Predatory bacterial hydrogels for topical treatment of infected wounds

Wound infection is becoming a considerable healthcare crisis due to the abuse of antibiotics and the substantial production of multidrug-resistant bacteria. Seawater immersion wounds usually become a mortal trouble because of the infection of Vibrio vulnificus. Bdellovibrio bacteriovorus, one kind of natural predatory bacteria, is recognized as a promising biological therapy against intractable bacteria. Here, we prepared a B. bacteriovorus-loaded polyvinyl alcohol/alginate hydrogel for the topical treatment of the seawater immersion wounds infected by V. vulnificus. The B. bacteriovorus-loaded hydrogel (BG) owned highly microporous structures with the mean pore size of 90 μm, improving the rapid release of B. bacteriovorus from BG when contacting the aqueous surroundings. BG showed high biosafety with no L929 cell toxicity or hemolysis. More importantly, BG exhibited excellent in vitro anti-V. vulnificus effect. The highly effective infected wound treatment effect of BG was evaluated on mouse models, revealing significant reduction of local V. vulnificus, accelerated wound contraction, and alleviated inflammation. Besides the high bacterial inhibition of BG, BG remarkably reduced inflammatory response, promoted collagen deposition, neovascularization and re-epithelization, contributing to wound healing. BG is a promising topical biological formulation against infected wounds.

The pattern of Bacterial Growth in Infected Wounds Following Emergency Laparotomy with The Variation of Sensitivity to Antibiotics-A Study of 58 Cases

Background: An emergency laparotomy is a commonly performed operation by general surgeons where the abdomen is opened and the abdominal organs examined for any injury or disease. A few major indications for an emergency laparotomy are perforation peritonitis, acute intestinal obstruction, burst appendix and blunt or penetrating abdominal injuries either due to roadside accidents, fall from height or gun shot or stab injuries. The study aims to see the causative organism of wound infection and prevent misuse of antibiotics in infected wounds following emergency laparotomy.Material & Methods:This observational study was carried out in the Department of Surgery, Khulna Medical College, Khulna from July 2008 to June 2009. A total of 58 specimens consisting of wound swabs, pus, purulent exudates or wound discharge were collected from patients who had emergency laparotomy at Khulna Medical College.Results:Out of 58 patients with abdominal operation developed wound infection following emergency laparotomy, 14 cases were ileal perforation, 19 cases were duodenal ulcer perforation, and 9 cases were sigmoid volvulus, and F13 cases were small intestinal obstruction and 3 were blunt abdominal trauma. Among 58 postoperative abdominal wound infected cases all require antibiotics and regular dressing 60.34% require a secondary stitch 25.86% require no secondary stitch and 13.79% required wound excision with a secondary stitch.Conclusions:Postoperative complications are more common after emergency laparotomies compared to elective laparotomies. Maximum complications were found in patients with delayed presentation or in patients having any associated co-morbidities. Therefore, early detection and immediate intervention with better postoperative care can minimize postoperative complications. The present study suggests that proper awareness among rural populations, adequate health education to seek prompt medical aid, a good referral and efficient transportation can reduce the delayed presentation which in turn will prevent postoperative complications following emergency laparotomy.

Sharing a microbe with man’s best friend: A case of canine streptococcal infection in a diabetic patient

We report a case of a diabetic patient with an infected leg wound leading to septicemia and abscess formation in the contra-lateral leg due to Streptococcus canis. This organism belongs to the Lancefield group G and is more commonly found in dogs. It is often mistaken for Streptococcus dysgalactiae which is a human strain of streptococci. Infections in humans are not common and usually involve infected wounds or ulcers and the surrounding soft tissue. In most reported cases, patients had close contact with domestic dogs and a pre-existing wound as a portal of entry. Our patient recovered after surgical debridement and drainage of abscess together with antibiotics. This organism is sensitive to common antibiotics like penicillin, amoxycillin, cephalosporins and erythromycin. The incidence of infections due to Streptococcus canis may be under-reported as laboratories may just report an isolate as group G streptococcus. Susceptible patients with wounds or ulcers should be counselled on proper wound care and advised to avoid or minimise contact with the family dog.

Proposta de criação de protocolo de enfermagem para o cuidado de pacientes com abscesso de parede pós-cesária / Proposal of establishment of a nursing protocol for the care of patients with abscess wall after cesarean section

Objetivo: Elaborar protocolo para atender as pacientes portadoras de abscesso de parede pós-cesarianas no setor de Alojamento Conjunto do Hospital Regional da Asa Sul – DF a partir do perfil da clientela e da avaliação da assistência de enfermagem prestada a essas pacientes. Métodos: Trata-se de um estudo exploratório de abordagem qualitativa e quantitativa. Para elaboração do protocolo foi realizado a aplicação de questionário semiestruturado e roteiro de observação de campo. Em seguida definiram-se as normas terapêuticas e normas de atendimento, baseadas em evidências científicas. Resultados: Foram entrevistadas 14 pacientes com diagnóstico de abscesso de parede associado à cesariana. A idade variou de 15 a 38 anos; 50 por cento são solteiras; 36 por cento não concluíram o ensino médio; e 64 por cento apresentam uma renda per capta de 1 – 3 salários mínimos. Entre as mulheres com infecção de parede obteve-se a predominância das primigestas (64 por cento). A média de consultas de pré-natal frequentadas pelas entrevistas foi de 6.64. Com relação aos antecedentes pessoais/obstétricos observou-se o relato de 2 casos de anemia, 2 casos de hipertensão arterial crônica, 1 caso de infecção puerperal em cesárea anterior, 1 caso de tabagismo e 1 caso de sequela de paralisia. A equipe médica e de enfermagem possuem conhecimento técnico científico acerca do cuidado deste grupo de pacientes, porém não existe uma sistematização do cuidado por meio de protocolo e tampouco trabalho multiprofissional. Conclusão: Foi desenvolvido um protocolo para atender as pacientes portadoras de abscesso de parede pós-cesarianas no Setor de Alojamento Conjunto que poderá ser aplicado e testado futuramente.

Objetives: To develop protocol to meet the patients with abscess wall after cesarean section in the sector Rooming Hospital Regional da Asa Sul - DF from the client profile and evaluation of nursing care to these patients. Methods: This is an exploratory study of qualitative and quantitative approach. To develop this protocol was used to apply a semi-structured script and field observation. Then outlined the therapeutic norms and standards of care based on scientific evidence. Results: We interviewed 14 patients with a diagnosis of abscess wall associated with cesarean section. The age ranged from 15 to 38 years, 50 percent are single, 36 percent not completed high school, and 64 percent have an income per capita from 1 to 3 minimum wages. Among the infected women of wall obtained the prevalence of pregnancy (64 percent). The average prenatal care attended the interviews was 6.64. Regarding the personal background / obstetric there was a report of 2 cases of anemia, 2 cases of chronic hypertension, 1 case of puerperal infection in previous cesarean section, 1 case of smoking and 1 case of sequelae of paralysis. The medical and nursing staff have scientific expertise regarding the care of this group of patients, but no systematic care through a protocol nor a multidisciplinary approach. Conclusion: We developed a protocol to meet the patients with abscess wall after cesarean section in the Department of Rooming that can be applied and tested in the future.

The Long-Term Conservative Drainage Care of Extensive Osteomyelitis Associated with Mandibular Compound Fracture: Report of a Case

Treatment of infected prepuce wound with potassium permanganate solution / 国际外科学杂志

Objective To evaluate the clinical effect of potassium permanganate solution in treating the infected prepuce wound. Method From July 2000 to July 2007,97 patients with infected prepuce wound from Beijing Chaoyang hospital and other hospitals, aged 3 ～ 69 years, averaging 22.6 years, were all washed with 0. 1% potassium permanganate solution for 5～10 minutes 1～3 times a day. The 8 cases with abscess were sutured when exudate disappeared and fresh granulation tissue appeared. Results For the 89 infected patients, the wound surface became clear, dry and less exudate appeared after 3～5 days and then formed scabs. They all healed in 1 to 2 weeks. The 8 cases with abscess were all healed within 1 to 2 weeks after saturation. Conclusion Potassium permanganate solution is a convenient, economic and effective method in treating the infected prepuce wound.

Application of Modified Vacuum Assisted Closure with Silver Materials in Chronic Infected Wound

PURPOSE: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. METHODS: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. RESULTS: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. CONCLUSION: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

The Clinical Study of Patients with Cellulitis in the ROK Army / 대한피부과학회지

BACKGROUND: Cellulitis is one of the most common infectious skin diseases in primary care units of military service in which personal hygiene could be easily neglected under special circumstances such as outdoor training. OBJECTIVE: This study was designed to elucidate the probable causes of the high incidence rate of cellulitis in military service. METHODS: We prospectively evaluated the clinical findings of 59 patients with cellulitis who were hospitalized in the medical detachment of the 1st Infantry Division of the ROK Army from May, 1995 to April, 1996. RESULTS: The mean age of patients was 21(19-25). Analysing the rank of the patients, the number of recruits was 3(5%), private 26(44%), private first class 17(29%), corporal 11(19%) and sergeant 2(3%). Seventy eight percent of them were included in ranks below corporal. The recurrence rate of cellulitis during the 2 1/2 year follow-up period was only 4%. Skin lesions noted were erythema(100%), tenderness(98%), swelling(98%), local heating(97%), lymphadenopathy(73%), pus (63%), fluctuation(32%), ulcer(27%), lymphangitis(14%), bullae(8%), etc. The most common route of infection was the previous wounds(46%) which allows a portal for invasion of microorganisms. Tinea pedis was also found to be in 39% of patients with cellulitis of the lower leg. The pus culture performed on 7 patients who had not been responsive to primary antibiotics resulted in 6 positive cases of Staphylococcus aureus. CONCLUSION: Considering the ranks of the patients and the routes of infection, we found that the incidence of cellulitis in the military service of the ROK Army could be reduced if more attention would be paid to preventive counterplans for secondary infection and tinea pedis.