The effect of an antimicrobial drain sponge dressing on specific bacterial isolates at tracheostomy sites.

Patients with tracheostomies frequently experience complications, including bacteremia, sepsis, pneumonia, and multi antibiotic-resistant bacterial infections. A prospective, descriptive, randomized, controlled, clinical case series involving seven men and three women was conducted on patients in the neuroscience unit of a long-term rehabilitation hospital during a period of 25 days to compare the use of an nonwoven drain sponge dressing containing an antimicrobial (polyhexamethylene biguanide) to a non-impregnated, nonwoven drain sponge dressing on tracheostomy sites. Specifically, the purpose of the study was to compare the presence of four bacterial pathogens (methicillin-resistant Staphylococcus aureus, Enterobacter cloacae, Pseudomonas aeruginosa, and Staphylococcus aureus) and resident normal skin flora (alpha-hemolytic Streptococci and Staphylococcus epidermidis) at the tracheostomy sites. Culture results for total days of growth showed an absence of pathogens and presence of normal skin flora for 11 study days in patients randomized to the antimicrobial dressing group and an absence of pathogens and presence of normal skin flora for six study days in patients randomized to the control group. The results of this descriptive case series suggest that an antimicrobial drain sponge dressing could be an important adjunct in the control of infections in patients with tracheostomies without compromising normal skin flora.

Impact of antimicrobial gauze on bacterial colonies in wounds that require packing.

Heavy microbial contamination has been associated with delayed wound healing and infection in both acute and chronic wounds. A prospective, randomized, 5-week controlled, open label, multicenter study was conducted to determine whether using antimicrobial gauze containing polyhexamethylene biguanide in wounds that require packing will result in a greater reduction of bacterial colony counts than using a gauze without polyhexamethylene biguanide (the control). Twenty-one subjects were randomized to the treatment or control dressing. Wounds were evenly distributed with respect to etiology and both study groups had a median baseline wound size of 7 cm2. At baseline, 15 microbial isolates were recovered and counted in treatment group wounds and 12 were recovered in the controls. At Week 1, six isolates were recovered from subjects in the polyhexamethylene biguanide antimicrobial gauze treatment group while 10 were recovered in the control. Change in polymicrobial bioburden was most prominent during the first few weeks of the study in the polyhexamethylene biguanide group. Polymicrobial counts in the treatment group remained reduced for the following three study weeks, returning to baseline at Week 4. In the control group, the number of polymicrobial cultures rose to 60% above baseline at Week 4. Two wounds of subjects randomized to the polyhexamethylene biguanide antimicrobial gauze healed; one wound in the control group healed. Polyhexamethylene biguanide antimicrobial gauze dressing could be an important adjunct to control the polymicrobial bioburden of delayed closure surgical wounds, pressure ulcers, and diabetic foot ulcers. Additional studies seem warranted.