Formação do biofilme em ferida cutânea e seu comportamento diante das intervenções: revisão integrativa / Biofilm formation in cutaneous wounds and its behavior in the face of interventions: an integrative review

RESUMO Objetivo identificar na literatura a formação do biofilme e o seu comportamento diante das intervenções em feridas cutâneas. Métodos revisão integrativa, realizada nas bases de dados Cumulative Index to Nursing and Allied Health Literature , Literatura Latino-Americana e do Caribe em Ciências da Saúde, EMBASE, Scopus, The Cochrane Library Collaboration , MEDLINE/PubMed e Science Direct, sem delimitação temporal. Foram selecionados 19 estudos. Avaliação das informações ocorreu de forma descritiva, confrontando com os achados pertinentes. Resultados os estudos da amostra foram publicados no idioma inglês e contemplaram três tipos de pesquisa de biofilme: dois clínicos, seis in vitro e 11 in vivo (animal). Incluíram-se três temas: criação de modelo biofilme (n=4), avaliação do biofilme (n=3), comportamento do biofilme diante de intervenções para o seu manejo (n=12). Conclusão efeitos prejudiciais do biofilme na cicatrização de feridas foram confirmados. Diversas intervenções foram capazes de reduzir e eliminar o biofilme nos modelos in vitro e in vivo . Contribuições para a prática constatou-se que avaliação clínica da lesão não permite identificar o biofilme, inclusive quando presente encontra-se abaixo da superfície da lesão. Este achado suscita reflexão por parte dos enfermeiros a respeito das intervenções adotadas para a remoção do biofilme.

ABSTRACT Objective to identify in the literature the biofilm formation and its behavior when faced with interventions in cutaneous wounds. Methods an integrative review, carried out in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, EMBASE, Scopus, The Cochrane Library Collaboration, MEDLINE/PubMed and Science Direct databases, without temporal delimitation. Nineteen studies were selected. The information was evaluated descriptively, comparing it with the pertinent findings. Results the sample studies were published in English and included three types of biofilm research: two clinical, six in vitro and 11 in vivo (animal). Three themes were included: biofilm model creation (n=4), biofilm assessment (n=3), biofilm behavior before interventions for its management (n=12). Conclusion the detrimental effects of biofilm on wound healing have been confirmed. Several interventions were able to reduce and eliminate biofilm in in vitro and in vivo models. Contributions to practice it was found that clinical evaluation of the lesion does not allow the identification of biofilm, even when present; it is below the surface of the lesion. This finding raises reflection on the part of nurses regarding the interventions adopted for the removal of biofilm.

Actualización en el manejo de fracturas abiertas: prevención de infección: utilidad de cultivos de herida: revisión bibliográfica / Update on the management of open fractures: infection prevention: utility of wound culture: bibliographic review / Atualização sobre o manejo de fraturas expostas: prevenção de infecções: utilidade das culturas de feridas: revisão bibliográfica

En las fracturas abierta una de las complicaciones más temidas por los cirujanos ortopédicos es la infección de partes blandas y ósea. A pesar de múltiples investigaciones, las pautas de manejo terapéutico para las fracturas abiertas continúan en constante cambio. El objetivo principal de nuestro trabajo fue realizar una actualización sobre la prevención de la infección en las fracturas abiertas a través de una búsqueda bibliográfica poniendo especial énfasis en la utilidad de los cultivos (recuento microbiano) de heridas en el perioperatorio de estas fracturas.

In open fractures, one of the most feared complications by orthopedic surgeons is soft tissue and bone infection. Despite multiple investigations, therapeutic management guidelines for open fractures, is constantly changing. The main objective of our work was to make an update on the prevention of infection in open fractures through a bibliographic search, with special emphasis on the usefulness of cultures (microbial count) of wounds in the perioperative period of these fractures.

Nas fraturas abertas, uma das complicações mais temidas pelos cirurgiões ortopédicos é a infecção de tecidos moles e ossos. Apesar de várias investigações, as diretrizes de tratamento terapêutico para fraturas expostas estão mudando constantemente. O principal objetivo do nosso trabalho foi atualizar a prevenção de infecção em fraturas expostas por meio de uma pesquisa bibliográfica, com ênfase especial na utilidade das culturas (contagem microbiana) de feridas no período perioperatório dessas fraturas.

Infecciones en pie diabético: Elección del tratamiento antibiótico empírico / Infections in diabetic foot. Choice of empirical antibiotic regimen

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Prevalencia y perfil de susceptibilidad antimicrobiana en bacterias aisladas de úlceras crónicas infectadas en adultos / Prevalence and susceptibility pattern of bacteria isolated from infected chronic wounds in adult patients

Resumen Introducción: Las úlceras crónicas son un problema de salud pública, agravándose por infecciones bacterianas causadas principalmente por agentes resistentes. Objetivo: Estudiar prevalencia y perfil de susceptibilidad en bacterias aisladas de úlceras crónicas en pacientes adultos. Pacientes y Métodos: Pacientes atendidos en la Fundación Instituto Nacional de Heridas entre mayo y julio de 2014, con úlceras crónicas en extremidades inferiores con signos inflamatorios clínicos. Las muestras fueron cultivadas en aerobiosis y anaerobiosis y para la identificación bacteriana se empleó el sistema de galerías API (Biomerieux). La susceptibilidad in vitro se evaluó según el método de Kirby Bauer. Resultados: Se reclutaron 73 pacientes, entre quienes 46 presentaron úlceras infectadas, diagnosticándose 33 úlceras venosas con predominio de infección polimicrobiana y 10 úlceras de pie diabético con predominio de infección monomicrobiana (p ≤ 0,05). Se aislaron 68 cepas de los 46 pacientes con úlcera infectada. Las enterobacterias predominaron en infección monomicrobiana (p ≤ 0,05) y los demás grupos bacterianos fueron levemente más frecuentes en infección polimicrobiana. La especie prevalente fue Staphylococcus aureus (24%) seguida de Pseudomonas aeruginosa (18%). Cincuenta cepas (77%) presentaron resistencia a uno o más antibacterianos. Destacamos resistencia de S. aureus a ciprofloxacina (50%) y cefoxitina (37,5%) identificándose así resistencia a meticilina en la comunidad (SARM-AC), siendo todas sensibles a cotrimoxazol. Las enterobacterias presentaron resistencia a sensibilidad a amikacina (95,5%), P. aeruginosa evidenció resistencia a ciprofloxacina (33,3%) con alta sensibilidad a gentamicina (91,7%) y amikacina (83,3%), mientras Acinetobacter spp presentó resistencia a ciprofloxacina y ceftazidima en 60%, con 100% de sensibilidad a imipenem. Streptococcus β hemolítico presentó 50% de resistencia a clindamicina y penicilina. Conclusión: Estos datos entregan información epidemiológica de infecciones de úlceras crónicas, representando un apoyo al diagnóstico, tratamiento y manejo de esta patología.

Background: Chronic wounds are considered a public health problem that may be complicated by bacterial infections, mainly caused by resistant strains. Aim: To study the bacteria prevalence and antimicrobial susceptibility in samples from adult patients with chronic wounds. Methods: Patients treated at National Institute of Wounds Foundation between May and July 2014, with chronic ulcers in lower extremities with clinical inflammatory signs were recluted. Samples were cultured in aerobic and anaerobic atmosphere and species identification was performed by API (Biomerieux) galleries. The in vitro susceptibility was evaluated according to the Kirby Bauer method. Results: From 73 patients, 46 had infected wounds most of them were venous ulcers (33) with prevalence in polymicrobial infections and 10 with foot-diabetes ulcers with prevalence in monomicrobial infections (p ≤ 0.05). Sixty-eight strains were isolated and Enterobacteriaceae were predominant in monomicrobial infection (p ≤ 0.05) and the other groups were slightly higher in polymicrobial infection. The main species were Staphylococcus aureus (24%) followed by P. aeruginosa (18%). Fifty strains (77%) were resistant or multi-resistance. We emphasize resistance of S. aureus to ciprofloxacin (50%) and cefoxitin (37.5%), thus identifying resistance to methicillin in the community (CA-SAMR), all of which are sensitive to cotrimoxazole. Enterobacteria showed sensitivity to amikacin (95.5%), P. aeruginosa showed resistance to ciprofloxacin (33.3%) with high sensitivity to gentamicin (91.7%) and amikacin (83.3%), while Acinetobacter spp showed resistance to ciprofloxacin and ceftazidime in 60%, with 100% sensitivity to imipenem. 50% Streptococcus β hemolytic showed resistance to clindamycin and penicillin. Conclusion: These data provide epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology.

Incidencia y factores de riesgo para bacteriemia en pacientes pediátricos con quemaduras en un Centro de Atención Especializado en México / Incidence and risk factors for bacteremia on pediatric patients with burns in a specialized care center in Mexico

Background: Bacteremia events are frequent cause of mortality in burn patients and may originate from infected wounds, by bacterial translocation of endogenous microorganisms, from invasive devices or contaminated intravenous solutions. Objective: To quantify the incidence of bacteremia in pediatric patients with burns and to identify risk factors. Material and Methods: A prospective cohort study was performed in pediatric patients with burns of Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Bacteremia was diagnosed by blood cultures in patients with clinical manifestations of sepsis. Risk factors were investigated by multivariate analysis with Cox regression. Results: Were included in the cohort 260 patients, median age 3 years. The incidence of bacteremia was 9.6 events per 1,000 days patient. The most frequently isolated bacteria were Enterobacteriaceae (41.9%), Staphylococcus aureus (22.6%) and Pseudomonas aeruginosa (22.6%). Factors associated with bacteremia were: bums ≥ 20% TBSA (HR 11.06; 95% CI 4.8-25.4), deep second degree bums or higher (HR 6.9; 95% CI 2.0-23.3) and have had two or less debridement (HR 26.4; 95% CI 8.0-87.7). Conclusions: Patients with more extensive and deep burns with fewer debridement are at increased risk of bacteremia.

Introducción: Los eventos de bacteriemia son causa frecuente de mortalidad en pacientes con quemaduras y pueden originarse en heridas infectadas, por translocación bacteriana de microorganismos endógenos, por dispositivos invasores o por soluciones intravenosas contaminadas. Objetivo: Cuantificar la incidencia de bacteriemia en pacientes pediátricos con quemaduras e identificar los factores de riesgo. Material y Métodos: Estudio de cohorte prospectivo, en población pediátrica con quemaduras del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". En pacientes con manifestaciones clínicas de sepsis se diagnosticó bacteriemia mediante cultivos de sangre. Se indagaron factores de riesgo con análisis multivariado con regresión de Cox. Resultados: Se incluyeron en la cohorte 260 pacientes, mediana de edad 3 años. La incidencia de bacteriemia fue de 9,6 eventos por 1.000 días paciente. Las bacterias más frecuentes aisladas fueron enterobacterias (41,9%), Staphylococcus aureus (22,6%) y Pseudomonas aeruginosa (22,6%). Los factores asociados a bacteriemia fueron: quemaduras ≥ 20% de superficie corporal quemada (HR 11,06; IC 95% 4,8-25,4), quemaduras de segundo grado profundo o mayores (HR 6,9; IC 95% 2,0-23,3) y haber tenido dos o menos desbridamientos (HR 26,4; IC 95% 8,0-87,7). Conclusiones: Pacientes con quemaduras más extensas y profundas, con menor número de desbridamientos presentan mayor riesgo de bacteriemia.

Comportamiento antibacteriano de partículas de cobre frente a microorganismos obtenidos de úlceras crónicas infectadas y su relación con la resistencia a antimicrobianos de uso común / Antibacterial activity of copper salts against microorganisms isolated from chronic infected wounds

Background: The antimicrobial activity of copper (Cu+2) is recognized and used as an antimicrobial agent. Aim: To evaluate the antimicrobial activity of copper against microorganisms obtained from chronic cutaneous wound infections. Material and Methods: Five chemical products that contained copper particles in their composition were tested (zeolite, silica, acetate, nitrate and nanoparticle of copper). The antimicrobial activity against antibiotic resistant strains usually isolated from chronic cutaneous wound infections was determined for two of the products with better performance in copper release. Results: The minimal inhibitory and minimal bactericidal concentrations of copper acetate and nitrate were similar, fluctuating between 400-2,000 µg/ml. Conclusions: The studied copper salts show great potential to be used to control both gram positive and gram negative, antibiotic resistant bacteria isolated from wound infections.

Antibacterial properties and healing effects of Melipona scutellaris honey in MRSA-infected wounds of rats

ABSTRACT PURPOSE : To investigate the antimicrobial, immunological and healing effects of Melipona scutellaris honey on infected wounds of rat skin. METHODS: Twenty four Wistar rats were distributed in four groups (6-each). The uninfected skin wounds of group I rats were treated daily with saline for 7 days. Uninfected wounds (group II) rats were treated with honey. In group III (treated with saline) and group IV (treated with honey) wounds were inoculated with MRSA ATTC43300. The first bacterial culture was performed 24 hours later. In the 7th day new culture was done, and wound biopsies were used for cytokines dosage and histopathology. RESULTS: In group I and III rats the CFU/g count of S. aureus in wounds was zero. In group II rats the CFU/g counts in the wound tissue were significantly higher than in wounds of group IV rats. The density histopathological parameters and the expression of TNF-α, IL1-β, Il-6 were significantly higher on wounds of group IV then in the other groups. CONCLUSION: Honey of Melipona scutellaris was effective in the management of infected wounds, by significant bacterial growth inhibition, enhancement of cytokine expression, and positively influenced the wound repair.

Genotyping of multidrug-resistant strains of Pseudomonas aeruginosa isolated from burn and wound infections by ERIC-PCR

ABSTRACT PURPOSE: To determine the genetic diversity of MDR P. aeruginosa strains isolated from burn and wound infections in Ahvaz, Iran, by ERIC-PCR. METHODS: From total 99 strains of P. aeruginosa defined as MDR by using drug susceptibility testing, 66 were subjected to ERIC-PCR analysis, comprises 53 strains isolated from burn infection, and 13 randomly selected strains from wound infection with higher resistance to combinations of more numbers of drugs. RESULTS: Eight clusters (I to VIII), and 50 single clones were generated for tested MDR isolates analyzed by ERIC-PCR. The high heterogeneity was observed among the isolates from burn infections including 16 isolates which were categorized in eight clusters and 37 single clones. The isolates in clusters II, III, VI, VIII showed 100% similarity. CONCLUSIONS: The high level of genotypic heterogeneity in P. aeruginosa strains demonstrated no genetic correlation between them. Extremely high drug resistance in isolates from burn, suggests that efficient control measures and proper antibiotic policy should be observed.

First isolation of Vibrio vulnificus causing sepsis in Santa Catarina, Brazil / Primeiro isolamento de Vibrio vulnificus causando sepse em Santa Catarina, Brasil

Vibrio vulnificus is a bacterium present in natural marine environments that causes infections in immunocompromised people. Sepsis in humans caused by this microorganism is usually accompanied by bullous skin lesions. In the present study we report a case of infection caused by this bacterium affecting a diabetic man, 74 years old, who fell overboard and hurt his leg. The identification of the V. vulnificus was made in the blood culture sample. This is the first report of isolation of V. vulnificus in Santa Catarina, Brazil, showing the dissemination of this bacterium in warm seawater over the world (AU)

Vibrio vulnificus é uma bactéria que se desenvolve em ambientes marinhos naturais e causa infecção em pessoas imunocomprometidas. Sepse em humanos causada por esse microrganismo é geralmente acompanhada por lesões bolhosas da pele. Relatamos um caso de infecção causada por esta bactéria que afetou um homem diabético, de 74 anos, que caiu ao mar e machucou a perna. A identificação do V. vulnificus foi feita na amostra de hemocultura. Este é o primeiro relato de isolamento de V. vulnificus em Santa Catarina, Brasil, elucidando a disseminação das bactérias de ambiente marítimo de água quente pelo mundo (AU)

Influence of microbiome species in hard-to-heal wounds on disease severity and treatment duration

ABSTRACT BACKGROUND: Infections, mostly those associated with colonization of wound by different pathogenic microorganisms, are one of the most serious health complications during a medical treatment. Therefore, this study is focused on the isolation, characterization, and identification of microorganisms prevalent in superficial wounds of patients (n = 50) presenting with bacterial infection. METHODS: After successful cultivation, bacteria were processed and analyzed. Initially the identification of the strains was performed through matrix-assisted laser desorption/ionization time-of-flight mass spectrometry based on comparison of protein profiles (2-30 kDa) with database. Subsequently, bacterial strains from infected wounds were identified by both matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and sequencing of 16S rRNA gene 108. RESULTS: The most prevalent species was Staphylococcus aureus (70%), and out of those 11% turned out to be methicillin-resistant (mecA positive). Identified strains were compared with patients' diagnoses using the method of artificial neuronal network to assess the association between severity of infection and wound microbiome species composition. Artificial neuronal network was subsequently used to predict patients' prognosis (n = 9) with 85% success. CONCLUSIONS: In all of 50 patients tested bacterial infections were identified. Based on the proposed artificial neuronal network we were able to predict the severity of the infection and length of the treatment.

Infecciones por Fusarium spp. en una unidad de quemados pediátrica / Fusarium spp. infections in a pediatric burn unit

Introducción: Fusarium spp. son hongos ubicuos que producen infecciones oportunistas en humanos incluyendo algunas severas en quemados. La literatura sobre infecciones por Fusarium spp. en pacientes quemados pediátricos es escasa. Objetivos: describir los hallazgos clínicos, epidemiológicos y evolutivos de infecciones por Fusarium spp. en pacientes quemados pediátricos. Pacientes y métodos: estudio retrospectivo, descriptivo de infecciones por Fusarium spp. en una unidad de cuidados intensivos pediátrica especializada entre enero de 2006 y marzo de 2015. Resultados: Quince pacientes presentaron infección por Fusarium spp. El 87% eran varones. La mediana de edad fue de 48 meses. En el 67% de los casos la quemadura fue por fuego directo. La superficie corporal quemada fue de una mediana de 45%. El 80% tuvo quemaduras profundas y el 93% presentó un índice de Garcés > 3. La infección fúngica se detectó con una mediana de 11 días desde la injuria. Todos los pacientes tuvieron catéteres centrales durante una mediana de 20 días y trece pacientes requirieron asistencia respiratoria mecánica durante una mediana de 16 días. En 14 pacientes el hongo fue aislado en la quemadura y en un paciente en el hueso. Trece pacientes tuvieron infecciones bacterianas concomitantes. Los antifúngicos de elección fueron anfotericina B y voriconazol. El tratamiento duró una mediana de 23 días. La mediana de internación fue de 55 días. Un solo paciente falleció debido a la infección fúngica. Conclusión: Fusarium spp. es un patógeno poco frecuente en pacientes quemados graves. La mortalidad fue baja (AU)

Introduction: Fusarium spp. are ubiquitous fungi recognized as opportunistic agents of human infections. They can produce severe infections in burn patients. The literature about Fusarium spp. infections in burn pediatric patients is scarce. Objectives: To describe clinical, epidemiological and outcome features of cases of Fusarium spp. infections in burn pediatric patients. Patients and Methods: Retrospective, descriptive study of Fusarium spp. infections in a specialized intensive care from January 2006 to March 2015. Results: 15 patients developed Fusarium spp infections. 87 % were male. Median age was 48 months. Direct fire injury was in ten patients. The affected burn surface was a median of 45%. Twelve patients had a full thickness burn. Fourteen patients had Garces Index>3. Fungal infection appears at a median of 11 days from injury. All patients had central lines during a median of 20 days and thirteen patients had mechanical ventilatory assistance for a median of sixteen days. Fungi vas isolated from burn wound in 14 patients and in bone in one patient. Thirteen patients had bacterial infection also. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of complete treatment was 23 days. The median hospital stay was 55 days. One patient died of fungal infection related causes. Conclusion: Fusarium spp. is an uncommon pathogen in severely burn patients. Mortality was low (AU)

Susceptibility Pattern of Aerobic Bacterial Isolates from Wound Swab.

Wound swab culture is the most frequently employed method of confirming wound infection. A regular bacteriological review of infected wounds is necessary to provide qualitative health care particularly when blind treatment is a necessity as in underdeveloped and developing nations. Materials and Methods: A total of 614 Wound swabs sample were received in the department during the study period. Direct Gram staining of the specimens were done after which they were inoculated in Blood agar and MacConkey agar plates and antibiotic sensitivity was done according to CLSI guideline. Result: A total of 496 strains were isolated out of which 232 (46.77%) were Gramnegative bacilli and 264(53.23%) were Gram-positive cocci. Out of the 466 culture positive samples, 29 samples showed polymicrobial growth. E coli was the most common pathogen isolated. Of the 156 isolates of Staphylococcus aureus 68 was from ward and 88 from Out Patient Department (OPD) of which 31(45.58%) and 30(34.09%) were determined to be methicillin resistant (MRSA) respectively. Out of 95 isolates of Coagulase Negative Staphylococcus(CoNS ), 56 was from ward and 39 from OPD. Methicillin Resistant Staphylococcus (MRCoNS) prevalence rate was 46 (82.14%) and 28(71.79%) for ward and OPD respectively. The gram negative isolates were most sensitive to imipenem and it was least sensitive to cephalosporin groups of antibiotics. Conclusion: The most commonly isolated pathogen from wound swab specimens was Gram positive bacteria but 46.77% of the isolates were Gram negative bacteria so antimicrobial coverage for Gram negative bacteria should be included in treatment of wound infection.

Infección de herida traumática por Cedecea lapagei: Comunicación de un caso y revisión de la literatura / Cedecea lapagei traumatic wound infection: Case report and literature review

Cedecea lapagei is a gram-negative, facultative anaerobic, non-spore-forming bacteria, belonging to the family Enterobacteriaceae. It has been reported as a pathogen in few cases of bacterial peritonitis, wound infection, chemicals burns and pneumonia. We report a case of traumatic wound infection by this pathogen with a pertinent review.

Cedecea lapagei es un bacilo gramnegativo, anaerobio facultativo, no formador de esporas, perteneciente a la familia Enterobacteriaceae. Se han comunicado escasos casos en la literatura científica entre los cuales se destacan una peritonitis bacteriana, una infección de herida por quemadura química y una neumonía. A continuación se presenta el caso de una infección por este patógeno en una herida traumática. Se realiza una revisión bibliográfica del tema.

Low level laser therapy (AlGaInP) applied at 5J/cm2 reduces the proliferation of Staphylococcus aureus MRSA in infected wounds and intact skin of rats* / Laser de baixa intensidade (AlGaInP) aplicado com 5J/cm2 reduz a proliferação de Staphilococcus aureus MRSA em feridas infectadas e em pele íntegra de ratos

Laser therapy is a low cost, non-invasive procedure with good healing results. Doubts exist as to whether laser therapy action on microorganisms can justify research aimed at investigating its possible effects on bacteria-infected wounds. To assess the effect of low intensity laser on the rate of bacterial contamination in infected wounds in the skin of rats. An experimental study using 56 male Wistar rats. The animals were randomly divided into eight groups of seven each. Those in the "infected" groups were infected by Staphylococcus aureus MRSA in the dorsal region. Red laser diode (AlGaInP) 658nm, 5J/cm2 was used to treat the animals in the "treated" groups in scan for 3 consecutive days. Samples were drawn before inoculating bacteria and following laser treatment. For statistical analysis we used the nonparametric Wilcoxon (paired data) method with a significance level of p <0.05. The statistical analysis of median values showed that the groups submitted to laser treatment had low bacterial proliferation. The laser (AlGaInP), with a dose of 5J/cm2 in both intact skin and in wounds of rats infected with Staphylococcus aureus MRSA, is shown to reduce bacterial proliferation. .

Fundamentos: A terapia a laser é um procedimento de baixo custo, não invasiva e com bom desempenho na cicatrização. As dúvidas existentes quanto a sua ação sobre microrganismos justifica a realização de pesquisas visando investigar os possíveis efeitos em feridas infectadas por bactérias. Avaliar o efeito do laser de baixa intensidade sobre a taxa de contaminação bacteriana em feridas infectadas na pele de ratos. Estudo experimental, utilizando 56 ratos machos Wistar. Os animais foram distribuídos aleatoriamente em oito grupos de sete animais. Nos animais dos grupos lesionados foi realizada uma incisão na região dorsal.Os animais dos grupos infectados foram infectados por Staphylococcus aureus MRSA. os animais dos grupos tratados foram tratados com laser de Diodo vermelho (AlGaInP) 658nm, 5J/cm2 em varredura, durante 3 dias consecutivos. Foi colhida uma amostra antes de inocular as bactérias e outra após o tratamento com laser. Para a análise estatística foram utilizados os testes não paramétricos de Wilcoxon (dados pareados). Considerando como significante p<0,05. Através da análise estatística das medianas, observou-se que os grupos submetidos ao laser apresentavam uma proliferação bacteriana menor. O laser (AlGaInP), com uma dose de 5J/cm2, tanto em feridas quanto em pele íntegra de ratos infectados por Staphilococcus aureus MRSA, se mostrou capaz de reduzir a proliferação bacteriana. .

novel multiplex PCR for detection of pseudomonas aeruginosa: a major cause of wound infections

Wound infections are often difficult to treat due to various bacterial pathogens. Pseudomonas aeruginosa is one of the common invaders of open wounds. Precise diagnosis of this etiological agent in wound infections is of critical importance particularly in treatment of problematic cases. The existing diagnostic methods have certain limitations particularly related to specificity. Our objective was to establish a comprehensive and reliable multiplex PCR to confirm diagnosis of P. aeruginosa. A multiplex PCR test was developed for rapid and comprehensive identification of P. aeruginosa. Four highly specific genes were targeted simultaneously for detection of genus, species and exotoxin production [16S rDNA, gyrB, oprL and ETA] in P. aeruginosa; additionally one internal control gene invA of Salmonella was used. The specificity of the multiplex PCR was confirmed using internal and negative controls. Amplified fragments were confirmed by restriction analysis and DNA sequencing. The developed method was applied on 40 morphologically suspected P. aeruginosa isolates [from 200 pus samples] and 18 isolates were confirmed as P. aeruginosa. In comparison, only 12 could be identified biochemically. Combination of the four reported genes in multiplex PCR provided more confident and comprehensive detection of P. aeruginosa which is applicable for screening of wound infections and assisting treatment strategy

Antimicrobial activities against biofilm formed by Proteus mirabilis isolates from wound and urinary tract infections.

Background: Bacterial species are capable of living as biofilm and/or planktonic forms. There is increasing evidence for the role of bacterial biofilm in various wound and urinary tract infections (UTIs). The aim of the present study was to evaluate the ability of the bacteria, isolated from urinary tract infections (UTIs) and wound infections, to form biofilm and correlate the role of biofilm with their antimicrobial resistance. Materials and Methods: All the isolated bacteria were screened for their ability to form biofilm using the microtitre plate method. Results: Wound isolates of Staphylococcus aureus and Enterobacter sp. had more biofilm forming capacity than the UTI isolates. Proteus mirabilis isolates were among the strongest biofilm forming bacteria and were chosen for antimicrobial study. In sub-MIC concentrations of antimicrobial agents used, ciprofloxacin was found to be the most effective in decreasing biofilm formation. On the other hand, ceftriaxone and ciprofloxacin were effective in partial removal of preformed biofilm biomass. Conclusion: Ciprofloxacin was more effective in killing bacterial cells especially at high antimicrobial concentrations that could be reached in urine levels and can be used in impregenating catheters.

Shewanella infection of snake bites: a twelve-year retrospective study

OBJECTIVE: Infections of snake bite wounds by Shewanella are rarely discussed in the medical literature. This study aims to characterize the presentation and management of Shewanella infections in snake bite wounds. METHOD: We retrospectively investigated the microbiology, clinical features, and outcomes of patients with Shewanella infected snake bite wounds admitted to a tertiary medical center from January 1998 to December 2009. RESULTS: Ten patients with Shewanella-infected snake bite wounds were identified. All of the snake bites were caused by cobras. The majority of patients had moderate to severe local envenomation and polymicrobial infections. Shewanella isolates are susceptible to ampicillin-sulbactam, piperacillin-tazobactam, third-and fourthgeneration cephalosporins, carbapenems, aminoglycosides, and quinolones but are resistant to penicillin and cefazolin. All of the patients examined had favorable outcomes. CONCLUSION: It is recommended that Shewanella infection be considered in snake bite patients, especially when patients present with moderate to severe local envenomation.

Detection of ESBL producing nosocomial gram negative bacteria from a tertiary care hospital in Bangladesh

Extended spectrum beta-lactamases [ESBLs] represent a major group of lactamases currently being identified in large number worldwide mostly produced by gram-negative bacteria. The present study was done to see the frequency of ESBLs in gram-negative bacterial isolates causing nosocomial wound infections from a tertiary care hospital in Bangladesh. A total of 125 wound swabs were collected from surgical site infections and burn cases, admitted in Rajshahi Medical College Hospital [RMCH], during January to June, 2008. Swabs were cultured for aerobic bacteria and antimicrobial susceptibility testing was carried out using the Kirby-Bauer agar diffusion method. Gram-negative isolates were tested for ESBLs on Mueller Hinton agar by both modified double disc and phenotypic confirmatory methods. Culture yielded 71 [56.8%] bacterial growths with 60 [84.51%] gram-negative and 11 [15.49%] gram-positive bacteria [Staph aureus]. Gram-negative isolates included 23 [32.39%] E. coli, 19 [26.76%] Klebsiella spp., 16 [22.54%] Pseudomonas spp., and 02 [2.82%] Proteus spp. The number of ESBL producing bacteria in modified double disc and phenotypic confirmatory methods were 28 [46.67%] and 25 [41.66%] respectively. Highest rate of ESBLs was observed in Klebsiella spp. [57.89%] followed by Proteus spp. [50.0%], E. coli [47.83%] and Pseudomonas spp. [31.25%], which showed significantly increasing resistance to 3rd generation cephalosporins, aminoglycoside, quinolone and trimethoprim-sulfamethoxazole. Significant number of nosocomial wound infections is caused by ESBL bacteria; those are not detected by routine antimicrobial susceptibility testing. It is recommended that clinical microbiology laboratory should take urgent measure for ESBLs detection as routine to enhance hospital infection control programme

Prospective analysis of nosocomial infections in a Burn Care Unit, Turkey.

Background & objectives: Prevention of infection in burned patients poses a great challenge as infection is the most common cause of mortality after burn injury. An analysis of burned patients, admitted and treated between January 2004 and December 2005 in a nine-bed burn unit in Turkey, was performed prospectively to identify the common pathogens and incidence of nosocomial infection in these patients. Methods: Of the 182 burn cases admitted to Burn Care Unit during the study period, 169 met the inclusion criteria. Information related to nosocomial infection (NI) was collected. Samples were collected for culture and microorganisms isolated were tested for antimicrobial sensitivity. Results: Of the 169 burn patients, 127 acquired 166 nosocomial infection (NI) (15.7% pneumonia, 56.0% burn wound infection, 8.4% urinary tract infection and 19.9% blood stream infection) with an overall NI rate of 18.2 per 1000 patient-days. The mean age (38 ± 21 yr), the mean length of hospitalization (45.06 ± 11.67 days) and the total burned surface area (TBSA) (34.58 ± 18.46%) of the patients with NI were higher than those of the patients with non NI (23 ± 17 yr), (16.38 ± 11.14 days) and (12.44± 8.69%) (P=0.03, P=0.001, P=0.01) respectively. By multiple logistic regression analysis, TBSA co-morbidities, broad spectrum antibiotic usage and invasive devices usage were significantly related to acquisition of NI. Pseudomonas aeruginosa (57%), Acinetobacter baumannii (21%) and Staphylococcus aureus (14%) were the most common resistant organisms isolated. Interpretation & conclusion: Our findings emphasize the need for careful disinfection and more strict infection control procedures in areas that serve immunosupressed individuals, such as burn patients.