Unrestrained anti-microbial resistance (AMR) among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. This study assessed the current AMR patterns of bacterial isol...Unrestrained anti-microbial resistance (AMR) among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. This study assessed the current AMR patterns of bacterial isolates in post-operative wound infections in a tertiary care hospital in Kathmandu,Nepal. Pus swabs collected from post-operative wound infections and submitted for culture and sensitivity were included in this study. Isolation and identification of the organism was done by standard microbiological methods. Antibiotic susceptibility test was performed by Kirby Bauer disc diffusion method and result was interpreted as per National Committee for Clinical Laboratory Standards (NCCLS) guide lines. Of the 120 pus swabs processed for culture, 96 showed bacterial growth. Staphylococcus aureus 36 (37.5%) was the predominant gram positive isolate and Escherichia coli 24 (25%) was the major gram negative isolate .The infection was most prevalent in the age group 20-40 years. All S. aureus isolates were sensitive to aminoglycosides and vancomycin. Out of 36 S. aureus, 15 (41.66%) isolates were methicillin resistant S. aureus (MRSA). Staphylococcus epidermidis showed high resistance (50%-100%) to all antibiotics but were sensitive to vancomycin. All gram negative isolates showed high resistance against cephalexin (75%-100%) and ceftriaxone (25%-100%). Overall multi-drug resistant isolates were 66.7%. A high level of AMR was observed in gram negative bacterial isolates. Rational use of antibiotics and a regular monitoring of AMR patterns in post-operative wound infections are essential and mandatory to avert further emergence and spread of anti-microbial resistance among bacterial pathogens.展开更多
BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment...BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.展开更多
AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In ...AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(HbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was evaluated.RESULTS Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet explored.CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection,instituting a standard protocol for all the described steps appears beneficial.展开更多
Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January ...Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.展开更多
Diabetic wound healing is often complicated due to bacterial infections that intensify inflammation.Employing hydrogel dressings with inherent antibacterial properties can significantly reduce reliance on antibiotics ...Diabetic wound healing is often complicated due to bacterial infections that intensify inflammation.Employing hydrogel dressings with inherent antibacterial properties can significantly reduce reliance on antibiotics for treating infected wounds in diabetics.Traditional hydrogels typically rely on the infiltration of bacteria into their porous structure to manifest antibacterial effects.However,this infiltration process is not only prolonged but can also exacerbate inflammation,further delaying the healing of the wound.Thus,promptly capturing and eliminating bacteria is crucial for enhancing the antibacterial efficiency of the hydrogel.In this context,we present a multifunctional hydrogel dressing,termed SIP,designed to tackle drug-resistant bacterial infections in diabetic wounds.This dressing integrates ionic liquid functional groups into a sericin-based matrix:phenylboronic acid for the immobilization of bacteria and imidazole for their subsequent annihilation.Expectedly,the SIP system demonstrates potent antibacterial activity against methicillin-resistant Staphylococcus aureus,verified through in vitro and in vivo experiments.As a result,SIP emerges as a promising candidate in the realm of hydrogel dressings with innate antibacterial properties,showcasing considerable potential for addressing diabetic wounds plagued by drug-resistant bacterial infections.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,n...BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,necessitating extensive medical intervention,and increasing the risk of amputation.Vitamin D(VD)plays a critical role in immune regulation and tissue repair.AIM To investigate the effects of VD supplementation on infection rates,wound healing,and immune function in patients with DFUs.METHODS A randomized controlled trial was conducted involving 120 patients with DFUs.Participants were randomly assigned to either a control group(n=60),which received standard care without VD supplementation,or an intervention group(n=60),which received 2000 IU of oral VD3(cholecalciferol)daily for 12 weeks.The primary outcomes included the incidence and severity of infections,whereas the secondary outcomes included wound healing rate,serum 25-hydroxyvitamin D level,levels of immune markers(cathelicidin,interleukin-6 and tumor necrosis factor-α),and adverse events,such as hypercalcemia.RESULTS The incidence of infection was significantly lower in the VD supplementation group(25%)compared with the control group(45%)(P=0.01).Severe infections requiring systemic antibiotics or hospitalization were also less frequent in the VD supplementation group.Wound healing was notably enhanced in the VD supplementation group,with a 60%reduction in ulcer size compared with a 35%reduction in the control group(P<0.01).Serum 25(OH)D level significantly increased in the VD supplementation group(from 16.5 ng/mL to 35.2 ng/mL),confirming the efficacy of VD supplementation.Immune function improved,as demonstrated by a 30%rise in cathelicidin level and a 20%decline in levels of pro-inflammatory cytokines.No adverse effects,including hypercalcemia,were reported.CONCLUSION The VD supplementation effectively reduced infection rate,promoted wound healing,and strengthened immune responses in patients with DFUs.These findings support the incorporation of VD as a safe and effective adjunctive therapy in the clinical management of DFUs.展开更多
Treating severe burn wounds poses significant challenges,including considerable cell loss,excessive inflammation,and a high susceptibility to bacterial infections.Ideal burn dressings should exhibit excellent antibact...Treating severe burn wounds poses significant challenges,including considerable cell loss,excessive inflammation,and a high susceptibility to bacterial infections.Ideal burn dressings should exhibit excellent antibacterial properties,anti-inflammatory effects,and promote cell proliferation.Additionally,they need facilitate painless dressing changes and be user-friendly.Herein,we synthesized a thermosensitive hydrogel by crosslinking poly(N-isopropylacrylamide-co-allyloxybenzaldehyde)(PNA)and amino-terminated Pluronic F127(APF)through a Schiffbase reaction.It exhibited reversible gelsol transition and spread-ability.By incorporating piezoelectric gold nanoparticle-modified barium titanate(Au@BaTiO3)and cas-cade antioxidant MOF-818,a nanocomposite hydrogel dressing with diverse bioactive functionalities was developed.Results demonstrated that the nanocomposite hydrogel possessed gel-sol transition properties,maintained a stable gel state within a broad temperature range,and desirable self-healing property.Au@BaTiO3 exhibited good piezoelectric properties and ROS generation upon ultrasound stimulation,while MOF-818 displayed highly efficient cascade nanozyme activity.The combination of Au@BaTiO3 and MOF-818 promoted fibroblast proliferation and migration,reduced intracellular ROS levels,and induced anti-inflammatory polarization of macrophages under ultrasound stimulation.In vitro and in vivo antibacterial results disclosed that the nanocomposite hydrogel had excellent antibacterial activity under highintensity ultrasound stimulation.When applied to infected burn wounds,the nanocomposite hydrogel can rapidly sterilize the wound upon initial high-intensity ultrasound,and then reduce inflammation and promote M2 macrophage polarization by the following low-intensity ultrasound stimulation,and thus accelerating the healing by improving granulation tissue formation,angiogenesis,and collagen deposition.展开更多
Background: Postoperative wound healing has been a problem which causes high mortality in the developing world;postoperative wound has been reported to cause devastating consequences and a measurable mortality. There ...Background: Postoperative wound healing has been a problem which causes high mortality in the developing world;postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing;however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.展开更多
Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbi...Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.展开更多
Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses w...Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.展开更多
BACKGROUND Colostomy is important in the treatment of colorectal cancer.However,surgical site wound infections after colostomy seriously affect patients’physical recovery and quality of life.AIM To investigate the ab...BACKGROUND Colostomy is important in the treatment of colorectal cancer.However,surgical site wound infections after colostomy seriously affect patients’physical recovery and quality of life.AIM To investigate the ability of high-quality nursing care to prevent surgical site wound infections and reduce post-colostomy complications in patients with co-lorectal cancer.METHODS Eighty patients with colorectal cancer who underwent colostomy at our hospital between January 2023 and January 2024 were selected as research subjects.The random number table method was used to divide the participants into control and research groups(n=40 each).The control group received routine nursing care,while the research group received high-quality nursing care.The differences in indicators were compared between groups.RESULTS The baseline characteristics did not differ between the research(n=40)and control(n=40)groups(P>0.05).The incidences of wound infection,inflam-mation,and delayed wound healing were significantly lower in the research(5.00%)vs control(25.00%)group(P=0.028).The incidence of postoperative complications,including fistula stenosis,fistula hemorrhage,fistula prolapse,peristome dermatitis,urinary retention,pulmonary infection,and intestinal ob-struction,was significantly lower in the research(5.00%)vs control(27.50%)group(P=0.015).In addition,the time to first exhaust(51.40±2.22 vs 63.80±2.66,respectively;P<0.001),time to first bowel movement(61.30±2.21 vs 71.80±2.74,respectively;P<0.001),and average hospital stay(7.94±0.77 vs 10.44±0.63,respectively;P<0.001)were significantly shorter in the research vs control group.The mean Newcastle satisfaction with nursing scale score was also significantly higher in the research(91.22±0.96)vs control(71.13±1.52)group(P<0.001).CONCLUSION High-quality nursing interventions can effectively reduce the risk of wound infections and complications in patients undergoing colostomy,promote their postoperative recovery,and improve their satisfaction with the nursing care received.展开更多
Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the ...Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m<sup>2</sup>. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.展开更多
Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is...Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is a popular procedure in every day surgical practice,the lack of procedure standardization,leads to studies with high heterogeneity and often controversial results.Thus,there are studies that advocate its use,while others discourage its implementation in clinical practice to reduce the risk of surgical site infection.The present article reviews the current literature on wound irrigation for preventing surgical site infections.Several irrigants are presented.Chlorexidine is generally considered to be less effective than povidone-iodine,while antibiotics are not that common nowadays,as they require prolonged exposure with the target to act.Hydrogen peroxide has several potential complications,which eliminate its use.Any differences in the incidence of surgical site infections between different irrigants,especially between antibacterial and non-bacterial ones,should be viewed sceptically.More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants'effectiveness and safety.展开更多
Bacterial biofilms(BFs)are widely present in nature,and more than 99%of bacteria can form BF,which is an important factor leading to persistent infection of refractory wound and repeated infection.The formation of BF i...Bacterial biofilms(BFs)are widely present in nature,and more than 99%of bacteria can form BF,which is an important factor leading to persistent infection of refractory wound and repeated infection.The formation of BF is a dynamic cyclic process involving various physical,chemical and biological processes,mainly including bacterial attachment,BF formation and maturation,and bacterial diffusion.The bacteria in bacterial biofilms are more resistant to antibiotics and disinfectants,and more resilient to environmental changes,which presents many challenges in treatment.This article reviews the basic characteristics,resistance mechanisms and treatment strategies of BF.At present,there are many studies on the treatment of BF,which need to be selected according to the specific situation and pathophysiological process of wound infection,and can be used as a single method or in combination.This article introduces some treatment methods to provide a reference for the clinical prevention and treatment of BF.展开更多
Despite many advances in prevention and perioperative care, deep sternal wound infection(DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospit...Despite many advances in prevention and perioperative care, deep sternal wound infection(DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy(NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors- when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate.展开更多
Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department...Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.展开更多
Altered bowel flora is currently thought to play a role in a variety of disease conditions, and the use of Bifidobacterium spp. and Lactobacillus spp. as probiotics has been demonstrated to be health-promoting, even i...Altered bowel flora is currently thought to play a role in a variety of disease conditions, and the use of Bifidobacterium spp. and Lactobacillus spp. as probiotics has been demonstrated to be health-promoting, even if the success of their administration depends on the applied bacterial strain（s） and the targeted disease. In the last few decades, specific probiotics have been shown to be effective in the treatment or the prevention of acute viral gastroenteritis, pediatric post-antibiotic-associated diarrhea, some pediatric allergic disorders, necrotizing enterocolitis in preterm infants, inflammatory bowel diseases and postsurgical pouchitis. The potential application of probiotics is continuously widening, with new evidence accumulating to support their effect on the prevention and treatment of other disease conditions, including several oral diseases, such as dental caries, periodontal diseases and oral malodor, as well as genitourinary and wound infections. Considering the increasingly widespread ability of pathogens to generate persistent biofilm-related infections, an even more attractive proposal is to administer probiotics to prevent or counteract biofilm development.The response of biofilm-based oral, intestinal, vaginal and wound infections to probiotics treatment will be reviewed here in light of the most recent results obtained in this field.展开更多
BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were...BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.METHODS: The study was performed at two urban hospitals enrolling 125 emergency department(ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit(10–14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1–10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals(CI).RESULTS: In the 125 patients with SHL [median age: 28(18, 43); range: 1–102 years old; 36% female], 44(35%, 95% CI: 27%–44%) were given antibiotics in the ED. Wound infection was reported in 6 patients(4.8%, 95% CI: 2%–10%). Age, gender, history of diabetes and wound closure were not associated with wound infection(P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7%(3/44), 95% CI: 2%–10% vs. 4%(3/81), 95% CI: 1%–11%, P=0.66]. Patient's satisfaction with appearance ofinfected and non-infected wounds were significantly different [7.5(6, 8) vs. 9(8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk ofinfection.展开更多
Medical cotton dressing is cheap and widely used in diversified fields,but in the application of promoting wound healing,the continuous research of multifunctional medical cotton dressing is still of great significanc...Medical cotton dressing is cheap and widely used in diversified fields,but in the application of promoting wound healing,the continuous research of multifunctional medical cotton dressing is still of great significance.Here,we developed a fresh type of antibacterial cotton dressing through a succinct strategy based on chemically anchoring polyhexamethylene biguanide(PHMB).Intriguingly,after PHMB modification,the cotton dressing exhibited outstanding antibacterial performance which could maintain>99.99%antibacterial rate after several treatments,including washing 50 times,repeated use 10 times,UV irradiation for 7 days,cationic dyes dying,and conditioned under 90℃water bath for 2 h.In addition,the water contact angle of cotton dressing increased dramatically from 0°to 111°,which could facilitate bacterial adhesion,thus further enhance the antibacterial efficiency,and easily remove the bacterial debris.Apart from that,the developed cotton dressing showed good cytocompatibility,promoted blood clotting and expression of platelets,and promoted the wound healing process in the infection intervened skin wound model.Taken together,this antibacterial cotton dressing with desirable blood clotting,sustained protection against bacterial infection and bacterial removal features shows the potential to be a candidate for infected skin wound healing.展开更多
Bacterial infection causes wound inflammation and makes angiogenesis difficult.It is urgent to develop effectively antibacterial and pro-vascularizing dressings for wound healing.The hydrogel is developed with pH-resp...Bacterial infection causes wound inflammation and makes angiogenesis difficult.It is urgent to develop effectively antibacterial and pro-vascularizing dressings for wound healing.The hydrogel is developed with pH-responsive drug-releasing microcarriers which were loaded with vascular endothelial growth factor(VEGF)that promotes angiogenesis and actively respond to wound pH for control and prolong VEGF release.The surfaces of the microcarriers were coated with polydopamine which can reduce the silver nanoparticles(AgNPs)in situ,and dynamically crosslink with the polyacrylamide,which forms a stable slow-release system with different release behavior for the VEGF and AgNPs.The hydrogel inhib-ited bacterial formation and accelerated wound healing.With the hydrogel dressing,83.3%±4.29%of the wound heals at day 7,which is 40.9%±8.5%higher than the non-treatment group in defect infected model.The antibacterial properties of hydrogel down-regulate early inflammation-related cytokines,and the release of VEGF in the middle and late phases of wound healing in response to pH changes pro-motes angiogenesis and up-regulate the expression of angiogenesis-associated cytokine.The sequential release of antibacterial agents and pro-vascularizing agents in response to the change in wound microen-vironmental cues facilitate temporally controlled therapy that suites the need of different wound healing phases.Collectively,the hydrogel loaded with multifunctional microcarriers that enable controlled release of AgNPs and VEGF is an effective system for treating infected wounds.展开更多
文摘Unrestrained anti-microbial resistance (AMR) among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. This study assessed the current AMR patterns of bacterial isolates in post-operative wound infections in a tertiary care hospital in Kathmandu,Nepal. Pus swabs collected from post-operative wound infections and submitted for culture and sensitivity were included in this study. Isolation and identification of the organism was done by standard microbiological methods. Antibiotic susceptibility test was performed by Kirby Bauer disc diffusion method and result was interpreted as per National Committee for Clinical Laboratory Standards (NCCLS) guide lines. Of the 120 pus swabs processed for culture, 96 showed bacterial growth. Staphylococcus aureus 36 (37.5%) was the predominant gram positive isolate and Escherichia coli 24 (25%) was the major gram negative isolate .The infection was most prevalent in the age group 20-40 years. All S. aureus isolates were sensitive to aminoglycosides and vancomycin. Out of 36 S. aureus, 15 (41.66%) isolates were methicillin resistant S. aureus (MRSA). Staphylococcus epidermidis showed high resistance (50%-100%) to all antibiotics but were sensitive to vancomycin. All gram negative isolates showed high resistance against cephalexin (75%-100%) and ceftriaxone (25%-100%). Overall multi-drug resistant isolates were 66.7%. A high level of AMR was observed in gram negative bacterial isolates. Rational use of antibiotics and a regular monitoring of AMR patterns in post-operative wound infections are essential and mandatory to avert further emergence and spread of anti-microbial resistance among bacterial pathogens.
文摘BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.
文摘AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(HbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was evaluated.RESULTS Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet explored.CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection,instituting a standard protocol for all the described steps appears beneficial.
文摘Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection(DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males(73.7%) and 5 females(26.3%), aged 55±13(18-78) years. According to the Pairolero classification of infected median sternotomies, 3(15.8%) patients were type II, and the other 16(84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients(78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients(21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients(10.5%) presented with subcutaneous infection, and 3 patients(15.8%) had hematoma. They recovered following local debridement and medication. 17 patients(89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.
基金supported by the National Natural Science Foundation of China(No.82372551)。
文摘Diabetic wound healing is often complicated due to bacterial infections that intensify inflammation.Employing hydrogel dressings with inherent antibacterial properties can significantly reduce reliance on antibiotics for treating infected wounds in diabetics.Traditional hydrogels typically rely on the infiltration of bacteria into their porous structure to manifest antibacterial effects.However,this infiltration process is not only prolonged but can also exacerbate inflammation,further delaying the healing of the wound.Thus,promptly capturing and eliminating bacteria is crucial for enhancing the antibacterial efficiency of the hydrogel.In this context,we present a multifunctional hydrogel dressing,termed SIP,designed to tackle drug-resistant bacterial infections in diabetic wounds.This dressing integrates ionic liquid functional groups into a sericin-based matrix:phenylboronic acid for the immobilization of bacteria and imidazole for their subsequent annihilation.Expectedly,the SIP system demonstrates potent antibacterial activity against methicillin-resistant Staphylococcus aureus,verified through in vitro and in vivo experiments.As a result,SIP emerges as a promising candidate in the realm of hydrogel dressings with innate antibacterial properties,showcasing considerable potential for addressing diabetic wounds plagued by drug-resistant bacterial infections.
基金Supported by Natural Science Foundation of Henan Province,No.202300410396the Young Talents Promotion Project of Henan Province,No.2021HYTP043.
文摘BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,necessitating extensive medical intervention,and increasing the risk of amputation.Vitamin D(VD)plays a critical role in immune regulation and tissue repair.AIM To investigate the effects of VD supplementation on infection rates,wound healing,and immune function in patients with DFUs.METHODS A randomized controlled trial was conducted involving 120 patients with DFUs.Participants were randomly assigned to either a control group(n=60),which received standard care without VD supplementation,or an intervention group(n=60),which received 2000 IU of oral VD3(cholecalciferol)daily for 12 weeks.The primary outcomes included the incidence and severity of infections,whereas the secondary outcomes included wound healing rate,serum 25-hydroxyvitamin D level,levels of immune markers(cathelicidin,interleukin-6 and tumor necrosis factor-α),and adverse events,such as hypercalcemia.RESULTS The incidence of infection was significantly lower in the VD supplementation group(25%)compared with the control group(45%)(P=0.01).Severe infections requiring systemic antibiotics or hospitalization were also less frequent in the VD supplementation group.Wound healing was notably enhanced in the VD supplementation group,with a 60%reduction in ulcer size compared with a 35%reduction in the control group(P<0.01).Serum 25(OH)D level significantly increased in the VD supplementation group(from 16.5 ng/mL to 35.2 ng/mL),confirming the efficacy of VD supplementation.Immune function improved,as demonstrated by a 30%rise in cathelicidin level and a 20%decline in levels of pro-inflammatory cytokines.No adverse effects,including hypercalcemia,were reported.CONCLUSION The VD supplementation effectively reduced infection rate,promoted wound healing,and strengthened immune responses in patients with DFUs.These findings support the incorporation of VD as a safe and effective adjunctive therapy in the clinical management of DFUs.
基金the National Key Re-search and Development Project of China(No.2023YFC2412600)National Natural Science Foundation of China(Nos.52003216,82272155, 52403168)+3 种基金the Youth Project of Shaanxi Provin-cial Department of Science and Technology(Nos.2024JC-YBQN-0368,2024JC-YBQN-04502024JC-YBQN-0202)the High-Level Talents Program of Xi’an University of Science and Technology(No.2050122015)the China Postdoctoral Science Foundation(Nos.2022M712506,2024T170717).
文摘Treating severe burn wounds poses significant challenges,including considerable cell loss,excessive inflammation,and a high susceptibility to bacterial infections.Ideal burn dressings should exhibit excellent antibacterial properties,anti-inflammatory effects,and promote cell proliferation.Additionally,they need facilitate painless dressing changes and be user-friendly.Herein,we synthesized a thermosensitive hydrogel by crosslinking poly(N-isopropylacrylamide-co-allyloxybenzaldehyde)(PNA)and amino-terminated Pluronic F127(APF)through a Schiffbase reaction.It exhibited reversible gelsol transition and spread-ability.By incorporating piezoelectric gold nanoparticle-modified barium titanate(Au@BaTiO3)and cas-cade antioxidant MOF-818,a nanocomposite hydrogel dressing with diverse bioactive functionalities was developed.Results demonstrated that the nanocomposite hydrogel possessed gel-sol transition properties,maintained a stable gel state within a broad temperature range,and desirable self-healing property.Au@BaTiO3 exhibited good piezoelectric properties and ROS generation upon ultrasound stimulation,while MOF-818 displayed highly efficient cascade nanozyme activity.The combination of Au@BaTiO3 and MOF-818 promoted fibroblast proliferation and migration,reduced intracellular ROS levels,and induced anti-inflammatory polarization of macrophages under ultrasound stimulation.In vitro and in vivo antibacterial results disclosed that the nanocomposite hydrogel had excellent antibacterial activity under highintensity ultrasound stimulation.When applied to infected burn wounds,the nanocomposite hydrogel can rapidly sterilize the wound upon initial high-intensity ultrasound,and then reduce inflammation and promote M2 macrophage polarization by the following low-intensity ultrasound stimulation,and thus accelerating the healing by improving granulation tissue formation,angiogenesis,and collagen deposition.
文摘Background: Postoperative wound healing has been a problem which causes high mortality in the developing world;postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing;however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.
文摘Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients;small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.
文摘Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.
文摘BACKGROUND Colostomy is important in the treatment of colorectal cancer.However,surgical site wound infections after colostomy seriously affect patients’physical recovery and quality of life.AIM To investigate the ability of high-quality nursing care to prevent surgical site wound infections and reduce post-colostomy complications in patients with co-lorectal cancer.METHODS Eighty patients with colorectal cancer who underwent colostomy at our hospital between January 2023 and January 2024 were selected as research subjects.The random number table method was used to divide the participants into control and research groups(n=40 each).The control group received routine nursing care,while the research group received high-quality nursing care.The differences in indicators were compared between groups.RESULTS The baseline characteristics did not differ between the research(n=40)and control(n=40)groups(P>0.05).The incidences of wound infection,inflam-mation,and delayed wound healing were significantly lower in the research(5.00%)vs control(25.00%)group(P=0.028).The incidence of postoperative complications,including fistula stenosis,fistula hemorrhage,fistula prolapse,peristome dermatitis,urinary retention,pulmonary infection,and intestinal ob-struction,was significantly lower in the research(5.00%)vs control(27.50%)group(P=0.015).In addition,the time to first exhaust(51.40±2.22 vs 63.80±2.66,respectively;P<0.001),time to first bowel movement(61.30±2.21 vs 71.80±2.74,respectively;P<0.001),and average hospital stay(7.94±0.77 vs 10.44±0.63,respectively;P<0.001)were significantly shorter in the research vs control group.The mean Newcastle satisfaction with nursing scale score was also significantly higher in the research(91.22±0.96)vs control(71.13±1.52)group(P<0.001).CONCLUSION High-quality nursing interventions can effectively reduce the risk of wound infections and complications in patients undergoing colostomy,promote their postoperative recovery,and improve their satisfaction with the nursing care received.
文摘Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m<sup>2</sup>. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.
文摘Wound irrigation(i.e.washing out a wound before wound closure)aims to reduce the microbial burden by removing tissue debris,metabolic waste,and tissue exudate from the surgical field before site closure.Although it is a popular procedure in every day surgical practice,the lack of procedure standardization,leads to studies with high heterogeneity and often controversial results.Thus,there are studies that advocate its use,while others discourage its implementation in clinical practice to reduce the risk of surgical site infection.The present article reviews the current literature on wound irrigation for preventing surgical site infections.Several irrigants are presented.Chlorexidine is generally considered to be less effective than povidone-iodine,while antibiotics are not that common nowadays,as they require prolonged exposure with the target to act.Hydrogen peroxide has several potential complications,which eliminate its use.Any differences in the incidence of surgical site infections between different irrigants,especially between antibacterial and non-bacterial ones,should be viewed sceptically.More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants'effectiveness and safety.
文摘Bacterial biofilms(BFs)are widely present in nature,and more than 99%of bacteria can form BF,which is an important factor leading to persistent infection of refractory wound and repeated infection.The formation of BF is a dynamic cyclic process involving various physical,chemical and biological processes,mainly including bacterial attachment,BF formation and maturation,and bacterial diffusion.The bacteria in bacterial biofilms are more resistant to antibiotics and disinfectants,and more resilient to environmental changes,which presents many challenges in treatment.This article reviews the basic characteristics,resistance mechanisms and treatment strategies of BF.At present,there are many studies on the treatment of BF,which need to be selected according to the specific situation and pathophysiological process of wound infection,and can be used as a single method or in combination.This article introduces some treatment methods to provide a reference for the clinical prevention and treatment of BF.
文摘Despite many advances in prevention and perioperative care, deep sternal wound infection(DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy(NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors- when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate.
文摘Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751;of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.
文摘Altered bowel flora is currently thought to play a role in a variety of disease conditions, and the use of Bifidobacterium spp. and Lactobacillus spp. as probiotics has been demonstrated to be health-promoting, even if the success of their administration depends on the applied bacterial strain（s） and the targeted disease. In the last few decades, specific probiotics have been shown to be effective in the treatment or the prevention of acute viral gastroenteritis, pediatric post-antibiotic-associated diarrhea, some pediatric allergic disorders, necrotizing enterocolitis in preterm infants, inflammatory bowel diseases and postsurgical pouchitis. The potential application of probiotics is continuously widening, with new evidence accumulating to support their effect on the prevention and treatment of other disease conditions, including several oral diseases, such as dental caries, periodontal diseases and oral malodor, as well as genitourinary and wound infections. Considering the increasingly widespread ability of pathogens to generate persistent biofilm-related infections, an even more attractive proposal is to administer probiotics to prevent or counteract biofilm development.The response of biofilm-based oral, intestinal, vaginal and wound infections to probiotics treatment will be reviewed here in light of the most recent results obtained in this field.
基金in part was funded by a medical student grant($2500)by the Emergency Medicine Foundation
文摘BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.METHODS: The study was performed at two urban hospitals enrolling 125 emergency department(ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit(10–14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1–10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals(CI).RESULTS: In the 125 patients with SHL [median age: 28(18, 43); range: 1–102 years old; 36% female], 44(35%, 95% CI: 27%–44%) were given antibiotics in the ED. Wound infection was reported in 6 patients(4.8%, 95% CI: 2%–10%). Age, gender, history of diabetes and wound closure were not associated with wound infection(P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7%(3/44), 95% CI: 2%–10% vs. 4%(3/81), 95% CI: 1%–11%, P=0.66]. Patient's satisfaction with appearance ofinfected and non-infected wounds were significantly different [7.5(6, 8) vs. 9(8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk ofinfection.
基金the National Natural Science Foundation of China(Nos.51803128,52073186,21802097)Fundamental Research Funds for the Central Universities(No.20826041D4160)+2 种基金Sichuan Science and Technology Programs(Nos.2020KJT0031-2020ZHCG0051,2020KJT0061-2020ZHFP0148)State Key Laboratory of Polymer Materials Engineering(No.sklpme20213–01)Funding of Engineering Characteristic Team,Sichuan University(No.2020SCUNG122)。
文摘Medical cotton dressing is cheap and widely used in diversified fields,but in the application of promoting wound healing,the continuous research of multifunctional medical cotton dressing is still of great significance.Here,we developed a fresh type of antibacterial cotton dressing through a succinct strategy based on chemically anchoring polyhexamethylene biguanide(PHMB).Intriguingly,after PHMB modification,the cotton dressing exhibited outstanding antibacterial performance which could maintain>99.99%antibacterial rate after several treatments,including washing 50 times,repeated use 10 times,UV irradiation for 7 days,cationic dyes dying,and conditioned under 90℃water bath for 2 h.In addition,the water contact angle of cotton dressing increased dramatically from 0°to 111°,which could facilitate bacterial adhesion,thus further enhance the antibacterial efficiency,and easily remove the bacterial debris.Apart from that,the developed cotton dressing showed good cytocompatibility,promoted blood clotting and expression of platelets,and promoted the wound healing process in the infection intervened skin wound model.Taken together,this antibacterial cotton dressing with desirable blood clotting,sustained protection against bacterial infection and bacterial removal features shows the potential to be a candidate for infected skin wound healing.
文摘Bacterial infection causes wound inflammation and makes angiogenesis difficult.It is urgent to develop effectively antibacterial and pro-vascularizing dressings for wound healing.The hydrogel is developed with pH-responsive drug-releasing microcarriers which were loaded with vascular endothelial growth factor(VEGF)that promotes angiogenesis and actively respond to wound pH for control and prolong VEGF release.The surfaces of the microcarriers were coated with polydopamine which can reduce the silver nanoparticles(AgNPs)in situ,and dynamically crosslink with the polyacrylamide,which forms a stable slow-release system with different release behavior for the VEGF and AgNPs.The hydrogel inhib-ited bacterial formation and accelerated wound healing.With the hydrogel dressing,83.3%±4.29%of the wound heals at day 7,which is 40.9%±8.5%higher than the non-treatment group in defect infected model.The antibacterial properties of hydrogel down-regulate early inflammation-related cytokines,and the release of VEGF in the middle and late phases of wound healing in response to pH changes pro-motes angiogenesis and up-regulate the expression of angiogenesis-associated cytokine.The sequential release of antibacterial agents and pro-vascularizing agents in response to the change in wound microen-vironmental cues facilitate temporally controlled therapy that suites the need of different wound healing phases.Collectively,the hydrogel loaded with multifunctional microcarriers that enable controlled release of AgNPs and VEGF is an effective system for treating infected wounds.
