RESUMEN
INTRODUCTION: During the metabolic processes of malignant wounds, bacteria produce a large amount of volatile organic compounds (VOCs) that are responsible for malodors and may have a major impact on the patient's quality of life with a risk of isolation. OBJECTIVE: A translational study was conducted on 32 malignant breast wounds by combining the identification of bacterial strains present on wounds, the identification of VOCs produced by these bacterial strains, and sensory evaluation to assess odor intensity and quality of odorous bacteria. MATERIALS AND METHODS: Thirty-two patients with malignant breast cancer wounds > 10 cm2 at various stages of the disease (curative or palliative) were included in the protocol. Volatile organic compounds were collected from primary dressings by headspace solid-phase microextraction and then analyzed by gas chromatography separation coupled with a mass spectrometer detector analysis. Microbiological samplings were taken and analyzed on agar plates. The odors of selected bacteria were assessed by a panel of staff members. RESULTS: Proteus mirabilis and Fusobacterium necrophorum seem to produce the strongest and most typical malignant wound odor. The VOCs were analyzed and dimethyl disulfide, dimethyl trisulfide, phenol, indole, and 3-methylbutanal were found to be produced by bacteria generating the most typical wound odor. CONCLUSIONS: This study suggests the bacteria present in wounds may be responsible for odors. In addition, these findings could pave the way to engineer new types of dressings and to develop an evaluation method to assess their efficiency both quantitatively and qualitatively as well as improve quality of palliative care and comfort for women with malignant wounds.
RESUMEN
The risk of infections and the appearance of symptoms (e.g., odors) represent the main troubles resulting from malignant wounds. The aim of this study was to characterize the balance of bacterial floras and the relationships between biofilms and bacteria and the emergence of symptoms. Experimental research was carried out for 42 days on malignant wounds associated with breast cancer. Investigations of bacterial floras (aerobes, aero-anaerobes, and anaerobes), detection of the presence of biofilms by microscopic epifluorescence, and clinical assessment were performed. We characterized biofilms in 32 malignant wounds associated with breast cancer and bacterial floras in 25 such wounds. A mixed group of floras, composed of 54 different bacterial types, was identified, with an average number per patient of 3.6 aerobic species and 1.7 anaerobic species; the presence of strict anaerobic bacterial strains was evidenced in 70% of the wounds; biofilm was observed in 35% of the cases. Odor was a reliable indicator of colonization by anaerobes, even when this symptom was not directly linked to any of the identified anaerobic bacteria. Bacteria are more likely to be present during myelosuppression and significantly increase the emergence of odors and pain when present at amounts of >10(5) · g(-1). The presence of biofilms was not associated with clinical signs or with precise types of bacteria. No infections occurred during the 42-day evaluation period. This study provides a dynamic description of the bacterial floras of tumoral wounds. The study results highlight the absolute need for new therapeutic options that are effective for use on circulating bacteria as well as on bacteria organized in biofilm.