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Background: Having chronic wounds and impaired wound healing are associated with psychological distress. The current study aims to evaluate migraine and headache complaints in young adults with self-reported impaired wound healing. Methods: A survey was conducted among N=1935 young adults (83.6% women), 18–30 years old, living in the Netherlands. Wound healing status was verified, immune fitness was assessed using a single-item rating scale, and ID Migraine was completed. In addition, several questions were answered on past year’s headache experiences (including frequency, quantity, type, location, and severity). Results: In both the control group (p < 0.001) and the IWH group (p = 0.002) immune fitness was significantly lower among those that reported headaches compared to those that reported no headaches. Individuals with self-reported impaired wound healing (IWH) scored significantly higher on the ID Migraine scale, and individuals of the IWH group scored significantly more often positive for migraine (ie, an ID Migraine score ≥2). They reported a younger age of onset of experiencing headaches, and significantly more often reported having a beating or pounding headache than the control group. Compared to the control group, the IWH group reported being significantly more limited in their daily activities compared to the control group. Conclusion: Headaches and migraines are more frequently reported by individuals with self-reported impaired wound healing, and their reported immune fitness is significantly poorer compared to healthy controls. These headache and migraine complaints significantly limit them in their daily activities.

Background: Previous studies in Dutch young adults revealed that individuals with self-reported impaired wound healing reported poorer mood, increased inattention and impulsivity, poorer quality of life, and poorer immune fitness compared to healthy controls. Another study revealed that the negative impact of lockdowns during the 2019 coronavirus disease (COVID-19) pandemic was significantly more profound among the impaired wound healing group than the control group. The purpose of the current study was to replicate and extend these findings among young adults living in Germany. Methods: A retrospective, cross-sectional survey was conducted among N = 317 young adults living in Germany, 18–35 years old. They were allocated to the IWH group (N = 66) or the control group (N-251). Participants completed the Attention Control Scale, and mood, quality of life, and immune fitness were assessed with single-item ratings. All assessments were made for (1) the period before the COVID-19 pandemic, (2) the first lockdown period, March–May 2020, (3) the first no-lockdown period, summer 2020, (4) the second lockdown, November 2020 to May 2021, and (5) the second no-lockdown period, summer 2021. Results: The impaired wound healing group reported significantly poorer mood, quality of life, and immune fitness. The effects were evident before the pandemic. The impaired wound healing group scored significantly poorer on attention focusing, but no significant differences between the groups were found for attention shifting. During the pandemic, negative lockdown effects (i.e., further aggravation of mood and immune fitness and lower quality of life) were evident in both groups but significantly more profound in the impaired wound healing group. No differences between the groups were found for the no-lockdown periods. Conclusion: Individuals with self-reported impaired wound healing have significantly poorer mood, attention focusing, and immune fitness and report a poorer quality of l

OBJECTIVES The study aims to determine the outcome of the WALANT technique for Carpal Tunnel Release CTR.METHODOLOGY A descriptive study was done in the Neurosurgery department at Qazi Hussain Ahmad Medical Complex, Nowshera, from 15th September 2020 to 15th March 2021. A total of 29 consecutive patients of carpal tunnel syndrome (CTS) were undergoing carpal tunnel release (CTR) under wide awake local anaesthesia no tourniquet (WALANT) technique, using a mixture of lidocaine and epinephrine for local anaesthesia, and the outcome was assessed for patient satisfaction by Boston Carpal Tunnel Questionnaire (BCTQ) (symptom severity scales (SSS)) at pre-operatively and six weeks postoperatively.RESULTSWide awake CTR was done in 29 patients; 86.2% were female and 13.8% male. The mean age was 47.3 years. The average time of return to daily activity was three weeks. No complications were noted, like wound infection and dehiscence. BCTQ symptom (BCTQ-S) score significantly improved at six weeks postoperatively. 86% significantly reduced the symptom severity score (SSS). Mean SSS improved from preoperative 3.2 points to 1.7 points postoperatively. There was a significant decrease in distal latencies (p <0.01). CONCLUSIONWide awake surgery is an excellent technique with favourable outcomes and good satisfaction rates for CTR. The study shows that clinical symptoms resolve rapidly after CTR. Without the need for monitored anaesthesia, the cost could decrease dramatically.

Introduction. Chronic wounds are a serious health problem with great socioeconomic impact due to their morbidity and mortality and the affectation of quality of life. The properties of lipids in the immune system have been known for a long time. A weak immune system could lead to infection or chronic wounds. Cholesterol is a quantitatively important lipid in cell membranes where it contributes to maintaining membrane fluidity. Low levels of cholesterol are associated with an increased risk of infections. The objective of the study was to analyze the levels of lipids in patients with pressure ulcers infected. Methodology. 77 patients with infections in pressure ulcers from the Health Department of Elche-General Hospital were studied for one year. Results. Statistically significant differences are revealed between patients with LDL-C levels below 70mg/dL and patients with levels above 70mg/dL. Levels of TC were below 140mg/dL in both groups. Discussion. Future research on these aspects will help clarify the mechanisms of cholesterol transport to the tissues and therefore protect them from microorganism aggressions., Introducción. Las heridas crónicas suponen un grave problema de salud con gran impacto socioeconómico debido a su morbimortalidad y a la afectación de la calidad de vida. Desde hace tiempo se conocen las propiedades de los lípidos en el sistema inmunitario. Un sistema inmunológico débil podría conducir a una infección o cronificación de las heridas. El colesterol es un lípido con importancia cuantitativa en las membranas de las células donde contribuye al mantenimiento de la fluidez de membrana. Unos niveles bajos de colesterol se relacionan con mayor riesgo de padecer infecciones. El objetivo del estudio fue analizar los niveles de lípidos en pacientes con úlceras por presión infectadas. Metodología. Se estudiaron 77 pacientes del Departamento de Salud de Elche Hospital General con úlceras por presión infectadas en un periodo de un año. Resultados. Se ponen de manifiesto diferencias estadísticamente significativas entre pacientes con niveles de C-LDL por debajo de 70mg/dL y pacientes con niveles por encima de 70mg/dL que presentan un CT por debajo de 140mg/dL. Discusión. La investigación futura sobre estos aspectos ayudará a aclarar los mecanismos de transporte del colesterol hacia los tejidos para así protegerlos de las agresiones de los microorganismos.

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Inframalleolar bypass is an effective intervention for chronic limb threatening ischemia. A successful outcome can be compromised by early pedal wound disruption with secondary bypass exposure. We describe the case of a 74-year-old man with a WIfI (wound, ischemia, foot infection) clinical stage 4 foot who underwent popliteal-dorsalis pedis bypass, complicated by early skin necrosis overlying the pedal anastomosis. This necessitated a multidisciplinary approach to obtain tissue coverage over the anastomosis. The wound healed within 28 days, and at 2 years, the patient was mobilizing independently. We outline the approach taken and discuss the management of this challenging limb salvage problem.

Objective: The aim of the present study was to assess the impact of different maternal Body Mass Index (BMI) classes on the risk of postpartum endometritis, wound infection, and breast abscess after different modes of delivery. Secondly to estimate how the risk of postpartum infection varies with different maternal BMI groups after induction of labor and after obstetric anal sphincter injuries. Methods: A population-based observational study including women who gave birth during eight years (N = 841,780). Data were collected from three Swedish Medical Health Registers, the Swedish Medical Birth Register, the Swedish National Patient Register, and the Swedish Prescribed Drug Register. Outcomes were defined by ICD-10 codes given within eight weeks postpartum. The reference population was uninfected women. Odds ratios were determined using Mantel-Haenszel technique. Year of delivery, maternal age, parity and smoking in early pregnancy were considered as confounders. Results: There was a dose-dependent relationship between an increasing maternal BMI and a higher risk for postpartum infections. Women in obesity class II and III had an increased risk for endometritis after normal vaginal delivery aOR 1.45 (95% CI: 1.29-1.63) and for wound infections after cesarean section aOR 3.83 (95% CI: 3.39-4.32). There was no difference in how maternal BMI affected the association between cesarean section and wound infection, regardless of whether it was planned or emergent. Women in obesity class II and III had a lower risk of breast abscess compared with normal-weight women, aOR 0.47 (95% CI: 0.38-0.58). The risk of endometritis after labor induction decreased with increasing maternal BMI. The risk of wound infection among women with an obstetrical sphincter injury decreased with increasing BMI. Conclusion: This study provides new knowledge about the impact of maternal BMI on the risk of postpartum infections after different modes of delivery. There was no difference in how BMI aff

Severe surgical site infections (SSIs) are a frequent nosocomial complication after vascular interventions, an important cause of postoperative morbidity, and a substantial burden to the health care system. Patients undergoing arterial interventions are at elevated risk of SSIs, possibly because of the presence of several risk factors in this patient population. In this review, we examined the available clinical evidence for the prevention, treatment, and prognostication of postoperative severe SSIs after vascular exposure in the groin and other body areas. Results from studies evaluating preoperative, intraoperative, and postoperative preventive strategies and several treatment options are reviewed. In addition, risk factors for surgical wound infections are analyzed in detail and related evidence from the literature is highlighted. Although several measures have been implemented over the time to prevent them, SSIs continue to pose a substantial health care and socioeconomic challenge. Therefore, strategies to decrease the risk and improve the treatment of SSIs for the highrisk vascular patient population should be the focus of continuing improvement and critical review. This review aimed at identifying and reviewing the current evidence for preventing, treating, and performing stratification according to the prognosis of postoperative severe SSIs after vascular exposure in the groin and other body areas. & COPY; 2023 Elsevier Inc. All rights reserved.

Background and Aims: The coronavirus disease-2019 (COVID-19) pandemic disrupted medical care of patients with chronic wounds, and in combination with other negative effects of lockdown measures, this may have a negative effect on mood and quality of life. Until now, the consequences of the COVID-19 pandemic and associated lockdowns for individuals with impaired wound healing have not been investigated. Methods: An online survey was conducted to evaluate perceived immune fitness, mood, and health, both before and during the COVID-19 pandemic. Results: Of the 331 Dutch pharmacy students that completed the survey, N = 42 participants reported slow healing wounds and/or wound infection and were allocated to the impaired wound healing group; the other N = 289 participants served as control group. The survey assessed mood, perceived immune fitness, and health correlates for (a) the year 2019 (the period before the lockdown), (b) the first lockdown period (March 15–May 11, 2020), (c) summer 2020 (no lockdown), and (d) the second lockdown (November 2020–April 2021). The analysis revealed that negative mood effects, reductions in quality of life, and perceived immune fitness during the two lockdowns were significantly more pronounced among individuals that reported impaired wound healing compared to the control group. The effects on mood, perceived immune fitness, and health correlates were most pronounced for the second lockdown period. Conclusion: The COVID-19 pandemic is associated with significantly poorer mood, quality of life, and reduced perceived immune fitness. These effects are significantly more pronounced among individuals with self-reported impaired wound healing.

Background and Objectives: Adequate sleep and an effective immune system are both essential to maintain a good health status. The current study aimed to determine the nature of insomnia complaints and perceived immune fitness among Dutch young adults with and without self-reported impaired wound healing. Materials and Methods: A total of (n = 2033) Dutch students (83.8% women) completed an online survey. Perceived immune fitness was assessed with a single-item scale and insomnia complaints with the SLEEP-50 insomnia subscale. The sample comprised a control group without self-reported impaired wound healing (n = 1622), a wound infection (WI) group (n = 69), a slow healing wounds (SHW) group (n = 250), and a COMBI group that experienced both WI and SHW (n = 92). Results: Comparisons with the control group revealed that individuals of the SHW and COMBI groups reported significantly poorer perceived immune functioning, increased insomnia complaints and daytime fatigue, and poorer sleep quality. Conclusions: Individuals with self-reported impaired wound healing have a poorer perceived immune functioning, increased insomnia complaints, daytime fatigue, and poorer sleep quality.

The purpose of this study was to evaluate the impact of self-reported impaired wound healing on quality of life, wellbeing, and mood. It was hypothesized that individuals with impaired wound healing report significantly poorer mood compared to healthy controls. An online survey was conducted among 2173 Dutch young adults (18-30 years old) to investigate mood, neuroticism, and mental resilience. Participants were allocated to a healthy control group (N = 1728) or impaired wound healing groups comprising a wound infection group (WI, N = 76), a slow-healing wounds group (SHW, N = 272), and a group that experienced both WI and SHW (the COMBI group, N = 97). The Kruskal-Wallis test was used to compare outcomes the groups. Compared to the healthy control group, the SHW and COMBI groups, but not the WI group, reported significantly poorer mood, increased neuroticism, reduced mental resilience, and reduced quality of life. An analysis evaluating sex differences found that negative effects on stress, mental resilience, and neuroticism were significantly more pronounced among women than among men. In conclusion, self-reported impaired wound healing is associated with poorer mood and reduced quality of life. To improve future wound care, these findings advocate for an interdisciplinary approach taking into account mood effects accompanying having impaired wound healing.

The current study examined to what extent individuals with wound infection (WI group), slow healing wounds (SHW group), or both (COMBI group) report poorer immune fitness and whether they experience immune-related complaints more often as compared to healthy participants (control group). Survey data from 3613 Dutch students was re-analyzed. Compared to the control group, perceived immune fitness was significantly lower by the SHW group (p < 0.001) and the COMBI group (p < 0.001), but no difference was found for the WI group (p = 0.059). Also, perceived immune fitness of the COMBI group was significantly worse compared to the WI group (p = 0.040). Compared to the control group, reduced immune fitness was reported to be significantly more frequently by the SHW group (p < 0.001) and the COMBI group (p < 0.001). Reduced immune fitness was significantly more common for the COMBI group compared to the SHW group (p = 0.011) and WI group (p = 0.001). Immune-related complaints such as headache, runny nose, coughing, sore throat, diarrhea, flu, and fever were significantly more frequently reported by individuals with impaired wound healing. The effects were most pronounced in the COMBI group, followed by the SHW group and a lesser extent the WI group. A highly significant correlation was found between perceived immune fitness and the percentage of individuals that reported impaired wound healing. In conclusion, the findings confirm that poorer immune functioning is characteristic for individuals with impaired wound healing. In follow-up studies, immune biomarkers analyses are needed to support patient-reported outcome measures.

Background: Inattention and impulsivity are common causes of accidents and injury. The aim of the current study was to examine the level of attention deficit (AD), hyperactivity, and impulsivity (HI) in individuals with and without self-reported impaired wound healing (IWH). Methods: A survey was conducted among N = 773 Dutch young adults, 18–30 years old. N = 198 were allocated to the IWH group and N = 575 to the control group. All participants completed the Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale. Results: The analysis revealed that the IWH group has significantly higher scores on AD and HI, compared to the control group. Among the IWH group, 12.8% screened positive for AD (compared to 5.8% of the control group) and 14.0% screened positive for HI (compared to 7.4% of the control group). Conclusion: Clinically relevant increased inattention, impulsivity, and hyperactivity were observed among individuals with self-reported impaired wound healing.

Background: In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. Material and methods: 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. Results: Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*,0.37 - 4.27 *,0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 +/- 30.0-67.7 +/- 13.2 (SD) mm(2)). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p = 0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. Conclusion: At the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey coul, Funding agencies: Kamprad Family Foundation [20170287]; Swedish government [LIO-700121]; county councils, the ALF-agreement [LIO-700121]

PurposeThere are no established guidelines regarding management of antibiotics for patients specifically undergoing urethral reconstruction. Our aim was to minimize antibiotic use by following a standardized protocol in the pre-, peri- and postoperative setting, and adhere to American Urological Association antibiotic guidelines. We hypothesized that prolonged suppressive antibiotics post-urethroplasty does not prevent urinary tract infection and/or wound infection rates.Materials and methodsWe prospectively treated 900 patients undergoing urethroplasty or perineal urethrostomy at 11 centers over 2 years. The first-year cohort A received prolonged postoperative antibiotics. Year 2, cohort B, did not receive prolonged antibiotics. A standardized protocol following the American Urological Association guidelines for perioperative antibiotics was used. The 30-day postoperative infectious complications were determined. We used chi-square analysis to compare the cohorts, and multivariate logistic regression to identify risk factors.ResultsThe mean age of participants in both cohorts was 49.7 years old and the average stricture length was 4.09 cm. Overall, the rate of postoperative urinary tract infection and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2, p=0.064) and 3.9% (4.1% in phase 1 vs 3.7% in phase 2, p=0.772), respectively. Multivariate logistic regression analysis of patient characteristics and operative factors did not reveal any factors predictive of postoperative infections.ConclusionsThe use of a standardized protocol minimized antibiotic use and demonstrated no benefit to prolonged antibiotic use. There were no identifiable risk factors when considering surgical characteristics. Given the concern of antibiotic over-prescription, we do not recommend prolonged antibiotic use after urethral reconstruction.

Battlefield injury management requires specialized care, and wound infection is a frequent complication. Challenges related to characterizing relevant pathogens further complicates treatment. Applying metagenomics to wounds offers a comprehensive path toward assessing microbial genomic fingerprints and could indicate prognostic variables for future decision support tools. Wound specimens from combat-injured U.S. service members, obtained during surgical debridements before delayed wound closure, were subjected to whole metagenome analysis and targeted enrichment of antimicrobial resistance genes. Results did not indicate a singular, common microbial metagenomic profile for wound failure, instead reflecting a complex microenvironment with varying bioburden diversity across outcomes. Genus-level Pseudomonas detection was associated with wound failure at all surgeries. A logistic regression model was fit to the presence and absence of antimicrobial resistance classes to assess associations with nosocomial pathogens. A. baumannii detection was associated with detection of genomic signatures for resistance to trimethoprim, aminoglycosides, bacitracin, and polymyxin. Machine learning classifiers were applied to identify wound and microbial variables associated with outcome. Feature importance rankings averaged across models indicated the variables with the largest effects on predicting wound outcome, including an increase in P. putida sequence reads. These results describe the microbial genomic determinants in combat wound bioburden and demonstrate metagenomic investigation as a comprehensive tool for providing information toward aiding treatment of combat-related injuries.

Acinetobacter baumannii is a leading cause of antibiotic-resistant nosocomial infections with high mortality rates, yet there is currently no clinically approved vaccine formulation. During the onset of A. baumannii infection, neutrophils are the primary responders and play a major role in resisting the pathogen. Here, we design a biomimetic nanotoxoid for antivirulence vaccination by using neutrophil membrane-coated nanoparticles to safely capture secreted A. baumannii factors. Vaccination with the nanotoxoid formulation rapidly mobilizes innate immune cells and promotes pathogen-specific adaptive immunity. In murine models of pneumonia, septicemia, and superficial wound infection, immunization with the nanovaccine offers significant protection, improving survival and reducing signs of acute inflammation. Lower bacterial burdens are observed in vaccinated animals regardless of the infection route. Altogether, neutrophil nanotoxoids represent an effective platform for eliciting multivalent immunity to protect against multidrug-resistant A. baumannii in a wide range of disease conditions.

Objective: To determine the prevalence and etiology of appendicitis in patients attended at the Surgery Service of the Basic Hospital IESS Latacunga. Method: Systematic scientific observation of the medical records of patients with appendicitis. Results: Hospitalization time was determined according to the type of surgery where 83.38% or 326 patients underwent open appendectomies which require 3 to 4 postoperative days. Conclusion: The practice of open appendectomies was evidenced in 326 patients with a hospitalization time of 3 to 4 days. On the other hand, 65 patients underwent laparoscopic appendectomies with a postoperative period of 1 to 2 days with better advantages such as quick recovery and lower incidence of infections., Objetivo: Determinar la prevalencia y etiología de apendicitis en pacientes atendidos en el servicio de Cirugía del Hospital Básico IESS Latacunga. Método: Observación Científica Sistemática de las historias clínicas de los pacientes con apendicitis. Resultados: Se determinó el tiempo de hospitalización según el tipo de cirugía donde el 83.38% es decir 326 pacientes se realizó apendicectomías abiertas las cuales necesitan de 3 a 4 días posoperatorios. Conclusión: Se evidenció la práctica de apendicectomías abiertas a 326 pacientes con un tiempo de hospitalización de 3 a 4 días por otro lado a 65 pacientes se realizó apendicectomías laparoscópicas con un posoperatorio de 1 a 2 días con mejores ventajas como recuperación rápida y menor incidencia de infecciones.

Objective: To analyze the risks of wound infection in post-surgical patients. Method: Descriptive observational. Conclusion: Nurses state that the priority care of surgical incisions is the administration of medications prescribed by doctors or specialists, such as antibiotics and analgesics, in order to combat microorganisms and pain from the inside of the body, which can be evidenced by 48%, and then change the dressing with the medical prescription, which is evidenced by 44% who agree., Objetivo: Analizar los riesgos de infección de heridas en pacientes post- quirúrgicos. Método: Descriptivo observacional. Conclusión: Los enfermeros y enfermeras manifiesta que el cuidado prioritario de las incisiones quirúrgica es la administración de los medicamentos que son prescritos por los doctores o el especialista que esto son los antibióticos, analgésicos para poder así desde el interior del cuerpo se pueda combatir tanto como los microorganismo y el dolor de esta, donde se puede evidenciar con el 48% y posteriormente realizan el cambio de apósito con la prescripción médica que se evidencia con un 44% que están de acuerdo.

ABSTRACT: Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII-WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.

Background Methods Acknowledgments Correspondence Seasonality of Microbiology of Combat-related Wound Infections in Afghanistan Matthew A. Soderstrom MD1, Dana M. Blyth MD2, M. Leigh Carson MS3,4, Wesley R. Campbell MD2, Joseph M. Yabes MD1, Faraz Shaikh MS3,4, Laveta Stewart Ph.D.3,4, David R. Tribble MD, Dr.PH3, Clinton K. Murray MD1, and John L. Kiley MD1  Gram-negatives (N=188, 59.5%) were more commonly isolated from wound cultures in summer (N=81, 43.1%) and fall (N=57, 30.3%) versus winter (N=18, 9.6%) and spring (N=32, 17%) (p<0.001)  MDR Gram-negatives (N=69, 21.8%) were more common in summer (N=26, 37.7%), and fall (N=26, 37.7%) versus winter (N=3, 4.3%) and spring (N=14, 20.3%) (p=0.028).  Escherichia coli and Enterobacter spp. were the most common infecting Gram-negative bacilli with no significant difference across the seasons (p=0.267 and 0.463, respectively)  There was a higher proportion of infecting Acinetobacter baumannii (N=29, 15%) isolates recovered in the summer (20.5%) (p=0.009)  Infecting Gram-positive isolates (N=128, 65%) were not significantly different by season (p=0.126) We are indebted to the TIDOS team of clinical coordinators, microbiology technicians, data managers, clinical site managers, and administrative support personnel for their contributions to the success of this project. This project has been funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072, the Department of the Navy under the Wounded, Ill, and Injured Program and the Military Infectious Disease Research Program. Disclaimer. The views expressed are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., National Institutes of Health and Department of Health and Human Services, Brooke Army Medical Center, the U.S, RITM0029536, War wound infections and their management have played a key role in morbidity and mortality throughout the history of combat ? Seasonality of these infections has been described in previous conflicts, such as in the colder climate of Korea where Gram-positive organisms predominated and in the warmer and wetter climate of Vietnam where enteric Gramnegative organisms were frequently isolated ? The Trauma Infectious Disease Outcomes Study (TIDOS) is a retrospective, longitudinal observational study of infectious complications associated with trauma sustained during the wars in Iraq and Afghanistan ? Prior work from TIDOS has elucidated risk factors for infections with multidrug-resistant (MDR) organisms, including sustaining blast injuries, ICU stays and colonization ? We examined the seasonality of wound and wound infection microbiology, including occurrence of multidrug resistance, among combat casualties injured in Afghanistan

Chronic wounds represent an important healthcare challenge in developed countries, being wound infection a serious complication with significant impact on patients’ life conditions. However, there is a lack of methods allowing an early diagnosis of infection and a right decision making for a correct treatment. In this context, we propose a novel methodology for the electrical monitoring of infection biomarkers in chronic wound exudates, using nanoporous alumina membranes. Lysozyme, an enzyme produced by the human immune system indicating wound infection, is selected as a model compound to prove the concept. Peptidoglycan, a component of the bacterial layer and the native substrate of lysozyme, is immobilized on the inner walls of the nanochannels, blocking them both sterically and electrostatically. The steric blocking is dependent on the pore size (20 - 100 nm) and the peptidoglycan concentration, whereas the electrostatic blocking depends on the pH. The proposed analytical method is based on the electrical monitoring of the steric/electrostatic nanochannels unblocking upon the specific degradation of peptidoglycan by lysozyme, allowing to detect the infection biomarker at 280 ng/mL levels, which are below those expected in wounds. The low protein adsorption rate and thus outstanding filtering properties of the nanoporous alumina membranes allowed us to discriminate wound exudates from patients with both sterile and infected ulcers without any sample pre-treatment usually indispensable in most diagnostic devices for analysis of physiological fluids. Although size and charge effects in nanochannels have been previously approached for biosensing purposes, as far as we know, the use of nanoporous membranes for monitoring enzymatic cleavage processes, leading to analytical systems for the specific detection of the enzymes has not been deeply explored so far. Compared with previously reported methods, our methodology presents the advantages of no need of neither biorece, Peer Reviewed, Postprint (published version)

The gut–brain–skin axis is important in wound healing. The aim of this study was to investigate the association between experiencing irritable bowel syndrome (IBS) symptoms, perceived immune fitness, and impaired wound healing. N = 1942 Dutch students (mean (SD) age 21.3 (2.1), 83.6% women) completed an online survey. They were allocated to one of four groups: (1) control group (N = 1544), (2) wound infection (WI) group (N = 65), (3) slow healing wounds (SHW) group (N = 236), or (4) a combination group (COMBI), which experienced both WI and SHW (N = 87). Participants rated their perceived immune fitness on a scale ranging from very poor (0) to excellent (10), and the severity of IBS symptoms (constipation, diarrhea, and pain) was assessed with the Birmingham IBS Symptom Questionnaire. Compared to the control group, perceived immune fitness was significantly poorer for the SHW group (p < 0.001) and COMBI group (p < 0.001), but not for the WI group. Compared to the control group, constipation was reported significantly more frequently by the SHW group (p < 0.001) and the WI group (p = 0.012), diarrhea was reported significantly more frequent by the SHW group (p = 0.038) and the COMBI group (p = 0.004), and pain was reported significantly more frequent by the SHW group (p = 0.020) and COMBI group (p = 0.001). Correlations between IBS complaints and perceived immune fitness were statistically significant (p < 0.001), and also a highly significant and negative association was found between the percentage of participants that reported impaired wound healing and perceived immune fitness (r = −0.97, p < 0.001). In conclusion, among participants with self-reported impaired wound healing, IBS complaints were significantly more severe, and accompanied by a significantly reduced perceived immune fitness.

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 microo

The treatment of deep wound sternal infection requires loco-regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the superior epigastric artery perforator (SEAP) flaps to repair sternal defect. Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53-83) years. The mean length and width of the defect were 16.2 × 7 cm (ranging 8-20 × 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° to cover the defect. All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 × 7.3 cm (ranging 14-27 × 6-9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2-years postoperative follow-up all-patients were alive with a successful mediastinal cover. The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.

The incidence of wound botulism in injection drug users has increased since the introduction of black tar heroin. Many species of the Clostridium genus, most commonly Clostridium botulinum, Clostridium baratii, and Clostridium butyricum, have been associated with wound botulism. Patients often present with progressive bulbar weakness, including dysphagia, cranial nerve palsies, and loss of speech, in addition to symmetrical descending weakness of the upper extremities that may progress to the chest and lower extremities. In this article, we present 3 cases of wound botulism, in which the patients presented with bulbar weakness and were treated with botulism antitoxin heptavalent. The time to antitoxin administration and its effect on the patients' clinical courses is compared.

Study designRetrospective hospital-registry study.ObjectiveTo characterize the microbial epidemiology of surgical site infection (SSI) in spinal fusion surgery and the burden of resistance to standard surgical antibiotic prophylaxis.Summary of background dataSSI persists as a leading complication of spinal fusion surgery despite the growth of enhanced recovery programs and improvements in other measures of surgical quality. Improved understandings of SSI microbiology and common mechanisms of failure for current prevention strategies are required to inform the development of novel approaches to prevention relevant to modern surgical practice.MethodsSpinal fusion cases performed at a single referral center between January 2011 and June 2019 were reviewed and SSI cases meeting National Healthcare Safety Network criteria were identified. Using microbiologic and procedural data from each case, we analyzed the anatomic distribution of pathogens, their differential time to presentation, and correlation with methicillin-resistant Staphylococcus aureus screening results. Susceptibility of isolates cultured from each infection were compared with the spectrum of surgical antibiotic prophylaxis administered during the index procedure on a per-case basis. Susceptibility to alternate prophylactic agents was also modeled.ResultsAmong 6727 cases, 351 infections occurred within 90 days. An anatomic gradient in the microbiology of SSI was observed across the length of the back, transitioning from cutaneous (gram-positive) flora in the cervical spine to enteric (gram-negative/anaerobic) flora in the lumbosacral region (correlation coefficient 0.94, P < 0.001). The majority (57.5%) of infections were resistant to the prophylaxis administered during the procedure. Cephalosporin-resistant gram-negative infection was common at lumbosacral levels and undetected methicillin-resistance was common at cervical levels.ConclusionIndividualized infection prevention strategies tailored to opera

Acute appendicitis (AA) is the leading cause of surgical acute abdomen worldwide, with a prevalence of approximately 7% of the population. The present study was conducted to compare different treatment modalities of acute appendicitis. 102 cases of acute appendicitis undergoing appendectomy were divided into 2 groups of 51 each. Group I patients were managed with laparoscopy appendectomy and Group II patients were managed with open appendectomy. Symptoms and parameter such as requirement of oral feed started postoperatively, average hospital stay, wound abscess and wound infection were recorded. Group I had 31 males and 20 females and group II had 35 males and 16 females. Symptoms were fever in 22 in group I and 14 in group II, abdominal pain 48 in group I and 44 in group II and nausea/vomiting 31 in group I and 30 in group II. The mean hospital stay was 5.2 days in group I and 4.3 days in group II, wound abscess was seen in 2 in group I and 5 in group II and wound infection 3 in group I and 7 in group II and oral feed started postoperatively at mean of 5.4 days in group I and 3.2 days in group II. The difference was significant (P< 0.05). There were less complications and better outcome in laparoscopic appendectomy as compared to open appendectomy.

Wound infection is a common and serious medical condition with an unmet need for improved diagnostic tools. A peptidomic approach, aided by mass spectrometry and bioinformatics, could provide novel means of identifying new peptide biomarkers for wound healing and infection assessment. Wound fluid is suitable for peptidomic analysis since it is both intimately tied to the wound environment and is readily available. In this study we investigate the peptidomes of wound fluids derived from surgical drainages following mastectomy and from wound dressings following facial skin grafting. By applying sorting algorithms and open source third party software to peptidomic label free tandem mass spectrometry data we provide an unbiased general methodology for analyzing and differentiating between peptidomes. We show that the wound fluid peptidomes of patients are highly individualized. However, differences emerge when grouping the patients depending on wound type. Furthermore, the abundance of peptides originating from documented antimicrobial regions of hemoglobin in infected wounds may contribute to an antimicrobial wound environment, as determined by in silico analysis. We validate our findings by compiling literature on peptide biomarkers and peptides of physiological significance and cross checking the results against our dataset, demonstrating that well-documented peptides of immunological significance are abundant in infected wounds, and originate from certain distinct regions in proteins such as hemoglobin and fibrinogen. Ultimately, we have demonstrated the power using sorting algorithms and open source software to help yield insights and visualize peptidomic data.

Antibiotic resistant pathogens cause more than 2.8 million infections and 35000 deaths in the United States each year. We need unique and effective therapies that will eradicate bacterial colonization, reduce patient suffering, and improve our ability to deliver necessary medications with reduced complications. Unfortunately, making new classes of antibiotics will not solve the antibiotic resistant problem.Bacteria face different stressful conditions which have an adverse effect on the physiological welfare of bacterial cells. Stress response mechanisms protect cells against stress and make them tolerant to antibiotics. As a result, tolerant cells might be a source of resistance. Targeting the stress response mechanisms can be a good tool to prevent tolerance. Throughout this research, different analytical and characterization methods were used to investigate different stress responses from pathogens in different environmental conditions. Additionally, the effects of stress response mechanisms on making cells tolerant to antibiotics was studied. Consequently, this approach was used to develop some strategies for preventing infection. For example, a small molecule was found to be effective against bacterial survival in some stressful environments, and one type of probiotic strain was used to interact with pathogens and prevent the growth by using its stress response mechanism. Using this knowledge, we can find the ways tolerance arises to target mechanisms of tolerance to combat antibiotic resistance as a more time saving strategy.

PurposeBolus injection of fluid into subcutaneous tissue results in accumulation of fluid at the injection site. The fluid does not form a pool. Rather, the injection pressure forces the interstitial matrix to expand to accommodate the excess fluid in its volume, and the fluid becomes bound similar to that in a hydrogel. We seek to understand the properties and dynamics of externally tumesced (swollen) subcutaneous tissue as a first step in assessing whether tumescent antibiotic injections into wounds may provide a novel method of treatment.MethodsSubcutaneous injections of saline are performed in live and dead pigs and the physical properties (volume, expansion ratio, residence time, apparent diffusion constant) of the resulting fluid deposits are observed with diffusion-weighted magnetic resonance imaging, computed tomography, and 3D scanning.ResultsSubcutaneous tissue can expand to a few times its initial volume to accommodate the injected fluid, which is dispersed thoroughly throughout the tumescent volume. The fluid spreads to peripheral unexpanded regions over the course of a few minutes, after which it remains in place for several hours. Eventually the circulation absorbs the excess fluid and the tissue returns to its original state.ConclusionsGiven the evidence for dense fluid dispersal and several-hour residence time, a procedure is proposed whereby tumescent antibiotic injections are used to treat drug-resistant skin infections and chronic wounds that extend into the subcutaneous tissue. The procedure has the potential to effectively treat otherwise untreatable wounds by keeping drug concentrations above minimum inhibitory levels for extended lengths of time.

Background: While combination therapy with nab-paclitaxel/gemcitabine (nab-gem) is effective in pancreatic ductal adenocarcinoma (PDAC), its efficacy as perioperative chemotherapy is unknown. The primary objective of this multicenter, prospective, single-arm, phase II study was to determine whether neoadjuvant therapy with nab-gem was associated with higher complete resection rates (R0) in resectable PDAC, while the secondary objectives were to determine the utility of radiological assessment of response to preoperative chemotherapy and the safety and efficacy of nab-gem as perioperative therapy. Method(s): Patients were recruited from eight Australian sites, and 42 patients with radiologically defined resectable PDAC and an Eastern Cooperative Oncology Group performance status of 0-2 were enrolled. Participants received two cycles of preoperative nab-paclitaxel 125 mg/m2 and gemcitabine 1000 mg/m2 on days 1, 8, and 15 (28-day cycle) presurgery, and four cycles postoperatively. Early response to chemotherapy was measured with fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans on day 15. Result(s): Preoperative nab-gem was completed by 93% of participants, but only 63% postoperatively. Thirty-six patients had surgery: 6 (17%) were unresectable, 15 (52%) had R0 (>= 1 mm) resections, 14 (48%) had R1 (< 1 mm) resections, and 1 patient did not have PDAC. Median progression-free survival was 12.3 months and median overall survival (OS) was 23.5 months: R0 patients had an OS of 35 months versus 25.6 months for R1 patients after surgery. Seven patients had not progressed after 43 months. Conclusion(s): The GAP trial demonstrated that perioperative nab-gem was tolerable. Although the primary endpoint of an 85% R0 rate was not met, the R0 rate was similar to trials using a > 1 mm R0 resection definition, and survival rates were comparable with recent adjuvant studies.Copyright © 2020, Society of Surgical Oncology.

Background: Parents play an integral role in postoperative wound care. Existing parental knowledge is potentially variable. Our aim was to evaluate for any gaps or misconceptions in the parental knowledge base to determine the need for targeted educational programs. Method(s): Parents of children presenting to a tertiary pediatric center were surveyed in the preoperative stage. This consisted of 26 questions relating to wound healing, complications, and postoperative care. Participants were asked to complete the questionnaire for a same-day, clean abdominal procedure with a 2 cm incision to standardize responses. Expert responses from pediatric surgeons were utilized as a benchmark for nominating concordant answers. Result(s): 200 parents were surveyed. 129 parents (64.5%) had previous experience with surgical wound care. Only 64.5% of parents recognized the most concerning features of wound infection, with 65% of parents correctly identifying when infection is most likely to occur. Parents misjudged the time required before return to school (73.5%) and physical activity (51%). More than half of parents (51.5%) expected postoperative antibiotics to be given. Contrary to our routine surgical practice, 80% and 46% of parents respectively felt that regular dressing changes and application of antiseptics to the wound were necessary postoperatively. Conclusion(s): There is a deficit of parental knowledge concerning wound healing in children. Therefore, there is a requirement for standardization of advice provided to parents with regards to wound and dressing care, development of wound complications, antibiotic and antiseptic use, and the timing of return to regular activities. Type of Study: Survey. Level of Evidence: IIICopyright © 2019 Elsevier Inc.

Background: Tissue adhesive (TiA), adhesive tape (AdT), and sutures can be used to close surgical wounds and lacerations in children. However, it is unclear which technique produces the best results. Method(s): In this prospectively registered study, the PubMed, Ovid MEDLINE, Cochrane Library, Centre for Reviews and Dissemination Database, and ScienceDirect databases were searched. English language studies published between January 1980 and August 2017 evaluating TiA and/or AdT for primary skin closure of surgical wounds or lacerations in patients aged <= 18 years were included. Study endpoints included clinician-rated wound cosmesis and incidence of wound complications. Result(s): Thirty-one studies were included in the systematic review and 16 studies in the meta-analysis. Amongst heterogeneous studies, AdT yielded marginally better cosmetic outcomes than TiA (p = 0.04). There was no difference in cosmesis between sutured wounds and those closed with TiA (p = 0.2). No difference in overall risk of wound infection or dehiscence was identified when comparing TiA with AdT (p = 0.3), and TiA with sutures (p = 0.9 and 0.3 respectively). Conclusion(s): TiA, AdT, and sutures can all be used for wound closure with equivalent risk of wound infection and dehiscence. AdT appears to convey better cosmesis. Further adequately powered studies directly comparing techniques are required. Levels of Evidence: Level IV.Copyright © 2020 Elsevier Inc.

The case of a 32-year-old woman is reported, who was affected by a persisting wound infection caused by Photobacterium damselae after an accident in the Mediterranean Sea. Besides the clinical case, microbiological characteristics based on the phenotypic and genotypic description of the isolate (including whole genome data) are presented and discussed., Wir berichten über den Fall einer 32-jährigen Frau, die nach einem Badeunfall im Mittelmeer von einer persistierenden Wundinfektion, welche durch Photobacterium damselae verursacht wurde, betroffen war. Neben der Beschreibung des klinischen Falls werden mikrobiologische Charakteristika des Isolats vorgestellt und diskutiert. Diese beinhalten phänotypische und genotypische Beschreibungen (auch unter Bezugnahme des gesamten bakteriellen Genoms).

Objective: Diabetic patients suffer more frequently from biofilm-associated infections than normoglycemic patients. Well described in the literature is a relationship between elevated blood glucose levels in patients and the occurrence of biofilm-associated wound infections. Nevertheless, the underlying pathophysiological pathways leading to this increased infection vulnerability and its effects on biofilm development still need to be elucidated. We developed in our laboratory a model to allow the investigation of a biofilm-associated wound infection in diabetic mice under controlled insulin treatment. Methods: A dorsal skinfold chamber was used on 16 weeks old BKS.Cg-Dock7m +/+ Leprdb/J mice and a wound within the observation field of the dorsal skinfold chamber was created. These wounds were infected with Staphylococcus aureus ATCC 49230 (106 cells/mL). Simultaneously, we implanted implants for sustained insulin release into the ventral subcutaneous tissue (N=5 mice). Mice of the control group (N=5) were treated with sham implants. Serum glucose levels were registered before intervention and daily after the operation. Densitometrical analysis of the wound size was performed at day 0, 3, and 6 after intervention. Mice were sacrificed on day 6 and wound tissue was submitted to fluorescence in situ hybridization (FISH) and colony forming unit (CFU) analysis in addition to immunohistochemical staining to observe wound healing. Experiments were carried out in accordance with the National Institute of Health Guidelines for the Care and Use of Laboratory Animals (protocol number 05/19).Results: The insulin implants were able to reduce blood glucose levels in the mice. Hence, the diabetic mice in the intervention group were normoglycemic after the implantation. The combination with the dorsal skinfold chamber allowed for continuous, in vivo measurements of the infection development. Implantation of the insulin implant and the dorsal skinfold chamber was a tolerable condit, Einleitung: Patienten mit Diabetes mellitus leiden häufiger unter Biofilm-assoziierten Infekten als normoglykämische Patienten. Das vermehrte zeitgleiche Auftreten erhöhter Blutzuckerwerte und Biofilm-assoziierter Wundinfekte ist gut beschrieben; der dieser erhöhten Infektvulnerabilität zugrundeliegende Pathomechanismus ist allerdings bisher nicht abschließend erforscht. Um dieses Forschungsfeld künftig tiefergehend zu studieren, haben wir in unserem Labor ein neues Tiermodel zur Untersuchung der Biofilmbildung in diabetischen Mäusen unter einer kontrollierten Insulinbehandlung etabliert. Material und Methoden: 16 Wochen alten BKS.Cg-Dock7m +/+ Leprdb/J Mäusen wurde in einem Rückenhautkammermodell eine dermale Wunde gesetzt. Diese Wunden wurden mit Staphylococcus aureus ATCC 49230 (106 Zellen/mL) infiziert. Zeitgleich wurden den Tieren je nach Versuchsgruppe (je N=5) entweder Insulin verabreichende subkutane Implantate (LinShin Canada Inc., Toronto, Canada) oder wirkstofffreie Implantate appliziert. Die Tiere lebten insgesamt 6 Tage. Täglich wurden das Gewicht, die Temperatur und Blutzuckerwerte der Tiere bestimmt. Nach 6 Tagen wurden Gewebeproben jeweils für Fluoreszenz-in-situ -Hybridisierung, CFU und immunhistochemische Färbungen gewonnen. Die Versuche sind entsprechend der Tierversuchsordnung des Landes Sachsen durchgeführt worden (TVV05/19).Ergebnisse: Wir konnten ein neuartiges zuverlässiges Modell zur Untersuchung der Insulintherapie auf die Ausbildung Biofilm-assoziierter Wunden in diabetischen Mäusen etablieren. Die Insulinpumpentherapie konnte eine Reduktion der Blutzuckerwerte erreichen. Die Kombination des Rückenhautkammermodells, welches kontinuierliche In-vivo-Untersuchungen der Infektion erlaubt, mit Insulinimplantaten ist ein für die diabetischen Mäuse gut tolerierbares Modell.Diskussion: Wir haben ein neuartiges Modell zur Untersuchung des Zusammenhangs zwischen Insulin- und Blutzuckerwerten auf die Bildung von Biofilm-assoziierten Wundinfekten am d

Chronic wounds represent a large and growing disease burden. Infection and biofilm formation are two of the leading impediments of wound healing, suggesting an important role for the microbiome of these wounds. Debridement is a common and effective treatment for chronic wounds. We analyzed the bacterial content of the wound surface from 20 outpatients with chronic wounds before and immediately after debridement, as well as healthy skin. Given the large variation observed among different wounds, we introduce a Bayesian statistical method that models patient-to-patient variability and identify several genera that were significantly enriched in wounds vs. healthy skin. We found no difference between the microbiome of the original wound surface and that exposed by a single episode of sharp debridement, suggesting that this debridement did not directly alter the wound microbiome. However, we found that aerobes and especially facultative anaerobes were significantly associated with wounds that did not heal within 6 months. The facultative anaerobic genus Enterobacter was significantly associated with lack of healing. The results suggest that an abundance of facultative anaerobes is a negative prognostic factor in the chronic wound microbiome, possibly due to the increased robustness of such communities to different metabolic environments.

PurposeThe usefulness of topical antibiotic prophylaxis for routine oculofacial plastic surgery is not well established. Given concerns such as contact dermatitis, antibiotic resistance, and healthcare costs in conjunction with a low baseline rate of surgical site infections, the investigators sought to determine the frequency of infection with and without the use of topical antibiotic prophylaxis.DesignRandomized, controlled, unmasked clinical trial.ParticipantsAdult patients undergoing routine periocular surgery without prior history of periocular surgical site infection, need for perioperative oral or parenteral antibiotics, or allergy to all study medications.MethodsParticipants were randomized before surgery to receive either antibiotic or placebo (mineral oil and petrolatum-based) ointment after surgery. Outcomes were measured at the first postoperative visit. The 2-tailed Fisher exact test was used to compare outcomes between groups.Main outcome measuresThe primary outcome was the incidence of surgical site infections. The secondary outcomes included stratification of infections by patient risk characteristics, incidence of allergic contact dermatitis, and incidence of wound complications.ResultsFour hundred one participants were enrolled and randomized, and 13 participants did not proceed with surgery or were lost to follow-up. High-risk features for infection were identified in 24% of the placebo group and 21% of the antibiotic group. Surgical site infections were more common in the placebo group (2.7% vs. 0.0%; P = 0.025). The rate of contact dermatitis was similar (0.5% vs. 0.5%; P = 1.00), as was the rate of wound dehiscence (2.7% vs. 3.5%; P = 0.77). Among the placebo group, the incidence of infections in the low- and high-risk participants was 2.9% and 2.2%, respectively. Infections were treated with oral or topical antibiotics and resolved without complication, except in 1 patient who required 2 subsequent surgeries to address the seque

No abstract

IMCHV - infekce v místě chirurgického výkonu je druhou nejčastější infekcí spojenou se zdravotní péčí. I přesto, že lze této infekci efektivně předcházet, je i nadále spojena se signifikantní morbiditou a mortalitou, s prodlužováním hospitalizace a s vysokými ekonomickými výdaji na léčbu. Teoretická část se zabývá IMCHV a její etiopatogenezí, rizikovými faktory vzniku, druhy, diagnostikou i léčbou a dále také prevencí, a to zejména v rámci předoperační přípravy. Empirická část je analýzou informací získaných z výzkumného šetření formou rozhovorů s praktickými/všeobecnými sestrami pracujícími na standardních odděleních., SSI - surgical site infection is the second most common health care-associated infection. Although this infection can be effectively prevented, it continues to be associated with significant morbidity and mortality, with prolonged hospitalization and high economic costs for treatment. The theoretical part deals with SSI and its etiopathogenesis, risk factors of origin, types, diagnostics and treatment, as well as prevention of SSI, especially during preoperative preparation. The empirical part is an analysis of information obtained from a research survey in the form of interviews with practical/general nurses working in standard departments., Fakulta zdravotnických studií, Hodnocení vedoucího: velmi dobře Hodnocení oponenta: velmi dobře minus Doplňující otázky k obhajobě: 1. Popište, jaký je rozdíl mezi kategorií a kódem v technice kódování? 2. Vyvoďte prosím obecný závěr k dodržování pravidel předoperační přípravy u VS/PA ve Vašem průzkumném šetření? 3. Jaká byla informovanost VS/PA v rámci IMCHV ve Vašem průzkumném šetření? Obhajoba diplomové práce s prezentací velmi dobrá minus., Dokončená práce s úspěšnou obhajobou

A balanced redox state is critical for proper healing. Although human chronic wounds are characterized by high levels of oxidative stress (OS), whether OS levels are critical for chronic wound development is not known. For these studies, we used our chronic wound model in diabetic mice that has similar characteristics as human chronic wounds, including naturally developed biofilm. We hypothesize that OS levels in wound tissues are critical for chronic wound initiation and development. We show that increased OS levels in the wound correlate with increased chronicity. Moreover, without increased OS levels, biofilm taken from chronic wounds and placed in new excision wounds do not create chronic wounds. Similarly, high OS levels in the wound tissue in the absence of the skin microbiome do not lead to chronic wounds. These findings show that both high OS levels and bacteria are needed for chronic wound initiation and development. In conclusion, OS levels in the wound at time of injury are critical for biofilm formation and chronic wound development and may be a good predictor of the degree of wound chronicity. Treating such wounds might be accomplished by managing OS levels with antioxidants combined with manipulation of the skin microbiome after debridement.

In vivo bioluminescence imaging has been used to monitor Staphylococcus aureus infections in preclinical models by employing bacterial reporter strains possessing a modified lux operon from Photorhabdus luminescens. However, the relatively short emission wavelength of lux (peak 490 nm) has limited tissue penetration. To overcome this limitation, the gene for the click beetle (Pyrophorus plagiophtalamus) red luciferase (luc) (with a longer >600 emission wavelength), was introduced singly and in combination with the lux operon into a methicillin-resistant S. aureus strain. After administration of the substrate D-luciferin, the luc bioluminescent signal was substantially greater than the lux signal in vitro. The luc signal had enhanced tissue penetration and improved anatomical co-registration with infected internal organs compared with the lux signal in a mouse model of S. aureus bacteremia with a sensitivity of approximately 3 × 104 CFU from the kidneys. Finally, in an in vivo mixed bacterial wound infection mouse model, S. aureus luc signals could be spectrally unmixed from Pseudomonas aeruginosa lux signals to noninvasively monitor the bacterial burden of both strains. Therefore, the S. aureus luc reporter may provide a technological advance for monitoring invasive organ dissemination during S. aureus bacteremia and for studying bacterial dynamics during mixed infections.

Background: Radical prostatectomy (RP) is recommended for the treatment of men with clinically localised prostate cancer. However, RP is associated with a high incidence of erectile dysfunction (ED), which can impact the quality of life (QoL) significantly. Objective(s): To evaluate the effectiveness of end-to-side nerve grafting surgery to restore erectile function and improve sexual QoL in men with ED after RP. Design, setting, and participants: A retrospective review of a single-centre experience of nerve grafting in men with ED following RP was performed. Seventeen men had surgery between March 2015 and October 2017 in Melbourne, Australia, which fulfilled study inclusion and exclusion criteria. Intervention(s): Microsurgical bilateral end-to-side nerve grafts from a selective fascicular neurotomy of the femoral nerve to the penile corpora cavernosa. Outcome measurements and statistical analysis: Results were serially measured utilising the International Index of Erectile Function (IIEF-5) and the sexual domain of Expanded Prostate Cancer Index Composite (EPIC-26). The proportion and 95% confidence interval (CI) of men recovering sexual function following nerve grafting were determined. Results and limitations: All patients had ED following their RP. Median age at nerve grafting was 64 yr (interquartile range [IQR] 60-66 yr). Median time between nerve- and non-nerve-sparing RP, and nerve grafting was 2.4 (IQR 2.1-3.1) and 2.2 (IQR 1.7-5.1) yr, respectively. Median follow-up was 18 (IQR 15-24) mo. At 12 mo after nerve grafting, 71% (95% CI 44-90%) of patients had erectile function recovery sufficient for satisfactory sexual intercourse, and 94% (95% CI 71-99%) and 82% (95% CI 57-96%) had clinically significant improvements in sexual function and reduced bother, respectively. There were two minor wound infections. Limitations include the retrospective study design. Conclusion(s): End-to-side nerve grafting restored erectile function in 71% of men with ED following

40 p. : il. -- Bibliogr.: p. 23-25, Marco y Justificación: El cuidado de heridas con biofilm es uno de los mayores retos actuales para los profesionales sanitarios. El biofilm presenta unas características especiales que conduce a un retardo en la evolución y cicatrización de heridas. Esto está generando un gasto sanitario elevado, y la calidad de vida de los usuarios que lo sufren se ve afectada de forma negativa. En los últimos años se ha estudiado el impacto de diversas estrategias terapéuticas en la disrupción del biofilm, de forma in vitro e in vivo obteniendo diferentes resultados. Objetivo: Esta revisión crítica de la literatura pretende analizar la efectividad de estrategias terapéuticas actuales para combatir el biofilm en heridas crónicas. Metodología: Realizamos búsquedas con las siguientes palabras clave: Biofilm, Wound healing, Treatment, Management, Anti-bacterial agents, Wound closure techniques, Wound and Injuries, Wound Infection, Chronic ulcers, Chronic wounds y Non-healing wounds. Revisamos fuentes bibliográficas que son Medline-Ovid, Cuiden, CINHAL y Cochrane. Resultados: Hemos seccionando 15 estudios que analizan la efectividad de agentes surfactantes, Terapia de Presión Negativa, plata, amonio, cadexómero yodado, triptófano, ultrasonidos de baja frecuencia y terapia fotodinámica, tanto in vitro como in vivo. Conclusiones: Los surfactantes, la plata y la Terapia de Presión Negativa han sido las estrategias más estudiadas y cuya efectividad sobre el biofilm se confirma. Sobre el resto de terapias solo hemos encontrado un único estudio sobre cada una de ellas con rigor científico que también defienden la capacidad de las mismas para combatir el biofilm; así es que sería necesario realizar más estudios, especialmente in vivo, que evidencien más precisión y fiabilidad en los resultados.

This thesis provides the most comprehensive information available to date, about the presentation of infection, and factors associated with an increased likelihood of developing infection in chronic leg ulcers. These factors include comorbid conditions, medications, psychosocial factors, and local lower-limb factors. A conceptual framework, named Factors for Infection in Chronic Leg Ulcers or FICLUs, was also constructed, which can be used to guide future research in wounds. The thesis recommends a holistic approach when assessing patients with chronic leg ulcers and early interventions to prevent infection.

Topical treatment of wound infections is often a challenge due to limited drug availability at the site of infection. Topical drug delivery is an attractive option for reducing systemic side effects, provided that a more selective and sustained local drug delivery is achieved. In this study, a poorly water-soluble antibiotic, ciprofloxacin, was loaded on polyvinylpyrrolidone (PVP)-based foils and nanofiber mats using acetic acid as a solubilizer. Drug delivery kinetics, local toxicity, and antimicrobial activity were tested on an ex vivo wound model based on full-thickness human skin. Wounds of 5 mm in diameter were created on 1.5 × 1.5 cm skin blocks and treated with the investigated materials. While nanofiber mats reached the highest amount of delivered drug after 6 h, foils rapidly achieved a maximum drug concentration and maintained it over 24 h. The treatment had no effect on the overall skin metabolic activity but influenced the wound healing process, as observed using histological analysis. Both delivery systems were efficient in preventing the growth of Pseudomonas aeruginosa biofilms in ex vivo human skin. Interestingly, foils loaded with 500 µg of ciprofloxacin accomplished the complete eradication of biofilm infections with 1 × 109 bacteria/wound. We conclude that antimicrobial-loaded resorbable PVP foils and nanofiber mats are promising delivery systems for the prevention or topical treatment of infected wounds.

The prevalence of infection in chronic wounds is well documented in the literature but not optimally studied due to the drawbacks of current methodologies. Here, we describe a tractable and simplified ex vivo human skin model of infection that addresses the critical drawbacks of high costs and limited translatability. Wounds were generated from excised abdominal skin from cosmetic procedures and cultured, inoculated with Staphylococcus aureus strain UAMS-1, or under aseptic conditions. After three days, the infected wounds exhibited biofilm formation and significantly impaired reepithelialization compared to the control. Additionally, promigratory and proreparative genes were significantly downregulated, while proinflammatory genes were significantly upregulated, demonstrating molecular characterizations of impaired healing as in chronic wounds. This model allows for a simplified and versatile tool for the study of wound infection and subsequent development of novel therapies.