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Objective: To investigate the clinical characteristics and treatment outcomes of Nocardia infection after ocular surface surgery., Methods: This is a retrospective study. Eight cases of culture-proven Nocardia infection, which developed within 1 month after ocular surface surgery were included. Demographics and clinical history of patients were investigated., Results: There were 8 eyes (2 left and 6 right) of 8 patients (5 males and 3 females), aged 27-65, with a median age of 52.9 years. Three cases underwent pterygium excision, three were subjected to conjunctival flap covering, and two were treated with lamellar corneal transplantation. The time interval between previous surgery and the onset of symptoms varied from 7 to 28 days (mean = 20.5 ± 7.13 days). All the cases presented grey-white infiltrates at the surgical incision site while appearing with six corneal ulcers and two conjunctival ulcers. Filaments of Nocardia were founded by confocal microscopy in two of the five cases. All responded poorly to medical therapy. Seven of the eight cases were treated with reoperation. Nocardia infection recurred in three cases after reoperation, and one was eviscerated., Conclusions: Surgical trauma is a risk factor for ocular Nocardia infection. Nocardia infection should be suspected when secondary infection occurs in a surgical incision with an atypical clinical presentation. The use of corticosteroids may influence the efficacy of drugs. Complete removal of lesions may lower the recurrence of Nocardia infection with poor drug treatment effects., (© 2022. The Author(s).)

Background/aim: The aim of this study was to verify the efficacy of wound protection with a plastic ring wound protector (ring drape) and using new sterile instruments when closing the abdominal wall (wound closure set), both of which were used to prevent incisional surgical site infection (SSI) after hepatectomy., Patients and Methods: The incidence of incisional SSIs and the clinical courses of 572 patients who underwent hepatectomy between January 2010 and December 2015 were studied retrospectively. The patients were divided into three period groups according to the period when each infection countermeasure was started., Results: Incisional SSI incidence decreased significantly with additional countermeasures: 1 st period 10.1%; 2 nd period 2.08% (p=0.0114); 3 rd period, 1.63% (1st vs. 3 rd period, p=0.0016). A multivariate analysis showed that postoperative bile leakage [odds ratio (OR)=4.12, p=0.012] and not using a ring drape (OR=0.176, p=0.003) were independent factors for incisional SSI., Conclusion: Incisional SSI incidence was significantly reduced by using ring drape after hepatectomy., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Purpose: To study the effect on infection factors and nursing care of postoperative incision in gynecological cancer patients., Method: 72 patients with gynecological malignant tumors who came to the hospital from January 2019 to December 2019 were selected as the research objects. They were divided into the study group and control group by cluster random sampling. The control group was given routine nursing mode, including matters needing attention in surgery, health education, prevention of complications, and dietary guidance. The study group implemented the high-quality nursing mode on the basis of the control group. Postoperative situation, incision infection rate, and quality of life were observed and compared between the two groups., Results: The control group's time to get out of bed, postoperative eating time, postoperative exhaust time, and hospital stay were longer than those of the study group. The comparison of the postoperative related conditions of the two groups showed that P < 0.05, which indicated that the difference was statistically significant. The postoperative incision infection rate in the study group was 2.78%, and in the control group, the postoperative incision infection rate was 19.44%; the postoperative incision infection rate in the study group was significantly lower than that in the control group. The difference was statistically significant, P < 0.05. The factors affecting the quality of life of patients in the study group were lower than that of the control group, and the difference was statistically significant, P < 0.05. Time to get out of bed, postoperative eating time, postoperative exhaust time, hospital stay, and quality of life were the main influencing factors of postoperative incision infection in gynecological tumors., Conclusion: Time to get out of bed, postoperative eating time, postoperative exhaust time, hospital stay, and quality of life were the main influencing factors of postoperative incision infection in gynecological tumors. High-quality nursing intervention had better clinical nursing effect in preventing postoperative incision infection. It should be widely used in clinical nursing., Competing Interests: The author declares that he has no conflict of interest., (Copyright © 2021 Yan Sun.)

Background: Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs)., Study Design: We conducted a retrospective cohort study of patients who underwent AWR using ADM, from March 2005 to June 2019. Outcomes were compared between Centers for Disease Control and Prevention (CDC) wound classifications. The primary outcome measure was HR. Secondary outcomes were SSOs and SSIs., Results: We identified 725 AWRs using ADM that met the study criteria. Participants had a mean age of 60 ± 11.5 years, mean BMI of 31 ± 7 kg/m 2 , and mean follow-up time of 42 ± 29 months. Three hundred two patients (41.6%) had clean defects, 322 patients (44.4%) had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. Patients with contaminated/dirty-infected defects had an HR rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. Multivariate logistic regression found that contaminated/dirty-infected defects were independent predictors of SSOs (OR 2.99; 95% CI 1.72-5.18; p < 0.0001) and SSIs (OR 2.32; 95% CI 1.27-4.25; p = 0.006), but not HR (OR 1.06; 95% CI 0.57-1.98; p = 0.859)., Conclusions: SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination., (Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Skin tissue repair is of fundamental importance for maintaining homeostasis regulation, protection barrier, absorption, and excretion of skin tissue. Wound healing is a complicated process that can be impaired by infections and therefore have a significant economic and social impact. Simultaneously, the overuse of antibiotics has led to antimicrobial resistance and loss of their efficacy. Thus, the need for alternative antimicrobial agents is urgent. The newest approaches on wound dressings employ new therapeutic agents, such as probiotics. Probiotics alone or in tandem with nanotechnology-based techniques exhibit a broad range of benefits on surgical wounds. This systematic review aims to consider current knowledge of probiotic effects on animals and humans regarding surgical wound healing and provide new insights into the role of nanotechnology. The databases included were PubMed (MEDLINE), Scopus, and Cochrane Library (CENTRAL). Studies focused on burns, chronic wounds, and diabetic ulcers were excluded. The promising industry of probiotics demonstrates a significant upsurge as more and more healthy individuals rely their well-being on alternative medicine. Included probiotics illustrated positive results on wound re-epithelization, neovascularization, and wound healing. No adverse effects were noted.

Background: Cutibacterium acnes is found in skin flora of the shoulder and is the most common microbe identified in periprosthetic shoulder infections. The purpose of this study is to determine if there is C acnes present on the incision scalpel in patients undergoing shoulder arthroplasty despite extensive skin preparation techniques to prevent wound contamination., Methods: The authors collected a consecutive case series of patients meeting inclusion criteria. Patients were included if they underwent either primary or revision shoulder arthroplasty at the tertiary care hospital with the senior author during the study period. Culture swab samples, testing for presence of C acnes, were collected from 17 consecutive patients who underwent shoulder arthroplasty with a single fellowship-trained surgeon between November 2019 and March 2020. Culture reports were recorded as "positive" or "negative" after 21 days. Institutional review board approval of the study protocol was obtained. The null hypothesis was that there would be no cases with knife blades "culture positive" for C acnes., Results: 17 patients were identified and fit inclusion criteria. There were 12 men (mean age 64.3 years, range 48-79 years) and 5 women (mean age 69.8 years, range 59-79 years). Two patients (11.8%) were found to have C acnes growth on the skin knife. Both patients were male and older than 70 years undergoing primary reverse shoulder arthroplasty with no history of previous shoulder infections., Conclusion: The presence of C acnes on the skin blade in 2 patients validates concerns that there is C acnes present in dermal tissue despite extensive attention to eradication of these microbes. There was a high rate of C acnes contamination on scalpel blades used for initial skin incisions and the authors conclude that there is value in discarding these blades from the surgical field., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Chronic wound biofilm infections are a threat to the population with respect to morbidity and mortality. The presence of multidrug-resistant bacterial pathogens in chronic wound renders the action of antibiotics and antibiofilm agents difficult. Therefore an alternative therapy is essential for reducing bacterial biofilm burden. In this scenario, the peptide-based antibiofilm therapy for chronic wound biofilm management seeks more attention. A synthetic peptide with a broad range of antibiofilm activity against preformed and established biofilms, having the ability to kill multispecies bacteria within biofilms and possessing combinatorial activity with other antimicrobial agents, provides significant insights. In this review, we portray the possibilities and difficulties of peptide-mediated treatment in chronic wounds biofilm management and how it can be clinically translated into a product., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The risk of surgical site infection in pediatric posterior spine fusion (PSF) is up to 4.3% in idiopathic populations and 24% in patients with neuromuscular disease. Twenty-three percent of pediatric PSF tissue cultures are positive before closure, with a higher rate in neuromuscular patients. Our primary aim was to evaluate the feasibility of a complete randomized controlled trial to study the efficacy of surgical site irrigation with povidone-iodine (PVP-I) compared with sterile saline (SS) to reduce the bacterial contamination rate before closure in children undergoing PSF., Methods: One hundred seventy-five subjects undergoing PSF were enrolled in a multicenter, single-blind, pilot randomized controlled trial. We recruited patients at low-risk (LR) and high-risk (HR) for infection 3:1, respectively. Before closure, a wound culture was collected. Nonviable tissues were debrided and the wound was soaked with 0.35% PVP-I or SS for 3 minutes. The wound was then irrigated with 2 L of saline and a second sample was collected., Results: One hundred fifty-three subjects completed the protocol. Seventy-seven subjects were allocated to PVP-I (18 HR, 59 LR) and 76 to SS (19 HR, 57 LR). Cultures were positive in 18% (14/77) of PVP-I samples (2 HR, 12 LR) and in 17% (13/76) of SS samples (3 HR, 10 LR) preirrigation and in 16% (12/77) of PVP-I samples (5 HR, 7 LR) and in 18% (14/76) of SS samples (4 HR, 10 LR) postirrigation. Eight percent (3/37) HR subjects (1 PVP-I, 2 SS) experienced infection at 30 days postoperative. No LR subjects experienced infection., Conclusions: Positive cultures were similar across treatment and risk groups. The bacterial contamination of wounds before closure remains high regardless of irrigation type. A complete randomized controlled trial would be challenging to adequately power given the similarity of tissue positivity across groups., Level of Evidence: Level II-pilot randomized controlled trial.

The remedy for infected chronic wounds such as diabetic foot ulcers is more complicated particularly in the case of patients with an inefficient immune system. Also, fighting against microbial infections in the wound site by available antibiotics may not be effective because of emerging antibiotic resistance properties among pathogenic bacteria and fungi. Recently, applications of micro- and nanoformulations of biomaterials have demonstrated improved therapeutic abilities for wound dressings. In this way, carboxymethyl, dialdehyde, and 2,2,6,6-tetramethylpiperidine-1-oxyl-oxidized celluloses are common biomaterials having outstanding physicochemical and therapeutic properties compared to unmodified cellulose. Therefore, in this review, recent progress in the field of wound healing and antimicrobial activities of these derivatives are presented and discussed., (© 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: To review the clinical experience for non-shaved middle ear/mastoid surgery and evaluate the proper method of preparing the postauricular surgical field., Methods: This retrospective study reviewed medical records of cases where the non-shaved surgical procedure was carried out for middle ear/mastoid diseases. In all cases, middle ear and mastoid surgery was performed by one otologic surgeon without hair shaving to treat chronic perforation of tympanic membrane, as well as chronic suppurative otitis media, with or without mastoiditis during two years. The prevalence of surgical site infection (SSI) and bacterial culture of the surgical field was assessed just before the skin incision., Results: In this review of 106 cases, the SSI rate was 1.6% for the non-shaved ear surgery. Bacterial colonisation was found on the prepared surgical field in 8.5% of cases and these bacteria was different from true pathogens. SSI of the skin incision occurred in two cases, although no bacterial colonisation of the non-shaved surgical field was found. The surgical exposure of postauricular area was enough to do tympanoplasty or tympanomastoidectomy, even though in cases where a hairline was close to postauricular sulcus., Conclusion: This study showed that when preparing the non-shaved ear surgery, the surgeons should not have to worry about skin contamination by hair. We suggest that the non-shaved ear surgery would appear to be preferable for the postauricular approach.

Objective: To analyze contamination of surgical wound during tracheal resection depending on the mode of mechanical ventilation., Material and Methods: There were 976 patients. Circular tracheal resection was made in 396 of these patients., Results: Overall postoperative morbidity was 15.7%, mortality - 0.8%. Bacteriological examination of surgical wound was performed before tracheotomy and after formation of anastomosis depending on the method of mechanical ventilation. Surgical field was sterile before tracheotomy in all cases, contamination was confirmed after tracheotomy in all patients. Minimal contamination was observed in case of apneic oxygenation (100 times less than volumetric mechanical ventilation or high frequency mechanical ventilation). In all cases, several species of pathogenic microorganisms were identified. The number of species was also minimal in case of hypnotic mechanical ventilation., Conclusion: Contamination does not directly affect the development of local purulent-inflammatory process. However, this factor should not be ignored and compliance with all preventive measures is required.

Purpose: To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence., Methods: Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33-49) and 20 control patients with scoliosis (median age 17, IQR 15-20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes., Results: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated., Conclusions: Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. These slides can be retrieved under Electronic Supplementary Material.

In the past few years the increasing incidence of hospital infections with Acinetobacter baumannii, especially in immunocompromised patients, and its proneness to develop multidrug resistance have been raising considerable concern. This study examines the antimicrobial and antibiofilm activity of protegrin 1 (PG-1), an antimicrobial peptide from porcine leukocytes, against A. baumannii strains isolated from surgical wounds. PG-1 was tested both alone and combined with the antibiotics commonly used in clinical settings. Its antimicrobial activity was evaluated by determination of minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), checkerboard assays, and time-kill experiments. Its effects on biofilm inhibition/eradication were tested with crystal violet staining. The strains were grown in subinhibitory or increasing PG-1 concentrations to test the development of resistance. Mammalian cell toxicity was tested by XTT assays. PG-1 MICs and MBCs ranged from 2 to 8 µg/ml. PG-1 was most active and demonstrated a synergistic interaction with colistin, a last resort antibiotic. Interestingly, antagonism was never observed. In time-kill experiments, incubation with 2 × MIC for 30 min suppressed all viable cells. PG-1 did not select resistant strains and showed a limited effect on cell viability, but it did exert a strong activity against multidrug-resistant A. baumannii. In contrast, in our experimental conditions it had no effect on biofilm inhibition/eradication. PG-1 thus seems to be a promising antimicrobial agent against multidrug-resistant Gram-negative infections.

Biocompatible polymers are being used in recent times for treating skin injuries and burn wounds. Polymers like Poly Vinyl Alcohol and Chitosan are proven to be biocompatible with least toxic to treat injuries with minimal side-effects. Curcumin, a primary component of turmeric has anti-inflammatory properties and anti-microbial activity but has extremely low bioavailability. Converting Curcumin to its nano form increased its bioavailability exponentially allowing it to play a vital role in the process of wound healing. This PVA/Chi/Cur patch increased cell proliferation as shown by the results of cell line studies and MTT assay. Its anti-bacterial activity against four major bacterial strains commonly found in wound sites and water retainability indicates it to be a perfect material for wound treatment. Results of in-vivo studies conducted on wistar rats by testing the patch's healing ability on a surgically induced wound displayed its superiority over commercial ointment. This treatment for epidermal wounds reduces the frequency in which the patch has to be replaced and increases the rate of wound rehabilitation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Mycobacterium bovis is the main agent of bovine tuberculosis, but has also zoonotic potential. An 8-month-old female domestic shorthaired cat imported from Ukraine developed wound complications after abdominal surgery. A second surgery performed in Germany showed a focal, partly cystic mass within the mesentery. Despite antimicrobial treatment, the cat did not recover and was humanely destroyed. Grossly, several abdominal lymph nodes were enlarged. Histopathology revealed a mild to moderate, multifocal, granulomatous to pyogranulomatous, partially necrotizing inflammation, most prominent in the abdominal cavity. Within the lesions there were acid-fast bacilli within the cytoplasm of macrophages demonstrated by Ziehl-Neelsen staining. Further investigations revealed M. bovis SB0950 in the affected tissues., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Debates still exist whether delayed primary incision closure (DPC) could bring more benefits to patients suffering contaminated abdominal surgery. So, we want to determine whether DPC has advantage over primary incision closure (PC) in contaminated abdominal surgery., Methods: Embase, Medline, and the Cochrane Library databases were searched for eligible studies from January 1, 1980 to August 6, 2017. Bibliographies of potential eligibility were also retrieved. The primary outcome was the rate of surgical site infection (SSI) and the second outcome was length of hospital stay (LOS). A systematic review and meta-analysis of RCTs were performed., Results: Twelve studies were included in the final quantitative synthesis. Of the 12 studies included, five were from third world countries (i.e., India and Pakistan), and all of these demonstrated an improvement in SSI rate with DPC. When the fixed-effect model used, compared with PC, SSI was significantly reduced in DPC with a risk ratio of 0.64 (0.51-0.79) (P < 0.0001), and a significant difference in LOS between DPC and PC was also identified with a mean difference of 0.39 (0.17-0.60) (P = 0.0004). Although the random-effect model was used, no significant difference in SSI between DPC and PC was observed with a risk ratio of 0.65 (0.38-1.12) (P = 0.12), and no significant difference in LOS between DPC and PC was found with a mean difference of 1.19 (-1.03 to 3.41) (P = 0.29)., Conclusions: DPC may be the preferable choice in contaminated abdominal surgeries, especially in patients with high risk of infection, and particularly in resource constrained environments. In addition, more high-quality studies with well design are needed to provide clear evidence., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: This study aimed to determine the magnitude and associated factors of surgical site infection following cesarean section at Felegehiwot referral hospital, Amhara, Bahir Dar, Ethiopia, 2018. An institution-based retrospective cross-sectional study was conducted from April 1 to May 30, 2018, at Felegehiwot referral hospital. Retrospective chart review was implemented on 383 women who gave birth via cesarean section at Felegehiwot hospital from October 1, 2016 to September 30, 2017. Systematic random sampling technique was implemented to select patient medical charts., Results: This study revealed that the prevalence of surgical site infection following cesarean section was 7.8% with the [95% CI 5.2-10.5%]. Rupture of membrane before cesarean section (AOR = 13.9, 95% CI 2.99-64.8), vertical skin incision/longitudinal abdominal incision (AOR = 4.77, 95% CI 1.74-13.06), duration of operation lasting longer than 30 min (AOR = 4.9, 95% CI 1.8-13.1), interrupted skin closure technique (AOR = 6.29, 95% CI 2.07-19.11) were statistically associated with surgical site infection following cesarean section.

Background and objectives: Treatment of a prosthetic vascular graft infection (PVGI) remains a challenging problem in vascular surgery. The aim of this study was to design a novel rat model for treatment of peripheral vascular prosthesis infection caused by Staphylococcus aureus (S. aureus) and to determine the efficacy of different antiseptic solutions in suppressing or eradicating infection from the wound and the graft material itself. Materials and methods: A piece of Dacron vascular prosthesis was surgically implanted at the dorsum of 48 Wistar rats and the wounds were infected with 5 McFarland standard inoculum of S. aureus . Suppurating wounds were daily irrigated with different antiseptic solutions: octenidine dihydrochloride, povidone-iodine, chlorhexidine digluconate, and sterile saline. The antimicrobial action of antiseptics was defined according to their capability to eradicate bacteria from the graft surroundings and bacteriological examination of the graft itself. Extended studies on wound microbiology, cytology, and histopathology were performed with an additional group of 10 rats, treated with the most effective antiseptic-octenidine dihydrochloride. Results: Four-day treatment course with octenidine, povidone-iodine, and chlorhexidine resulted in 99.98% ( p = 0.0005), 90.73% ( p = 0.002), and 65.97% ( p = 0.004) decrease in S. aureus colonies in wound washouts, respectively. The number of S. aureus colonies increased insignificantly by 19.72% ( p = 0.765) in control group. Seven-day treatment course with octenidine eradicated viable bacteria from nine out of 10 wound washouts and sterilized one vascular graft. Conclusions : A reproducible rat model of PVGI with a thriving S. aureus infection was designed. It is a first PVGI animal model where different antiseptic solutions were applied as daily irrigations to treat peripheral PVGI. Seven-day treatment with octenidine eradicated bacteria from the wound washouts for 90% of rats and one vascular graft. Further studies are needed to investigate if irrigations with octenidine could properly cure vascular bed from infection to assure a successful implantation of a new synthetic vascular substitute.

Diabetic patients suffer from persistent and non-healing wounds. Salvia species are traditionally used for the treatment of wounds and colds. The aims of the present study were to evaluate the in vivo wound healing potential, in vitro antimicrobial and antioxidant activities, and total phenolic and flavonoid contents of the aerial parts of two endemic taxa, Salvia kronenburgii Rech. f. (SK) and Salvia euphratica Montbret, Aucher & Rech. f. var. euphratica (SE). Two different concentrations (0.5% and 1% (w/w)) of ethanol extracts were investigated in incision and excision wound models on Streptozotocin-induced diabetic rats using biomechanical, biochemical, histopathological, macroscopic, and genotoxic methods for 7 and 14 days. Antimicrobial activity was evaluated against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Acinetobacter baumannii, Aeromonas hydrophila, Mycobacterium tuberculosis, Candida glabrata, Candida parapsilosis, and Candida tropicalis using the broth microdilution and the resazurin microtiter assay plate methods. Fito ® , Ampicillin, Ethambutol, Isoniazid, and Fluconazole were used as reference drugs. Antioxidant capacities and total phenolic and flavonoid contents of both extracts were detected using DPPH free radical scavenging assay, Folin-Ciocalteu, and Al(NO 3 ) 3 methods, respectively. SK ointment at 0.5% and 1% (w/w) concentrations and SE ointment at 1% (w/w) concentration showed 99.9%, 99.5%, and 99.7% contraction, respectively for excision wounds, and SK and SE ointments at 1% (w/w) concentration showed 99.4% and 99.2% contraction for incision wounds while Fito ® showed 98.9% and 98.5% contraction, respectively. Increased re-epithelialization (P < 0.01 and P < 0.001), angiogenesis, and decreased dermal inflammation (P < 0.001) were determined for SK and SE ointments at both 7 and 14 days. SE ointment on day 7 and SK ointment on day 14 reduced oxidative damage to DNA when compared to control (P < 0.01 and P < 0.001). Both tested plants had greater antibacterial activity against A. baumannii (62.5 μg/mL MIC value) and SE had greater antimycobacterial activity against M. tuberculosis (0.24 μg/mL MIC value) when compared to reference drugs Ampicillin, Isoniazid, and Ethambutol (125, 0.97, and 1.95 μg/mL MIC values, respectively). Antioxidant capacities, total phenolic and flavonoid contents of SE and SK were 87.08%, 76.21 μg GAE/mg, 43.43 μg QE/mg and 72.17%, 41.81 μg GAE/mg, 33.62 μg QE/mg, respectively. SK and SE had strong wound healing effects while SK found to be more effective than SE at both 7 and 14 days., (Copyright © 2019 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: There was a controversy about surgery approach of thoracic and lumbar tuberculosis (TB) treatment. The aim of this study was to compare the microbiology outcomes of the drainage liquid and the clinical outcomes of a posterior and anterior approach in the treatment of thoracic and lumbar TB., Materials and Methods: A total of 105 patients were enrolled in this prospective study from February 2011 to September 2015. Patients were divided into two groups: group A (51 patients, posterior approach surgery) and group B (54 patients, anterior approach surgery). Intraoperative TB samples were sent for Mycobacterium tuberculosis culture (MTBC). Drainage fluid was postoperatively collected for polymerase chain reaction (PCR), acid-fast strains (AFS), MTBC, and DNA molecular detection (DNAMD) analyses. Compare the drainage liquid positive rate of the two groups and estimate relationship between the positive results of drainage fluid and the lesion region. In addition, the clinical outcomes including the bony fusion, relapse rate, complications, and neurological status were collected., Results: There was no significant difference in the positive rate of AFS, PCR, DNAMD, MTBC, or any positive rate (APR) of drainage liquid between the two groups (P > 0.05). In both groups, the MTBC-positive rate of postoperative drainage fluid was significantly lower than that of the intraoperative sample (P < 0.01). There was no significant relationship between APR and the lesion region (P > 0.05). All the patients had at least 2 years of follow-up, with an average of 34.4 ± 15.8 months. There were four patients in group A and two patients in group B who had recurrent spine TB, and the rest of the patients had fusion in the surgical area. There was no significant difference in the incidence of TB recurrence or other complications between the two groups (P > 0.05). All the patients with neurological dysfunction had improved after surgery., Conclusion: Compared with anterior approach surgery, posterior approach surgery had equal effectiveness of debridement. The two kinds of surgery can effectively clear the lesions surrounding the spine and heal thoracic and lumbar TB.

Background: There is limited information about bacterial isolates that are present on the equine midline incision during and following exploratory laparotomy., Objectives: To investigate the bacterial species cultured from the ventral midline pre-, intra- and post- laparotomy, whether particular bacterial isolates are associated with the development of surgical site infections (SSIs) and to report the antimicrobial resistance phenotypes of these isolates., Study Design: Prospective cohort study., Methods: The ventral midline of 31 horses undergoing exploratory laparotomy was sampled for bacterial culture at set time-points pre, intra and post-operatively. Inclusion criteria were that horses must have undergone exploratory laparotomy within 90 min of the initial colic examination upon hospital admission and must not have been placed in a stable prior to surgery. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration., Results: Seven horses (22.6%) developed a SSI. None of the variables tested were associated with the altered risk of SSI. The prevalence of a positive bacterial culture from the incision increased progressively over time and a variety of bacteria were isolated. A positive intra-operative culture was not a predictor of SSI; and when a SSI did occur, it was due to a different bacterial isolate. MRSA and ESBL-producers were identified in the post-operative period in one and four different horses respectively, but none of these developed a SSI., Main Limitations: Sampling was limited to hospitalisation and no culture results were available for horses developing SSI following hospital discharge., Conclusions: A variety of bacterial species may be isolated from equine laparotomy incisions peri-operatively without development of SSI. SSI does not appear to be solely related to bacterial contamination of the incision peri-operatively and other mechanisms such as bacteraemia merit further investigation., (© 2018 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)

Relevance of microbiological monitoring in chronic osteomyelitis of the tibia developed during treatment of fractures with a plate is associated with a noticeable increase of various kinds of the microflora. A microbiological study was conducted of pathological material taken from wounds, fistulas and from the focus of inflammation in 49 patients with chronic tibial osteomyelitis, developed during treatment of fractures with a plate. The patients underwent sequestrectomy of the tibia and subsequent application of bilocal consecutive compression-distraction osteosynthesis or monolocal compression osteosynthesis. Microbiological study of smears taken before the reconstructive treatment from fistulas and wounds of patients showed that in monoculture there were 30 strains, the remaining 30 - as a part of 14 two - and three-component associations. The frequency of S. aureus strains was 55.3%, followed by coagulase-negative staphylococcus - 13.6% and representatives of the family Enterobacteriacae - 10.2%. There were methicillin-resistant strains of S. aureus in 11.8%, strains of coagulase-negative staphylococcus (MRCoNS) - 6.8%. Recurrence of the disease was observed in 7 patients. The microflora of the discharge from the fistula was represented by monocultures of S. aureus and associations of bacteria in which one of the components was methicillin-resistant strains of S. aureus. We observed differences in the contents of the microflora before reconstructive treatment of patients and in recurrence of infection. In case of recurrence of infection, the qualitative contents of the microflora changed: in 2 patients in the association of microorganisms and in 3 - in monocultures, S. aureus strains acquired resistance to ß-lactam antibiotics, new associations appeared, which were not present in primary cultures before reconstructive treatment. The study showed that the spectrum of micro-organisms in chronic osteomyelitis of the tibia, developed after osteosynthesis with a plate, varied and is subject to change and that dictates the need for microbiological monitoring to detect the etiological structure of pathogens, monitoring of antibiotic resistance of the isolated strains and rational approach to treatment of patients., Competing Interests: The authors declare no conflict of interest.

For the practicing surgeon, the development of a postoperative wound infection represents a major complication that can be both costly and disabling. As a result, surgeons apply multiple methods of prevention including skin decontamination, use of antibiotics, irrigation with or without antiseptics and meticulous use of technique. In elective surgery, however, most wound infections cannot be predicted. In this review we discuss emerging concepts in wound infection pathogenesis and include a discussion on how the wound environment may directly activate bacteria to express a more harmful or virulent phenotype. Based on these emerging concepts, we provide the practicing surgeon with molecular level evidence to explain why some methods of wound infection protection may be useful while others are not., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Many clinical-pathogens have developed resistance against known antibiotics and there is an urgent need for the discovery of novel antibiotics. In this study, low molecular weight peptides were isolated from seeds/leaves of 20 medicinal plants and tested for their antibacterial activity against laboratory strains of S. aureusand P. aeruginosa. Peptides isolated from Peganum harmala (PhAMP) exhibited maximum activity against laboratory strains. As clinical-isolates are more virulent and resistant to antibiotics, we tested the potential of PhAMP on these bacterial strains isolated from infected wounds. Pathogens isolated from burn-wounds (S. aureus, P. aeruginosa and K. pneumoniae) and surgical-wounds (P. aeruginosa and K. pneumoniae) exhibited zones of inhibition against PhAMP when tested by disc diffusion method. Biofilm formation of wound pathogens in the presence/absence of PhAMP was analyzed to check its effect. Surgical-wound pathogens and K. pneumoniae from burn-wound showed significant reduction in biofilm formation and planktonic bacteria. While biofilms of S. aureus and P. aeruginosa from burn-wound showed resistance against PhAMP. An effective antibiotic treatment should not only inhibit but should also disrupt already developed biofilms. PhAMP was very effective in the disruption of developed biofilm of all pathogens after 36 hours. This data unravels the potential of PhAMP as a novel, natural antibiotic against clinical-pathogens.

Background: Surgical site infection (SSI) remains a persistent and morbid problem in colorectal surgery. Key to its pathogenesis is the degree of intraoperative bacterial contamination at the surgical site. The purpose of this study was to evaluate a novel wound retractor at reducing bacterial contamination., Methods: A prospective multicenter pilot study utilizing a novel wound retractor combining continuous irrigation and barrier protection was conducted in patients undergoing elective colorectal resections. Culture swabs were collected from the incision edge prior to device placement and from the exposed and protected incision edge prior to device removal. The primary and secondary endpoints were the rate of enteric and overall bacterial contamination on the exposed incision edge as compared to the protected incision edge, respectively. The safety endpoint was the absence of serious device-related adverse events., Results: A total of 86 patients were eligible for analysis. The novel wound retractor was associated with a 66% reduction in overall bacterial contamination at the protected incision edge compared to the exposed incision edge (11.9 vs. 34.5%, P < 0.001), and 71% reduction in enteric bacterial contamination (9.5% vs. 33.3%, P < 0.001). The incisional SSI rate was 2.3% in the primary analysis and 1.2% in those that completed the protocol. There were no adverse events attributed to device use., Conclusions: A novel wound retractor combining continuous irrigation and barrier protection was associated with a significant reduction in bacterial contamination. Improved methods to counteract wound contamination represent a promising strategy for SSI prevention (NCT 02413879).

Objectives: This study aimed to characterise extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacterial isolates from patients with surgical site infections (SSIs) at a tertiary healthcare facility in Abuja, Nigeria., Methods: Consecutive, non-duplicate wound swabs were collected over a 3-month period from wounds of patients with SSI and were cultured appropriately. Bacterial isolates were identified using rapid identification kits. The modified agar disk diffusion method was used for antimicrobial susceptibility testing, and phenotypic ESBL activity of the isolates was determined using the double-disk synergy test (DDST). PCR was thereafter used for molecular characterisation of the isolates., Results: A total of 57.1% (20/35) of the bacterial isolates were Gram-negative, with Pseudomonas aeruginosa (7/20; 35.0%) being the most prevalent. The isolates exhibited varying degree of antimicrobial resistance, with resistance as high as 100% for ampicillin and amoxicillin. Phenotypic ESBL production was observed in 65.0% (13/20) of the Gram-negative bacterial isolates. DNA analysis revealed that 61.5%, 53.8% and 38.5% of the isolates harboured bla SHV , bla CTX-M and bla TEM genes, respectively, with 30.8% of the isolates co-harbouring bla SHV and bla CTX-M . Similarly, 23.1% of the isolates harboured bla SHV and bla TEM , whilst 15.4% harboured bla CTX-M and bla TEM . However, none of the investigated isolates harboured a bla OXA gene., Conclusion: The prevalence of ESBL genes among Gram-negative SSI pathogens is high. This calls for an urgent need to review infection control policies and antimicrobial prescription patterns as well as increased surveillance of ESBLs as the possibility of an epidemic outbreak of multidrug-resistant pathogens in the hospital is high., (Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

Chronic, nonhealing wounds place an enormous burden on both the health care system and patients, with no definitive treatments available. There has been increasing evidence that the microbial composition of wounds may play an important role in wound healing. Culture-independent methods for bacterial detection and analysis have revealed the wound microbiome to be much more diverse and complex than culture alone. Such methods primarily rely on targeted amplification and sequencing of various hypervariable regions of the bacterial 16S rRNA for phylogenetic analysis. To date, there have been several studies utilizing culture-independent methods to investigate the microbiome of a variety of chronic wounds, including venous insufficiency ulcers, pressure ulcers, and diabetic foot ulcers. Major bacteria found include Staphylococcus, Streptococcus, Corynebacterium, Pseudomonas, and various anaerobes. Current studies suggest that improved healing and outcomes may be correlated with increased bacterial diversity and instability of the microbiome composition of a wound. However, the exact role of the microbiome in wound healing remains poorly understood. While the current research is promising, studies are very heterogeneous, hindering comparisons of findings across different research groups. In addition, more studies are needed to correlate microbiome findings with clinical factors, as well as in the relatively unexplored fields of acute wounds and nonbacterial microbiomes, such as the wound mycobiome and virome. Better understanding of the various aspects of the microorganisms present in wounds may eventually allow for the manipulation of the wound microbiota in such a way as to promote healing, such as through bacteriophage therapies or probiotics.

Bacterial infection is a major concern during the wound healing process. Herein, Ag/AgBr-loaded mesoporous silica nanoparticles (Ag/AgBr/MSNs) are designed to harvest visible light for rapid sterilization and acceleration of wound healing. The Ag/AgBr nanostructure has remarkable photocatalysis ability due to the critical factor that it can generate electron-hole pairs easily after light absorption. This remarkable photocatalytic effect enhances the antibacterial activity by producing reactive oxygen species (ROS). The bacterial killing efficiency of Ag/AgBr/MSNs is 95.62% and 99.99% against Staphylococcus aureus and Escherichia coli, respectively, within 15 min under simulated solar light irradiation due to the generation of ROS. Furthermore, the composites can arrest the bacterial growth and damage the bacterial membrane through electrostatic interaction. The gradual release of Ag+ not only prevents bacterial infection with good long-term effectiveness but also stimulates the immune function to produce a large number of white blood cells and neutrophils, which favors the promotion of the wound healing process. This platform provides an effective strategy to prevent bacterial infection during wound healing.

Information on surgical site infection (SSI) after surgical treatment of ankle fracture is limited and remains controversial. The purpose of the present study was to determine the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of ankle fracture. Patients who underwent ORIF for ankle fracture at 3 centers between January 2015 and December 2016 were included. The potential risk factors for SSI included demographic variables, including age, sex, body mass index (BMI), hypertension, diabetes mellitus, heart disease, smoking, and excessive alcohol intake; blood test variables including preoperative white blood cell count, neutrophil count, red blood cell count, hemoglobin, total protein, albumin and globulin; injury- and surgery-related variables, including duration of operation (minutes), intraoperative blood loss, surgeon level, fracture site, accompanied dislocation, use of a drainage tube, and antibiotic use. Factors related with SSI occurrence were investigated by univariate analysis, and then by multivariate analysis. During hospitalization, 4.37% (66/1511) of patients developed SSI, which was deep in 1.32% (20/1510) and superficial in 3.05% (46/1510). The most common causative agent was polymicrobial (causing approximately half of all SSIs), followed by methicillin-resistant Staphylococcus aureus (MRSA). Multivariate analysis revealed that the significant risk factors for SSI occurrence were open injury, advanced age, incision cleanliness II - IV, high-energy injury, more experienced surgeon level, greater BMI, chronic heart disease, history of allergy, and preoperative neutrophil count > 75%. Preoperative preventative measures should be taken in patients with these conditions to lower the incidence of SSI after ORIF of ankle fracture., Level of Evidence: Level III - Retrospective Comparative Study.

Regenerative activity of locally applied drugs based on copper nanoparticles was compared on white male rats with an experimental purulent wound infected with clinical polyantibiotic resistant strains of Staphylococcus aureus. The use of a suspension of copper nanoparticles and complex drugs based on chitosan and starch with copper nanoparticles led to a rapid reduction of the wound area and elimination of the wound-contaminating agent, which confirmed high antibacterial and regenerative activity of copper nanoparticles in the composition of the studied drugs.

Antimicrobial properties of a long-chain, synthetic, cationic, and hydrophobic amino acid block copolymer are reported. In 5 and 60 min time-kill assays, solutions of K 100 L 40 block copolymers (poly(l-lysine·hydrochloride) 100 -b-poly(l-leucine) 40 ) at concentrations of 10-100 µg mL -1 show multi-log reductions in colony forming units of Gram-positive and Gram-negative bacteria, as well as yeast, including multidrug-resistant strains. Driven by association of hydrophobic segments, K 100 L 40 copolymers form viscous solutions and self-supporting hydrogels in water at concentrations of 1 and 2 wt%, respectively. These K 100 L 40 preparations provide an effective barrier to microbial contamination of wounds, as measured by multi-log decreases of tissue-associated bacteria with deliberate inoculation of porcine skin explants, porcine open wounds, and rodent closed wounds with foreign body. Based on these findings, amino acid copolymers with the features of K 100 L 40 can combine potent, direct antimicrobial activity and barrier properties in one biopolymer for a new approach to prevention of wound infections., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Surgical site infections (SSIs) are common, occurring in up to 25% of > 4 million operations performed in England each year. Previous trials of the effect of wound dressings on the risk of developing a SSI are of poor quality and underpowered., Methods/design: This study is a feasibility and pilot trial to examine the feasibility of a full trial that will compare simple dressings, no dressing and tissue-glue as a dressing. It is examining the overall acceptability of trial participation, identifying opportunities for refinement, testing the feasibility of and validating new outcome tools to assess SSI, wound management issues and patients' wound symptom experiences. It is also exploring methods for avoiding performance bias and blinding outcome assessors by testing the feasibility of collecting wound photographs taken in theatre immediately after wound closure and, at 4-8 weeks after surgery, taken by participants themselves or their carers. Finally, it is identifying the main cost drivers for an economic evaluation of dressing types. Integrated qualitative research is exploring acceptability and reasons for non-adherence to allocation. Adults undergoing primary elective or unplanned abdominal general surgery or Caesarean section are eligible. The main exclusion criteria are abdominal or other major surgery less than three months before the index operation or contraindication to dressing allocation. The trial is scheduled to recruit for nine months. The findings will be used to inform the design of a main trial., Discussion: This pilot trial is the first pragmatic study to randomise participants to no dressing or tissue-glue as a dressing versus a simple dressing. Early evidence from the ongoing pilot shows that recruitment is proceeding well and that the interventions are acceptable to participants. Combined with the qualitative findings, the findings will inform whether a main, large trial is feasible and, if so, how it should be designed., Trial Registration: ISRCTN49328913 . Registered on 20 October 2015.

Background: Left ventricular assist device (LVAD) exit-site infections represent a major challenge in the era of modern LVADs. Infections caused by Pseudomonas are particularly difficult to treat due to limited antibiotic susceptibility. We hypothesized that keeping the LVAD exit site dry while bathing could result in reduced incidence of Pseudomonas infections., Methods: Starting in April 2013, all patients who underwent placement of HeartMate II (HM II) LVAD were instructed not to take conventional showers and to keep the exit site dry while bathing. We retrospectively reviewed patients who underwent HeartMate II LVAD implantation at our institution. Overall and Pseudomonas exit-site infections were compared between two groups: Group 1 was implanted with an LVAD prior to intervention (4/1/2013) and Group 2 after the intervention. Both groups were subjected to cumulative hazard analysis and compared using log-rank test., Results: From November 2006 to September 2015, 283 patients underwent HM II LVAD placement at a single institution (Group 1, 163 patients; Group 2, 120 patients). Median age was 59 years (interquartile range [IQR] 50-65), and 57 (20%) were female. Overall, driveline infection was noted in 86 (30%) patients. Pseudomonas was the causative or coexisting organism in 16 (6%) patients. Median days to infection were 347 (IQR, 162-568). Driveline infection was identified in 69 (42%) patients in Group 1 and 17 (14 %) in Group 2. Pseudomonas was an infectious organism in 15 (9%) patients of Group 1 and one (1%) patient of Group 2. The incidence of Pseudomonas exit-site infections (p = 0.077) decreased substantially after the intervention., Conclusions: Stopping conventional showering may reduce the rate of Pseudomonas LVAD exit-site infections. Additional, multi-institutional data are needed to further evaluate these findings.

We studied 19 cases of proven/probable mucormycosis diagnosed from 2007 to 2015 in our hospital and assessed the microbiological characteristics of the isolates. We recorded the incidence of mucormycosis and clinical and microbiological data of infected patients. Isolates were identified to molecular level and tested for their antifungal susceptibility to azoles, amphotericin B, and liposomal amphotericin B according to the CLSI M-38 A2 procedure. The incidence of mucormycosis in cases/100,000 hospital admissions during 2007-2015 increased significantly with respect to that reported in 1988-2006 (3.3 vs. 1.2; P<0.05). Patients mainly had hematological malignancies (52.6%) and/or trauma/surgical wounds (52.6%) and had received antifungal agents before the diagnosis of mucormycosis in 68% of cases. Diagnosis was by isolation (n = 17/19) and/or direct staining (n = 17/18) of Mucorales fungi in clinical samples. Identification was by panfungal PCR in patients with negative results in culture and in direct staining. The microorganisms identified were Lichtheimia spp. (42%), Rhizopus spp. (21%), Cunninghamella bertholletiae (16%), and others (21%). Liposomal amphotericin B was always more active than the other drugs against all the microorganisms except C. bertholletiae. All patients received antifungal treatment with 1 or more antifungal agents, mainly liposomal amphotericin B (17/19). Mortality was 47.4%, although this was significantly lower in the 11 patients in whom debridement was performed (18% vs. 87.5%) (P = 0.015). The incidence of mucormycosis has risen in recent years. The proportion of cases with soft tissue involvement was high, and Lichtheimia was the most frequently involved species. The highest antifungal activity was observed with liposomal amphotericin B.

In order to investigate new effective and inexpensive nano-therapeutic approach for P. aeruginosa, staphylococcus aureus and coagulase negative staphylococci (CoNS), the present study reports an eco-friendly process for rapid synthesis of silver nanoparticles (Ag-NPs) using aqueous leaf extract of Corchorus Capsularis (CRCP). Formation of stable Ag-NPs at different time intervals gives mostly spherical particles with diameters ranging from 5 to 45 nm. The resulting Ag-NPs were characterized using Ultraviolet visible (UV-Vis) spectroscopy, Fourier Transform Infrared (FT-IR) spectroscopy, X-Ray Diffraction (XRD) analysis, Transmission Electron Microscopy (TEM) and Energy Dispersive X-ray analysis (EDX). XRD study shows that the particles are crystalline in nature with face centered cubic geometry. TEM studies show the formation of Ag-NPs with average size of 20.52 nm. The antimicrobial activity of the synthesized Ag-NPs was investigated against multi drug resistant (MDR) P. aeruginosa, Staphylococcus aureus and CoNS isolates from post-surgical wound infections. The present study suggests that Ag-NPs synthesized from aqueous leaf extract of CRCP shows significant antibacterial potential against MDR isolates from post-surgical wound infections., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Surfaces in the patient environment may play a role in microbial transmission if they become colonized by bacteria. Patient privacy curtains are one such surface that may pose a high risk for transmission because they are high-contact surfaces, are infrequently cleaned, and healthcare workers are less likely to wash their hands after contacting inanimate objects such as curtains., Aim: To determine the amount and type of bacterial colonization of patient privacy curtains at a regional burns/plastic surgery unit., Methods: Privacy curtain contamination on the burns/plastic surgery ward was determined for two separate occasions six months apart: 23 curtains on August 2015 and 26 curtains on January 2016. Dey-Engley neutralizing agar (DENA) replicate organism detection and counting (RODAC) contact plates were used daily to sample curtains near the edge hem where they are most frequently touched. Microbial contamination was reported as cfu/cm 2 and the presence of meticillin-resistant Staphylococcus aureus (MRSA) was determined. Swabs were also taken of any open wounds and from tracheostomy sites on the ward., Findings: Curtain contamination in August 2015 was 0.7-4.7 cfu/cm 2 with 22% testing positive for MRSA, whereas contamination on January 2016 was 0.6-13.3 cfu/cm 2 with 31% of curtains testing positive for MRSA., Conclusion: Curtains on the burns/plastic surgery ward become colonized with significant quantities of bacteria. Future studies will need to address the rate of colonization and the clinical impact of this colonization to better inform cleaning protocols., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m 2 ); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred., (© 2016 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Objectives: NDM-producing Enterobacteriaceae are considered emergent on the African continent and have been increasingly reported in recent years. In contrast, strains producing NDM-type enzymes have been rarely reported in Italy, usually associated with sporadic cases or small outbreaks. Here we report two cases of infection caused by NDM-1-producing Klebsiella pneumoniae (NDM-KP) in two unrelated patients returned from travel to Egypt., Case Reports: The two patients had been previously hospitalised for a short period in two different Egyptian hospitals. In our institution in Italy, NDM-KP isolates were detected from surgical wound drainage (patient #1) and respiratory secretions and blood cultures (patient #2). Rectal swabs of both patients were persistently positive for NDM-KP. In both cases, NDM-1-producing isolates exhibited a multidrug-resistant phenotype, being susceptible only to tigecycline and colistin. Analysis by multilocus sequence typing (MLST) revealed that the two K. pneumoniae isolates were not clonally related, belonging to different sequence types (STs), namely ST15 from patient #1 and ST11 from patient #2., Conclusions: To the best of our knowledge, this is the first report of NDM-producing isolates imported from Africa to Italy, with no obvious link to the Indian subcontinent. Our experience confirms that Egypt is an emergent source of NDM-producing Enterobacteriaceae, thus representing a cause of concern for Mediterranean countries. Owing to its geographical position, Italy is a first-line European checkpoint with respect to African countries and plays a pivotal role in limiting the dissemination of high-risk clones, especially considering the latest strong migration flows., (Copyright © 2016 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

Background: Surgical debridement, negative-pressure wound therapy (NPWT) and antibiotics are used for the treatment of open wounds. However, it remains unclear whether this treatment regimen is successful in the reduction and shift of the bacterial load., Methods: After debridement in the operating room, NPWT, and antibiotic treatment, primary and secondary consecutive microbiological samples of 115 patients with 120 open wounds with bacterial or yeast growth in ≥1 swab or tissue microbiological sample(s) were compared for bacterial growth, Gram staining and oxygen use at a level one trauma center in 2011., Results: Secondary samples had significantly less bacterial growth (32 vs. 89%, p < .001, OR 17), Gram-positive bacteria (56 vs. 78%, p = .013), facultative anaerobic bacteria (64 vs. 85%, p = .011) and Staphylococcus aureus (10 vs. 46%, p = .002). They also tended to include relatively more Coagulase-negative Staphylococci (CoNS) (44 vs. 18%) and Pseudomonas species (spp.) (31 vs. 7%). Most (98%) wounds were successfully closed within 11 days, while wound revision was needed in 4%., Conclusions: The treatment regimen of combined use of repetitive debridement, irrigation and NPWT in an operating room with antibiotics significantly reduced the bacterial load and led to a shift away from Gram-positive bacteria, facultative anaerobic bacteria, and S. aureus, as well as questionably toward CoNS and Pseudomonas spp. in this patient cohort. High rates of wound closure were achieved in a relatively short time with low revision rates. Whether each modality played a role for these findings remains unknown.

Background: The evidence to support dressing standards for breast surgery wounds is empiric and scarce., Objective: This two-arm randomized clinical trial was designed to assess the effect of dressing wear time on surgical site infection (SSI) rates, skin colonization and patient perceptions., Methods: A total of 200 breast cancer patients undergoing breast reconstruction were prospectively enrolled. Patients were randomly allocated to group I (dressing removed on the first postoperative day, n = 100) or group II (dressing removed on the sixth postoperative day, n = 100). SSIs were defined and classified according to criteria from the Centers for Disease Control and Prevention. Samples collected before placing the dressing and after 1 day (group I) and 6 days (both groups) were cultured for skin colonization assessments. Patients preferences and perceptions with regard to safety, comfort and convenience were recorded and analyzed., Results: A total of 186 patients completed the follow-up. The global SSI rate was 4.5%. Six patients in group I and three in group II had SSI (p = 0.497). Before dressing, the groups were similar with regard to skin colonization. At the sixth day, there was a higher colonization by coagulase-negative staphylococci in group I (p<0.0001). Patients preferred to keep dressing for six days (p<0.0001), and considered this a safer choice (p<0.05)., Conclusions: Despite group I had a higher skin colonization by coagulase-negative staphylococci on the sixth postoperative day, there was no difference in SSI rates. Patients preferred keeping dressing for six days and considered it a safer choice., Trial Registration: ClinicalTrials.gov NCT01148823., Competing Interests: The authors have declared that no competing interests exist.

The article presents analysis of results of microbiological study of pathologic samples from fistula and surgical wounds of 155 patients with chronic osteomyelitis of long bones in the period of exacerbation of disease during 2014-2015. In totality, 126 samples from fistula and 95 samples from wounds were analyzed. Correspondingly, 164 and 102 strains of bacteria were separated. The microbial contamination of fistula and wounds was established. The species composition of microflora was analyzed. It is established that in the analyzed groups the main agent still continues to be staphylococcus and priority pathogen Staphylococcus aureus differing slightly in rate of occurrence and coefficient of resistance. MRSA was separated up to 5.6% more often from surgical wounds than from fistula. The highest detection rate of strains S. aureus and MRSA falls on 2009-2010. In 2015, the lowest detection rate of S. aureus was marked with relatively high rate of detection of MRSA. The disk diffusion D-test was applied to determine resistance of inducible type to Clindamycin of 17 strains of S. aureus resistant to Erythromycin and sensitive to Clindamycin. The inducible resistance to Clindamycin for strains from surgery pounds made up to 62.5% that is three times higher than in case of strains separated from fistula. The important role in development of chronic of osteomyelitis of long bones is played by Gram-negative microorganisms (E. coli, Enterobacter, P. aeruginosa, etc.). The rate of detection of these microorganisms in surgery wounds makes up to 22.5% and 17.1% in fistula.

Background: Pseudomonas aeruginosa is one of the major pathogens responsible for hospital-acquired infections, which harbor a wide array of virulence factors. The main aim of this study was to determine the frequency of the virulent ExoU genotype in relation to the ExoS genotype among isolated P. aeruginosa from infected surgical incisions, followed by phylogenetic analysis., Methods: A total of 66 P. aeruginosa isolates were identified by cultural and biochemical characteristics. All isolates were tested for antimicrobial susceptibility against the following antimicrobial agents: imipenem, amikacin, gentamicin, amoxycillin, cefotaxime, cefepime, and levofloxacin. Molecular detection of the ExoS and ExoU as well as two other virulence genes was done by polymerase chain reaction (PCR). Sequencing of ExoU gene and phylogenetic analysis was performed., Results: Approximately 81% of the isolated P. aeruginosa were multi-drug resistant. The ExoS genotype was more prevalent (63%) among the isolates than the ExoU genotype (18%), with 9% of the isolates possessing both toxins. LasB and AprA were detected in 63.6% and 27.2% of the isolates, respectively. An association was observed between the number of virulence genes and the presence of multi-drug resistance. All the ExoU were multi-drug resistant (MDR), whereas 71% of the ExoS were MDR. Phylogenetic analysis of ExoU gene showed a 99% similarity with four different strains., Conclusion: Despite the greater frequency of the ExoS genotype, the presence of the virulent MDR ExoU genotype isolates from surgical site infections is an alarming sign requiring further intervention and investigations., Competing Interests: Author Disclosure Statement No competing financial interests exist.

The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (P<0.05). The usage of combination antibiotic therapy for type I incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type I incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.

Background: Chronic wounds, and among these infected diabetic foot ulcers, are a worldwide problem. The poor treatment outcomes result in high healthcare costs, amputations, a decreased quality of life, and an increased mortality. These outcomes are influenced by several factors, including biofilm formation. A biofilm consists of pathogenic bacteria that are encased in an exopolysaccharide layer and communicate through secretion of signaling molecules. Bacteria that live in a biofilm are refractory to host responses and treatment., Methods: We performed a nonsystematic review of the currently published to-date medical biofilm literature. The review summarizes the evidence of biofilm in chronic wounds, the role of biofilm in wound healing, detection of biofilm, and available antibiofilm treatments. Articles containing basic science and clinical research, as well as systematic reviews, are described and evaluated. The articles have variable levels of evidence. All articles have been peer reviewed and meet the standards of evidence-based medicine., Results: Both animal and human studies have identified biofilm in chronic wounds and have suggested that healing might be influenced by its presence. A promising development in biofilm detection is rapid molecular diagnostics combined with direct microscopy. This technique, rather than classic culture, might support individualized treatment in the near future. A wide range of treatments for chronic wounds also influence biofilm formation. Several agents that specifically target biofilm are currently being researched., Conclusions: Biofilm formation has a substantial role in chronic wounds. Several diagnostic and therapeutic methods against biofilm are currently being developed.

Background: As the population grows older, the incidence and prevalence of conditions that lead to a predisposition for poor wound healing also increase. Ultimately, this increase in nonhealing wounds has led to significant morbidity and mortality with subsequent huge economic ramifications. Therefore, understanding specific molecular mechanisms underlying aberrant wound healing is of great importance. It has and will continue to be the leading pathway to the discovery of therapeutic targets, as well as diagnostic molecular biomarkers. Biomarkers may help identify and stratify subsets of nonhealing patients for whom biomarker-guided approaches may aid in healing., Methods: A series of literature searches were performed using Medline, PubMed, Cochrane Library, and Internet searches., Results: Currently, biomarkers are being identified using biomaterials sourced locally from human wounds and/or systemically using high-throughput "omics" modalities (genomic, proteomic, lipidomic, and metabolomic analysis). In this review, we highlight the current status of clinically applicable biomarkers and propose multiple steps in validation and implementation spectrum, including those measured in tissue specimens, for example, β-catenin and c-myc, wound fluid, matrix metalloproteinases and interleukins, swabs, wound microbiota, and serum, for example, procalcitonin and matrix metalloproteinases., Conclusions: Identification of numerous potential biomarkers using different avenues of sample collection and molecular approaches is currently underway. A focus on simplicity and consistent implementation of these biomarkers, as well as an emphasis on efficacious follow-up therapeutics, is necessary for transition of this technology to clinically feasible point-of-care applications., Competing Interests: Authors declare no conflict of interest.

Background: Recent literature has shown that Propionibacterium acnes can be cultured from superficial and deep layers of the shoulder. Our aims were to assess the rate of P. acnes colonization in patients undergoing primary shoulder arthroplasty, to identify patient-related risk factors, and to evaluate the efficacy of our perioperative antisepsis protocol., Methods: Thirty consecutive patients undergoing primary shoulder arthroplasty were included in our study. Swabs were taken perioperatively (4 superficial and 2 deep wound swabs) and analyzed quantitatively for P. acnes. Cefazolin minimum inhibitory concentration was determined for P. acnes isolates from positive deep cultures., Results: Twenty-two patients (73%) had positive cultures for P. acnes. Male gender (P = .024) and presence of hair (P = .005) had significantly higher rates of P. acnes superficial cultures. Subjects with positive superficial P. acnes cultures (P = .076) and presence of hair with a history of steroid injection (P = .092) were more likely to have deep P. acnes-positive cultures, but this was not statistically significant. Local topical antisepsis measures did not eradicate P. acnes (P = .12). Mean cefazolin minimum inhibitory concentration for P. acnes was 0.32 μg/mL., Conclusion: P. acnes is commonly isolated from the skin and deep surgical wounds of patients undergoing primary total shoulder arthroplasty who have not had previous shoulder surgery. Male gender and presence of hair were significant risk factors for P. acnes colonization. Perioperative local topical antisepsis and cefazolin administration were not effective in eliminating P. acnes colonization., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

The extent to which microorganisms impair wound healing is an ongoing controversy in the management of chronic wounds. Because the high diversity and extreme variability of the microbiota between individual chronic wounds lead to inconsistent findings in small cohort studies, evaluation of a large number of chronic wounds using identical sequencing and bioinformatics methods is necessary for clinicians to be able to select appropriate empiric therapies. In this study, we utilized 16S rDNA pyrosequencing to analyze the composition of the bacterial communities present in samples obtained from patients with chronic diabetic foot ulcers (N = 910), venous leg ulcers (N = 916), decubitus ulcers (N = 767), and nonhealing surgical wounds (N = 370). The wound samples contained a high proportion of Staphylococcus and Pseudomonas species in 63 and 25% of all wounds, respectively; however, a high prevalence of anaerobic bacteria and bacteria traditionally considered commensalistic was also observed. Our results suggest that neither patient demographics nor wound type influenced the bacterial composition of the chronic wound microbiome. Collectively, these findings indicate that empiric antibiotic selection need not be based on nor altered for wound type. Furthermore, the results provide a much clearer understanding of chronic wound microbiota in general; clinical application of this new knowledge over time may help in its translation to improved wound healing outcomes., (© 2015 by the Wound Healing Society.)