Hydrofiber Wound Dressing (AHWD); Dermal Scaffold with Silver (DRSAg); Collagen Extracellular Matrix (CEM); Collagen Wound Matrix (CWM); Matrix Wound Dressing with Silver (MWDAg); Cadexomer Iodine Gel (CIG); Triple Antibiotic Ointment (TAO); and Antimicrobial Wound Gel (AWG). For the in vitro zone of inhibition assay, AWG and CIG had the largest diffused areas, followed by CWM-AM and CWM-AM XT. Furthermore, CWM-AM, CWM-AM XT, AWG, and CIG exhibited a persistent antimicrobial activity for up to 10 days after incubation. However, in the cytotoxicity studies performed using human fibroblasts, CWM-AM and CWM-AM XT had no detrimental effects in cell proliferation and viability, while AWG and CIG were cytotoxic and prohibitive for cell proliferation. Treatments were then assessed for microbiology and wound healing efficacy using an in vivo porcine deep reticular dermal wound model. CWM-AM XT displayed the greatest in vivo antimicrobial activity against MRSA USA300 and expedited the reepithelialisation at a faster rate than other treatment groups. This study shows that a novel collagen matrix containing an antimicrobial agent can reduce the bacterial load and support healing.
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Affiliation(s)
- Stephen C. Davis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Joel Gil
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Michael Solis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Alexander Higa
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Colin Simms
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Pilar Valencia Pena
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Jie Li
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Vivek Raut
- Organogenesis Inc.CantonMassachusettsUSA
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23
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Ruiz PBDO, Lima AFC. Custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0295pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RESUMO Objetivo: Analisar os custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas. Método: Pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso, realizada numa Unidade de Tratamento Integral de Ferida. Obtiveram-se os custos multiplicando-se o tempo despendido pelos profissionais pelo custo unitário da mão de obra da respectiva categoria, somando-se aos custos dos materiais e terapias tópicas. Resultados: Os custos da assistência ambulatorial corresponderam a US$4,25 (DP ± 7,60), da hospitalar a US$3,87 (DP ± 17,27) e da domiciliar a US$3,47 (DP ± 5,73). Nessas três modalidades, os custos diretos com os curativos e consultas médicas foram os mais representativos: US$7,76 (DP ± 9,46) e US$6,61 (DP ± 6,54); US$7,06 (DP ± 24,16) e US$15,60 (DP ± 0,00); US$4,09 (DP ± 5,28) e US$15,60 (DP ± 0,00), respectivamente. Conclusão Considerando a assistência integral aos pacientes com feridas crônicas, o custo direto médio total foi de US$10,28 (DP ± 17,21), sendo a modalidade ambulatorial a mais representativa na sua composição. Constatou-se diferença estatística significante (valor p = 0,000) entre os custos da assistência domiciliar e ambulatorial, domiciliar e hospitalar e ambulatorial e hospitalar.
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24
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Ruiz PBDO, Lima AFC. Average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds. Rev Esc Enferm USP 2022; 56:e20220295. [PMID: 36448569 PMCID: PMC10111378 DOI: 10.1590/1980-220x-reeusp-2022-0295en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT Objective: To analyze the average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds. Method: Quantitative, exploratory-descriptive case study, carried out in a Comprehensive Wound Care Unit. Costs were obtained by multiplying the time spent by professionals by the unit cost of labor in the respective category, adding to the costs of materials and topical therapies. Results: Outpatient care costs corresponded to US$4.25 (SD ± 7.60), hospital care to US$3.87 (SD ± 17.27), and home care to US$3.47 (SD ± 5.73). In these three modalities, direct costs with dressings and medical consultations were the most representative: US$7.76 (SD ± 9.46) and US$6.61 (SD ± 6.54); US$7.06 (SD ± 24.16) and US$15.60 (SD ± 0.00); US$4.09 (SD ± 5.28) and US$15.60 (SD ± 0.00), respectively. Conclusion: Considering comprehensive care for patients with chronic wounds, the mean total direct cost was US$10.28 (SD ± 17.21), with the outpatient modality being the most representative in its composition. There was a statistically significant difference (p value = 0.000) between the costs of home and outpatient, home and hospital, and outpatient and hospital care.
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25
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Lopez AJ, Jones LM, Reynolds L, Diaz RC, George IK, Little W, Fleming D, D'souza A, Rennie MY, Rumbaugh KP, Smith AC. Detection of bacterial fluorescence from in vivo wound biofilms using a point-of-care fluorescence imaging device. Int Wound J 2021; 18:626-638. [PMID: 33565263 PMCID: PMC8450799 DOI: 10.1111/iwj.13564] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
Wound biofilms must be identified to target disruption and bacterial eradication but are challenging to detect with standard clinical assessment. This study tested whether bacterial fluorescence imaging could detect porphyrin-producing bacteria within a biofilm using well-established in vivo models. Mouse wounds were inoculated on Day 0 with planktonic bacteria (n = 39, porphyrin-producing and non-porphyrin-producing species, 107 colony forming units (CFU)/wound) or with polymicrobial biofilms (n = 16, 3 biofilms per mouse, each with 1:1:1 parts Staphylococcus aureus/Escherichia coli/Enterobacter cloacae, 107 CFU/biofilm) that were grown in vitro. Mouse wounds inoculated with biofilm underwent fluorescence imaging up to Day 4 or 5. Wounds were then excised and sent for microbiological analysis. Bacteria-matrix interaction was assessed with scanning electron microscopy (SEM) and histopathology. A total of 48 hours after inoculation with planktonic bacteria or biofilm, red fluorescence was readily detected in wounds; red fluorescence intensified up to Day 4. Red fluorescence from biofilms persisted in excised wound tissue post-wash. SEM and histopathology confirmed bacteria-matrix interaction. This pre-clinical study is the first to demonstrate the fluorescence detection of bacterial biofilm in vivo using a point-of-care wound imaging device. These findings have implications for clinicians targeting biofilm and may facilitate improved visualisation and removal of biofilms.
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Affiliation(s)
- Andrea J. Lopez
- Department of Honors StudiesTexas Tech UniversityLubbockTexasUSA
| | | | - Landrye Reynolds
- Department of Honors StudiesTexas Tech UniversityLubbockTexasUSA
| | - Rachel C. Diaz
- Department of Honors StudiesTexas Tech UniversityLubbockTexasUSA
| | - Isaiah K. George
- Department of Honors StudiesTexas Tech UniversityLubbockTexasUSA
| | - William Little
- Department of Honors StudiesTexas Tech UniversityLubbockTexasUSA
| | - Derek Fleming
- Department of SurgeryTexas Tech University Health Sciences CenterLubbockTexasUSA
- Division of Clinical Microbiology, Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | | | | | - Kendra P. Rumbaugh
- Department of SurgeryTexas Tech University Health Sciences CenterLubbockTexasUSA
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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: 1.5] [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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27
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Holubová A, Chlupáčová L, Cetlová L, Cremers NAJ, Pokorná A. Medical-Grade Honey as an Alternative Treatment for Antibiotics in Non-Healing Wounds-A Prospective Case Series. Antibiotics (Basel) 2021; 10:antibiotics10080918. [PMID: 34438968 PMCID: PMC8388796 DOI: 10.3390/antibiotics10080918] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 02/06/2023] Open
Abstract
Non-healing wounds are usually colonised by various types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical-grade honey (MGH), which favourably affects the healing process with its antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory properties. The objective of this study was to evaluate the effect of MGH therapy on the healing process of non-healing wounds of various aetiologies and different wound colonisations. Prospective, observation–intervention case studies (n = 9) of patients with wounds of various aetiologies (venous leg ulcers, diabetic foot ulcers, surgical wound dehiscence) are presented. All wounds were treated with MGH and the healing trajectory was rigorously and objectively monitored. In all cases, pain, odour, and exudation were quickly resolved, which led to an improvement in the quality of life of patients. Despite the proven bacterial microflora in wounds, antibiotic treatment was not necessary. The effects of MGH alleviated the signs of local infection until their complete elimination. In eight out of nine cases, the non-healing wound was completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in wounds of various aetiologies and forms an effective alternative for the use of antibiotics for treating locally infected wounds.
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Affiliation(s)
- Adéla Holubová
- Faculty of Health and Social Sciences, University of Bohemia, 370 11 České Budějovice, Czech Republic
- DiaPodi Care spol. s r.o., 392 01 Soběslav, Czech Republic;
- Correspondence: ; Tel.: +420-774-672-220
| | | | - Lada Cetlová
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
| | | | - Andrea Pokorná
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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Falcone M, De Angelis B, Pea F, Scalise A, Stefani S, Tasinato R, Zanetti O, Dalla Paola L. Challenges in the management of chronic wound infections. J Glob Antimicrob Resist 2021; 26:140-147. [PMID: 34144200 DOI: 10.1016/j.jgar.2021.05.010] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly occur in the care of these patients, this review aims to provide a practical guide underlining actions to avoid in the management of chronic wound infections. METHODS We performed a systematic review of the literature available in PubMed in the last 10 years, identifying studies regarding the management of patients with chronic wound infections. A panel of experts discussed the potential malpractices in this area. A list of 'Don'ts', including the main actions to be avoided, was drawn up using the 'Choosing Wisely' methodology. RESULTS In this review, we proposed a list of actions to avoid for optimal management of patients with chronic wound infections. Adequate wound bed preparation and wound antisepsis should be combined, as the absence of one of them leads to delayed healing and a higher risk of wound complications. Moreover, avoiding inappropriate use of systemic antibiotics is an important point because of the risk of selection of multidrug-resistant organisms as well as antibiotic-related adverse events. CONCLUSION A multidisciplinary team of experts in different fields (surgeon, infectious disease expert, microbiologist, pharmacologist, geriatrician) is required for the optimal management of chronic wound infections. Implementation of this approach may be useful to improve the management of patients with chronic wound infections.
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Affiliation(s)
- Marco Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
| | - Barbara De Angelis
- Surgical Science Department, Plastic and Reconstructive Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Federico Pea
- Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Alessandro Scalise
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, Biological Tower, University of Catania, Catania, Italy
| | - Rolando Tasinato
- Azienda Sanitaria Locale 3 Serenissima del Veneto, Department of General and Vascular Surgery, Venice, Italy
| | - Orazio Zanetti
- Alzheimer Unit, IRCCS S. Centro Giovanni di Dio 'Fatebenefratelli', Brescia, Italy
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Abstract
In the ever-changing world of wound care and nursing, it remains apparent that chronic wounds are a growing challenge. Evidence shows that age increases the likelihood of developing a chronic wound, which supports the notion that the burden of these wounds on the NHS is likely to further intensify with the ageing population. There are many reasons why a wound may fail to progress, including wound aetiology, comorbidities and environmental and socio-economic factors. One of the most significant reasons why wounds may fail to progress and become chronic is untreated wound infection. In order for clinicians to be able to treat and manage wound infections, it is vital that they understand how infection develops, the many ways in which infections may present themselves and how and when to initiate appropriate topical and systemic therapies to treat wound bed infections. The present article provides an overview of wound bed infections and their management.
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Affiliation(s)
- Martha Williams
- Senior Tissue Viability Nurse, Community Tissue Viability Service, Oxford Health NHS Foundation Trust, Abingdon
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30
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Schroeppel DeBacker SE, Bulman JC, Weinstein JL. Wound Care for Venous Ulceration. Semin Intervent Radiol 2021; 38:194-201. [PMID: 34108806 PMCID: PMC8175111 DOI: 10.1055/s-0041-1727161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Venous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.
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Affiliation(s)
| | - Julie C. Bulman
- Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffrey L. Weinstein
- Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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31
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Hammond JA, Gordon EA, Socarras KM, Chang Mell J, Ehrlich GD. Beyond the pan-genome: current perspectives on the functional and practical outcomes of the distributed genome hypothesis. Biochem Soc Trans 2020; 48:2437-2455. [PMID: 33245329 PMCID: PMC7752077 DOI: 10.1042/bst20190713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023]
Abstract
The principle of monoclonality with regard to bacterial infections was considered immutable prior to 30 years ago. This view, espoused by Koch for acute infections, has proven inadequate regarding chronic infections as persistence requires multiple forms of heterogeneity among the bacterial population. This understanding of bacterial plurality emerged from a synthesis of what-were-then novel technologies in molecular biology and imaging science. These technologies demonstrated that bacteria have complex life cycles, polymicrobial ecologies, and evolve in situ via the horizontal exchange of genic characters. Thus, there is an ongoing generation of diversity during infection that results in far more highly complex microbial communities than previously envisioned. This perspective is based on the fundamental tenet that the bacteria within an infecting population display genotypic diversity, including gene possession differences, which result from horizontal gene transfer mechanisms including transformation, conjugation, and transduction. This understanding is embodied in the concepts of the supragenome/pan-genome and the distributed genome hypothesis (DGH). These paradigms have fostered multiple researches in diverse areas of bacterial ecology including host-bacterial interactions covering the gamut of symbiotic relationships including mutualism, commensalism, and parasitism. With regard to the human host, within each of these symbiotic relationships all bacterial species possess attributes that contribute to colonization and persistence; those species/strains that are pathogenic also encode traits for invasion and metastases. Herein we provide an update on our understanding of bacterial plurality and discuss potential applications in diagnostics, therapeutics, and vaccinology based on perspectives provided by the DGH with regard to the evolution of pathogenicity.
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Affiliation(s)
- Jocelyn A. Hammond
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Center for Advanced Microbial Processing, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, U.S.A
| | - Emma A. Gordon
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, U.S.A
| | - Kayla M. Socarras
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Center for Surgical Infections and Biofilms, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, U.S.A
| | - Joshua Chang Mell
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Center for Advanced Microbial Processing, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Meta-omics Shared Resource Facility, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Garth D. Ehrlich
- Center for Genomic Sciences, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Center for Advanced Microbial Processing, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Center for Surgical Infections and Biofilms, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, U.S.A
- Meta-omics Shared Resource Facility, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, U.S.A
- Department of Otolaryngology – Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, U.S.A
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Synergistic Antimicrobial Activity of Supplemented Medical-Grade Honey against Pseudomonas aeruginosa Biofilm Formation and Eradication. Antibiotics (Basel) 2020; 9:antibiotics9120866. [PMID: 33291554 PMCID: PMC7761815 DOI: 10.3390/antibiotics9120866] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Biofilms hinder wound healing. Medical-grade honey (MGH) is a promising therapy because of its broad-spectrum antimicrobial activity and the lack of risk for resistance. This study investigated the inhibitory and eradicative activity against multidrug-resistant Pseudomonas aeruginosa biofilms by different established MGH-based wound care formulations. Six different natural wound care products (Medihoney, Revamil, Mebo, Melladerm, L-Mesitran Ointment, and L-Mesitran Soft) were tested in vitro. Most of them contain MGH only, whereas some were supplemented. L-Mesitran Soft demonstrated the most potent antimicrobial activity (6.08-log inhibition and 3.18-log eradication). Other formulations ranged between 0.89-log and 4.80-log inhibition and 0.65-log and 1.66-log eradication. Therefore, the contribution of different ingredients of L-Mesitran Soft was investigated in more detail. The activity of the same batch of raw MGH (1.38-log inhibition and 2.35-log eradication), vitamins C and E (0.95-log inhibition and 0.94-log eradication), and all ingredients except MGH (1.69-log inhibition and 0.75-log eradication) clearly support a synergistic activity of components within the L-Mesitran Soft formulation. Several presented clinical cases illustrate its clinical antimicrobial efficacy against Pseudomonas aeruginosa biofilms. In conclusion, MGH is a potent treatment for Pseudomonas biofilms. L-Mesitran Soft has the strongest antimicrobial activity, which is likely due to the synergistic activity mediated by its supplements.
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Di Domenico EG, De Angelis B, Cavallo I, Sivori F, Orlandi F, Fernandes Lopes Morais D’Autilio M, Di Segni C, Gentile P, Scioli MG, Orlandi A, D’Agosto G, Trento E, Kovacs D, Cardinali G, Stefanile A, Koudriavtseva T, Prignano G, Pimpinelli F, Lesnoni La Parola I, Toma L, Cervelli V, Ensoli F. Silver Sulfadiazine Eradicates Antibiotic-Tolerant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms in Patients with Infected Diabetic Foot Ulcers. J Clin Med 2020; 9:3807. [PMID: 33255545 PMCID: PMC7760944 DOI: 10.3390/jcm9123807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
Infections are among the most frequent and challenging events in diabetic foot ulcers (DFUs). Pathogenic bacteria growing in biofilms within host tissue are highly tolerant to environmental and chemical agents, including antibiotics. The present study was aimed at assessing the use of silver sulfadiazine (SSD) for wound healing and infection control in 16 patients with DFUs harboring biofilm-growing Staphylococcus aureus and Pseudomonas aeruginosa. All patients received a treatment based on a dressing protocol including disinfection, cleansing, application of SSD, and application of nonadherent gauze, followed by sterile gauze and tibio-breech bandage, in preparation for toilet surgery after 30 days of treatment. Clinical parameters were analyzed by the T.I.M.E. classification system. In addition, the activity of SSD against biofilm-growing S. aureus and P. aeruginosa isolates was assessed in vitro. A total of 16 patients with S. aureus and P. aeruginosa infected DFUs were included in the study. Clinical data showed a statistically significant (p < 0.002) improvement of patients' DFUs after 30 days of treatment with SSD with significant amelioration of all the parameters analyzed. Notably, after 30 days of treatment, resolution of infection was observed in all DFUs. In vitro analysis showed that both S. aureus and P. aeruginosa isolates developed complex and highly structured biofilms. Antibiotic susceptibility profiles indicated that biofilm cultures were significantly (p ≤ 0.002) more tolerant to all tested antimicrobials than their planktonic counterparts. However, SSD was found to be effective against fully developed biofilms of both S. aureus and P. aeruginosa at concentrations below those normally used in clinical preparations (10 mg/mL). These results strongly suggest that the topical administration of SSD may represent an effective alternative to conventional antibiotics for the successful treatment of DFUs infected by biofilm-growing S. aureus and P. aeruginosa.
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Affiliation(s)
- Enea Gino Di Domenico
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Barbara De Angelis
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Fabrizio Orlandi
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | | | - Chiara Di Segni
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Pietro Gentile
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Maria Giovanna Scioli
- Department of Anatomic Pathology, University of Rome Tor Vergata, 00144 Rome, Italy; (M.G.S.); (A.O.)
| | - Augusto Orlandi
- Department of Anatomic Pathology, University of Rome Tor Vergata, 00144 Rome, Italy; (M.G.S.); (A.O.)
| | - Giovanna D’Agosto
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Elisabetta Trento
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Daniela Kovacs
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (D.K.); (G.C.)
| | - Giorgia Cardinali
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (D.K.); (G.C.)
| | - Annunziata Stefanile
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.S.); (T.K.)
| | - Tatiana Koudriavtseva
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.S.); (T.K.)
| | - Grazia Prignano
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Ilaria Lesnoni La Parola
- Lichen Sclerosus Unit, Department of Dermatology, STI, Environmental Health, Tropical and Immigration, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy;
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Fabrizio Ensoli
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
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Morilla‐Herrera JC, Morales‐Asencio JM, Gómez‐González AJ, Díez‐De Los Ríos A, Lupiáñez‐Pérez I, Acosta‐Andrade C, Aranda‐Gallardo M, Moya‐Suárez AB, Kaknani‐Uttumchandani S, García‐Mayor S. Effectiveness of a hydrophobic dressing for microorganisms' colonization of vascular ulcers: Protocol for a randomized controlled trial (CUCO-UV Study). J Adv Nurs 2020; 76:2191-2197. [PMID: 32395842 PMCID: PMC7496185 DOI: 10.1111/jan.14412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/09/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
AIM To determine the effectiveness of a hydrophobic dressing (Cutimed Sorbact® ) against a silver dressing (Aquacel® Ag Extra) in the level of colonization of chronic venous leg ulcers. The secondary endpoints are health-related quality of life, level of pain, and time to complete healing. DESIGN Open randomized controlled trial, with blinded endpoint. METHODS Patients with chronic venous leg ulcers with signs of critical colonization will be randomized in a concealed sequence using computer software to receive one of the alternative dressings. A total of 204 participants recruited in Primary Health Care and nursing homes will be necessary to assure statistical power. Measures will include sociodemographic variables, wound-related variables (area, exudate, and time to healing), level of pain, adverse effects, and health-related quality of life. Smear samples will be collected from the ulcers and will be subject to DNA-typing technique through polymerase chain reaction to obtain the level of colony-forming units. Measures will be collected at baseline, 4, 8, and 12 weeks. DISCUSSION Elevated levels of microorganisms prevent wound healing and favour its chronification. The main target when colonization is present is to reduce the bacterial load to levels that promote immune system mobilization. Hydrophobic dressings prevent the formation of biofilm in the wound by means of physical effect, so that the possibility of antimicrobial resistance is significantly reduced. IMPACT Current evidence about the effectiveness of dressings to minimize venous leg ulcers colonization is very limited. Previous studies have important methodological flaws. This study will permit to obtain the effectiveness of hydrophobic dressings against silver dressings with a robust design based on conditions of routine clinical practice in Primary Health Care and nursing homes.
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Affiliation(s)
- Juan C. Morilla‐Herrera
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Distrito Sanitario Málaga – Valle del GuadalhorceMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | - José M. Morales‐Asencio
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | | | | | - Inmaculada Lupiáñez‐Pérez
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Distrito Sanitario Málaga – Valle del GuadalhorceMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | | | - Marta Aranda‐Gallardo
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
- Agencia Sanitaria Costa del SolMarbellaSpain
| | - Ana B. Moya‐Suárez
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
- Agencia Sanitaria Costa del SolMarbellaSpain
| | - Shakira Kaknani‐Uttumchandani
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
| | - Silvia García‐Mayor
- Department of NursingUniversity of Málaga, Faculty of Health SciencesMalagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MalagaSpain
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Pinto AM, Cerqueira MA, Bañobre-Lópes M, Pastrana LM, Sillankorva S. Bacteriophages for Chronic Wound Treatment: from Traditional to Novel Delivery Systems. Viruses 2020; 12:E235. [PMID: 32093349 PMCID: PMC7077204 DOI: 10.3390/v12020235] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
The treatment and management of chronic wounds presents a massive financial burden for global health care systems, with significant and disturbing consequences for the patients affected. These wounds remain challenging to treat, reduce the patients' life quality, and are responsible for a high percentage of limb amputations and many premature deaths. The presence of bacterial biofilms hampers chronic wound therapy due to the high tolerance of biofilm cells to many first- and second-line antibiotics. Due to the appearance of antibiotic-resistant and multidrug-resistant pathogens in these types of wounds, the research for alternative and complementary therapeutic approaches has increased. Bacteriophage (phage) therapy, discovered in the early 1900s, has been revived in the last few decades due to its antibacterial efficacy against antibiotic-resistant clinical isolates. Its use in the treatment of non-healing wounds has shown promising outcomes. In this review, we focus on the societal problems of chronic wounds, describe both the history and ongoing clinical trials of chronic wound-related treatments, and also outline experiments carried out for efficacy evaluation with different phage-host systems using in vitro, ex vivo, and in vivo animal models. We also describe the modern and most recent delivery systems developed for the incorporation of phages for species-targeted antibacterial control while protecting them upon exposure to harsh conditions, increasing the shelf life and facilitating storage of phage-based products. In this review, we also highlight the advances in phage therapy regulation.
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Affiliation(s)
- Ana M. Pinto
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
- CEB—Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Miguel A. Cerqueira
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
| | - Manuel Bañobre-Lópes
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
| | - Lorenzo M. Pastrana
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
| | - Sanna Sillankorva
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
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Pomponio G, Tedesco S, Peghetti A, Bianchi T, Rowan S, Greco A, Cutting K, Price P, Moore Z, Gabrielli A, Wolcott R. Improving the quality of clinical research on chronic wound infection treatment: expert-based recommendations. J Wound Care 2019; 28:S26-S31. [PMID: 30724117 DOI: 10.12968/jowc.2019.28.sup1.s26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE: To produce recommendations for the design of reliable and informative clinical investigations in chronic wound infection. METHOD: A multidisciplinary panel of international experts from four countries (Italy, UK, Ireland and the US) were involved in a detailed, semi-structured discussion on how to better select and describe a target population, interventions and outcomes, and which infection-related criteria to apply in order to achieve a high-quality trial. Consent among the experts was measured using the Delphi method and GRADE Working Group suggestions. The project was fully supported by AISLeC 2016 (Italian Nursing Society for Wound Care Study). RESULTS: In total, 37 recommendations achieved substantial agreement among the experts; 10 concerned the most appropriate description and selection of a target population, four related to interventions and 15 to outcomes. A further eight statements about critical methodological points were approved. CONCLUSION: Developing recommendations in a systematic manner through a representative group of experts could generate tools for improving the design of clinical trials in this challenging area.
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Affiliation(s)
| | - Silvia Tedesco
- SOSD Fibrosi Cistica, AOU Ospedali Riuniti di Ancona, Italy
| | - Angela Peghetti
- Ospedale S. Orsola-Malpighi, Bologna, former AISLeC President, Executive Board of World Union of Wound Healing Societies, Italy
| | - Tommaso Bianchi
- UO Dermatologia AUSL Bologna - Istituto delle scienze neurologiche Bellaria, Bologna, Italy
| | - Sara Rowan
- C3S - Clinical Scientific Support Services, Italy
| | - Alessandro Greco
- Outpatient Wound Care Centre, Local Health Care System Frosinone, Italy
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Tissue Viability Specialist, First Community Health and Care, Surrey, UK
| | - Patricia Price
- Emeritus Professor; c/o Pro Vice-Chancellors' Office, Cardiff University, UK
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland; and Visiting Professor, Department of Public Health, Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium
| | - Armando Gabrielli
- Professor; Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
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Viviana Serna González C, Thum M, de Oliveira Ramalho A, Beloto Silva O, Franco Coelho M, Medeiros da Silva Queiroz W, Maria Sebba Tosta de Souza D, Cristina Nogueira P, Lúcia Conceição Gouveia Santos V. Análise da “1a Recomendação Brasileira para o Gerenciamento do Biofilme em Feridas Crônicas e Complexas”. ESTIMA 2019. [DOI: 10.30886/estima.v17.783_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivos: Analisar criticamente a “1ª Recomendação brasileira para o gerenciamento de biofilme em feridas crônicas e complexas”. Método: Realizou-se revisão da literatura atual às informações nele contidas. Resultados: Observou-se que a publicação carece de metodologia compatível com o título, existem lacunas nas recomendações quanto à classificação das evidências e com ausência de fundamentação a partir de importantes consensos internacionais para o tratamento das feridas complexas com suspeita de biofilme, publicados nos últimos três anos. Conclusão: Conclui-se que o manuscrito não deve ser usado como guia de recomendações clínicas, mas como revisão bibliográfica sobre o tema.
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Viviana Serna González C, Thum M, de Oliveira Ramalho A, Beloto Silva O, Franco Coelho M, Medeiros da Silva Queiroz W, Maria Sebba Tosta de Souza D, Cristina Nogueira P, Lúcia Conceição Gouveia Santos V. Analysis of “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds”. ESTIMA 2019. [DOI: 10.30886/estima.v17.783_in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Analyze critically the “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds” (from Portuguese, “1a Recomendação Brasileira para o Gerenciamento de Biofilme em Feridas Crônicas e Complexas”). Method: Reviewing information contained in said document according to current literature. Results: The publication was showed to lack methodology compatible with its title; gaps in the recommendations were perceived regarding evidence classification, as well as an absence of grounding from important international consensus, published in the last three years, about treatment of complex wounds with suspected biofilm. Conclusion: The document was concluded to be inadequate for use as a clinical guideline, being considered only a bibliographic review about the theme.
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Lázaro-Martínez JL, Álvaro-Afonso FJ, García-Álvarez Y, Molines-Barroso RJ, García-Morales E, Sevillano-Fernández D. Ultrasound-assisted debridement of neuroischaemic diabetic foot ulcers, clinical and microbiological effects: a case series. J Wound Care 2019; 27:278-286. [PMID: 29738301 DOI: 10.12968/jowc.2018.27.5.278] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the clinical and microbiological effects of sequential wound debridement in a case series of neuroischaemic diabetic foot ulcers (DFUs) using an ultrasound-assisted wound debridement (UAW) device. METHOD A prospective, single-centre study, involving a case series of 24 neuroischaemic DFUs, was conducted to evaluate sequential wound debridement with UAW during a six-week treatment period. Soft tissue punch biopsies were taken every second week of treatment, both before and after wound debridement sessions. Qualitative and quantitative microbiological analysis was performed and wounds were assessed at patient admission, and before and after each debridement procedure. RESULTS Wound tissue quality scores improved significantly from a mean score of 2.1±1.3 points at patient inclusion, to 5.3±1.7 points (p=0.001). Mean wound sizes were 4.45cm2 (range: 2-12.25cm2) at week zero, and 2.75cm2 (range: 1.67-10.70cm2) at week six (p=0.04). The mean number of bacterial species per culture determined at week zero and at week six was 2.53±1.55 and 1.90±1.16, respectively (p=0.023). Wound debridement resulted in significant decreases in bacterial counts (1.17, 1.31 and 0.77 log units in colony forming units (CFU) for week zero, three and six, respectively). The average bacterial load in tissue samples before and after wound debridement after the six-week treatment was Log 5.55±0.91CFU/g and Log 4.59±0.89CFU/g, respectively (p<0.001). CONCLUSIONS The study results showed a significant bacterial load reduction in DFU tissue samples as a result of UAW debridement, independent of bacterial species, some of which exhibited antibiotic-resistance. Significant bacterial load reduction was correlated with improved wound conditions and significant reductions of wound size.
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Affiliation(s)
- José Luis Lázaro-Martínez
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Section of Microbiology, Department of Medicine, School of Medicine. Universidad Complutense de Madrid
| | - Francisco Javier Álvaro-Afonso
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Section of Microbiology, Department of Medicine, School of Medicine. Universidad Complutense de Madrid
| | - Yolanda García-Álvarez
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Section of Microbiology, Department of Medicine, School of Medicine. Universidad Complutense de Madrid
| | - Raúl Juan Molines-Barroso
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Section of Microbiology, Department of Medicine, School of Medicine. Universidad Complutense de Madrid
| | - Esther García-Morales
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Section of Microbiology, Department of Medicine, School of Medicine. Universidad Complutense de Madrid
| | - David Sevillano-Fernández
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Section of Microbiology, Department of Medicine, School of Medicine. Universidad Complutense de Madrid
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Roes C, Calladine L, Morris C. Biofilm management using monofilament fibre debridement technology: outcomes and clinician and patient satisfaction. J Wound Care 2019; 28:608-622. [PMID: 31513491 DOI: 10.12968/jowc.2019.28.9.608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment of biofilm. Biofilm that is not removed inhibits healing and redevelops if not prevented from doing so with topical antimicrobial agents. Monofilament fibre debriding technology (MFDT) is used for effective and rapid mechanical debridement of loose material, slough and biofilm. The objective of this evaluation was to determine the clinical effect and consequential levels of health professional and patient satisfaction with the results of a biofilm pathway that included MFDT to achieve debridement. Methods: This non-comparative, open label evaluation was conducted in static and non-static wounds that required debridement. MFDT was used to debride in a two-week evaluation of a biofilm pathway. Wounds were debrided three times in week one and twice in week two. Each debridement was followed by treatment with an antimicrobial dressing. Other care included secondary dressings and compression delivered according to local practice, guidelines and formularies. After the clinical evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with the biofilm pathway. Results: There were 706 health professionals who provided answers to the survey questions. Wound types evaluated were leg ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%). Of the wounds, 9% were reported as non-static despite the eligibility criteria. Not all wounds followed the pathway. The most frequently-used antimicrobial was silver. Non-antimicrobial products used included all-in-one dressings, other secondary dressings and compression. There was a change in 77% of wounds overall after two weeks. Change was reported almost equally for both static and non-static wounds. Health professionals who did or did not follow the pathway were ‘completely satisfied’ or ‘satisfied’ with the overall clinical outcome 96% and 95%, respectively. Of the patients, 77% were ‘completely satisfied’ or ‘satisfied’ with healing after following the pathway, as reported by the treating health professional. Conclusion: The biofilm pathway that includes MFDT appears effective. Wounds managed on the pathway were debrided effectively and healing progressed to the satisfaction of both health professionals and patients.
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Affiliation(s)
- Claas Roes
- 1 Scientific Support Manager, Lohmann & Rauscher GmbH & Co. KG, Global Scientific Support, Rengsdorf, Germany
| | - Leanne Calladine
- 2 Communications and Events Manager, Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
| | - Clare Morris
- 2 Senior Clinical Services Manager, Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
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Swanson T, Wolcott RD, Wallis H, Woodmansey EJ. Understanding biofilm in practice: a global survey of health professionals. J Wound Care 2019; 26:426-440. [PMID: 28795881 DOI: 10.12968/jowc.2017.26.8.426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this survey was to examine health professionals' views and practices relating to biofilm in chronic wounds. METHOD A global online survey was conducted to assess the current understanding of biofilm and wound management practices. The survey consisted of 20 questions designed to evaluate health professional knowledge of biofilm, perception and understanding of biofilm behaviour, detection and diagnosis, and treatment. Respondents were classified as 'specialists' if wounds were their primary focus and they developed protocols and determined formularies. Respondents were classified as 'generalists' if wounds were part of multiple indications they treat and they were able to choose wound care products from a restricted list of products. The Pearson's chi-square or Fisher's exact test was used to assess whether the responses were independent of the clinician role, health-care setting and country. RESULTS Overall, 3011 health professionals took part in the survey, of which 397 were excluded or disqualified. Of the remaining 2614 respondents, 1223 (46.8%) completed the entire survey. Although the majority of health professionals were aware of biofilm, knowledge gaps regarding its prevalence in chronic wounds were evident. In general, the majority indicated that they understood that biofilm is detrimental to wound healing. With the exception of wound stalling, there was a lack of consensus on other clinical signs in the detection and diagnosis of biofilm. Knowledge gaps were also evident over the treatment of biofilm and the efficacy of antimicrobial treatments, debridement and wound dressing. CONCLUSION Our results show that though there is a broad recognition of biofilm and its possible role in chronic wounds, there is still a need to educate and increase knowledge on recognition and treatment of biofilm.
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Affiliation(s)
- T Swanson
- Nurse Practitioner Wound Management, South West Healthcare, Ryot St. Warrnambool. Victoria 3280, Australia
| | - R D Wolcott
- Medical Director, Southwest Regional Wound Care Center, Lubbock, Texas, US
| | - H Wallis
- Senior Global Brand Development Manager, Smith & Nephew Ltd, Hull, UK
| | - E J Woodmansey
- Scientific Communications Manager, Smith & Nephew Ltd, Hull, UK
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Hou Y, Yang M, Jiang H, Li D, Du Y. Effects of low-intensity and low-frequency ultrasound combined with tobramycin on biofilms of extended-spectrum beta-lactamases (ESBLs) Escherichia coli. FEMS Microbiol Lett 2019; 366:5304977. [DOI: 10.1093/femsle/fnz026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuru Hou
- State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Collaborative Innovation Center for Minimally Invasive and Noninvasive Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Min Yang
- State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Collaborative Innovation Center for Minimally Invasive and Noninvasive Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Hexun Jiang
- State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Collaborative Innovation Center for Minimally Invasive and Noninvasive Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, China
| | - Dairong Li
- Department of Respiratory Disease, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yonghong Du
- State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Collaborative Innovation Center for Minimally Invasive and Noninvasive Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
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Iacopi E, Abbruzzese L, Goretti C, Riitano N, Piaggesi A. The Use of a Novel Super-Oxidized Solution on Top of Standard Treatment in the Home Care Management of Postsurgical Lesions of the Diabetic Foot Reduces Reinfections and Shortens Healing Time. INT J LOW EXTR WOUND 2018; 17:268-274. [PMID: 30282510 DOI: 10.1177/1534734618795593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are still many unmet needs in the treatment of chronic wounds, especially regarding microenvironment modulation. Nexodyn is a novel super-oxidized solution capable of contrast bacterial proliferation. We aimed to evaluate if this solution, on top of standard of care, was safe and effective in improving diabetic foot outcome. We selected 50 patients admitted in our department to be submitted to surgery for acute diabetic foot infection. All patients were left open to heal for secondary intent. We divided patients into 2 groups: Group A (n = 25, male/female = 17/8, age = 67.3 ± 12.1 years, hemoglobin A1C = 7.9 ± 1.1%), patients treated with standard of care and, on top of this, Nexodyn solution, and Group B, treated only with standard of care. After discharge, patients continued Nexodyn application. We followed up patients until complete healing or up to 6 months. No differences between groups in healing rate, while time required for complete healing was significantly shorter in Group A (64.9 ± 12.1 days vs 147.4 ± 23.1 days, P < .01). During follow-up, the group treated with Nexodyn showed a reduced rate of reinfections (12 patients in Group B vs 3 patients in Group A, P < .05) and of further debridement procedures (1 patient in Group A vs 10 patients in Group B, P < .05). Nexodyn provided effective protection against reinfections in diabetic foot patients, thus reducing the necessity for debridement procedures and their healing time and presents a safety profile similar to saline solution.
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Affiliation(s)
| | | | - Chiara Goretti
- 1 Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
| | - Nicola Riitano
- 1 Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
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Mandel VD, Persechino F, Fiorentini C, Passini E, Magnoni C. Treatment of chronic infected post-oncological wounds with a dermal matrix: two case studies. J Wound Care 2018; 27:558-562. [DOI: 10.12968/jowc.2018.27.9.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Victor Desmond Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Flavia Persechino
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Fiorentini
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Passini
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Magnoni
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Ricci E. Cleansing versus tailored deep debridement, a fresh approach to wound cleansing: an Italian experience. J Wound Care 2018; 27:512-518. [DOI: 10.12968/jowc.2018.27.8.512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elia Ricci
- Director, Difficult Wound Healing Centre, St Luca's Clinic, Pecetto Torinese, Italy
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Brocco E, Ninkovic S, Marin M, Whisstock C, Bruseghin M, Boschetti G, Viti R, Forlini W, Volpe A. Diabetic foot management: multidisciplinary approach for advanced lesion rescue. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:670-684. [PMID: 29808982 DOI: 10.23736/s0021-9509.18.10606-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The diabetic foot is a complication of diabetes affecting 15% of diabetics in their lives. It is associated to diabetic neuropathy and peripheral vascular disease and its incidence has increased. The ulceration is the initial cause of a dramatic process leading, if not correctly treated, to amputations. Both neuropathy, neuro-ischemia and infections have a role in determining healing or worsening of the lesions and 85% of all amputations in diabetic patients are preceded by a foot ulceration deteriorating to a severe gangrene or infection. The different causative agents and the different clinical presentations of diabetic foot ask a multidisciplinary approach in order to address treatments to the final goals, the prevention of the amputations and the maintenance of a functional foot able with weight-bearing ability. Many professional figures, diabetologists, surgeons (both general and vascular and orthopedics), interventional radiologists, infectious diseases specialists, specialized nurses, podiatrists, orthotic technicians, are called to apply their knowledges to the diabetic patients affected by diabetic foot in a virtuous circle leading to reach the goals, with the imperative action of the multidisciplinary team. The so organized center will allow both a correct and rapid diagnosis, the use in ambulatorial environments of modern tools, or the hospitalization in multitasking wards, in which all the complications and the necessary treatments are possible, both in emergencies or in elective way, considering both revascularizations and surgery.
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Affiliation(s)
- Enrico Brocco
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy -
| | - Sasa Ninkovic
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Mariagrazia Marin
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Christine Whisstock
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Marino Bruseghin
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Giovanni Boschetti
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Raffaella Viti
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | | | - Antonio Volpe
- Department of Orthopedic Surgery, Foot and Ankle Clinic, Abano Terme Polyclinic, Abano Terme, Padua, Italy
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Vatan A, Saltoglu N, Yemisen M, Balkan II, Surme S, Demiray T, Mete B, Tabak F. Association between biofilm and multi/extensive drug resistance in diabetic foot infection. Int J Clin Pract 2018; 72:e13060. [PMID: 29381248 DOI: 10.1111/ijcp.13060] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI). METHODS Demographic, clinical, laboratory and outcome data of 165 patients, prospectively recorded and followed between January 2008 and December 2015 by a multidisciplinary committee, were analysed. Standard microbiological methods were adopted. Risk factors associated with biofilm were determined by univariate and multivariate analyses. RESULTS The overall rate of biofilm production among 339 wound isolates was 34%. The biofilm production rate was significantly higher in Gram-negative micro-organisms (39%) in comparison with Gram positives (21%) (P = .01). A. baumannii presented the highest biofilm production (62%), followed by P. aeruginosa (52%) and Klebsiella spp. (40%). On univariate analysis, significant factors associated with biofilm were antibiotic use within last 3 months (OR:2.94, CI: 1.5-5.75, P = .002), recurrent DFI within last 6 months (OR:2.35, CI: 1.23-4.53, P = .01), hospitalisation within last 3 months due to ipsilateral recurrent DFI (OR:2.44, CI: 1.06-5.58, P = .03), presence of amputation history (OR: 2.20, CI: 1.14-4.24, P = .01), multidrug-resistant (MDR) micro-organism (OR: 7.76, CI: 4.53-13.35, P<.001) and extensively drug-resistant (XDR) micro-organism (OR:11.33, CI:4.97-26.55, P<.001). Multivariate regression analysis revealed two variables to be significant factors associated with biofilm: MDR micro-organism (OR: 3.63, CI: 1.58-8.33, P = .002) and XDR micro-organism (OR:4.06, CI: 1.25-13.1, P = .01). CONCLUSIONS Multi/extensive drug resistance and previous recurrent DFIs were significantly associated with biofilm formation in patients with diabetic foot.
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Affiliation(s)
- Aslı Vatan
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Nese Saltoglu
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Mucahit Yemisen
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Serkan Surme
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Tayfur Demiray
- Sakarya University Medical Faculty, Microbiology, Sakarya, Turkey
| | - Birgul Mete
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Fehmi Tabak
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
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49
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Barrett S, Callaghan R, Chadwick P, Haycocks S, Rippon M, Stephen-Haynes J, Simm S. An observational study of a superabsorbent polymer dressing evaluated by clinicians and patients. J Wound Care 2018; 27:91-100. [DOI: 10.12968/jowc.2018.27.2.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Simon Barrett
- Humber NHS Foundation Trust, The Grange Hessle, 11 Hull Road, Hessle, HU13 9LZ
| | | | - Paul Chadwick
- National Clinical Director at the College of Podiatry, College of Podiatry, Quartz House, Mill Street, London
| | - Sam Haycocks
- Advanced Podiatrist, Salford Royal (NHS) Foundation Trust, UK
| | - Mark Rippon
- Visiting Clinical Research Fellow, Huddersfield University, Medical Marketing Consultant Daneriver Consultancy Ltd, Holmes Chapel, UK
| | - Jackie Stephen-Haynes
- Professor and Consultant Nurse in Tissue Viability, Birmingham City University and Worcestershire Health & Care Trust, UK
| | - Sue Simm
- Clinical Development Manager, Hartmann UK
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50
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Schultz GS, Woo K, Weir D, Yang Q. Effectiveness of a monofilament wound debridement pad at removing biofilm and slough: ex vivo and clinical performance. J Wound Care 2018; 27:80-90. [DOI: 10.12968/jowc.2018.27.2.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gregory S. Schultz
- Department of Obstetrics & Gynecology, University of Florida, Gainesville, Florida, US
| | - Kevin Woo
- Associate Professor, School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centers, Buffalo, NY, US
| | - Qingping Yang
- The Institute for Wound Research at the University of Florida, Department of Obstetrics & Gynecology, University of Florida, Gainesville, FL, US
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