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Răducu L, Moraru OE, Gheoca-Mutu DE, Peligrad T, Țigăran AE, Abu-Baker A, Ion DE, Ursuț BM, Jecan CR, Avino A. Confronting a New Challenge in Plastic Surgery: MDR Infections in Patients with Chronic Wounds. Life (Basel) 2024; 14:444. [PMID: 38672715 PMCID: PMC11050788 DOI: 10.3390/life14040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number of effective antibiotics place a heavy burden on the healthcare system, with patients going through multiple surgeries during a prolonged hospitalization time. By analyzing the resistance patterns of pluri-bacterial populations and the approach used in managing complex cases, we aim to improve the protocols applied in caring for chronic wounds in our practice and share our experiences and observations. METHODS We designed a retrospective study on 212 diabetic and non-diabetic patients, aiming to evaluate the course of chronic wound treatment in our practice. We focused on the impact that MDR bacteria and diabetes have on surgical outcomes and their role in the healing process. RESULTS Patients who received empiric antibiotic therapy before being admitted eventually presented with multiple MDR bacteria compared to those who did not receive antibiotics (p = 0.014). The presence of at least one MDR bacteria in the wound bed was associated with ulcers reaching bone (p = 0.02) and was positively correlated with the number of surgeries performed (p < 0.001). Diabetes played a significant role in surgery-related complications (p = 0.02) and hospitalization time (p < 0.001). CONCLUSIONS Proper management of chronic wounds requires a comprehensive, multidisciplinary approach and a thorough understanding of antibiotic usage. To address this need, we have developed and implemented a chronic wound treatment protocol in our clinic, with the goal of discharging patients once their ulcers have been treated and closed. A key summary of the protocol presented is to reduce the incidence of MDR bacteria and improve the patient's quality of life.
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Affiliation(s)
- Laura Răducu
- Discipline of Plastic Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.R.); (C.-R.J.); (A.A.)
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Oriana Elena Moraru
- Discipline of Cardiovascular Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Vascular Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
- Discipline of Anatomy, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Abdalah Abu-Baker
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Bogdan Mihai Ursuț
- Discipline of Anatomy, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of General Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Cristian-Radu Jecan
- Discipline of Plastic Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.R.); (C.-R.J.); (A.A.)
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
| | - Adelaida Avino
- Discipline of Plastic Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.R.); (C.-R.J.); (A.A.)
- Department of Plastic and Reconstructive Surgery, “Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (A.A.-B.); (D.-E.I.)
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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