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Hecker A, Watzinger N, Pignet AL, Michelitsch B, Kotzbeck P, Kamolz LP. Ceramic Dressings-A New Non-Pharmacological Therapeutic Option in the Management of Chronic Wounds? J Pers Med 2024; 14:498. [PMID: 38793080 PMCID: PMC11122284 DOI: 10.3390/jpm14050498] [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: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
A new ceramic dressing, free from active antimicrobial or pharmaceutical agents, uses physical binding mechanisms for its absorption capacities and bacterial-binding properties. The purpose of this study was to evaluate wound healing, bacterial-related retention, and diagnostic properties of ceramic dressings in patients with stagnated chronic wounds. METHODS In this monocentric, intra-individually controlled, prospective study, patients with conservatively treated refractory chronic wounds were enrolled. One week before the start of the application with ceramic dressing, it was ensured during a screening phase that chronic wounds showed less than a 10% reduction in wound size. During the 4-week ceramic dressing treatment wound size measurements, wound scoring, measurement of wound exudate amount, wound swabs, and ceramic dressing sonication (low-intensity ultrasound) were carried out. The sonication fluid of the removed ceramic dressing was used for analysis of bacterial retention and compared to wound swabs. RESULTS A total of 20 patients with a mean age of 64.6 years (±26.2) and 21 chronic wounds were included in this study. After a 4-week treatment, a significant reduction of median wound size from 1178 mm2 (range 104-6300) to 751.5 mm2 (range 16-4819) and better total wound scores were observed (p < 0.001). The sensitivity of bacteria detection was 90.7% in the sonication fluid from the ceramic dressings, while only 76.9% in the conventional wound swabs. CONCLUSION The new ceramic dressing seems to have a positive impact on wound healing in chronic wounds. Bacteria-binding characteristics of the investigated ceramic dressing, in combination with its debridement, absorption, and detoxification properties, could contribute to its healing abilities. Based on those results, the investigated ceramic dressing seems to be a promising new treatment option for chronic wounds without the use of any active antimicrobial or pharmacological agents. Moreover, ceramic dressings can also be considered for microbiological diagnostic purposes.
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Affiliation(s)
- Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Birgit Michelitsch
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
| | - Petra Kotzbeck
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
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Rippon MG, Daly K, Rogers AA, Westgate S. Safety and effectiveness of an antiseptic wound cleansing and irrigation solution containing polyhexamethylene biguanide. J Wound Care 2024; 33:324-334. [PMID: 38683774 DOI: 10.12968/jowc.2024.33.5.324] [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: 05/02/2024]
Abstract
OBJECTIVE There is currently a wide range of cleansing and irrigation solutions available for wounds, many of which contain antimicrobial agents. The aim of this study was to assess the safety of HydroClean Solution (HARTMANN, Germany), a polyhexamethylene biguanide (PHMB)-containing irrigation solution, in a standard cytotoxicity assay, and to assess its effect in a three-dimensional (3D) full-thickness model of human skin. METHOD A number of commercially available wound cleansing and irrigation solutions, including the PHMB-containing irrigation solution, were tested in a cytotoxicity assay using L929 mouse fibroblasts (ISO 10993-5:2009). The PHMB-containing irrigation solution was then assessed in an in vitro human keratinocyte-fibroblast 3D full-thickness wounded skin model to determine its effect on wound healing over six days. The effect of the PHMB-containing irrigation solution on tissue viability was measured using a lactate dehydrogenase (LDH) assay, and proinflammatory effects were measured using an interleukin-6 (IL-6) production assay. RESULTS The PHMB-containing irrigation solution was shown to be equivalent to other commercially available cleansing and irrigation solutions when tested in the L929 fibroblast cytotoxicity assay. When assessed in the in vitro 3D human full-thickness wound healing model, the PHMB-containing irrigation solution treatment resulted in no difference in levels of LDH or IL-6 when compared with levels produced in control Dulbecco's phosphate-buffered saline cultures. There was, however, a pronounced tissue thickening of the skin model in the periwound region. CONCLUSION The experimental data presented in this study support the conclusion that the PHMB-containing irrigation solution has a safety profile similar to other commercially available cleansing and irrigation solutions. Evidence also suggests that the PHMB-containing irrigation solution does not affect tissue viability or proinflammatory cytokine production, as evidenced by LDH levels or the production of IL-6 in a 3D human full-thickness wound healing model. The PHMB-containing irrigation solution stimulated new tissue growth in the periwound region of the skin model.
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Affiliation(s)
- Mark G Rippon
- Huddersfield University, Huddersfield, UK
- Daneriver Consultancy Ltd, Holmes Chapel, Cheshire, UK
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Bishop A. Factors influencing dressing choice in wound care: a discussion. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S12-S20. [PMID: 37949493 DOI: 10.12968/bjon.2023.32.sup20.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Dressing choice can be challenging for clinicians, with many different product types and makes now available. The cost of wound care products is 93% higher for unhealed wounds than for those that heal, so planning appropriate care is essential. Wound care planning requires wound assessment and identification of the aim of care. In turn, this supports dressing selection. Using an assessment framework can help ensure that this is done in a structured way. Reassessment and review of the care plan at agreed intervals is also recommended. In addition to the aim of care, other factors influence the choice of dressing. These include local formulary requirements and allergies and sensitivities. An extensive range of dressings is available and these can be grouped into 10 types: hydrocolloid; wound contact layer; hydrogel; gelling fibre; alginate; foam; absorbent pads; film; odour absorbent; and antimicrobial. Clinicians should use available resources to support decision making and consider continuity of care when selecting the dressing to be used.
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Dissemond J, Aare K, Ozer K, Gandhi D, Ryan JL, DeKoven M. Aquacel Ag Advantage/Ag+ Extra and Cutimed Sorbact in the management of hard-to-heal wounds: a cohort study. J Wound Care 2023; 32:624-633. [PMID: 37830837 DOI: 10.12968/jowc.2023.32.10.624] [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: 10/14/2023]
Abstract
OBJECTIVE To compare Aquacel Ag Advantage/Ag+ Extra (Aquacel Ag+) (Convatec, UK) and Cutimed Sorbact (Sorbact) (Essity, US) dressings indicated for the treatment of patients with venous leg ulcers (VLUs), diabetes foot ulcers (DFUs) and pressure injuries (PIs) for clinical performance and outcomes using real-world evidence in Germany and the US. METHOD This study was a chart audit review of patients who used either Aquacel Ag+ or Sorbact dressings in the 24 months prior to October 2022. Healthcare providers with access to electronic medical records and charts were asked to capture data via patient record forms. The quantitative data were analysed. RESULTS Findings in Germany were comparable between Aquacel Ag+ and Sorbact with regards to wound description, management and treatment outcomes, including percent area reduction and wound closure. A difference was that a greater proportion of Sorbact patients required surgery (0% versus 11%; p=0.039). In the US, a greater proportion of wounds were worsening before dressing in the Aquacel Ag+ cohort (49% versus 34%; p=0.010). A multinomial logistic regression yielded the result that patients who received Aquacel Ag+ were 3.53 times more likely to have the wound completely healed (p=0.033). CONCLUSION Both Aquacel Ag+ and Sorbact dressings are widely used in Germany and the US for patients with VLUs, DFUs and PIs. Our study found two important differences: patients who used Aquacel Ag+ were less likely to need further surgery in Germany; and in the US, there were significantly higher odds that wounds would completely heal with Aquacel Ag+ dressings compared to Sorbact.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Essen University Hospital, Essen, Germany
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5
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Popplewell MA, Gwilym BL, Benson RA, Juszczak M, Bosanquet D, Pinkney TD, Chetter I, Wall M. A vascular multi-arm multi-stage trial to prevent groin wound surgical site infection: A feasibility survey. Int Wound J 2023; 20:2998-3005. [PMID: 37433749 PMCID: PMC10502270 DOI: 10.1111/iwj.14170] [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] [Received: 12/30/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 07/13/2023] Open
Abstract
Surgical site infection (SSI) is common following arterial surgery involving a groin incision. There is a lack of evidence regarding interventions to prevent groin wound SSI, therefore, a survey of vascular clinicians was undertaken to assess current opinion and practice, equipoise and feasibility of a randomised controlled trial (RCT). Participants at the Vascular Society of Great Britain and Ireland 2021 Annual Scientific Meeting were surveyed regarding three separate interventions designed to prevent SSI in the groin; impregnated incise drapes, diakylcarbomoyl chloride dressings and antibiotic impregnated collagen sponges. Results were collated via an online survey using the Research Electronic Data Capture platform. Seventy-five participants completed the questionnaire, most were consultant vascular surgeons (50/75, 66.7%). The majority agree that groin wound SSI is a major problem (73/75, 97.3%), and would be content using either of the three interventions (51/61, 83.6%) and had clinical equipoise to randomise patients to any of the three interventions versus standard of care (70/75, 93.3%). There was some reluctance to not use impregnated incise drapes as may be considered "standard of care". Groin wound SSI is perceived as major problem in vascular surgery, and a multicentre RCT of three preventative interventions appears acceptable to vascular surgeons.
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Affiliation(s)
| | - Brenig L. Gwilym
- South East Wales Vascular NetworkAneurin Bevan University Health Board, Royal Gwent HospitalWalesUK
| | - Ruth A. Benson
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Maciej Juszczak
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - David Bosanquet
- South East Wales Vascular NetworkAneurin Bevan University Health Board, Royal Gwent HospitalWalesUK
| | - Thomas D. Pinkney
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ian Chetter
- Centre for Clinical SciencesHull York Medical SchoolHeslingtonUK
| | - Michael Wall
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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Hong J, Xie L, Fan L, Huang H. The wound adjuncts effect of closed incision negative pressure wound therapy on stopping groin surgical site wound infection in arterial surgery: A meta-analysis. Int Wound J 2023; 20:2726-2734. [PMID: 36977282 PMCID: PMC10410315 DOI: 10.1111/iwj.14146] [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] [Received: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
A meta-analysis study was conducted to assess the influence of the wound adjuncts therapy of closed incision negative pressure wound therapy (ciNPWT) on stopping groin site wound infection (SWSI) in arterial surgery. A comprehensive literature examination till January 2023 was implemented and 2186 linked studies were appraised. The picked studies contained 2133 subjects with groin surgical wounds of arterial surgery in the picked studies' baseline, 1043 of them were using ciNPWT, and 1090 were using standard care. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the wound adjuncts therapy of ciNPWT on stopping groin SWSI in arterial surgery by the dichotomous and continuous styles and a fixed or random model. The ciNPWT had a significantly lower SWSI (OR, 0.42; 95% CI, 0.33-0.55, P < .001), superficial SWSI (OR, 0.46; 95% CI, 0.33-0.66, P < .001), and deep SWSI (OR, 0.39; 95% CI, 0.25-0.63, P < .001) compared with the standard care in groin surgical wound of arterial surgery. The ciNPWT had a significantly, lower SWSI, superficial SWSI, and deep SWSI compared with the standard care in groin surgical wounds of arterial surgery. Although precautions should be taken when commerce with the consequences because some of the picked studies for this meta-analysis was with low sample sizes.
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Affiliation(s)
- Jin Hong
- Department of Vascular Hernia SurgeryAffiliated Hospital of Shaoxing UniversityZhejiangChina
| | - Licheng Xie
- Department of Vascular Hernia SurgeryAffiliated Hospital of Shaoxing UniversityZhejiangChina
| | - Libin Fan
- Department of Vascular Hernia SurgeryAffiliated Hospital of Shaoxing UniversityZhejiangChina
| | - Haiyan Huang
- Department of Vascular Hernia SurgeryAffiliated Hospital of Shaoxing UniversityZhejiangChina
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Rippon M, Rogers AA, Ousey K, Chadwick P. Experimental and clinical evidence for DACC-coated dressings: an update. J Wound Care 2023; 32:S13-S22. [PMID: 37591666 DOI: 10.12968/jowc.2023.32.sup8a.s13] [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: 08/19/2023]
Abstract
OBJECTIVE To update the evidence in relation to the use of dialkylcarbamoyl chloride (DACC)-coated wound dressings in the prevention, treatment and management of wounds. METHOD PubMed and PubMed Central databases were searched to identify articles published since 2020 describing the experimental and clinical evidence for DACC-coated dressings, and their antimicrobial effect, as well as their impact on the prevention and treatment of infected wounds. The identified articles were then narratively reviewed. RESULTS The search yielded 113 articles (plus references from ad hoc sources), of which nine met the inclusion criteria. Of the nine included studies, five related to clinical aspects and four were laboratory studies. CONCLUSION A number of new studies have provided further evidence for the mode of action of the antimicrobial effect of DACC-coated dressings and its wide spectrum effect (including World Health Organization-prioritised microorganisms). Additional clinical studies have provided evidence of new applications, such as in treating wounds in paediatric patients, and extended the evidence relating to their use in treating surgical site infections. Evidence also shows that DACC-coated wound dressings can aid in the binding of biofilms, and how this technology can align and support antimicrobial stewardship in the prevention of antimicrobial resistance.
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Affiliation(s)
- Mark Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Medical Marketing Consultant, Daneriver Consultancy Ltd., Holmes Chapel, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | - Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
- Adjunct Professor, School of Nursing, Faculty of Health, Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons of Ireland, Dublin, Ireland
- Chair, International Wound Infection Institute, UK
- President Elect, International Skin Tear Advisory Panel
| | - Paul Chadwick
- Visiting Professor, Birmingham City University, Birmingham, UK
- Clinical Director and Acting Chief Executive, Royal College of Podiatry, UK
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8
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Ousey K, Rippon MG, Rogers AA, Totty JP. Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review. J Wound Care 2023; 32:334-347. [PMID: 37300859 DOI: 10.12968/jowc.2023.32.6.334] [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: 06/12/2023]
Abstract
OBJECTIVE Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives. METHOD A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews. RESULTS A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage. CONCLUSION There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.
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Affiliation(s)
- Karen Ousey
- Professor Skin Integrity, Director for the Institute of Skin Integrity, and Infection Prevention, University of Huddersfield, UK
- Department of Nursing and Midwifery, Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons of Ireland, Ireland
- Chair, International Wound Infection Institute UK
- President Elect, International Skin Tear Advisory Panel, US
| | - Mark G Rippon
- Visiting Clinical Research Associate, Huddersfield University, Huddersfield, UK
- Consultant, Dane River Consultancy Ltd, Cheshire, UK
| | - Alan A Rogers
- Independent Wound Care Consultant, Flintshire, North Wales, UK
| | - Joshua P Totty
- NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK
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Amoako YA, Agbanyo A, Novignon J, Owusu L, Tuffour J, Asante-Poku A, Hailemichael Y, Mosweu I, Canter R, Opondo C, Allen E, Pitt C, Yeboah-Manu D, Walker SL, Marks M, Phillips RO. Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacteriumulcerans disease, a protocol for a randomised controlled trial in Ghana. NIHR OPEN RESEARCH 2023; 2:59. [PMID: 36825217 PMCID: PMC7614217 DOI: 10.3310/nihropenres.13332.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 10/26/2023]
Abstract
Background Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. Methods This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. Discussion The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings. Trial registration Pan African Clinical Trials Repository (registration number; PACTR202011867644311). Registered on 30 th November 2020.
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Affiliation(s)
- Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
| | - Joseph Tuffour
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Iris Mosweu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Canter
- London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Opondo
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Catherine Pitt
- London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Amoako YA, Agbanyo A, Novignon J, Owusu L, Tuffour J, Asante-Poku A, Hailemichael Y, Mosweu I, Canter R, Opondo C, Allen E, Pitt C, Yeboah-Manu D, Walker SL, Marks M, Phillips RO. Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacterium ulcerans disease, a protocol for a randomised controlled trial in Ghana [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:59. [PMID: 36825217 PMCID: PMC7614217 DOI: 10.3310/nihropenres.13332.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. Methods This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. Discussion The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings.
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Affiliation(s)
- Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
| | - Joseph Tuffour
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Iris Mosweu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Canter
- London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Opondo
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Catherine Pitt
- London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Dialkyl Carbamoyl Chloride-Coated Dressing Prevents Macrophage and Fibroblast Stimulation via Control of Bacterial Growth: An In Vitro Assay. Microorganisms 2022; 10:microorganisms10091825. [PMID: 36144427 PMCID: PMC9502631 DOI: 10.3390/microorganisms10091825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
In this work, we evaluated the direct effect of a dialkyl carbamoyl chloride (DACC)-coated dressing on Staphylococcus aureus adhesion and growth in vitro, as well as the indirect effect of the dressing on fibroblast and macrophage activity. S. aureus cultures were treated with the dressing or gauze in Müller-Hinton medium or serum-supplemented Dulbecco’s modified Eagle medium. Bacterial growth and attachment were assessed through colony-forming units (CFU) and residual biomass analyses. Fibroblast and macrophage co-cultures were stimulated with filtered supernatants from the bacterial cultures treated with the DACC-coated dressing, following which tumor necrosis factor (TNF)-α/transforming growth factor (TGF)-β1 expression and gelatinolytic activity were assessed by enzyme-linked immunosorbent assays (ELISA) and zymography, respectively. The DACC-coated dressing bound 1.8−6.1% of all of the bacteria in the culture. Dressing-treated cultures presented biofilm formation in the dressing (enabling mechanical removal), with limited formation outside of it (p < 0.001). Filtered supernatants of bacterial cultures treated with the DACC-coated dressing did not over-stimulate TNF-α or TGF-β1 expression (p < 0.001) or increase gelatinolytic activity in eukaryotic cells, suggesting that bacterial cell integrity was maintained. Based on the above data, wound caregivers should consider the use of hydrophobic dressings as a first option for the management of acute or chronic wounds.
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Husmark J, Morgner B, Susilo YB, Wiegand C. Antimicrobial effects of bacterial binding to a dialkylcarbamoyl chloride-coated wound dressing: an in vitro study. J Wound Care 2022; 31:560-570. [PMID: 35797260 DOI: 10.12968/jowc.2022.31.7.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Wound dressings that inactivate or sequestrate microorganisms, such as those with a hydrophobic, bacteria-binding dialkylcarbamoyl chloride (DACC) surface, can reduce the risk of clinical infections. This 'passive' bioburden control, avoiding bacterial cell wall disruption with associated release of bacterial endotoxins aggravating inflammation, is advantageous in hard-to-heal wounds. Hence, the full scope of DACC dressings, including the potential impact of higher inoculum densities, increased protein load and different pH on antibacterial activity, needs to be evaluated. METHOD The Japanese Industrial Standard (JIS) L 1902 challenge test was used to evaluate the antimicrobial activity of the DACC-coated dressing against several World Health Organization (WHO)-prioritised wound pathogens (e.g., meticillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, microorganisms with extended-spectrum beta-lactamases and Acinetobacter baumannii), the effect of repeated bacterial challenge in an adverse wound environment, and antimicrobial performance at wound-related pH. RESULTS High antibacterial activity of the DACC-coated dressing against the WHO-prioritised bacteria strains by its irreversible binding and inhibition of growth of bound bacteria was confirmed using JIS L 1902. At increased inoculation densities, compared to standard conditions, the DACC-coated dressing still achieved strong-to-significant antibacterial effects. Augmenting the media protein content also affected antibacterial performance; a 0.5-1 log reduction in antibacterial activity was observed upon addition of 10% fetal calf serum. The pH did not influence antibacterial performance. The DACC-coated dressing also sustained antibacterial activity over subsequent reinfection steps. CONCLUSION It can be assumed that the DACC-coated dressing exerts beneficial effects in controlling the wound bioburden, reducing the overall demand placed on antibiotics, without using antimicrobial substances.
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Affiliation(s)
| | - Bianka Morgner
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07740 Jena, Germany
| | | | - Cornelia Wiegand
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07740 Jena, Germany
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13
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DAĞCI M, ÖZTEKİN D. Yara Bakımında Kullanılan Yara Örtüsü Teknolojileri: Randomize Kontrollü Çalışmaların İncelenmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.996192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Mirhaj M, Labbaf S, Tavakoli M, Seifalian A. An Overview on the Recent Advances in the Treatment of Infected Wounds: Antibacterial Wound Dressings. Macromol Biosci 2022; 22:e2200014. [PMID: 35421269 DOI: 10.1002/mabi.202200014] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/20/2022] [Indexed: 11/11/2022]
Abstract
A wound can be surgical, cuts from an operation or due to accident and trauma. The infected wound, as a result of bacteria growth within the damaged skin, interrupts the natural wound healing process and significantly impacts the quality of life. Wound dressing is an important segment of the skincare industry with its economic burden estimated at $ 20.4 billion (in 2021) in the global market. The results of recent clinical trials suggest that the use of modern dressings can be the easiest, most accessible, and most cost-effective way to treat chronic wounds and, hence, holds significant promise. With the sheer number of dressings in the market, the selection of correct dressing is confusing for clinicians and healthcare workers. The aim of this research was to review widely used types of antibacterial wound dressings, as well as emerging products, for their efficiency and mode of action. In this review, we focus on introducing antibiotics and antibacterial nanoparticles as two important and clinically widely used categories of antibacterial agents. The perspectives and challenges for paving the way for future research in this field are also discussed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marjan Mirhaj
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Sheyda Labbaf
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Mohamadreza Tavakoli
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Amelia Seifalian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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15
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Morgner B, Husmark J, Arvidsson A, Wiegand C. Effect of a DACC-coated dressing on keratinocytes and fibroblasts in wound healing using an in vitro scratch model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:22. [PMID: 35133505 PMCID: PMC8825393 DOI: 10.1007/s10856-022-06648-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Wound dressings that exert an antimicrobial effect in order to prevent and treat wound infections can be harmful to the wound healing process. Dressings with hydrophobic coatings, however, have been suggested to both reduce the microbial load and promote the healing process. Therefore, the potential effects of a dialkylcarbamoyl chloride (DACC)-coated dressing on fibroblasts and keratinocytes in wound healing were studied using mechanical scratch wounding of confluent cell layers as an in vitro model. Additionally, gene expression analysis by qRT-PCR was used to elucidate the longitudinal effects of the DACC-coated dressing on cell responses, specifically inflammation, growth factor induction and collagen synthesis. DACC promoted cell viability, did not stick to the cell layers, and supported normal wound healing progression in vitro. In contrast, cells became attached to the uncoated reference material, which inhibited scratch closure. Moreover, DACC slightly induced KGF, VEGF, and GM-CSF expression in HaCaT cells and NHDF. Physiological COL1A1 and COL3A1 gene expression by NHDF was observed under DACC treatment with no observable effect on S100A7 and RNASE7 levels in HaCaT cells. Overall, the DACC coating was found to be safe and may positively influence the wound healing outcome. Graphical abstract.
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Affiliation(s)
- Bianka Morgner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | | | | | - Cornelia Wiegand
- Department of Dermatology, University Hospital Jena, Jena, Germany.
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16
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Advanced dressings for the prevention of surgical site infection in women post-caesarean section: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:226-233. [PMID: 34826671 DOI: 10.1016/j.ejogrb.2021.11.014] [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: 09/14/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) Surgical site infections (SSIs) are a common complication post-caesarean section. Advanced dressings aim to provide an optimal wound environment, primarily by physically or chemically controlling moisture, in order to promote timely healing. A systematic review and meta-analysis was conducted to evaluate the effectiveness of advanced dressings in SSI prevention post-caesarean section. Secondary effectiveness outcomes included superficial SSI, endometritis, wound dehiscence, rehospitalisation and length of rehospitalisation. STUDY DESIGN We conducted a systematic review and meta-analysis according to PRISMA guidelines. A protocol was registered a priori. MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched from inception to May 2021, without date or language restrictions. Keywords included: caesarean section; bandages; dressing and surgical wound infection. Randomised controlled trials (RCTs) were included if they investigated any advanced dressing in women post-caesarean section compared to simple dressings and assessed SSI incidence. Relative risks (RR), with 95% confidence intervals (CIs) and p-values, were calculated using Review Manager software (RevMan version 5.0, The Cochrane Collaboration). I2 percentages were reported to assess heterogeneity and a funnel plot was produced to assess publication bias. Quality assessment was performed using the Cochrane Risk of Bias Assessment Tool. All data were double-extracted and discrepancies were finalised by a third reviewer. RESULTS From 253 citations identified, six RCTs were included in the systematic review and meta-analysis. Two studies investigated dialkylcarbamoyl chloride (DACC)-impregnated dressings; two investigated silver-impregnated dressings; one investigated copper-impregnated dressings and one investigated chlorhexidine gluconate dressings. The overall meta-analysis showed that advanced dressings did not reduce SSI risk (RR 0.81 [95% CI 0.52-1.24; p = 0.32]). However, subgroup analysis revealed that DACC-impregnated dressings reduced SSI risk (RR 0.33 [95% CI 0.14-0.77; p = 0.01]). Silver-impregnated dressings caused a nonsignificant increase in SSI risk (RR 1.20 [95% CI 0.77-1.88; p = 0.41]). All studies showed a high risk of bias. CONCLUSION This systematic review and meta-analysis suggests DACC dressings potentially reduce SSI. However we have shown no benefit of silver dressings. Further high-quality RCTs are required to recommend a change in clinical practice.
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Rippon MG, Rogers AA, Ousey K. Estrategias de protección antimicrobiana en el cuidado de heridas: evidencia para el uso de apósitos recubiertos con DACC. J Wound Care 2021; 30:21-35. [PMID: 34558974 DOI: 10.12968/jowc.2021.30.latam_sup_1.21] [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: 11/11/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is one of the most serious health threats globally. The development of new antimicrobials is not keeping pace with the evolution of resistant microorganisms, and novel ways of tackling this problem are required. One of such initiatives has been the development of antimicrobial stewardship programmes (AMS). The use of wound dressings that employ a physical sequestration and retention approach to reduce bacterial burden offers a novel approach to support AMS. Bacterial-binding by dressings and their physical removal can minimise their damage and prevent the release of harmful endotoxins. OBJECTIVE To highlight AMS to promote the correct use of antimicrobials and to investigate how dialkylcarbamyl chloride (DACC)-coated dressings can support AMS. METHOD MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify articles relating to AMS, and the use of wound dressings in the prevention and treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent wound infection in a way that does not kill or damage the microorganisms were reviewed. RESULTS The evidence demonstrated that using bacterial-binding wound dressings that act in a physical manner (eg, DACC-coated dressings) to preventing infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. CONCLUSION Some wound dressings work via a mechanism that promotes the binding and physical sequestration and removal of intact microorganisms from the wound bed (eg, a wound dressing that uses DACC technology to prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.
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Affiliation(s)
| | | | - Karen Ousey
- Huddersfield University, Reino Unido.,School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Royal College of Surgeons in Ireland, Dublin, Irlanda
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18
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Patiño MI, Restrepo LM, Becerra NY, van der Mei HC, van Kooten TG, Sharma PK. Nonviral Expression of LL-37 in a Human Skin Equivalent to Prevent Infection in Skin Wounds. Hum Gene Ther 2021; 32:1147-1157. [PMID: 33980038 DOI: 10.1089/hum.2021.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Inefficient autologous tissue recovery in skin wounds increases the susceptibility of patients to infections caused by multidrug resistant microorganisms, resulting in a high mortality rate. Genetic modification of skin cells has become an important field of study because it could lead to the construction of more functional skin grafts, through the overexpression of antimicrobial peptides that would prevent early contamination and infection with bacteria. In this study, we produce and evaluate human skin equivalents (HSEs) containing transfected human primary fibroblasts and keratinocytes by polyplexes to express the antimicrobial peptide LL-37. The effect of LL-37 on the metabolic activity of normal HSEs was evaluated before the construction of the transfected HSEs, and the antimicrobial efficacy against Pseudomonas aeruginosa and Staphylococcus aureus was evaluated. Subsequently, the levels of LL-37 in the culture supernatants of transfected HSEs, as well as the local expression, were determined. It was found that LL-37 treatment significantly promoted the cellular proliferation of HSEs. Furthermore, HSEs that express elevated levels of LL-37 were shown to possess histological characteristics close to the normal skin and display enhanced antimicrobial activity against S. aureus in vitro. These findings demonstrate that HSEs expressing LL-37 through nonviral modification of skin cells are a promising approach for the prevention of bacterial colonization in wounds.
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Affiliation(s)
- Maria Isabel Patiño
- Tissue Engineering and Cell Therapy Group, Faculty of Medicine, University of Antioquia, Medellín, Colombia.,Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Luz Marina Restrepo
- Tissue Engineering and Cell Therapy Group, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Natalia Yiset Becerra
- Tissue Engineering and Cell Therapy Group, Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Henny C van der Mei
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Theo G van Kooten
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Prashant K Sharma
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Rippon MG, Rogers AA, Ousey K. Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings. J Wound Care 2021; 30:284-296. [PMID: 33856907 DOI: 10.12968/jowc.2021.30.4.284] [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: 12/15/2022]
Abstract
BACKGROUND Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins. AIM Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals. METHOD MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed. RESULTS The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. CONCLUSION Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.
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Affiliation(s)
| | | | - Karen Ousey
- WoundCareSol Consultancy, UK.,School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Groin wound infection after vascular exposure (GIVE) multicentre cohort study. Int Wound J 2021; 18:164-175. [PMID: 33236858 PMCID: PMC8244001 DOI: 10.1111/iwj.13508] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow-up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post-operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90-day mortality. Female sex, Body mass index≥30 kg/m2 , ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non-modifiable variables.
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21
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Gwilym BL, Dovell G, Dattani N, Ambler GK, Shalhoub J, Forsythe RO, Benson RA, Nandhra S, Preece R, Onida S, Hitchman L, Coughlin P, Saratzis A, Bosanquet DC. Editor's Choice - Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery. Eur J Vasc Endovasc Surg 2021; 61:636-646. [PMID: 33423912 DOI: 10.1016/j.ejvs.2020.11.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision. DATA SOURCES MEDLINE, EMBASE, and CENTRAL databases were searched. REVIEW METHODS This review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis. RESULTS The search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 - 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 - 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 - 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates. CONCLUSION There is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK. https://twitter.com/VascResearchNet
| | | | | | | | - Joseph Shalhoub
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Rachael O Forsythe
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Sandip Nandhra
- Northern Vascular Centre, Institute of population health sciences, Newcastle University, Newcastle, UK
| | | | - Sarah Onida
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | | | - Patrick Coughlin
- Cardiovascular Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - Athanasios Saratzis
- NIHR Leicester Biomedical Research Centre, University of Leicester Department of Cardiovascular Sciences, Leicester, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK
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van Engelen E, Dijkstra T, Meertens NM, van Werven T. Bacterial flora associated with udder cleft dermatitis in Dutch dairy cows. J Dairy Sci 2020; 104:728-735. [PMID: 33189260 DOI: 10.3168/jds.2020-18414] [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] [Received: 02/24/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022]
Abstract
Udder cleft dermatitis (UCD) or udder sores is a skin lesion, characteristically located around the anterior junction between the udder and abdomen of dairy cows. It is a worldwide problem in dairy herds with a large effect on animal welfare. The etiology and possible infectious origins of UCD are largely unknown; however, specific bacterial or parasitic causes are suggested in the literature. Therefore the aim of this study was to investigate the possible bacteriological, mycological, or parasitic involvement in clinically scored UCD lesions. Bacteriological culture was performed on subcutaneous tissue samples taken postmortem at a depth of 5 to 10 mm of 87 mild or severe UCD lesions or from the same place in healthy cows. Fungal culture was performed on a subset of 22 subcutaneous tissue samples of severe UCD postmortem. To investigate the superficial flora, swabs were taken from normal skin or skin lesions of 15 live animals equally divided over 3 groups: healthy skin or mild and severe UCD lesions. Histopathology, to describe and classify the lesions and to assess the presence of mites, fungi, or bacteria, was performed on 128 tissue samples, taken separately. In severe UCD lesions, Trueperella pyogenes and Bacteroides pyogenes were more frequently present in deep tissue layers and in superficial layers, compared with the same layers in mild UCD lesions or healthy skin. Culturing and histopathology indicated no sign of involvement of treponemes, Staphylococcus aureus, Escherichia coli, fungi, or mites in the UCD lesions. Histopathological examination showed that the majority of the lesions were characterized by chronic aspecific inflammation. Severe UCD lesions more frequently showed chronic active inflammation on histopathology, compared with mild UCD lesions. Due to the cross-sectional character of this study, it is difficult to differentiate cause and effect; however, future preventive and curative measures against UCD should take into account the chronic and anaerobic nature of this illness.
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Affiliation(s)
| | - T Dijkstra
- Royal GD, 7400 AA Deventer, the Netherlands
| | | | - T van Werven
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, the Netherlands; University Farm Animal Practice, 3484 LZ Harmelen, the Netherlands
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23
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Freire JFB. Cinco complicaciones comunes en heridas quirúrgicas: prevención y manejo. J Wound Care 2020; 29:53-55. [PMID: 33251958 DOI: 10.12968/jowc.2020.29.latam_sup_3.53] [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: 11/11/2022]
Abstract
Five common complications with surgical wounds: prevention and management On 3 September 2020, at the Semana HEI virtual conference, vascular surgeon Juan Francisco Benalcázar Freire, from Hospital de Especialidades de las Fuerzas Armadas in Quito, Ecuador, presented a webinar describing the most common issues when facing surgical wounds. In this report, Dr Benalcázar summarises the key take-away messages from his talk and encourages health professionals not to focus on surgical site infection (SSI) alone, but also on other five common complications in surgical wounds.
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Andryukov BG, Besednova NN, Kuznetsova TA, Zaporozhets TS, Ermakova SP, Zvyagintseva TN, Chingizova EA, Gazha AK, Smolina TP. Sulfated Polysaccharides from Marine Algae as a Basis of Modern Biotechnologies for Creating Wound Dressings: Current Achievements and Future Prospects. Biomedicines 2020; 8:E301. [PMID: 32842682 PMCID: PMC7554790 DOI: 10.3390/biomedicines8090301] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/22/2022] Open
Abstract
Wound healing involves a complex cascade of cellular, molecular, and biochemical responses and signaling processes. It consists of successive interrelated phases, the duration of which depends on a multitude of factors. Wound treatment is a major healthcare issue that can be resolved by the development of effective and affordable wound dressings based on natural materials and biologically active substances. The proper use of modern wound dressings can significantly accelerate wound healing with minimum scar mark. Sulfated polysaccharides from seaweeds, with their unique structures and biological properties, as well as with a high potential to be used in various wound treatment methods, now undoubtedly play a major role in innovative biotechnologies of modern natural interactive dressings. These natural biopolymers are a novel and promising biologically active source for designing wound dressings based on alginates, fucoidans, carrageenans, and ulvans, which serve as active and effective therapeutic tools. The goal of this review is to summarize available information about the modern wound dressing technologies based on seaweed-derived polysaccharides, including those successfully implemented in commercial products, with a focus on promising and innovative designs. Future perspectives for the use of marine-derived biopolymers necessitate summarizing and analyzing results of numerous experiments and clinical trial data, developing a scientifically substantiated approach to wound treatment, and suggesting relevant practical recommendations.
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Affiliation(s)
- Boris G. Andryukov
- Somov Research Institute of Epidemiology and Microbiology, 690087 Vladivostok, Russian; (N.N.B.); (T.A.K.); (T.S.Z.); (A.K.G.); (T.P.S.)
- School of Biomedicine, Far Eastern Federal University (FEFU), 690091 Vladivostok, Russian
| | - Natalya N. Besednova
- Somov Research Institute of Epidemiology and Microbiology, 690087 Vladivostok, Russian; (N.N.B.); (T.A.K.); (T.S.Z.); (A.K.G.); (T.P.S.)
| | - Tatyana A. Kuznetsova
- Somov Research Institute of Epidemiology and Microbiology, 690087 Vladivostok, Russian; (N.N.B.); (T.A.K.); (T.S.Z.); (A.K.G.); (T.P.S.)
| | - Tatyana S. Zaporozhets
- Somov Research Institute of Epidemiology and Microbiology, 690087 Vladivostok, Russian; (N.N.B.); (T.A.K.); (T.S.Z.); (A.K.G.); (T.P.S.)
| | - Svetlana P. Ermakova
- Elyakov Pacific Institute of Bioorganic Chemistry (PIBOC) FEB RAS, 690022 Vladivostok, Russian; (S.P.E.); (T.N.Z.); (E.A.C.)
| | - Tatyana N. Zvyagintseva
- Elyakov Pacific Institute of Bioorganic Chemistry (PIBOC) FEB RAS, 690022 Vladivostok, Russian; (S.P.E.); (T.N.Z.); (E.A.C.)
| | - Ekaterina A. Chingizova
- Elyakov Pacific Institute of Bioorganic Chemistry (PIBOC) FEB RAS, 690022 Vladivostok, Russian; (S.P.E.); (T.N.Z.); (E.A.C.)
| | - Anna K. Gazha
- Somov Research Institute of Epidemiology and Microbiology, 690087 Vladivostok, Russian; (N.N.B.); (T.A.K.); (T.S.Z.); (A.K.G.); (T.P.S.)
| | - Tatyana P. Smolina
- Somov Research Institute of Epidemiology and Microbiology, 690087 Vladivostok, Russian; (N.N.B.); (T.A.K.); (T.S.Z.); (A.K.G.); (T.P.S.)
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Edwards-Jones V. Antimicrobial stewardship in wound care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S10-S16. [PMID: 32790545 DOI: 10.12968/bjon.2020.29.15.s10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Strategies to tackle the global crisis of antimicrobial resistance include implementing antimicrobial stewardship across the healthcare and agricultural sectors. Many clinical specialities have developed policies to advise practitioners on how to prescribe antibiotics more effectively, but there is still a lack of data on the impact of this change. Overuse and misuse of antibiotics have been commonplace since their introduction 70 years ago, and have contributed to the development of the resistance seen today. There is a dearth of new antibiotics and, if nothing is done to restrict the use of those that remain effective, there is a risk of returning to the pre-antibiotic era where simple infections could result in death. In wound care, it is essential that antibiotic treatment is appropriate to reduce infections. Many medical conditions predispose people to wounds that are difficult to heal and become chronic unless the underlying causes are addressed. Most wound infections are caused by bacteria, which are becoming increasingly resistant to commonly used antibiotics. This necessitates strict regimens for managing infection, which include prescribing antibiotics only when they are essential. Antimicrobial stewardship is undertaken in all UK healthcare facilities, and local advisory committees oversee the prudent use of antibiotics and other antimicrobial agents to try to prevent further increases in resistance. National guidance has been produced but whether full compliance has been followed has yet to be established and the impact of implementation needs to be analysed.
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Affiliation(s)
- Val Edwards-Jones
- Emeritus Professor of Medical Microbiology, Manchester Metropolitan University
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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: 1.0] [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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McNamara SA, Hirt PA, Weigelt MA, Nanda S, de Bedout V, Kirsner RS, Schachner LA. Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review. J Wound Care 2020; 29:321-334. [PMID: 32530778 DOI: 10.12968/jowc.2020.29.6.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.
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Affiliation(s)
- Stephanie A McNamara
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Penelope A Hirt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Maximillian A Weigelt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Sonali Nanda
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Valeria de Bedout
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Lawrence A Schachner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
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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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29
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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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30
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Kathawala MH, Ng WL, Liu D, Naing MW, Yeong WY, Spiller KL, Van Dyke M, Ng KW. Healing of Chronic Wounds: An Update of Recent Developments and Future Possibilities. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:429-444. [PMID: 31068101 DOI: 10.1089/ten.teb.2019.0019] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic wounds are the result of disruptions in the body's usual process of healing. They are not only a source of significant pain and discomfort but also, more importantly, an unguarded port of entry for pathogens into the body. While our current understanding of this phenomenon is far from complete, findings in physiological patterns and advancements in wound healing technologies have helped develop wound management and healing solutions to this long-standing medical challenge. This review presents an overview of known wound healing mechanics, abnormalities that lead to chronic wounds, and a summary of established and new wound healing technologies. Various approaches to heal wounds are discussed, from dermal replacements to advanced biomaterial-based treatments, from cell-, synthetic-, and composite-based approaches to preclinical approaches, which make developing such products possible. While tested breakthrough products are described, the authors focused more on recently developed innovations, which are at varying stages of maturity. The review concludes with a note on future perspectives and opinions on where the field and industry are headed and where they should be. Impact Statement Wound healing is an important area of research and clinical practice, and has captured the attention of tissue engineers since the nascent beginnings of the discipline. Tissue-engineered skin was the first FDA-approved product, achieved in 1996. Despite this success, and the passage of time, healing wounds, particularly chronic wounds, remains a vexing challenge. This comprehensive review article will provide readers with a synopsis of current issues, research approaches, animal models, technologies, and products that span the continuum from early development to clinical studies, in the hope of fueling new interests and ideas to overcome this long-standing medical challenge.
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Affiliation(s)
| | - Wei Long Ng
- Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Dan Liu
- Singapore Institute of Manufacturing Technology (SIMTECH), Singapore, Singapore
| | - May Win Naing
- Singapore Institute of Manufacturing Technology (SIMTECH), Singapore, Singapore
| | - Wai Yee Yeong
- Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kara L Spiller
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Mark Van Dyke
- Department of Biomedical Engineering and Mechanics (BEAM), Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Kee Woei Ng
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore.,Skin Research Institute of Singapore (SRIS), Singapore, Singapore.,Environmental Chemistry & Materials Centre, Nanyang Environment and Water Research Institute (NEWRI), Singapore, Singapore
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Sulaeva I, Vejdovszky P, Beaumont M, Rusakov D, Rohrer C, Rosenau T, Potthast A. Fast Approach to the Hydrophobization of Bacterial Cellulose via the Direct Polymerization of Ethyl 2-Cyanoacrylate. Biomacromolecules 2019; 20:3142-3146. [PMID: 31264848 DOI: 10.1021/acs.biomac.9b00721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bacterial cellulose (BC) has a broad range of applications in biomedical fields and cosmetics. Applied as wound dressing, BC tends to stick to the sore especially upon drying, and hydrophobization improves its performance in this regard. This article reports a facile and rapid yet a highly efficient approach for BC hydrophobization through direct polymerization of ethyl 2-cyanoacrylate on the BC fibers. The modified material preserves the favorable porous structure of the matrix material while displaying significantly higher hydrophobicity and significantly decreased stickiness to the wound. The BC surface can be modified in 15 min. Overall, this can be considered a ready-to-apply approach for the fabrication of BC wound dressings with enhanced performance. The modification was demonstrated to improve the material's biocompatibility and to introduce antimicrobial activity (immortalized human fibroblast assay).
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Affiliation(s)
- Irina Sulaeva
- Department of Chemistry , University of Natural Resources and Life Sciences Vienna (BOKU University) , Konrad-Lorenz-Strasse 24 , A-3430 Tulln , Austria
| | - Philipp Vejdovszky
- Department of Chemistry , University of Natural Resources and Life Sciences Vienna (BOKU University) , Konrad-Lorenz-Strasse 24 , A-3430 Tulln , Austria
| | - Marco Beaumont
- Department of Chemistry , University of Natural Resources and Life Sciences Vienna (BOKU University) , Konrad-Lorenz-Strasse 24 , A-3430 Tulln , Austria
| | - Dmitrii Rusakov
- Institute for Materials Chemistry & Research , University of Vienna , Währinger Strasse 42 , A-1090 Vienna , Austria
| | - Christian Rohrer
- Lohmann & Rauscher GmbH & Co KG , Irlicher Straße 55 , D-56567 Neuwied , Germany
| | - Thomas Rosenau
- Department of Chemistry , University of Natural Resources and Life Sciences Vienna (BOKU University) , Konrad-Lorenz-Strasse 24 , A-3430 Tulln , Austria
| | - Antje Potthast
- Department of Chemistry , University of Natural Resources and Life Sciences Vienna (BOKU University) , Konrad-Lorenz-Strasse 24 , A-3430 Tulln , Austria
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Chadwick P, Ousey K. Bacterial-binding dressings in the management of wound healing and infection prevention: a narrative review. J Wound Care 2019; 28:370-382. [DOI: 10.12968/jowc.2019.28.6.370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this review was to present the clinical data on the use of the family of bacterial-binding dressings (Sorbact; dialkylcarbamoyl chloride-coated) in the treatment of a variety of acute and chronic wounds. The findings are discussed in terms of the effectiveness of the bacterial-binding dressings on bacterial bioburden reduction, infection prevention, initiation/progression of wound healing and cost-effectiveness. The evidence in support of the bacterial-binding dressings is strongest in the area of infection prevention in surgical wounds, with several controlled trials showing the prophylactic benefit of the dressing in these wounds. Wound bioburden management in chronic wounds is supported by a number of clinical studies. In total, 29 published clinical studies (with a total of 4044 patients) were included in this review.
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Affiliation(s)
- Paul Chadwick
- Clinical Director, The College of Podiatry, Quartz House, 207 Providence Square, Mill Street, London, SE1 2EW
| | - Karen Ousey
- Professor of Skin Integrity, Professor and Director of the Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield
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Stanirowski PJ, Davies H, McMaster J, Mealing S, Sawicki W, Cendrowski K, Posnett J. Cost-effectiveness of a bacterial-binding dressing to prevent surgical site infection following caesarean section. J Wound Care 2019; 28:222-228. [DOI: 10.12968/jowc.2019.28.4.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paweł Jan Stanirowski
- Specialist in Obstetrics and Gynaecology, Assistant, Department of Obstetrics, Gynaecology and Oncology, II Faculty of Medicine, Medical University of Warsaw
| | - Heather Davies
- Research Assistant, York Health Economics Consortium, University of York, YO10 5NQ
| | - Jessica McMaster
- Research Assistant, York Health Economics Consortium, University of York, YO10 5NQ
| | - Stuart Mealing
- Associate Director, York Health Economics Consortium, University of York, YO10 5NQ
| | - Włodzimierz Sawicki
- Specialist in Obstetrics and Gynaecology, Head of Department, Department of Obstetrics, Gynaecology and Oncology, II Faculty of Medicine, Medical University of Warsaw
| | - Krzysztof Cendrowski
- Specialist in Obstetrics and Gynaecology, Assistant Professor, Department of Obstetrics, Gynaecology and Oncology, II Faculty of Medicine, Medical University of Warsaw
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Negative-Pressure Wound Therapy for Managing Complicated Wounds at Extracorporeal Membrane Oxygenation Sites. Adv Skin Wound Care 2019; 32:183-189. [PMID: 30889018 DOI: 10.1097/01.asw.0000553596.11034.d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of negative-pressure wound therapy (NPWT) for management of wound complications at extracorporeal membrane oxygenation (ECMO) removal sites. METHODS The authors retrospectively reviewed patients who underwent NPWT at ECMO removal sites followed by the development of wound complications including skin necrosis, lymphorrhea, and femoral vessel exposure. A nonadhesive bacteria-binding mesh was used as a wound contact layer of NPWT application. Patient characteristics and clinical outcomes were evaluated. RESULTS Nine patients underwent NPWT for complicated wounds at ECMO sites. The mean age of patients was 49.2 years (range, 14-64 years). All patients exhibited wound complications with lymphorrhea and skin necrosis. Seven of nine patients had wound cultures that were positive for microorganisms, but culture conversion to negative was achieved after NPWT application for a mean period of 21.2 days (range, 12-30 days). Lymphorrhea was successfully managed, and formation of fresh granulation tissue was observed in all patients. Wound healing either by primary closure, skin graft, or secondary healing was achieved without recurrence of wound complications. There were no cases of femoral vessel injury or aneurysm during NPWT application. CONCLUSIONS Negative-pressure wound therapy appears to be a safe and effective treatment option in the management of complicated wounds at ECMO sites.
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35
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Totty JP, Hitchman LH, Cai PL, Harwood AE, Wallace T, Carradice D, Smith GE, Chetter IC. A pilot feasibility randomised clinical trial comparing dialkylcarbamoylchloride-coated dressings versus standard care for the primary prevention of surgical site infection. Int Wound J 2019; 16:883-890. [PMID: 30868734 PMCID: PMC6850133 DOI: 10.1111/iwj.13113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 12/17/2022] Open
Abstract
A surgical site infection (SSI) may occur in up to 30% of procedures and results in significant morbidity and mortality. We aimed to assess the feasibility of conducting a randomised controlled trial (RCT) examining the use of dialkylcarbamoylchloride (DACC)‐impregnated dressings, which bind bacteria at the wound bed, in the prevention of SSI in primarily closed incisional wounds. This pilot RCT recruited patients undergoing clean or clean‐contaminated vascular surgery. Participants were randomised intraoperatively on a 1:1 basis to either a DACC‐coated dressing or a control dressing. Outcomes were divided into feasibility and clinical outcomes. The primary clinical outcome was SSI at 30 days (assessed using Centers for Disease Control criteria and Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, Isolation of bacteria and duration of inpatient Stay scoring methods). This study recruited 144 patients in 12 months at a median rate of 10 per month. Eligibility was 73% and recruitment 60%. At 30 days, there was a 36.9% relative risk reduction in the DACC‐coated arm (16.22% versus 25.71%, odds ratio 0.559, P = 0.161). The number needed to treat was 11 patients. A large‐scale RCT is both achievable and desirable given the relative risk reduction shown in this study. Further work is needed to improve the study protocol and involve more centres in a full‐scale RCT.
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Affiliation(s)
- Joshua P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | | | - Paris L Cai
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Amy E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Tom Wallace
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Dan Carradice
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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37
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Totty JP, Harwood AE, Cai PL, Hitchman LH, Smith GE, Chetter IC. Assessing the effectiveness of dialkylcarbamoylchloride (DACC)-coated post-operative dressings versus standard care in the prevention of surgical site infection in clean or clean-contaminated, vascular surgery (the DRESSINg trial): study protocol for a pilot feasibility randomised controlled trial. Pilot Feasibility Stud 2019; 5:11. [PMID: 30680225 PMCID: PMC6337832 DOI: 10.1186/s40814-019-0400-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/10/2019] [Indexed: 12/02/2022] Open
Abstract
Background Surgical site infection in vascular surgery has a reported incidence of up to 19%. A novel method of reducing this rate of infection is dressings coated with dialkylcarbamoylchloride (DACC), a hydrophobic wound contact layer that binds bacteria and removes them from the wound bed. Early research has suggested that DACC-coated wound dressings are effective in reducing surgical site infection when applied to wounds healing by primary intention post-operatively, therefore this trial aims to assess the feasibility of producing high-quality evidence assessing this theory. Methods Patients undergoing clean or clean-contaminated vascular surgery will be randomised to have their surgical wounds dressed with a DACC-coated dressing or a non-coated occlusive absorbent post-operative dressing. All other aspects of their peri-operative care will be standardised or carried out in line with hospital policy. Wound assessments will be carried out between day 5–7, day 30 (± 3 days) and 6 months post-operatively (± 7 days) by a blinded assessor using the ASEPSIS scoring tool. Quality of life data using EQ-5D and SF-36, resource use and mortality data will also be collected. This feasibility trial will dictate the conduct of a full-scale trial through the collection of data on recruitment and retention rates, and fitness-for-purpose of the follow-up arrangements. Discussion Surgical site infections are now the second most common hospital acquired infections with a significant cost implication. The aim of the DRESSINg trial is to investigate the effectiveness of a novel preventative measure at reducing wound infections post-surgery and will provide robust evidence to support or deny its use. Trial registration Clinicaltrials.gov identifier: NCT02992951, Registered 12/12/16. REC Reference: 16/LO/2135.
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Affiliation(s)
- Joshua P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Amy E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Paris L Cai
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Louise H Hitchman
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
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Kusu-Orkar TE, Islam U, Hall B, Araia E, Allorto N. The use of a non-medicated dressing for superficial-partial thickness burns in children: a case series and review. Scars Burn Heal 2019; 5:2059513119896954. [PMID: 32341804 PMCID: PMC7169358 DOI: 10.1177/2059513119896954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed® Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial thickness burn injuries in children. OBJECTIVE To summarise the clinical outcome of burn wounds in children with superficial-partial thickness burns in which Cutimed® Sorbact® was used. METHOD An observational case series was conducted in Edendale Hospital, Pietermaritzburg, South Africa over the course of four weeks. Patients where included if they were aged < 10 years and had a ⩽ 15% superficial-partial burn. The primary outcome measure was time to 95% re-epithelialisation. Secondary outcome measures included wound complications, adverse healing and number of dressing changes. RESULTS Ten patients (five girls, five boys; age range = 11 months-8 years) were included in this case series. All participants had a type VI Fitzpatrick skin type and 80% of burns were hot water burns. Of all patients treated with Cutimed® Sorbact®, 50% healed within seven days, 70% within 14 days and 100% within 21 days. There was only one wound complication noted in this study and there was no adverse healing in any burn wounds. The mean number of dressing changes was 1.4 (range = 1-2) and length of hospital stay was in the range of 0-11 days (mean = 5.1 days). CONCLUSION Cutimed® Sorbact® is a safe, useful and cost-effective dressing that should be used as an alternative for superficial-partial burns in children.
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Affiliation(s)
| | - Umar Islam
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Benjamin Hall
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Evan Araia
- St Helens and Knowsley Teaching Hospital, Liverpool, UK
| | - Nikki Allorto
- Burns Department of Surgery, Edendale Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa
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Gueltzow M, Khalilpour P, Kolbe K, Zoellner Y. Budget impact of antimicrobial wound dressings in the treatment of venous leg ulcers in the German outpatient care sector: a budget impact analysis. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2018; 6:1527654. [PMID: 30425803 PMCID: PMC6225520 DOI: 10.1080/20016689.2018.1527654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/08/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
Background: Hard-to-heal wounds are associated with high treatment costs and, in Germany, are mostly treated in the outpatient care sector. Wound dressings are the main cost-drivers in venous leg ulcer (VLU) care which prescription is budget-restricted. Objective: To determine to what extent the choice of antimicrobial dressing affects the spending in outpatient care by investigating the budget impact of the bioburden-reducing dressing Cutimed Sorbact. Methods: The budget impact analysis was performed comparing three different scenarios of the intervention mix of antimicrobial dressings. A Markov model was used to estimate the VLU progression during one year. The budget impact was determined by comparing the dressing and medicine resource use and costs of the three scenarios. Results: This analysis confirms the high treatment costs of VLU care. ScenarioA leads to a decreased resource use of antimicrobial dressings and results in 20.86% lower treatment costs after 12 months. The increased use of Cutimed Sorbact has a positive budget impact. Conclusion: This analysis indicates that the treatment of VLU patients may result in an exceedance of the budget per patient that is available to the treating practitioner. The choice of wound dressing, however, may positively affect the prescribers' budget spending in outpatient care.
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Affiliation(s)
- Maria Gueltzow
- Global Regulatory Affairs, BSN medical GmbH, Hamburg, Germany
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Braunberger TL, Fatima S, Vellaichamy G, Nahhas AF, Parks-Miller A, Hamzavi IH. Dress for Success: a Review of Dressings and Wound Care in Hidradenitis Suppurativa. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0231-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Piaggesi A, Låuchli S, Bassetto F, Biedermann T, Marques A, Najafi B, Palla I, Scarpa C, Seimetz D, Triulzi I, Turchetti G, Vaggelas A. Advanced therapies in wound management: cell and tissue based therapies, physical and bio-physical therapies smart and IT based technologies. J Wound Care 2018; 27:S1-S137. [DOI: 10.12968/jowc.2018.27.sup6a.s1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alberto Piaggesi
- Prof, Director, EWMA Scientific Recorder (Editor), Diabetic Foot Section of the Pisa University Hospital, Department of Endocrinology and Metabolism, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Severin Låuchli
- Chief of Dermatosurgery and Woundcare, EWMA Immediate Past President (Co-editor), Department of Dermatology, University Hospital, Zurich, Råmistrasse 100, 8091 Zärich, Schwitzerland
| | - Franco Bassetto
- Prof, Head of Department, Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Thomas Biedermann
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, August Forel-Strasse 7, 8008 Zürich, Switzerland
| | - Alexandra Marques
- University of Minho, 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco GMR, Portugal
| | - Bijan Najafi
- Professor of Surgery, Director of Clinical Research, Division of Vascular Surgery and Endovascular Therapy, Director of Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030-3411, US
| | - Ilaria Palla
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, University of Padova, Via Giustiniani, 35100 Padova
| | - Diane Seimetz
- Founding Partner, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
| | - Isotta Triulzi
- Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giuseppe Turchetti
- Fulbright Scholar, Institute of Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Annegret Vaggelas
- Consultant, Biopharma Excellence, c/o Munich Technology Center, Agnes-Pockels-Bogen 1, 80992 Munich, Germany
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Corazza M, Amendolagine G, Cristofaro D, Bernardi T, Borghi A. Contact dermatitis caused by dialkylcarbamoyl compounds in a medication used for chronic wounds. Contact Dermatitis 2018; 79:182-183. [PMID: 29761496 DOI: 10.1111/cod.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Graziana Amendolagine
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Dario Cristofaro
- Section of Chemistry, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Tatiana Bernardi
- Section of Chemistry, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Dialkylcarbamoyl Chloride Dressings in the Prevention of Surgical Site Infections after Nonimplant Vascular Surgery. Ann Vasc Surg 2017; 44:387-392. [DOI: 10.1016/j.avsg.2017.03.198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
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