Management Of Wound Infections Research Articles

IWII Wound Infection in Clinical Practice consensus document: 2022 update

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

Ayurveda Review on Bandha Vidhi and Clinical Significance of Pichu, Plota, Kavalika and Vikeshika

The Bandhan means bandaging and Acharya Sushruta has described various aspects of Bandhan. Ayurvedamentioned clinical significance of Bandhan, Sthana, Vidhiand Dravyafor Bandhan. The Bandhana gives Shodhan effect and keep wound cleanand improves process of healing. Bandha(bandage) gives steadiness in bones &provides compactness to the joints. Bandhana should be done according to the Kala and condition of disease& Ritu. Bandhana Vidhi utilizes Vranashodhana and Vranaropana drugs thus helps to cure cuts and wounds.Dressing material such as; Pichu, Plota and Kawalika, etc. offersearly healing and improves ability of body to regain physical ability. The Vrana Shodhana and Ropana properties help in the treatment of Vrana. Bandha Vidhisuch as Pichu, Plota, Kavalika and Vikeshika are simple and safe techniques with minimal invasion that can be used effectively for the management of infected wound /ulcer. Present article explores Ayurveda review on Bandha Vidhi and clinical significance of Pichu, Plota, Kavalika and Vikeshika.
 Keywords: Ayurveda, BandhaVidhi, Pichu, Plota, Kavalika

Infectious Diseases Management in Wound Care Settings: Common Causative Organisms and Frequently Prescribed Antibiotics.

To provide information about the management of infected wounds in wound care settings. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Identify a host factor that may predispose a patient to a wound infection as well as characteristics of each stage of wound infection.2. Distinguish a common organism that causes early, acute wound infections and explain the preferred method for obtaining a wound specimen for culture.3. Apply knowledge of commonly prescribed antibiotics in wound care settings.

ENHANCEMENT IN THE TREATMENT OF SEPTIC WOUNDS BY VACUUM THERAPY

The doctrine of the wound process is still one of the challenging issues of modern surgery; it reflects the achievements of theoretical and practical medicine and technical engineering as well. Slow-healing wounds, extensive necrosis in soft tissues, trophic ulcers of shins in patients with circulatory disorders of various aetiology, purulent bedsores, infected burn surfaces and other septic-inflammatory processes are particularly difficult to treat. The principles and methods of surgical treatment and pharmacotherapy over the phases of the wound process are aimed at reducing the infectious complications and core protocols provide standard guidance for appropriate prevention and management of infected wounds.
 The use of vacuum therapy (VAC therapy) according to numerous clinical studies improves both immediate and long-term treatment outcomes, updates standard therapy regimens for septic processes in soft tissues, especially in the presence of associated microbial colonies.
 The aim of the study is to evaluate the clinical efficacy of VAC therapy methods incorporated into a standard management of infected inflammatory wounds. The article presents the analysis of the case histories of 50 patients with acute septic inflammatory processes, who took the treatment course at the surgical department of Poltava Clinical Central District Hospital. The main group of 20 patients included 5 men (average age 52.2 ± 5.1 years) and 15 women (average age 51.4 ± 4.1 years). The control group involved 30 patients: 11 men (mean age 48.6 ± 3.7 years) and 19 women (mean age 54 ± 4.2 years). According to the character of surgical problem, patients were divided as follows: purulent-necrotic form of erysipelas was found in 11 patients (5 patients in the main group, 6 patients in the control), infected thermal burns were diagnosed in 11 patients (4 individuals in the main group and 7 individuals in the control), fооt phlegmon as diabetes complication was found in 13 patients (5 individuals in the main group, 8 individuals in the control), trophic ulcers of shins due to chronic venous insufficiency were detected in 15 patients (6 individuals in the main group, 9 individuals in the control). The VAC therapy methods allowed us to significantly reduce the period of wound cleansing, to accelerate the appearance of granulations, and that is the most importantly, to reduce the treatment duration in 1.5 times. The VAC-therapy for local treatment of septic-inflammatory processes is relatively inexpensive and quite effective therefore, it can be recommended for wider use in surgical practice.

An overview of the prevention and management of wound infection.

A wound can be defined as infected when the presence and subsequent proliferation of microorganisms leads to a local or systemic response in an individual. Wound infection is associated with delayed healing, wound chronicity, increased risk of hospital admission, loss of limb or digit and increased healthcare costs. The presence of biofilm is also recognised as a challenge in infected wounds and is associated with chronicity and delays in healing. Identifying and managing wound infection early can contribute to faster wound healing, thus reducing the risk of negative outcomes. This article details the pathophysiology, risk factors and signs and symptoms of wound infection. It also outlines various prevention and management options for wound infection.

Hyperbaric oxygen therapy as adjuvant treatment for surgical site infections after male-to-female gender affirmation surgery: A 10-year experience.

IntroductionSeveral urological conditions that share an impairment of tissue oxygenation can benefit from hyperbaric oxygen therapy; limited evidence is available of its impact on patients undergoing male‐to‐female gender affirmation surgery.AimTo evaluate the efficacy and safety of hyperbaric oxygen therapy as adjuvant treatment for surgical site infections in patients undergoing male‐to‐female gender affirmation surgery.MethodsThis research was conducted as an observational retrospective study. Patients undergoing male‐to‐female gender affirmation surgery at the principal investigators’ institution from January 2009 to September 2019, with a discharge diagnosis of complicated superficial or deep wound infections, were included. All patients underwent standard management of wound infection. Subjects received/not‐received hyperbaric oxygen therapy at the surgeon's discretion and were assigned to the hyperbaric oxygen therapy versus non‐hyperbaric oxygen therapy group accordingly. Complete wound healing rate (primary outcome), duration of antibiotic therapy, perineal drain time, bladder catheter time, and hospital stay were recorded. All adverse events that occurred during the study period were described.ResultsA total of 156 patients underwent male‐to‐female gender affirmation surgery in the study period. Thirty‐three patients were enrolled. Fifteen subjects belonged to the hyperbaric oxygen therapy group, the other 18 to the non‐hyperbaric oxygen therapy group. No statistically significant differences were found between the two groups at baseline. Penile inversion vaginoplasty and intestinal vaginoplasty were performed in nine (60%) and six (40%) patients of the hyperbaric oxygen therapy group. Only penile inversion vaginoplasty was performed in subjects of the non‐hyperbaric oxygen therapy group. Complete wound healing was obtained in 15 patients (100%) of the hyperbaric oxygen therapy group and 17 patients (94.4%) of the non‐hyperbaric oxygen therapy group (p = 0.35). Duration of antibiotic therapy, perineal drain time, bladder catheter time, and hospital stay were significantly lower in the hyperbaric oxygen therapy group (p < 0.05).ConclusionOur preliminary data suggest a role of hyperbaric oxygen therapy as adjuvant treatment for surgical site infection in patients undergoing male‐to‐female gender affirmation surgery. Randomized controlled trials properly powered are needed to confirm our findings.

Challenges in the diagnosis and management of wound infection.

Human epithelia are constantly exposed to microorganisms present in the environment or residing as part of commensal flora. Despite this exposure, infections involving the skin and subcutaneous tissue in healthy individuals are, fortunately, quite rare. Many of the wounds that afflict the human body occur in individuals of ill health and/or where the mechanism of wounding is impeded by host immunological, physiological or regenerative dysfunction. The interplay between microorganisms and host immunity is complex and remains ill defined; however, the interpretation of downstream manifestations of the host response to invading microorganisms is still based largely on the clinical signs and symptoms of an active infectious process. In this review article we will provide a brief overview of the current challenges clinicians face in diagnosing wound infections, how chronic infections caused by biofilms are a major challenge, and how there have been minimal advancements in developing new diagnostics or therapeutics in the identification and management of wound infections.

Harnessing antibacterial properties of biomaterials for fabricating wound healing patch

IntroductionStudies aimed at elucidating the role of infections caused by bacterial colonization in wound healing are gaining increasing recognition. Proper management of wound infections purposely aimed at keeping low levels of bacteria on wound surfaces is pivotal in enhancing the wound healing process and preventing local and systematic infections. In this research, biomaterials with inherent antimicrobial properties were exploited for fabricating a wound healing composite with an improved potential of reducing or completely inhibiting bacterial growth. The use of biomaterials with inherent antibacterial properties was necessitated by the desire to reduce the incorporated antibiotic load, thus reducing the risk of development of resistance to antibiotics by these bacteria.MethodsCarboxymethyl cellulose (CMC), one of the most common derivatives of cellulose, chitosan (CTS), a natural, biodegradable, non‐toxic polymer that demonstrates diverse biological properties, metalized and non‐metalized halloysites (HNT &amp; mHNT) as well as variants loaded with antibiotics (LHNT, LmHNT) were tested for antimicrobial properties against E.coli at concentrations of 2mg/ml and 0.5mg/ml in 3 repeats. CTS and CMC were then physically cross‐linked and impregnated with halloysites and metal coated halloysites. A Fourier‐transform infrared spectroscopy (FTIR) characterization test was then carried out to validate the cross‐linking of the polymers. The biocompatibility of the fabricated composite was assessed by studying the proliferation rate of human dermal fibroblasts treated with the test samples.Results2mg/ml and 0.5mg/ml of the biomaterials tested all inhibited growth of E. coli with metal‐coated halloysites loaded with antibiotics exhibiting the most antimicrobial effect. CTS and CMC both exhibited characteristic absorption peaks on the FTIR spectra which conforms with data reported in other studies, with cross‐linking between the two polymers characterized by broadening of the bands at 3400–3301 cm−1. The proliferation assay showed that all the samples did not inhibit fibroblast cell growth with the exception of CTS‐CMC composites incorporated with 5% HNT and 5% metalized HNT.DiscussionCTS and CMC composites incorporated with HNTs have the potential to effectively suppress microbial growth when used to fabricate wound dressings. The dressing is easy to fabricate, and its components are tunable from a personalized medicine perspective.

Coordination polymer nanozymes-integrated colorimetric microneedle patches for intelligent wound infection management

Biomedical patches are playing an indispensable role in wound infection management. Current efforts have focused on designing smart patches with both treating and sensing abilities to recognize wound infections and kill bacteria efficiently. Here, we present intelligent colorimetric microneedle patches (MNs) integrated with Fe ion-gallic acid coordination polymer nanodots (FNDs) for on-demand treatment and real-time report of infected wounds. Such FNDs are fabricated by coordination reactions among polyvinylpyrrolidone (PVP), gallic acid, and Fe ion, and are loaded inside the MNs using a template replication method (FNDs-MNs). Benefitting from the pH-dependent peroxidase mimic activity of the FNDs, the integrated MNs can catalyze H2O2 to generate much more OH at the acidic condition for bacteria killing. Besides, these FNDs-MNs also possess pH and H2O2 dependent color changes, and thus can timely reflect the wound repair and infection states. During the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infected wounds in mice, the FNDs-MNs exhibit obvious color changes at infected stages and achieve on-demand therapeutic effects. Thus, it is believed that such FNDs-MNs have great potentials for efficient wound infection management and will find wide applications in wound care.

The in vitro efficacy of betadine antiseptic solution and colloidal silver gel combination in inhibiting the growth of bacterial biofilms

Betadine (Povidone-Iodine) solution is a topically applied antiseptic, which has been used routinely used in wound care and general surgery to prevent skin and wound infections. However, several studies have documented the ineffectiveness of betadine. Other topical antimicrobial dressings, including those that contain silver, have been used in the management of infected wounds. The present study was undertaken to determine if the combination of 5% betadine solution and silver colloidal gel (Ag-gel) is more effective than either substance alone in inhibiting the growth gram-negative and gram-positive bacteria. The effectiveness of 5% betadine solution and Ag-gel as anti-microbial agents were assessed using both colony forming unit (CFU) assay and confocal laser scanning microscopy (CLSM). Ag-gel showed complete inhibition on all the bacteria species examined except the Klebsiella pneumoniae clinical isolate (CL) strain while 5% betadine concentrations did not completely kill any of the tested bacteria. In contrast, K. pneumoniae was completely eliminated in the presence of both 5% betadine solution and Ag-gel together. The CLSM showed similar findings to the CFU results examining the 5% betadine solution and Ag-gel combination. This study demonstrated that while the individual treatments using either 5% betadine solution and Ag-gel alone were infective antimicrobial agents, the combination of 5% betadine solution and Ag-gel was superior at eliminating all tested bacteria, including K. pneumoniae CL.

Near infrared light-responsive and drug-loaded black phosphorus nanosheets for antibacterial applications

The management of wound infection remain a major global challenge, effectively ablation of bacteria is of significant in fighting wound infectious diseases. Herein, black phosphorus nanosheets (BPNSs) were successfully prepared by liquid phase exfoliation technology, and composite nanosheets (BPNSs@phy) were formed by loading antimicrobial physcion（Phy）via hydrophobic interaction. Studies have shown that BPNSs@phy has good stability and low cytotoxicity under physiological conditions. In addition, BPNSs@phy has excellent photothermal conversion ability. After the irradiation of 808 nm near-infrared light, the light energy is converted into heat to promote the release of physcion. Under the synergistic effect of photothermal therapy (PTT) and antibacterial agents, BPNSs@phy has an excellent bactericidal effect against S.aureus (99.7%) and P.aeruginosa (99.9%). This study is expected to provide a new strategy for the development of BPNSs based antibacterial materials.

Preparation and in vitro evaluation of Vancomycin loaded Montmorillonite-Sodium Alginate topical gel for wound infection

Despite decades of research, wound healing remains a significant public health problem. This study aimed to develop and evaluate a topical sodium alginate gel containing vancomycin (Van) loaded MMT NPs for wound healing applications. Van was loaded in MMT at different conditions (pHs of 6, 7 and temperatures of 40, 50 °C) (Van/MMT NPs). The optimum formulation (with the smallest particle size and a high value of zeta potential; 270.8 ± 77.35 nm and -35.96 ± 2.73, respectively) showed a high drug-loading capacity (entrapment efficacy of 96%) and a sustained release pattern of Van (95%) over 480 min. The optimum Van/MMT NPs were embedded into the sodium alginate (SA) gel (Van/MMT NPs/SA gel). The Van/ MMT NPs/SA gel showed a sustained and slow release pattern of Van (95%) over 50 h. FTIR tests revealed the electrostatic interaction between MMT and Van. The broth macrodilution tube method was used to determine the minimum inhibitory concentration (MIC) of Van, Van/ MMT NPs, and Van/MMT NPs/SA gel against Staphylococcus aureus. The results showed the promising antibacterial activity of Van/MMT NPs/SA gel, thus, this gel can be a promising formulation for the management of infected wounds.

A Study of Early Parenteral Nutritional Support and Factors Associated with Clinical Outcomes in Major Pediatric Burn Patients

Objectives: Adequate nutritional support is one of the challenging treatments of major pediatric burns. Parenteral nutrition (PN) is one of the options to achieve daily caloric goal. Latest nutritional guidelines recommend late PN initiation due to unclear benefit over risk based on the limited data. Our study provides the data of parenteral nutrition within 7 days post admission (early PN) and factors affecting clinical outcomes in major pediatric burn patients.&#x0D; Methods: A retrospective study was conducted regarding pediatric burn patients who had over 15% of their total body surface area (TBSA) with second- or third-degree burns. All the patients were classified as requiring early PN support or non-early PN support.&#x0D; Results: 124 major pediatric burns were reviewed. Eighty-six patients (65.2%) were male, and the median age was three years (0.3-15 years). Early PN showed no association with length of hospital stay (LOS) (p=0.480) or a 30-day mortality (p=0.529). The children’s age, wound infections, and abdominal distension were the independent associated factors of LOS (p=0.025, 0.001, and 0.003 respectively). Pneumonia and urinary tract infection were independent factors associated with 30-day mortality (p=0.025).&#x0D; Conclusions: Early PN in acute pediatric burns was not associated with LOS or 30-day mortality. It can be considered as options of nutritional support in acute, major pediatric burns. Effective management of wound infections and abdominal distension may reduce LOS.

Risk Factors and Bacterial Profile of Abdominal Surgical Incisions- Changing Trends

Introduction: Surgical Site Infections (SSIs) remain a significant postoperative complication after abdominal surgeries, even with the advancement of infection control practices. The emergence of drug resistance to routine antibiotics was a challenge to infected wound management. Aim: To analyse the host risk factors and bacterial flora associated with abdominal surgical site infections and to evaluate the changes in the prevalence and antibiotic susceptibility pattern over the years. Materials and Methods: A cross-sectional study was done among 150 abdominal surgery cases admitted to a Government Medical College Thrissur, (referral hospital) in Kerala, India for one year, from September 2010 to August 2011. Host risk factors were analysed by clinical details and preoperative investigations. Samples were collected from the wound site on the third day of surgery using sterile swabs for bacteriological analysis. Repeated samples were taken in case of suspected wound infection to identify the types of pathogen if any. Statistical analysis was done using Microsoft excel and open Epi software. The results were compared with the similar studies conducted in this institution during 2015-2016 and 2016-2017 to know the changes in prevalence and antimicrobial sensitivity. Result: Out of 150 cases higher infection rate was found in patients &gt;60 years 5 (17.2%), emergency surgeries 16 (21.6%), large intestinal surgeries 4 (44.4%), with diabetes 5 (26.32%), patients on steroids and obese 3 (37.5%). Colonisers were present in 34.7% abdominal surgical wounds. Infection rate of 14.7% in abdominal surgeries was reduced to 11.2% and 10% between the years 2015-16 and 2016-17 respectively. Higher infection rate was noticed in patients with premorbid risk factors. When compared with the similar studies conducted in the same institute, Pseudomonas and Acinetobacter with E. coli and S. aureus were found to be most common wound pathogens and resistance to ciprofloxacin and ceftriaxone were increased. Amikacin, piperacillin tazobactam and imipenem were useful but decreasing in sensitivity were noticed. Conclusion: Bacterial colonisation with endogenous flora was the primary source of SSIs. Good infection control practices, early identification of the pathogen and treatment with an appropriate antibiotics can reduce the development of resistant organisms and cross infection. The use of antimicrobials for prophylaxis and treatment needed to be modified according to the antimicrobial sensitivity report and local susceptibility pattern.

Living Bacterial Hydrogels for Accelerated Infected Wound Healing.

Damaged skin cannot prevent harmful bacteria from invading tissues, causing infected wounds and even serious tissue damage. Traditional treatments can not only kill pathogenic bacteria, but also suppress the growth of beneficial bacteria, thus destroying the balance of the damaged skin microbial ecosystem. Here, a living bacterial hydrogel scaffold is reported that accelerates infected wound healing through beneficial bacteria secreting antibacterial substances. Lactobacillus reuteri, a common probiotic, is encapsulated in hydrogel microspheres by emulsion polymerization and further immobilized in a hydrogel network by covalent cross‐linking of methacrylate‐modified hyaluronic acid. Owing to light‐initiated crosslinking, the hydrogel dressing can be generated in situ at the wound site. This hydrogel scaffold not only protects bacteria from immune system attack, but also prevents bacteria from escaping into the local environment, thus avoiding potential threats. Both in vitro and in vivo experiments show that it has excellent ability against harmful bacteria and anti‐inflammatory capabilities, promoting infected wound closure and new tissue regeneration. This work may open up new avenues for the application of living bacteria in the clinical management of infected wounds.

Efficacy of Cathelicidin LL-37 in an MRSA Wound Infection Mouse Model.

Background: LL-37 is the only human antimicrobial peptide that belongs to the cathelicidins. The aim of the study was to evaluate the efficacy of LL-37 in the management of MRSA-infected surgical wounds in mice. Methods: A wound on the back of adult male BALB/c mice was made and inoculated with Staphylococcus aureus. Two control groups were formed (uninfected and not treated, C0; infected and not treated, C1) and six contaminated groups were treated, respectively, with: teicoplanin, LL-37, given topically and /or systemically. Histological examination of VEGF expression and micro-vessel density, and bacterial cultures of wound tissues, were performed. Results: Histological examination of wounds in the group treated with topical and intraperitoneal LL-37 showed increased re-epithelialization, formation of the granulation tissue, collagen organization, and angiogenesis. Conclusions: Based on the mode of action, LL-37 has a potential future role in the management of infected wounds.

Role of vacuum assisted closure in the management of infected wound in orthopaedics

Background and objective: Wounds are a major source of morbidity, lead to considerable disability, and are associated with increased mortality; therefore, they have a significant impact on public health and the expenditure of healthcare resources [1]. Vacuum-assisted closure (VAC) uses negative pressure to assist wound healing. Negative pressure drains fluid from the wound, thus removing the substrate for growth of microorganisms. Negative pressure may also accelerate granulation tissue formation and promote angiogenesis. The mechanical stimulation of cells by tensile forces may also play a role by increasing cellular proliferation and protein synthesis. Negative pressure wound therapy (NPWT) involves the use of a negative pressure therapy or suction device to aspirate and remove fluids, debris, and infectious materials from the wound bed to promote the formation of granulation tissue. Materials and Methods: A total of 30 post-operative infected wound cases presented in between December 2019 to August 2021 were taken for study. Each case was examined clinically in systematic manner as per the proforma drafted. VAC dressing was done and all cases were followed up to discharge and subsequently for a follow up on 10th day. Results: In our clinical study of 30 cases managed by VAC dressing, 30% of the cases were of post-operative infected wounds of radius & ulna, 13.3% humerus, 23.3% femur, 23.3% tibia, 3.3% spine, 3.3% calcaneum, 3.3% metatarsals. By the completion of VAC therapy none of the cases required a revision surgery or implant removal. There is a progression of healthy healing in all the cases (100%). Commonest organisms isolated were Staphylococcus, Pseudomonas and Proteus. Interpretation and conclusion: In our study VAC therapy enhanced granulation tissue formation leading to better wound healing, and faster recovery. VAC is thus a promising new technology in the field of wound healing with multiple applications in a variety of wounds and can be used in both acute and chronic wounds, salvage procedures or as an adjuvant therapy to improve the results of various surgical procedures.

Chitosan-Coated PLGA Nanoparticles Loaded with Peganum harmala Alkaloids with Promising Antibacterial and Wound Healing Activities.

Wound healing is a major healthcare concern, and complicated wounds may lead to severe outcomes such as septicemia and amputations. To date, management choices are limited, which warrants the search for new potent wound healing agents. Natural products loaded in poly (lactic-co-glycolic acid) (PLGA) coated with chitosan (CS) constitute a promising antibacterial wound healing formulation. In this work, harmala alkaloid-rich fraction (HARF) loaded into PLGA nanoparticles coated with chitosan (H/CS/PLGA NPs) were designed using the emulsion-solvent evaporation method. Optimization of the formulation variables (HARF: PLGA and CS: PLGA weight ratios, sonication time) was performed using the 33 Box–Behnken design (BBD). The optimal NPs were characterized using transmission electron microscopy (TEM) and Attenuated Total Reflection Fourier-Transformed Infrared Spectroscopy (ATR-FTIR). The prepared NPs had an average particle size of 202.27 ± 2.44 nm, a PDI of 0.23 ± 0.01, a zeta potential of 9.22 ± 0.94 mV, and an entrapment efficiency of 86.77 ± 4.18%. In vitro drug release experiments showed a biphasic pattern where an initial burst of 82.50 ± 0.20% took place in the first 2 h, which increased to 87.50 ± 0.50% over 72 h. The designed optimal H/CS/PLGA NPs exerted high antibacterial activity against Staphylococcus aureus and Escherichia coli (MIC of 0.125 and 0.06 mg/mL, respectively) compared to unloaded HARF (MIC of 0.50 mg/mL). The prepared nanoparticles were found to be biocompatible when tested on human skin fibroblasts. Moreover, the wound closure percentage after 24 h of applying H/CS/PLGA NPs was found to be 94.4 ± 8.0%, compared to free HARF and blank NPs (68.20 ± 5.10 and 50.50 ± 9.40%, respectively). In conclusion, the three components of the developed nanoformulation (PLGA, chitosan, and HARF) have synergistic antibacterial and wound healing properties for the management of infected wounds.

Management of wound infection after appendectomy: are parenteral antibiotics useful?

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix.

Characterizations and Antibacterial Efficacy of Chitosan Oligomers Synthesized by Microwave-Assisted Hydrogen Peroxide Oxidative Depolymerization Method for Infectious Wound Applications.

The use of naturally occurring materials with antibacterial properties has gained a great interest in infected wound management. Despite being an abundant resource in Vietnam, chitosan and its derivatives have not yet been intensively explored for their potential in such application. Here, we utilized a local chitosan source to synthesize chitosan oligomers (OCS) using hydrogen peroxide (H2O2) oxidation under the microwave irradiation method. The effects of H2O2 concentration on the physicochemical properties of OCS were investigated through molecular weight, degree of deacetylation, and heavy metal contamination for optimization of OCS formulation. Then, the antibacterial inhibition was examined; the minimum inhibitory concentration and minimum bactericidal concentration (MIC and MBC) of OCS-based materials were determined against common skin-inhabitant pathogens. The results show that the local Vietnamese chitosan and its derivative OCS possessed high-yield purification while the molecular weight of OCS was inversely proportional and proportional to the concentration of H2O2, respectively. Further, the MIC and MBC of OCS ranged from 3.75 to less than 15 mg/mL and 7.5–15 mg/mL, respectively. Thus, OCS-based materials induce excellent antimicrobial properties and can be attractive for wound dressings and require further investigation.