Wound Culture Results Research Articles

Efficacy of combined hyperbaric oxygen therapy and topical haemoglobin spray in treating hard-to-heal sloughy wounds.

This study examined the effectiveness of a combination of hyperbaric oxygen therapy (HBOT) and topical haemoglobin spray in treating hard-to-heal, sloughy diabetic foot ulcers (DFUs). Patients with hard-to-heal DFUs at least 25% sloughy or necrotic were included in the study. We compared the results of patients who received standard of care and HBOT with topical haemoglobin spray (oxygen group) to an equal number of patients who only received standard personalised wound care (control group). The initial values of haemoglobin A1C and C-reactive protein, wound culture results and SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) scores were documented. Wounds were considered healed when completely closed within 16 weeks. The oxygen group (n=21) had a mean SINBAD score of 5.00±0.89, while the control group (n=21) had a mean score of 4.62±0.80 (p=0.155). After 16 weeks, 85.7% of wounds in the oxygen group showed complete recovery, compared with 52.4% in the control group (p=0.02). In this study, a greater number of wounds in the oxygen group healed. Combining HBOT with topical haemoglobin spray provides oxygenation to the wound for longer, primarily because patients can receive 90 minutes of HBOT daily. This ensures that patients benefit from both systemic and local oxygen. This combination therapy may effectively address the problem of hypoxia and promote healing in hard-to-heal wounds.

Choice of Empirical Treatment in Patients With Wound Infection

Objective: We aimed to determine the distribution of infectious agents in wound culture specimens, their resistance rates, and to evaluate empirical treatment choices in wound infections. Methods: Wound culture results of adult patients between 2016-2020 were retrospectively investigated. Determination of bacteria and antibiotic sensitivity tests were done using conventional methods and automatized systems. Results: A total of 2576 wound specimens were sent, and significant bacterial growth was detected in 1254 (48.7%). Most frequently isolated agent was Escherichia coli (E.coli) (24.2%), followed by Staphylococcus aureus (S.aureus) (16.8%). The highest rate of resistance in Enterobacterales species was against amoxicillin-clavulanate (AMC), except Proteus mirabilis. Antibiotics that Enterobacterales species were most sensitive were amikacin and carbapenems, while it was trimethoprim – sulfamethoxazole (TMP-SXT) for Acinetobacter baumannii, and amikacin for Pseudomonas aeruginosa. The highest rate of resistance in S.aureus strains was against penicillin, with a methicillin resistance rate of 22.9%, while no resistance was found against vancomycin. Conclusion: Initial treatment in wound infections is empirical, and the range of treatment is narrowed when results of culture and sensitivity tests are obtained. Clindamycin, AMC, TMP – SXT and ciprofloxacin seem to be appropriate for outpatients, while TMP-SXT or vancomycin for gram-positive cocci, and TMP-SXT and amikacin combination for gram – negatives, and carbapenems as a last resort.

Reliability of superficial swab culture results compared with deep wound culture results in Fournier’s gangrene: a retrospective study

ObjectivesTo compare isolates from deep wound and superficial swab cultures to evaluate the detectability of pathogens by each culture in Fournier’s gangrene; and evaluate the association between microorganisms isolated from deep wounds and those isolated from blood or urine. MethodsPatients with Fournier’s gangrene who underwent debridement between October 2006 and January 2023 were retrospectively reviewed. In addition to comparing the isolates from deep wound cultures at initial debridement with those from superficial swab, blood, and urine cultures, the relationship between the traits of the organisms from deep wounds and patient disease severity and prognosis was examined. ResultsAmong 25 patients, deep wound and superficial swab cultures were obtained from 25 and 18 patients, respectively. The frequency of anaerobic isolates was significantly lower in the superficial cultures than in the deep wound cultures (31/76 versus 13/56, p = 0.034). Bacteria not isolated from deep wounds were isolated from superficial cultures in 55.6 % of the patients; the concordance rate between deep and superficial cultures was 27.8 % (5/18). The positive rates of blood and urine cultures were 20.8 % and 35.7 %, respectively; all isolates from the urine and blood cultures reflected the results of the deep wound culture. No significant association was observed between the severity or mortality and the type of causative bacteria. ConclusionsSuperficial swab cultures cannot be substituted for deep wound cultures in Fournier’s gangrene. Although the positivity rates for blood and urine cultures were not high, they were helpful in determining antibiotic de-escalation.

Risk Factors for Surgical Site Infections and the Effects of Betadine Irrigation and Intrawound Vancomycin Powder on Infection Rates in Spine Tumor Surgery.

Background Surgical site infection (SSI) following spine tumor surgery results in delays in radiation therapy and the initiation of systemic treatment.The study aims to assess risk factors for SSI in malignancy-related spinal infections and rates of infection observed in a single center with the use of betadine irrigation (BI) and intrawound vancomycin powder (IVP). Methods Spine tumor patients managed from 11/2012 to 11/2023 were identified using a surgical database (JotLogs, Efficient Surgical Apps, Portland, Maine). Inclusion criteria were patients receiving BI and IVP and alive at 30 days post-op.Exclusion criteria were patients not receiving a combination of BI and IVP due to allergies and mortality within 30 days of surgery. Patient demographics, histology, history of pre-operative and post-operative radiation treatment history, tumor location, procedure type, number of procedures per patient, SSI, wound culture results, and mortality were collected. Results One hundred two patients undergoing 130 procedures had an SSI rate of 3.85% (5/130).There were 18.6% primary and 81.4% metastatic tumors.Demographics were average age 59.5 years old (range 7-92), 60.8% male, 39.2% female, White 88.2%, Black 9.8%, and others 2%.Pre-operative radiation therapy was significantly associated with the risk of SSI (p=0.005). Percutaneous instrumentation did not lead to a significant difference in infection rates (p=0.139).There was no significant difference in infection rates between primary and metastatic tumors (p=0.58). Multivariable regression analysis revealed pre-operative radiation (OR: 18.1; 95%CI: 1.9-172.7; p=0.009) as the statistically significant independent risk factor. Conclusions Pre-operative radiation therapy remains a risk factor for SSI. However, percutaneous instrumentation did not lead to SSI, and there was no significant difference in infection rates between primary and metastatic tumors.SSI rate was3.85%in patients who had a combination of BI and IVPin spine tumor surgery.

Comparison of single and double incision leg fasciotomy in disaster settings—Experience from 2023 Türkiye earthquakes

IntroductionAlthough there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster. MethodsPatients that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups. Results62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaraş earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups. ConclusionSingle and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.

Utility of Routine Blood Cultures for Upper Extremity Abscesses.

Patients with skin and soft tissue infections (SSTIs) are often admitted by the emergency department for intravenous antibiotic therapy and surgical drainage of abscesses if necessary. As part of the initial diagnostic workup, blood cultures are routinely drawn at our institution in patients with SSTIs. This study seeks to identify the utility of performing blood cultures in patients with upper extremity abscesses as it relates to the number of incision and drainage (I&D) procedures performed, patient readmission rates, and length of hospital stay. A retrospective chart review of 314 patients aged 18 to 89 years who underwent 1 or more I&D procedures of upper extremity abscesses were included in the study. Patient demographic data, comorbidities, laboratory values, wound and blood culture results, number of I&D procedures performed, length of stay, and readmission rates were evaluated. Increasing age and white blood count were associated with an increased number of I&Ds performed. Obtaining blood cultures, whether positive or negative, was associated with increased length of stay. There was no association between obtaining blood cultures and number of procedures performed on multivariable analysis. Positive blood cultures were associated with increased readmission rates. Routinely obtaining blood cultures in patients with upper extremity abscesses may not be beneficial. Obtaining blood cultures is not associated with an increased number of I&D procedures or readmission rates. Furthermore, obtaining blood cultures, regardless of positivity, is associated with increased lengths of hospital stay.

Characteristics of lower extremity ulcers among patients treated at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali

Lower extremity ulcers are one of the ulcers that are difficult to heal. This condition causes significant morbidity, mortality, costs, and reduces the quality of life. Epidemiological studies in Indonesia often focus on diabetic foot ulcers, so a general description of lower extremity ulcers is still lacking. This study aimed to determine the characteristics of lower extremity ulcers in outpatients at the Dermatology and Venereology Outpatient Polyclinic, Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Bali. The data were taken retrospectively from medical records from January 2018 until December 2021. A total of 15 subjects were enrolled in this study. Among the subjects, 8 (53.3%) were male and 7 (46.6%) were female. The age group of 40 yo and over dominated this study (60%). The common ulcer predilection was on the cruris (42.1%) and the wound culture results were dominated by Staphylococcus aureus (40%). Comorbidities were found in 7 subjects (46.7%) and the majority was hypertension (42.8%). Several subjects also had additional diagnoses at the time of the visit, including Morbus Hansen (60%), deep vein thrombosis (10%), cellulitis (10%), pyoderma gangrenosum (10%), and systemic lupus erythematosus (10%). In conclusion, the most characteristics of lower extremity ulcer patients at Prof. Dr. I.G.N.G Ngoerah General Hospital are males, age group > 40 yr, with cruris as a predilection, and hypertension as the most common comorbid.

Burn trauma in infants

BackgroundA wealth of data exists concerning pediatric burn epidemiology in general, but more is explicitly needed in infants under 1 year of age, a particular group in which mobility begins to develop.MethodsIn this study,206 patients followed up for burns in Diyarbakır Gazi Yaşargil Training and Research Hospital Burn Center between January 2016 and September 2021 were included in the study.ResultsOf the patients, 120 (58.3%) were male, and 86 (41.7%) were female. The mean age was 10.0 ± 2.0 months. The total number of cases ranged from 3 to 12 months, with the incidence of burns peaking at 12 months.When we look at the etiology of burns, scalding burns were the most common, with 184 (89.3%) cases. Most of the burns occurred in the kitchen because their mothers and children spent a lot of time there.It was positive in 23.8% of the wound culture results obtained with a punch biopsy. Staphylococcus aureus was the most abundant microorganism in wound culture results, with 5.8%. The mean hospital stay of the patients was 4.99 ± 3.67 days. Our mortality rate was 1.94% (n:4).ConclusionIn conclusion, As preventive measures, it is necessary to increase protective measures at home and to raise awareness of families about burn etiologies.

Burn wound bacterial profile and antibiotic sensitivity results in Turkey’s southeast region of Anatolia

Introduction: The conducted study was done to reveal the profile of bacteria isolated from wound sites of patients hospitalized in our burn center. We also aimed to find the appropriate sensitive antibiotics for use in the treatment.
 Methods: In the study, we examined 394 patients with (+) wound cultures reports from the 1,415 patients hospitalized at the Gazi Yaşargil Training and Research Hospital Burn Center between January 2010 and January 2020.
 Results: From 394 patients, 217 (55%) were male and 177 (45%) were female. The average age of patients was 12.86 ± 17.34 (min 1 - max: 94 years). In the wound culture results, bacteria were 70.55% gram-pozitive and 28.68% gram-negative Candida albicans was found in wound culture growth at a rate of 0.07%. The most common gram (+) pathogen was Staphylococcus aureus at 23.09% (n = 91). The most common gram (-) pathogens were Escherichia coli at 9.13% (n = 36) and Pseudomonas aeruginosa at 9.13% (n = 36).
 Conclusion: As a result of our study, we found that the most common causes of burn infections in our region were due to S. aureus, E. coli, and P. aeruginosa, We hope that the use of broad spectrum antibiotics can be effective against these bacteria and will contribute to clinical treatments until culture reports are available.

Türkiye’nin Güneydoğu Anadolu Bölgesinde Yanık Yarası Enfeksiyonundan Bakteri İzolasyonu ve Antibiyotik Duyarlılık Testi Sonuçları

This study was conducted to find the bacterial profile isolated from the wound areas of the patients hospitalized in our burn center, which is the only one in our region and to find the sensitive antibiotics to be used in the treatment. In this study, the culture reports of 395 patients, whose wound culture results were (+), obtained from 1415 patients hospitalized in Gazi Yaşargil Training and Research Hospital burn center between January 2010 and January 2020, were included. Of the 394 patients, 217 (55%) were male and 117 (45%) were female. The average age of the patients is 12,86±17,34 years. The average burn degree is 2,67. In the wound culture results, 70,55% of gram (+) and 28,68% of gram (-) bacteria were found. Candida albicans were found in wound culture growth results with a rate of 0,07%. The most common gram (+) pathogen is Staphylococcus aureus with 23,09% (n: 91). In our study, the resistance rate of Staphylococcus aureus to methicillin was 20,31%. The most common gram (-) pathogen was E. coli with 9,13% (n: 36) and Pseudomonas aeruginosa with 9,13% (n: 36). Gram (+) organisms were mostly isolated with a rate of 78,95% in the culture results of patients who needed intensive care clinically due to infection. Staphylococcus aureus is the most common bacteria with 21,05%. As a result of our study, it was found that the most common cause of burn infection in our region was S. aureus, P. aeruginosa, and E. coli. We hope that the use of broad-spectrum antibiotics that can be effective against these bacteria will contribute to clinical treatment until culture results are available.

Comparison of Albumin and Fresh Frozen Plasma as Colloid Therapy in Patients With Major Burns.

Burn injuries are one of the main causes of morbidity and mortality throughout the world, and burn patients have higher chances of recovery if they are treated with effective fluid and colloid management. Fresh frozen plasma (FFP) and albumin suspension used as a colloid treatment agent are very useful for the treatment of severe burns. This retrospective clinical trial was conducted at the Numune Education and Research Hospital Burn Center, Ankara, Turkey. Two hundred and nine patients who had severe burns that involved more than 30% of their total body surface area (TBSA) were studied. After the first 24 hours, 13 patients were deceased, leaving 196 patients remaining in the study, including 139 patients in the fresh frozen plasma group and 57 patients in the albumin group. Both the fresh frozen plasma and albumin groups received the standard therapy of the burn center, which was based on a standard protocol. Then, these patients were compared according to their clinical findings and mortality. There were no significant differences between the groups with respect to age, gender, and comorbidities. The laboratory findings, blood, urine, and wound culture results were also similar between groups. The mortality rate was higher in the group receiving albumin than in the group receiving fresh frozen plasma (78.9% and 33.8%, respectively; p=0.0007). According to this study, there was a significant relationship between the improvement in mortality and the mode of colloid treatment in patients with major burns.

Comparison of tandir burns and other flame burns.

Because internal temperature of tandir may reach up very high levels, tandir burns, which is one of flame burns, may cause more morbidity and mortality than those of other flame burns. Therefore, we aimed to compare tandir burns with other flame burns in the present study. In this study, we compared tandir burns with other flame burns concerning age, gender, total burn surface area, burn depth, hospitalization times, hospitalization duration, surgical procedures performed, wound culture results, burn localization and mortality. Tandir burn patients were treated in the hospital for an average of 27.6±9.5 days, while non-tandir burn patients were treated for a period of 16.5±12.5 days. A significant difference was found between the hospitalization periods of the two groups (p<0.001). Tandir burn, which is a type of flame burn, affects the women and children much more frequently than other flame burns (p=0.0001), causes deeper burns (p=0.0001), which requires more surgical intervention (p=0.0001) and causes more frequent wound site infection. We think that it would be beneficial to treat high-temperature burns, such as tandir burns, as a separate group from other flame burns. We believe that further studies to be conducted in this field will bring new approaches to the treatment of tandir burns.

Infection Rate of a Prolonged Sacral Neuromodulation Test: A Large Retrospective Study

ObjectivesIt is estimated that 3.8% to 12.5% of patients develop a device infection during the two to four weeks of the sacral neuromodulation (SNM) test, leading to removal of the entire system. It is possible to prolong the test phase up to the clinician’s decision, particularly when benefits are unclear. The aim of our study is to assess the device infection rate in a prolonged SNM test. Materials and MethodsWe retrospectively enrolled patients who performed a prolonged SNM test (at least eight weeks) in the last five years (2017–2021). All procedures were performed using a standardized technique and the same prophylactic antibiotic protocol. In case of a clinical suspicion of infection, all components were explanted. Patient information (age at implantation, medical history of diabetes, metabolic syndrome, immunologic diseases, or chronic immunosuppressive therapy), surgical data (operative time, intraoperative complications), and infection data (timing of onset, symptoms reported, wound culture results) were recorded. ResultsWe enrolled 232 patients who underwent a prolonged SNM test (mean duration 65.5 days). A local infection that led to the removal of the entire system occurred in six patients (2.6%). The gluteal pocket was always involved, and in two cases, infection was also extended to the exit point of the extension wire. No significant correlations with clinical data were found. Infection occurred beyond four weeks in two cases, between three and four weeks in three cases, and within two weeks in one case. Intraoperative wound culture was performed in five of six patients, and Staphylococcus aureus (S aureus) was isolated in four cases. One culture test gave negative bacterial growth results. ConclusionsThe infection rate of a prolonged eight-week SNM test is low and does not differ from that reported in the literature for a two-to-four–week SNM test. S aureus remains the most frequent bacterium involved.

Neutrophil/lymphocyte and platelet/lymphocyte ratios as a biomarker in postoperative wound infections

Abstract Objectives We aimed to investigate retrospectively the association between the development of surgical wound infection after orthopedic surgery, and neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) obtained from complete blood count results. Methods A total of 120 patients who underwent orthopedic surgery between 2018 and 2020 were evaluated retrospectively in our study. Wound culture results, complete blood counts, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) values, orthopedic surgery, and wound types were obtained from the laboratory data administration system. The data were statistically analyzed using SPSS 22.0 software. Results A total of 70 patients who experienced surgical wound infection (66% males and 34% females) and 50 patients without wound infection (64% males and 36% females) were included in this study. The mean age was 46.8 ± 11.4 years for the patients with infection after surgery and 50.1 ± 11.7 years for the patients without infection. Preoperative CRP, NLR, and PLR, and post-operative white blood cell (WBC), neutrophils, ESR, CRP, NLR, and PLR values were significantly higher, and lymphocyte concentrations were significantly lower in the group with infection, in comparison with those without infection. In the postoperative period, CRP and ESR were high in patients with and without infection, while NLR was increased in only those with infection. A medium-level correlation was found between NLR and PLR, and CRP and ESR. Sensitivity was 66%, and specificity was 68% with a cut-off of &gt;3.5 for NLR, while sensitivity was 42% and specificity was 71% with a cut-off of &gt;135 for PLR. Conclusions We believe that the estimation of NLR and PLR values before the intervention in patients undergoing orthopedic surgery may be advantageous for identifying infection.

Colonization of Citrobacter koseri and Streptococcus agalactiae in a case of cellulitis cruris dextra et sinistra

Background: Cellulitis is a skin infection involving the deep dermis and subcutaneous tissue, characterized by localized pain, swelling, tenderness, erythema, and warmth. The most common causes of cellulitis are group A streptococci and Staphylococcus aureus. Streptococcus agalactiae or the so-called group B Streptococcus can also cause cellulitis. This case report aims to evaluate the colonization of Citrobacter koseri and Streptococcus agalactiae in a case of cellulitis cruris dextra et sinistra. Case Presentation: A 53-year-old married woman presented to the outpatient clinic complaining of swelling and redness in her left and right legs since five days ago. At first, there was only a little redness around the calf, but it became wider and pain in that area. On examination, there were multiple erythematous macules, patches, and multiple erosional lesions, warm palpable and tender to palpation, and the diascopy test disappeared with pressure. Based on the wound culture results, isolated Citrobacter koseri and Streptococcus agalactiae bacteria were considered colonization. Both of these bacteria were less virulent. The patient was treated with systemic and topical antibiotics, analgesics, wound care management and elevated lower limbs. Conclusion: The diagnosis of cellulitis is based on history and physical examination. On examination of the wound culture of this case, Citrobacter koseri and Streptococcus agalactiae were found, considered as colonization. The patient showed clinical improvement at each observation after administration of antibiotics and wound care management. The patient's prognosis is dubious ad bonam.

The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers.

In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum-assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.

Clinical Characteristics, Wound Culture Results and Ulcer-Related Dermatological Findings in Patients with Active Venous Ulcers

Amaç: Bu çalışmanın amacı, aktif venöz ülseri olan hastalarda klinik özellikleri, yara kültürü sonuçları ve ülserle ilişkili dermatolojik bulguları belirlemekti. Materyal ve Metod: Çalışmamıza aktif venöz ülseri olan 28 hasta dahil edildi. Veriler hasta dosyalarından geriye dönük olarak analiz edildi. Bulgular: Hastaların %89,2'si erkek,% 75'i 40 yaşın üzerindeydi. Ortalama yaş 53,89 ± 14,46 idi. Hastaların %42,8'inde ilk kez ülser görülürken, diğerlerinde (%57,2) tekrarlayan ülser vardı. Ortalama ülser süresi 3,08 ± 3,35 yıldı. Ortalama ülser boyutu 6,3 x 8,4 cm2 idi. Venöz ülser hastaların %50'sinde solda, %42.8'inde sağda ve %7.2'sinde her iki ekstremitede idi. Ülser sıklıkla tekti (%89.2). Ülser en çok medial malleolün (%71,5) üzerinde yerleşmişti. Etiyolojide ikincil nedenler (%71,5) ilk sırada yer aldı. Anatomik olarak derin venöz tutulum (%78.6) en sıktı. Hastaların %64.3'ünde posttrombotik sendrom ve %35.7'sinde izole venöz yetmezlik vardı. Yara kültüründe en sık üreyen mikroorganizmalar sırasıyla pseudomonas aeruginosa (%32,1), proteus mirabilis (%28,5), escherchia coli (%28,5) ve staphylococcus aureus (%21,3) idi. Ülserle ilişkili dermatolojik bulgular; lipodermatoskleroz (%92,8), hiperpigmentasyon (%92,8), ödem (%75), ekzematöz staz dermatiti (%32,1), korona flebektatika (%28,5), likenifikasyon (%25), flebolenfödem (%17,8), selülit (%17,8), atrofi blanche (%10,8), otosensitizasyon dermatiti (%7.1) ve onikomikoz (%21,3) idi. Sonuç: Aktif venöz ülser klinik olarak kronik venöz yetmezliğin son aşamasıdır. Venöz ülser tedavisi zordur ve nüksü sıktır. Venöz ülser tedavisinde başarıya ulaşmak için multidisipliner bir yaklaşım gereklidir.

624 Implementation of a Collaborative Drug Therapy Management Protocol in an Adult Burn Clinic

IntroductionCollaborative Drug Therapy Management (CDTM) protocols allow qualified clinical pharmacists working within a defined context to independently assume responsibility for a variety of direct patient care activities. The goal of this model is to improve access to care, often in a more affordable and timely manner. Pharmacists in our burn center have historically assisted with discharge planning and transitions of care for patients being sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing Burn Clinic patients. The objective of implementing a CDTM Protocol in Burn Clinic was to streamline management of burn-related pharmacologic issues.MethodsThe CDTM protocol allows the pharmacist to assess patients’ therapeutic needs related to thermal injury, inhalation injury, or dermatologic disorder. Disease states managed include: pain, agitation, delirium, insomnia, venous thromboembolism, skin and soft tissue infections, and complications of hypermetabolic burn response.ResultsIn Burn Clinic, via in-person or telephone visits, pharmacists can independently evaluate and modify pharmacologic treatment regimens in accordance with state legislation, including initiation, renewal, and adjustment of drugs and vitamins. The pharmacist can also review, order, interpret, and conduct pertinent laboratory studies and wound culture results. In addition, the pharmacist completes medication reconciliation, performs patient education, and consults other healthcare providers, as needed. All visits, patient care, education, and treatment decisions are documented in the electronic record. “Incident-to” billing is completed at Level 99211, as this is a hospital-based clinic.ConclusionsHistorically, pharmacists were peripherally involved with Burn Clinic patients when issues arose, serving in an “as-needed” capacity. With more proactive involvement, pharmacists are uniquely positioned to help with de-prescribing, drug interactions, insurance issues, access to medications, adherence, and dose optimization. Implementing a CDTM protocol allows pharmacists to become more formally involved in post-discharge follow-up and to help manage ambulatory burn patients.

Does preoperative wound infection impact outcomes of lower extremity salvage via microvascular free flap reconstruction? A cohort study

We sought to identify preoperative wound characteristics associated with a higher risk of adverse outcomes in patients undergoing lower extremity (LE) reconstruction with microvascular free flaps. A retrospective review of patients undergoing free flap reconstruction of the LE at a single academic institution between 2010-2021 was conducted. Preoperative wound culture results were classified by Gram stain, aerobe status, multi-drug resistance (MDR), and presence of multiple bacteria. Outcomes studied included flap viability at 60, 120, and 180 days, as well as flap dehiscence, partial and full necrosis, sepsis, and amputation. A total of 218 LE free flap reconstructions were performed during the study period. 152 (69.7%) of patients were male. Rate of secondary amputation following attempted limb salvage was 4.6%. LE reconstructions utilized either fasciocutaneous (79.4%) or muscular flaps (20.6%). The type of free flap used for reconstruction had no effect on reconstructive outcomes or flap viability. Preoperative bacterial wound cultures were obtained in 102 (46.8%) patients; 80 cultures (78.4%) were positive for bacterial growth. Of these, 33 (41.2%) grew Gram-positive bacteria, 14 (17.5%) grew Gram-negative bacteria, and 33 (41.2%) grew multiple organisms. Positive preoperative wound culture was independently associated with flap failure at 120 days ( p = 0.04) when compared to wounds with no infection. Among patients with positive cultures, polymicrobial infection was significantly associated with higher rates of amputation ( p = 0.04) compared to single Gram-positive or Gram-negative infectious agents. Identification and management of positive wound cultures may play an important role in outcomes of microvascular free flap reconstruction. • Positive preoperative wound culture is associated with free flap failure at 120 days. • Positive wound culture is not associated with flap dehiscence or necrosis. • Polymicrobial infection was associated with higher rates of amputation.

Necrotizing fasciitis in the form of Fournier gangrene in a 70 year old patient

Purpose: In this case report, we describe a patient with Fournier gangrene, as well as his treatmentcourse and management.&#x0D; Case report: A 70-year-old male was hospitalized for Fournier gangrene in the perianal region. We performed radical necrectomy, drainage of perianal abscess, and transversostomy. Based on wound culture results, Amoksiklav and Ciprobay were administered. The complication of decompensated adhesive ileus occurred, which required reoperative intervention.&#x0D; Conclusion: Fournier gangrene is a rare disease that usually affects males. The disease begins withswelling, cellulitis, fever, and odor. We successfully treated this disease with emergency surgery and reoperative intervention.