Wound Culture Results Research Articles

15. Sensitivity in visualizing vegetations in cardiac lead-induced endocarditis: A comparative study between transesophageal vs. transthoracic echocardiography

Despite advancement in sterile cardiac device implantation techniques, wound infections and/or bacteremia remain a significant problem. The presence of a vegetation in lead-induced endocarditis (LIE) is a critical factor that determines the management. Transthoracic (TTE) and Transesophageal (TEE) Echocardiography are two different cardiac modalities that are used for the detection of lead vegetation. However, it is not yet clear which of the two has the highest diagnostic accuracy. We aim to identify which of the two has the highest sensitivity. In addition, we aim to correlate the existence of a vegetation with blood and wound culture results. We conducted a chart review in 113 patients whom underwent lead extraction at Prince Sultan Cardiac Center in Saudi Arabia during the period of Jan, 2002 to Jul, 2015. Six patients underwent lead extraction twice, increasing the number to be a total of 119 cases. Out of the study cohort, we include 38 patients who had both TTE and TEE done prior to lead extraction. Data regarding TTE, TEE, as well as blood and wound cultures were collected from echocardiography and microbiology lab reports using a well-structured case report form.Of the study population, 21 patients (55.3%) had lead vegetations visualized either by TTE or TEE. Nineteen patients had vegetations detected by TEE, compared to 6 patients only when TTE was used. The sensitivity of TEE and TTE were 90.5% (CI: 69.6–98.8%) and 28.5% (95% CI: 11.3–52.1%), respectively. Blood and wound culture results showed that in the presence of a vegetation, blood cultures were positive in 55% of the cases ( P =0.036) while only 44.4% of those with vegetations had a positive wound culture ( P =0.347). TEE has higher sensitivity in detecting vegetations compared to TTE in LIE. The presence of a vegetation is more likely to be associated with a positive blood culture than a positive wound culture. Further studies ought to measure the accuracy of different modalities for capturing a vegetative lead. That is, measuring the additive value of blood and wound cultures to the overall cardiac imaging sensitivity, and to calculate the sensitivity of the combined techniques.

Diabetic Foot Infection

Diabetes is a worldwide disease. Diabetic foot infection is one of the most important complications of diabetes. It may lead to gangrene and amputation of the lower extremities. Peripheral neuropathy, peripheral arterial diseases in addition to immunosuppression contribute to the development of diabetic foot infection. Diabetic foot ulcers are classified according to the size of the ulcer in addition to its depth, site and appearance. Gram-positive cocci especially Staphylococcus aureus is the predominant bacterial pathogen that infect diabetic foot ulcer. However, Gram-negative bacteria and anaerobes are involved in chronic infections. The emergence of multidrug resistant bacteria and the formation of biofilms in diabetic foot ulcers complicate their treatment. Treatment of diabetic foot ulcer depends on medical and surgical intervention. Surgical removal of necrotic and unhealthy tissues, pressure offloading, revascularization and selection of proper wound dressing are important tools in the treatment of diabetic foot ulcers. For choice of the properantibiotic therapy, some factors must be taken into consideration such as the wound culture results, the severity of infection and the predominant bacteria. Staphylococcus aureus especially methicillin resistant Staphylococcus aureus, Gram-negative bacteria in most moderate and severe infections and obligate anaerobes in gangrenous foul smelling wounds should be targeted. Some adjunctive treatments may be helpful such as hyperbaric oxygen therapy, human skin equivalent and granulocyte-colony stimulating factor. Biofilms can be targeted by inhibition of adhesion, physical debridement, electrical stimulation of matrix penetration and quorum sensing inhibition.

Wound Complications Associated With Bone Morphogenetic Protein-2 in Orthopaedic Trauma Surgery

To document the incidence of postoperative wound complications associated with the use of rhBMP-2 in a large series of patients for both acute traumatic and reconstructive extremity cases. Retrospective chart and radiographic review. Level I trauma center. A retrospective chart and x-ray review was performed on cases between 2002 and 2009, in which rhBMP-2 (Infuse) was used in acute trauma or posttraumatic reconstruction. The following data points were collected: age, surgical site, purpose (acute vs. reconstructive), associated wound factors (open fractures, soft tissue injury requiring coverage, or history of infection), signs of infection (seroma, erythema, prolonged drainage, abscess), reoperation rate secondary to wound complication, culture results, and union. These cases were then compared with a matched cohort without the use of bone morphogenetic protein-2 (matched for age, type of case, anatomic site, and open injury) for statistical analysis. Group 1 was comprised a total of 193 patients whose treatment included rhBMP-2 (155 reconstructive and 38 acute open fractures). Group 2 was comprised 181 patients treated without the use of rhBMP-2 (145 reconstructive and 36 acute open fractures). The incidences of documented wound complications were 31% (60/193) in group 1 and 18% (33/181) in group 2 (P = 0.004). Reoperation rates for wound complications were in 3.1% of group 1 and 8.3% of group 2 (P = 0.04). Age, sex, anatomic site, acute trauma, open fracture, and the need for soft tissue reconstruction did not correlate with the need to return to the operating room for presumed or actual wound infection. The rates of union between rhBMP-2 and control groups were 90% versus 74% (P < 0.001); for acute trauma cases, 94% versus 79% (P = 0.220); and for reconstructive cases, 89% versus 73% (P = 0.002). The use of rhBMP-2 in both acute traumatic and posttraumatic reconstructive extremity surgery may increase the incidence of prolonged postoperative serous wound drainage. However, this does not seem to correlate with an increased incidence of postoperative wound infection or the need for reoperation. The use of rhBMP-2 seems to have a beneficial effect in improving union rates for both acute trauma and posttraumatic reconstruction of the extremities (P = 0.002); however, this and the mechanism for prolonged serous drainage require further study before definitive recommendations can be made. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment outcomes in the management of lower extremity venous stasis ulcers

The aim of the study is to present the treatment outcomes in patients with venous stasis ulcer and summarize results with a brief review of the literature. Thirty patients with venous leg ulcers referred to a single chronic wound care unit with a minimum one year follow-up were included. Demographic features, co-morbidities, localization and characteristics of the ulcerated lesions, symptoms, arterial and venous Doppler ultrasound examination results, wound culture results, and outcomes of medical and surgical treatments were summarized. The treatment approach includes treating superficial and deep infections, obtaining tissue revascularization, compression, daily wound care, oral pentoxifylline, reconstruction of the major skin defects with split thickness skin grafts and hyperbaric oxygen therapy in refractory lesions. Mean age was 54 (32-85). Male to female ratio was 87%. Most common symptom was edema (83%). Mean size of ulcers were 20 cm² (4-45). Seven patients were hospitalized. Eighty % of patients had venous insufficiency. Most common isolated pathogen was P. aeruginosa (23%). Most common complication was osteomyelitis (5%). Hyperbaric oxygen therapy was applied to 3 patients. Split thickness grafts were used for the treatment of the skin defects in six (%20) patients. There was no recurrence of lesion in any patients at one year follow-up. Despite chronic lower extremity venous stasis ulcers are difficult to treat and related with a high risk of recurrence, it is possible to obtain good results with patient education and a systematic treatment approach.

Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study.

Background:Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution. The purpose of this study was to determine if antibiotic irrigation reduced the incidence and severity of capsular contracture compared with saline irrigation.Methods:A cohort study enrolling all patients having undergone primary augmentation mammoplasty performed by surgeon A and surgeon B between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted. The only difference in surgical technique was the use of antibiotic irrigation by surgeon B. A chi-square test and analysis of variance with predetermined 95% confidence intervals were performed.Results:Fifty-five patients were operated on. Twenty-eight of surgeon A’s patients were included, ranging in age from 22 to 50 with a mean follow-up time of 1.8 years. Twenty-seven of surgeon B’s patients were included, ranging in age from 22 to 56 with a mean follow-up time of 1.6 years. Rate of capsular contracture was 3.6% (surgeon A) and 3.7% (surgeon B). Chi-square statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39).Conclusions:Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.

Antibiotic-loaded polymethylmethacrylate beads for the treatment of extracavitary vascular surgical site infections

This study assessed the efficacy of antibiotic-loaded polymethylmethacrylate (PMMA) beads in the treatment of lower extremity vascular surgical site infections (VSSIs). This was a retrospective review of all patients with a VSSI of a lower extremity bypass treated with antibiotic-loaded PMMA beads and culture-specific antibiotics during a 4.5-year period. Data collected included patient demographics, comorbidities, site of initial graft infection, symptoms and signs at presentation, initial and additional surgical debridement, wound culture results, type of antibiotic beads implanted, and graft treatment strategy, comprising conduit preservation or in situ replacement, with associated soft tissue management by muscle flap or vacuum-assisted closure. Primary outcome measures included death, recurrent infection, and limb salvage. Forty patients developed 42 extracavitary lower extremity VSSIs (bilateral groin infections in two). Patients were treated according to our treatment algorithm with antibiotic-impregnated PMMA beads. Previous reconstructions included nine aortofemoral bypasses (groin infection only), 20 infrainguinal bypasses, five extra-anatomic bypasses, five femoral interpositions, two combined inflow-outflow bypass procedures, and one patch angioplasty with VSSI. Cultures isolated 59 pathogens (39 gram-positive, 18 gram-negative, 2 Candida spp). Methicillin-resistant Staphylococcus aureus was cultured from 10 VSSs (23.8%) overall and from 27.7% of those patients with attempted graft preservation or in situ reconstructions. Two patients (4.8%) had no growth despite clinical signs of infection. Repeat VSS exploration and culture results led to an average of 1.4 bead replacements before definitive treatment. Final treatment strategy included graft preservation of patent bypasses in 28, partial graft excision with in situ replacement in eight, graft removal only with residual graft remaining at implant site (ie, incorporated anastomotic conduit, 11.9%) in five, and extra-anatomic reconstruction in one. Sartorius muscle flap was performed in 14 groin infections (37.8%). The 30-day mortality was 0%, and limb loss was 7.1% (n = 3). At the median follow-up of 17 months, the limb loss was 21.4% and the recurrent infection rate was 19.4% (seven of 36) in those with attempted graft preservation or in situ replacement. Antibiotic-loaded PMMA beads may serve as an adjunct in the management of VSSIs and may also expand treatment options for graft preservation or in situ reconstruction, with expected recurrent infection rate approaching 20%. Further experience with this adjunct may help elucidate its role in the management of this complicated problem, including the need for bead exchanges, until perigraft cultures are free of microbes.

Pediatric abscess characteristics associated with hospital admission from the ED

Objective To determine the characteristics of pediatric soft tissue abscesses that result in hospital admission. Methods All visits for soft tissue abscesses to the study emergency department (ED) were examined during 2008. Detailed records were reviewed to determine ED disposition, abscess size, location, presence of fever, duration of symptoms, previous antibiotic therapy, prior ED visit(s), and wound and blood culture results. Data were analyzed to determine which of these characteristics were associated with hospital admission from the ED. Results Six hundred twenty-two patients met the inclusion criteria. One hundred thirteen (18%) patients were admitted to the hospital and 509 (82%) were discharged home. Compared to those sent home, abscesses resulting in admission were more likely to be located in the genital area (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.37-6.90), breast (OR, 4.8; 95% CI, 1.08-21.4), or face (OR, 4.39; 95% CI, 1.86-10.3), and were more likely to be larger than 3 cm (OR, 3.66, 95% CI, 2.10-6.36). Patients who were admitted to the hospital were also more likely to have fever (OR, 5.93; 95% CI, 3.4-10.3) and have had a prior ED visit with the same complaint (OR, 3.81; 95% CI, 1.77-8.2). Seventy-seven percent of abscesses that were cultured were positive for methicillin-resistant Staphylococcus aureus. Conclusions Size and location (especially those in the genital region, breast, and face), appear to be associated with admission for pediatric abscesses. History of fever and previous ED visit also appear to be associated with hospital admission. Obtaining blood cultures for pediatric abscesses is likely of little clinical benefit.

Case Report: Use of a nanocrystalline silver dressing and vacuum‐assisted closure in a severely burned dog

AbstractObjective – To describe the first veterinary use of a nanocrystalline silver dressing (NSD) and use of vacuum‐assisted closure (VAC) to treat a severely burned dog.Case or Series Summary – A 1‐year‐old female intact American Staffordshire Terrier with 50% total body surface area burned was referred for definitive care approximately 18–24 hours post injury. The dog was treated with crystalloid fluids, hydroxyethyl starch, and antimicrobials based on culture and sensitivity results of wound cultures, fresh frozen plasma, human serum albumin, and packed red cells. Wound care initially consisted of daily debridement under anesthesia with silver sulfadiazine application and bandaging. Because of the extent and the location of the wounds and morbid state of the patient, early wound grafting was not an option. Because of its reported improvement in granulation tissue formation and decreased tissue edema, VAC was used once the majority of burned tissue was manually debrided. Because of the pain caused by VAC and traditional bandaging techniques with this extent of injury, an NSD was utilized. This strategy was chosen due to the antimicrobial properties of NSD and the reduced necessity for daily bandage changes, which was reduced to only every 3 days. This protocol reduced the need for daily sedation or anesthesia.New or Unique Information Provided – VAC and NSD were used successfully for the treatment of a severe burn injury in a dog. The use of NSD decreased the cost of therapy by reducing the need for daily bandage changes, thereby reducing the anesthetic and analgesic costs and allowing the patient to be managed on an outpatient basis.

Use of Diagnosis Codes and/or Wound Culture Results for Surveillance of Surgical Site Infection after Mastectomy and Breast Reconstruction

We compared surveillance of surgical site infection (SSI) after major breast surgery by using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and microbiology-based surveillance. The sensitivity of the coding algorithm for identification of SSI was 87.5%, and the sensitivity of wound culture for identification of SSI was 78.1%. Our results suggest that SSI surveillance can be reliably performed using claims data.

Surgical site infection rate is lower in laparoscopic than open colorectal surgery

Few studies have investigated whether surgical site infection (SSI) incidence differs between laparoscopic colorectal surgery (LCS) and open colorectal surgery (OCS). This study investigated the SSI incidence using the validated UK SSI Surveillance Service (SSISS) criteria for diagnosing wound infections. Prospective data collection recorded patients' demographics, operative details, antibiotic use, wound evaluation and microbiological wound culture results, for consecutive patients undergoing elective resectional LCS and OCS. Postdischarge surveillance consisted of patient questionnaires sent out at 30 days and the primary care communication. A total of 122 patients underwent colorectal resections over 1 year (LCS 43; OCS 79). Patients' demographics and operative case-mix were similar for both groups, including body mass index (BMI), diabetic and smoking status. Operative duration was longer in the LCS group compared with OCS group (P = 0.012, Mann-Whitney U-test), but hospital stay was shorter for LCS (P = 0.0001, Mann-Whitney U-test). The SSI rate was significantly lower in the LCS than OCS group (7%vs 25% respectively; P = 0.015, two-tailed Fisher's exact test). BMI > 30 and operation length > 4 h influenced the risk of SSI formation (P < 0.05, chi-squared test). One LCS patient required conversion to a limited laparotomy. Surgical site infection incidence is significantly lower following LCS when compared with OCS. Confounding factors in this study include patient selection for LCS and nonrandomization.

The Impact of Laser Doppler Imaging on Time to Grafting Decisions in Pediatric Burns

Early definitive treatment of burns facilitates optimal results by reducing the risk of subsequent hypertrophic scarring. Laser Doppler imaging (LDI) has been shown to assist in predicting burn wound healing potential. This study sought to determine whether use of LDI in pediatric burn patients has led to earlier decision making for grafting. The study cohort were patients who underwent a skin grafting procedure for a burn wound at a single institution, a state referral center for all major pediatric burns, between June 2006 and December 2007. Patients were divided into two groups: those who underwent LDI scanning and those who were only assessed clinically. Time of burn injury to time of decision making for the grafting procedure was calculated in days. Forty-nine percent of 196 patients underwent LDI. The mean time from the date of injury to decision making for graft procedure was 8.9 days in those patients who had an LDI scan vs 11.6 days in the group assessed by clinical observation alone. This trend for earlier decision for grafting procedure in the LDI group was statistically significant (P = .01). There was no significant difference between those patients who were scanned and those only assessed clinically in relation to gender, age, mechanism of injury, percentage BSA burnt, and wound culture results. There was a significant reduction in time to grafting decision in the LDI group. This would potentially lead to reduced length of stay, reduced number of hospital visits, and streamlined care for the patient and their family.

WOUND COMPLICATIONS ASSOCIATED WITH THE USE OF BOVINE SERUM ALBUMIN-GLUTARALDEHYDE SURGICAL ADHESIVE IN PEDIATRIC PATIENTS

The use of dural sealants has become common in neurosurgery. Ten patients in whom a bovine albumin-glutaraldehyde combination (BioGlue; Cryolife, Inc., Kennesaw, GA) was implanted have had wound complications. The clinical experience of these patients is presented along with recommendations regarding the use of BioGlue. All clinical information was reviewed for the patients who had wound complications after implantation of BioGlue. Data collected included diagnosis, type of original surgery, clinical presentation of the wound complication, culture results, and management. BioGlue was implanted in 75 patients during 77 procedures. Ten patients (13%) had wound complications. There were six boys and four girls with an average age of 5.2 years (range, 11 mo-16 yr). Three had undergone spinal procedures for detethering of the spinal cord and seven underwent craniotomies (five infratentorial, two supratentorial). Six patients presented with purulent drainage, two had periorbital cellulites, and two had swelling and fluctuance without drainage. All patients were managed operatively by washout, debridement, and removal of the BioGlue followed by a course of intravenous antibiotics. The average interval between the implantation and the debridement was 12.5 weeks (range, 2.5-28 wk). All patients had purulence around the BioGlue. Positive cultures were obtained in seven patients (Staphylococcus species in six and Streptococcus pneumoniae in one), including five who presented with wound drainage. We have found a strong association between the use of BioGlue and postoperative wound complications in our pediatric neurosurgical practice and, thus, discourage its future use. BioGlue triggers an intense acute pyogenic and chronic granulomatous inflammatory response, which is an ideal environment for bacterial growth. The bacteria may arise from the BioGlue or other foreign bodies or, more likely, from the skin if the inflammation breaches the skin surface.

Silicone Allergy

We introduce silicone allergy as a rare cause for cochlear implant extrusion and discuss its management. Retrospective case series and literature review. Tertiary referral centers. Primary eligibility criteria included patients who experienced a delayed extrusion of their cochlear implants with negative wound cultures and had a suspected or a test-proven allergy to silicone components of an implant. Silicone allergy testing, explantation of a cochlear implant containing allergenic silicone materials, reimplantation with a custom-made cochlear implant excluding an allergenic silicone component. Uneventful wound healing and extrusion-free long-term follow-up after the reimplantation with a custom-made cochlear implant excluding an allergenic silicone component. Three known cases of cochlear implant extrusion as a result of silicone allergy have been noted from 1991 through 2004 in three cochlear implant programs in the United States. All three devices extruded, resulting in explantation of the old device and reimplantation with a new custom-made device eliminating the allergenic silicone component. Wound cultures were negative in all cases. All three patients experienced a delayed extrusion of their devices. Two of these patients had a test-proven allergy to the implant's silicone components, whereas the third patient was presumed to have a hypersensitivity solely on the basis of a clinical presentation. We propose that silicone allergy is a rare cause of cochlear implant extrusion. Patients experiencing cochlear implant extrusion, particularly with a delayed onset and negative wound culture results, should be tested for silicone allergy.

Surgical management of sternoclavicular joint infections

Objective: Sternoclavicular joint infections are rare, and their management is controversial. We reviewed our experience with the surgical management of this condition. Methods: From August 1988 to August 2001, 26 patients (16 men and 10 women) were treated surgically for infected sternoclavicular joints. The median age was 56 years (range, 20-77 years). Patients who had a recent previous median sternotomy were excluded. Results: All patients were symptomatic. Pain was present in 21 patients, swelling in 14 patients, fever in 11 patients, and erythema in 9 patients. Associated conditions included recent or ongoing infections in other areas in 12 patients (pneumonia in 4 patients, multiple joint infections in 2 patients, and other in 6 patients) and an indwelling central venous catheter in 1 patient. Five patients had a history of trauma in the region of the joint. Four patients had prior joint incision and drainage. Unilateral sternoclavicular joint resection was done in 18 patients, bilateral resection in 2 patients, and incision and drainage with debridement in 6 patients. Wound culture results were positive in 24 patients, and the most common organism isolated was Staphylococcus aureus (n = 17). Eleven patients had transposition of the ipsilateral pectoralis major muscle to obliterate residual space and to reconstruct the chest wall. Two (7.7%) patients had complications, and 1 died (operative mortality, 3.8%). Follow-up was complete in all 25 operative survivors and ranged from 2 months to 10 years (median, 25 months). Twenty-one patients are alive without symptoms, infection, or limitations in range of motion. Four patients have died as a result of causes unrelated to their joint infections. Conclusions: Symptomatic sternoclavicular joint infections often require surgical intervention. Surgical resection combined with muscle transposition provides effective long-term outcome.J Thorac Cardiovasc Surg 2003;125:945-9

Impact of increasing antimicrobial resistance on wound management.

Wound infection with antimicrobial-resistant bacteria may result in prolonged debility of the patient and increased healthcare costs. Avoidance of the development of resistance therefore needs increasing attention in the management of patients with wound infections. Antimicrobial use is the major determinant in the development of resistance. Knowledge of the criteria for wound infections, the causative pathogens, and their prevailing susceptibility patterns is a prerequisite for the rational prescribing of antimicrobials. Since the benefits of wound debridement and wound irrigation have been proven, prescribing antibacterials should not usually be the initial treatment strategy in the management of infected wounds. The use of systemic antibacterials is only indicated when infection appears to be spreading through the subcutaneous soft tissues and in cases of ascending limb infection or severe sepsis. To minimize the selection pressure of individual antibacterials on the normal flora of the skin and gut, narrow-spectrum agents are to be preferred. Empirical treatment with systemic antibacterials should be adapted, based on the results of wound cultures. Topical antibacterials have also been successfully used in the management of patients with infected wounds. Defining guidelines for the rational use of systemic and topical antimicrobials is an important tool to limit and control the development of resistance. Because of geographical differences in resistance rates and methodological differences in published reports, local surveillance data should be available to assist clinicians in the development of these guidelines. New systemic and topical agents should be assessed at an early stage of development for their potential for selection of resistance. Research is needed on the applicability of alternatives to antimicrobials in the management of patients with wound infections in order to reduce the future risk of antimicrobial resistance.

A cost-benefit analysis of initial burn cultures in the management of acute burns.

It is common practice to obtain cultures in the first 24 hours after burn injuries. However, little evidence exists that these tests change clinical practice or clinical outcome. We conducted a retrospective chart review to determine how often the results of wound and other cultures lead to changes in the clinical treatment of patients. A total of 598 charts were reviewed. Four hundred forty-seven patients had a length of stay in the hospital of 1 day or less and were primarily treated in the emergency department and then discharged from the hospital. Wound cultures were obtained for 42 (10%) of these patients. Thirty cultures (71%) had no significant growth. Twelve cultures (29%) grew mixed common skin flora. No patients in this group were "pan-cultured." No patients in this group required antibiotic treatment on the basis of culture results. A total of 151 patients were admitted to the burn center, with an average length of stay of 3.9 days (range, 2-125 days). In this group, 45 patients (30%) had wound cultures and 24 patients (16%) were pan-cultured in the first 24 hours after admission to the hospital. Enterococcus species grew in the initial wound culture of 1 patient, and the patient was treated with antibiotics. Antibiotics were not ordered for any other patients on the basis of cultures. The collection of routine cultures during the first 24 hours after admission to the hospital is not cost-effective and rarely alters or provides therapeutic direction. An estimated $14,000 per year decrease in charges could be achieved by the elimination of cultures taken during the first 24 hours of admission to the hospital.

Salvage therapy of open, infected surgical wounds: a retrospective review using Techni-Care.

To determine outcome of infected surgical wounds treated with 3% para-chloro-meta-xylenol + 3% phospholipid PTC [PCMX-PL] (Techni-Care). Retrospective review of patient records. University hospital. Thirty consecutively treated patients (sixteen male, fourteen female) who had developed open infected wounds (twenty-one abdominal [seventy percent], nine extremity [thirty percent]). Mean patient age was 50.1 years. All wounds were treated with commonly practiced wound care techniques (e.g., debridement, frequent dressing changes using saline or topical antibiotics, and, in most cases, parenteral antibiotics) for an extended period of time prior to intervention (mean = 35 days). PCMX-PL, a topical microbicide, was used as adjunctive therapy. Eight outcome parameters were analyzed: (1) patient morbidity and mortality; (2) wound healing; (3) number of debridements; (4) wound culture results; (5) leukocytosis (peripheral white blood cell count > 10,000 cells/microl); (6) number of febrile days (temperature > 101 degrees F); (7) length of hospital stay; and (8) number of days of intensive care. No treatment failures or adverse reactions to PCMX-PL were seen. Twenty (sixty-seven percent) wounds were healed or had been successfully closed while ten (thirty-three percent) were granulating well at sixty-day follow-up. The number of debridements, positive wound cultures, white-blood-cells, and febrile days decreased after PCMX-PL treatment began. Despite severe underlying diseases, all patients were discharged from the hospital with closed or healing wounds. We recommend treatment with PCMX-PL as an adjunctive therapy for infected wounds particularly when standard care measures have failed.

Necrotizing Fasciitis After Cesarean Delivery

In Brief Objective To review our experience with the diagnosis and management of necrotizing fasciitis after cesarean delivery. Methods We reviewed medical records of women with serious post-cesarean wound infections at the University of Alabama at Birmingham between 1987 and 1994 to identify women with necrotizing fasciitis. The diagnosis of necrotizing fasciitis required intraoperative identification of necrotic fascia in febrile women undergoing post-cesarean wound debridement. Results During the study period, 5048 women had cesarean deliveries, nine of which were complicated by necrotizing fasciitis. The mean (± standard deviation) maternal age was 27 ± 6 years, and the mean maternal weight was 199 ± 64 Ib. None of the patients had insulin-dependent diabetes mellitus, and none had known peripheral vascular disease. There were no intraoperative complications at cesarean delivery. The mean time from cesarean delivery to the diagnosis of necrotizing fasciitis and reoperation was 10 ± 4 days (range 5–17). All patients had surgical debridement upon consideration of the diagnosis, and all received broad-spectrum antimicrobial therapy. Results of wound cultures were available in seven of the women, and all seven were found to have polymicrobial infections. There were two mortalities, one as a result of metastatic breast cancer and another with complications of sepsis. Conclusion Necrotizing fasciitis is infrequent (1.8 per 1000 women) after cesarean delivery at our institution, but it does result in appreciable morbidity and mortality. Necrotizing fascitis following cesarean delivery is uncommon but is associated with major morbidity and mortality.

Necrotizing fasciitis after cesarean delivery

To review our experience with the diagnosis and management of necrotizing fasciitis after cesarean delivery. We reviewed medical records of women with serious post-cesarean wound infections at the University of Alabama at Birmingham between 1987 and 1994 to identify women with necrotizing fasciitis. The diagnosis of necrotizing fasciitis required intraoperative identification of necrotic fascia in febrile women undergoing post-cesarean wound debridement. During the study period, 5048 women had cesarean deliveries, nine of which were complicated by necrotizing fasciitis. The mean (+/-standard deviation) maternal age was 27 +/- 6 years, and the mean maternal weight was 199 +/- 64 lb. None of the patients had insulin-dependent diabetes mellitus, and none had known peripheral vascular disease. There were no intraoperative complications at cesarean delivery. The mean time from cesarean delivery to the diagnosis of necrotizing fasciitis and reoperation was 10 +/- 4 days (range 5-17). All patients had surgical debridement upon consideration of the diagnosis, and all received broad-spectrum antimicrobial therapy. Results of wound cultures were available in seven of the women, and all seven were found to have polymicrobial infections. There were two mortalities, one as a result of metastatic breast cancer and another with complications of sepsis. Necrotizing fasciitis is infrequent (1.8 per 1000 women) after cesarean delivery at our institution, but it does result in appreciable morbidity and mortality.