Wound Swab Culture Research Articles

Distribution and Antibiotic Sensitivity of Burn Wound Colonization in Referred Patients at the Burn Care Centre, PIMS, Islamabad, Pakistan

ABSTRACT Background: Burn injuries represent a significant health challenge worldwide due to their high mortality and disability rates. These wounds often become prone to infection due to compromised immunity and disrupted blood vessels at the injury site. Timely surgical excision, coupled with topical chemotherapy, has notably reduced mortality rates in burn patients. Objective: The objective of this study was to determine the prevalence of common bacterial infections among referred patients, with a minimum delay of one week, and to assess their bacteriological susceptibility at the Burn Care Centre, PIMS, Islamabad. Methods: This retrospective descriptive study was conducted between March 2021 and February 2023. We reviewed wound swab culture results spanning 24 months, primarily from referred patients. Wound specimens were collected using sterile swabs and standard techniques from registered patients, then analyzed at the microbiological laboratory based on patients' culture reports. Results: A total of 226 culture reports were assessed, comprising 95 (42.04%) male patients and 131 (57.96%) female patients, with a mean age of 21 years (range: 11 months to 65 years). Among these reports, 16 (7.08%) showed no growth. Pseudomonas aeruginosa was identified in 88 patients (38.93%), while Staphylococcus aureus (MRSA) was present in 57 (25.22%), Klebsiella pneumoniae in 36 (15.93%), and a combination of Klebsiella and Pseudomonas in 18 (7.96%) cases, as per the swab culture reports. Escherichia coli was detected in 3 (1.33%) cases and Enterobacter in 2 (0.88%) cases. Other bacteria were found in 6 (2.65%) swab culture reports. Pseudomonas and Klebsiella exhibited maximum susceptibility to Polymyxin B, at 67.04% and 61.11%, respectively, while MRSA showed the highest susceptibility to linezolid, at 89.47%. Conclusion: Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae were the most prevalent bacteria among patients referred to our Burn Care Center. Referred burn patients were found to be colonized with multi-drug resistant bacteria, compared to inpatient cases at our center.

Microbial profile of burn wound injuries in the Northern West Bank − A retrospective cohort study

BackgroundDetermining frequently colonizing microorganisms and typical demographics affected by burns in the West Bank is essential to aid timely and effective injury management. MethodsThis study included n = 435 patients with burn injuries between January 2018-December 2021 at a tertiary center in Nablus. Eligible medical records were reviewed, and relevant data extracted. Resultsn = 244 males and n = 191 females, average age 14.5 years were included. n = 227 had wound swab cultures, n = 80 which were positive. Scald injuries were the most common mechanism of injury (n = 314, n = 162 in males (p < 0.001), average age of 10.5 years). The most common organisms isolated were Pseudomonas aeruginosa (n = 17) and Staphylococcus aureus (n = 18). n = 17 multidrug resistant (MDR) organisms were cultured, MRSA most commonly (n = 9), followed by K. pneumoniae (ESBL) (n = 5). Overall length of stay (LOS) was 17.27 days in all patients and 28.2 days in those with MDR, with increasing LOS significantly associated with positive culture and MDR development of MDR (p < 0.001). ConclusionsYounger male demographics and longer hospital admission increase the risk of burn wound colonization and MDR development in the Northern West Bank. Pseudomonas aeruginosa and Staphylococcus aureus were prevalent organisms isolated. MDR development represents a significant challenge in the effective management of injuries in an immunologically vulnerable cohort.

The Bacterial Species Behind the Wound and Their Antibacterial Resistant Pattern: A Three-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana.

Wound infections are often underestimated issues that can lead to chronic illnesses, and since the introduction of antibiotics, wound complications have become less common. However, due to the increased and irrational use of these antibiotics, the resistance in the bacterial isolates has become very common. This has led to reduced treatment options, delay in wound healing, and high treatment costs. This study aimed to investigate bacterial wound infections and their antibiotic resistance at St. Dominic Hospital, Ghana. A total of 517 records of wound swab culture and susceptibility testing, and patient demographics from 2020 to 2022 were collected from the microbiology unit of St. Dominic Hospital in the Eastern Region of Ghana. The data were entered into Microsoft Excel 2019, cleaned, and exported into IBM SPSS v26 for the statistical analysis. p < 0.05 was considered statistically significant for all analyses. The overall prevalence of bacteriological agents causing wound infection in individuals who visited the St. Dominic Hospital from 2020 to 2022 was 70.21% (363/517), with S. aureus 79/363 (21.76%) being the most abundant isolate. Out of the 79 S. aureus isolated, 40 (50.63%) and 39 (49.37%) were resistant to ampicillin and cephalexin, respectively. More than 50% of the predominant Gram-negative isolate, K. pneumoniae, were resistant to clindamycin 45/72 (62.50%) but susceptible to levofloxacin 70/72 (97.22%), cefotetan 69/72 (95.83%), and chloramphenicol 67/72 (93.06%). Antibacterial susceptibility patterns revealed significant resistance trends, particularly among Gram-negative isolates, emphasizing the urgent need for prudent antibiotic use and ongoing surveillance to combat resistance.

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.

Clinico Microbiological Study of Infection In Burn Patients at BPKIHS Teaching Hospital

Background: Each year around 2,00,000 peoples globally are injured by burn and 1,00,000 of these seek medical attention out of which 10,000 lose their lives. prevention is better in burns. The exact data about burns patient in Nepal is not known. Methods: Prospective observational study carried out at surgical ward of BPKIHS Teaching Hospital between 15 May 2001 to 14 May, 2002 i.e. one year altogether. Results: There were total 95 cases of burn patients admitted and managed by BPKIHS Teaching Hospital during that periods. Males were 40% (38) and Females were 60% (57). Accidental burns injury was 90.55% (86) and flame burns were 83% (79). Mixed infection in 36%, Acinobacter in 32% and pseudomonas in 14.4% found in wound swab cultures. Ofloxacin was found sensitive in 91.6%. 27% (26) patients expired in our study. Conclusion: Mortality is high in our study because of Major burn patients came late in our Teaching Hospital for treatment.

An exception-reporting approach for wound swab culture: effect on post-report antibiotic initiation.

Wound swab culture is a high-volume test performed in clinical microbiology laboratories. In this analysis, we have shown that an alternative approach to reporting positive wound swab cultures has resulted in a large reduction in post-report antibiotic initiation, suggesting that the current standard method of reporting generates considerable unnecessary antibiotic use. If these findings are replicated elsewhere, wider adoption of this reporting would represent an opportunity for many clinical microbiology laboratories to have a significant impact on community antimicrobial stewardship.

Driveline Infection in Patients With Left Ventricular Assist Devices Implanted as Destination Therapy

Donor organ shortages cause increasing demand for mechanical circulatory support in patients with end-stage heart failure not only as a bridge to heart transplantation but mainly as a destination therapy. Improved results and increased applicability and durability of left ventricular assist devices (LVADs) have established this treatment option as an alternative to heart transplantation in selected patients. One of the most common complications after LVAD implantation is driveline infections (DLIs). This study aimed to expand the understanding of DLI epidemiology and potential changes in implantation techniques regarding optimizing DLI prevention and treatment among all patients undergoing LVAD (Medtronic's Heartware HVAD and HeartMate 3 Abbott LVAD system) implantation with at least 12 months of follow-up time between 2015 and 2022. There were 120 individuals with LVAD implantation, of whom 90 had 12 months of follow-up (85 men [94%], 5 women [6%]) with a median age of 58 years (50.25-63.75). The median body mass index was 27.12 kg/m2 (25.27-29.68). Of the 90 patients, 43 had ischemic heart failure (48%), 43 had dilated cardiomyopathy (48%), and the remaining 3 had other etiologies (3%), such as postinflammatory, and the remaining 1 had congenital heart defect (1%). Preoperative echocardiography revealed a mean left ventricle ejection fraction of 13.8% and a median left ventricle dimension of 7.55 cm (6.92-8.2). Imaging confirmed pulmonary hypertension in 61 patients (68%). Thirty-four of the 90 patients had diabetes (38%), and 16 were active smokers (18%). Median follow-up was 30 months (17.25-42), with the longest period being 82 months. More than half of the patients (n = 52; 57%) experienced a DLI. The median time to the first episode of DLI was 13 months (6-25). The most common pathogen revealed in wound swab culture was methicillin-sensitive Staphylococcus aureus (n = 23; 44%), Pseudomonas aeruginosa (n = 9; 17%), Proteus mirabilis (n = 4; 7%), and others. We observed that deeper driveline implantation below the left rectus muscle and just above the posterior rectus sheath resulted in fewer DLIs and longer free-from-DLI follow-up time. There was no statistically significant difference in DLI frequency between patients with or without diabetes mellitus. Appropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of destination therapy. DLI is the most common complication after LVAD implantation. Optimal surgical techniques and early implementation of targeted antibiotics are crucial. Significant challenges remain in optimizing DLI prevention and treatment.

Effectiveness of APG and Honey Gauze in Pressure Injury of Elderly: A Randomized Control Trial.

This study was designed to evaluate the efficiency of the combination of autologous platelet-rich plasma gel (APG) and Manuka honey gauze in the treatment of Stages 3-4 pressure injury of older adults. Patients were divided into four groups: Manuka honey gauze and APG (M + A), Manuka honey gauze (M), APG (A), and a control group (C). Different treatments were given, then wound bed coverage with granulation tissue, wound size reduction, and Pressure Ulcer Scale for Healing (PUSH) score were examined. Paraffin-embedded sections of wound tissues were analyzed and wound swab cultures were assessed. Kruskal-Wallis test and Mann-Whitney U test were performed in statistical analysis at a 5% significance level. A total of 42 patients were accepted. Significant increase of wound bed coverage with granulation tissue (51.24%, P = .004, Kruskal-Wallis test) and decrease of PUSH score (-5) were observed in the M + A group at the end of the observation (P = .032, Mann-Whitney U test). The hematoxylin-eosin staining of wound tissues showed that typical squamous epithelium was seen in wound bed of patient in M + A group. Manuka honey gauze and APG were proved to be superior treatments for pressure injury of old patient. Increase of granulation tissue coverage, reduction of PUSH score, and improved growth of epithelium were observed in M + A group. There was no side-effect, and the treatment would not cause infection.

Q-Scoring System for the Evaluation of the Superficial Wound Swab Samples: A Clinical Microbiological Aspect.

Wound swab cultures are frequently requested from patients suspected of having a wound infection. The quality of the sample should also be evaluated by performing a Gram-stained microscopic examination. "Q-scoring system" is not widely used and the literature on the subject is limited. A total of 4648 wound swab samples were evaluated. Samples with a Q-score of "0" were considered as "poor quality samples", and those with a score of " ≥ 1" were classified as "good quality samples". Microorganisms grown in the culture of samples that scored above one were identified by mass spectrometry, and antimicrobial susceptibility testing was performed. Gram stain results were found to be consistent with the culture result in 57.10% (n = 1078) of and inconsistent with the culture result in 42.90% (n = 813) of the samples. The number of samples with Q-scores one, two, and three among the 813 samples was 62, 29, and 722, respectively. The value observed in Q3 was found to be statistically significantly higher than the values observed in Q1 and Q2 (p < 0.05). Samples sent from surgical departments (61.92%) with a Q-score of ≥ 1, were statistically significant compared to internal medicine departments (p < 0.0001). There was no significant difference between samples sent from intensive care units and those sent from other inpatient services. For both groups with Q-scores ≥ 1 and "0" similar microorganisms were identified. As a conclusion, the Q-scoring system will provide a common language between the laboratory and the clinic, especially by standardizing the evaluation of wound swab samples.

Clinical and microbiological evaluation in patients with Fournier’s gangrene

Introduction: Necrotising fasciitis (Fournier’s gangrene) is a bacterial inflammation of the subcutaneous tissues and skin, involving the urogenital area. The treatment is complex, with a high risk of systemic infection. A key aspect of treatment is antibiotic therapy. Materials and methods: The analysis involved 30 hospitalised patients with Fournier’s gangrene. An attempt was made to determine the relationship between laboratory parameters, types of pathogens, patterns of antibiotic susceptibility/resistance, and treatment outcomes. Results: The average value of Fournier’s Gangrene Severity Index (FGSI) was 4.37 ± 2.87. In the study group, a total of 18 (60%) patients had an infection caused by a single bacterial strain, while 12 (40%) had infections caused by multiple strains. The most commonly identified bacteria was Escherichia coli (53.33%) – 50% of monocultural infections and 58.33% of polyculture infections. The majority of bacteria were sensitive to piperacillin–tazobactam – 22 (73.33%) patients, clindamycin – 20 (66.66%) patients, and metronidazole – 18 (60%) patients. The highest percentage of antibiotic resistance was observed for cefuroxime – 19 (63.33%) patients, ciprofloxacin – 19 (63.33%) patients, and ceftriaxone – 17 (56.66%) patients. The average hospitalisation length was 30.03 ± 23.01 days. The overall mortality rate was 13.33% (n = 4). No correlation was found between the type of pathogen, hospitalisation length or mortality. No differences were observed in the results of laboratory parameters, FGSI, or length of hospitalisation in the analysed subgroups. Conclusions: Effective treatment of Fournier’s gangrene requires performing a wound swab culture as quickly as possible and implementing a targeted antibiotic therapy. There is no single laboratory parameter that can predict treatment outcomes and patient prognosis. There are no differences in the clinical course and prognosis between multibacterial and monobacterial infections.

Substantiation of tactics of chronic wound bed preparation at various stages of the infectious process on the basis of the analysis of the results of microbiological, clinical and morphological parameters

The chronic wounds (CW) bed preparation requires an integrated approach using wound assessment, microbiological and histological analysis, which will avoid skin graft failure.The aim was to evaluate the possibility of using microbiological and morphological parameters of CW assessment to substantiate the choice of tactics of wound bed preparation to skin grafting (SG).Morphological and microbiological indicators of CW (n = 229) at various stages of the infectious process were analyzed. To prepare CW to SG, the following treatment methods were used: dressings, vacuum therapy (VT), mechanical debridement (MD), and ultrasound debridement (UD).The criteria that determine the possibility of CW preparation “under a bandage” in combination with MD are: the absence of inflammation signs and the normal state of granulations (red-pink color, firm and moist), a negative result of wound swabs, the histological result of Si 1/Si 2 and Sp 1/Sp 2. For CW performed with pathologically altered granulations colonized by potential pathogens and having Sp 3, Si 2/Si 3 criteria, the use of 2 UD procedures is indicated (1st in combination with MD, 2nd before SG), between which VT is applied. Critically colonized wounds showing the signs of Sp 3 in combination with Si 1 or Si 2, from which microorganisms are isolated in an amount of ≤105 CFU/ml and are characterized by persistent properties, are an indication for VT, which is performed between two UD procedures. Clinical infection signs, the presence of bright red friable and bulge granulations in the wound, morphological signs of Si 3/Si 2 and Sp 1/Sp 2 are indications for the use of 2 UD procedures in combination with systemic antibiotic therapy based on wound swab culture results.Microbiological and morphological parameters characterize the CW state at various stages of the infectious process (colonization, critical colonization, infection) and are recommended as criteria for choosing tactics for wound bed prepara tion to SG.

Comparison of Efficacy of Vacuum Dressing Versus Conventional Dressing Over Autologous Split Skin Grafts in Burn Wounds: A Single-Center Prospective Cohort Study.

This study was carried out to compare the efficacy of vacuum dressing and conventional dressing over split skin grafts in burn patients. It was a single-center prospective cohort study on patients, with less than 40% TBSA burn, undergoing skin grafting at 2 different sites simultaneously over the burn wounds. One site underwent conventional dressing following grafting, and the other underwent vacuum dressing. The primary objective was to compare the percentages of skin graft uptake on Day 5 and Day 14. The secondary objectives were to compare the duration of dressings, time for complete epithelization, need for regrafting, and wound swab culture positivity rates. Three independent examiners assessed the efficacy of dressings in terms of epithelization percentage, need for continued dressing, graft loss, wound swab culture positivity rate, and qualitative assessment of grafts. A total of 16 patients were included in the study. The graft loss, number of days of dressings, and complete epithelization time were statistically lower in the negative-pressure wound therapy (NPWT) group compared with the conventional group (P values .007, .006, and 0009, respectively). The percentage of epithelization was also found to be higher in the NPWT group (P = .006). The incidence of positive cultures and clinically significant graft loss was found to be lower in the NPWT group. However, this was not found to be statistically significant. NPWT dressings can be used in burn wounds following skin grafting and have been found to reduce the time for epithelization compared to conventional dressing.

Identifying infection in chronic wounds in a community setting: A systematic review of diagnostic test accuracy studies.

To determine the diagnostic accuracy of different methods currently available to identify infection in chronic wounds applicable to adult patients in a community setting. Systematic review of diagnostic test accuracy studies. Two authors independently completed screening, data extraction and quality and bias assessments (QUADAS2). Eligible studies compared a method (index test) for detecting infection (diagnosis of interest) with microscopy and culture of either deep tissue biopsy or wound swab (reference test) in adult patients with wounds of >4 weeks duration (participants). The results were synthesized narratively. We systematically searched CINAHL, Embase and Medline from 2011 to April 2022. Four studies were included, all recruiting from secondary care wound clinics. Two studies assessed the diagnostic accuracy of Moleculight i:X, a bacterial fluorescence imaging device against deep tissue biopsy culture. One study assessed the diagnostic accuracy of the elevation of various enzymes detected in wound fluid against wound swab microscopy of culture. One study assessed the diagnostic accuracy of bacterial protease activity against wound swab microscopy and culture. Sensitivities of these methods ranged from 50 to 75% and specificities from 47 to 100%. Only a small number of studies were included in this systematic review due to our strict inclusion criteria. We have not identified any methods for diagnosing infection in chronic wounds with either a sufficient quality of evidence to recommend their use in community settings at present. Further research is needed to develop and evaluate appropriate diagnostics for this purpose. This study highlights the paucity of research into wound diagnostics in a community setting and should prompt further research in this area. Accurate diagnostic tests have the potential to improve community-based wound care by optimizing antibiotic use and potentially improving healing time. PRISMA-DTA checklist. The PPI group for the NIHR Community Healthcare MIC were supportive of this topic of work.

Antibiotic susceptibility of staphylococcus aureus strains isolated from various clinical specimens in a tertiary hospital

Aims: Staphylococcus aureus infection rates, which are the cause of infections, have rapidly risen in both hospitals and society, constituting a concern. In this study, it was aimed to examine the antibiotic susceptibility of S. aureus strains isolated from patients treated in a tertiary state hospital for four years. Methods: A retrospective analysis was performed on S. aureus strains (n=584) identified from clinical samples delivered to the medical microbiology laboratory of Niğde Ömer Halisdemir University Training and Research Hospital for bacterial culture between 2016 and 2019. The isolates were identified by standard laboratory procedure. VITEK 2 automated system (bioMerieux, France) was used to identification and antibiotic susceptibilities of evaluate the strains. Results: Strains were most commonly isolated from wound swab (n=173) and blood culture (n=107). While the highest resistance rate was observed against Erythromycin (n=232), the least amikacin (n=16) resistant strain was determined. Vancomycin and teicoplanin resistance was not observed. Conclusion: Multi-drug resistance and MRSA resistance still exist today. The absence of vancomycin and teicoplanin resistance, in addition to the low level of trimethoprim-sulfamethoxazole resistance, is encouraging. This information about S. aureus's susceptibility may be helpful in determining how to administer antibiotics.

Pacemaker Infective Endocarditis: Diagnostic and Therapeutic Particularities in 2 Case Reports Including One of the Left Heart

Pacemaker infective endocarditis is a more real diagnostic problem than a therapeutic one. The precise impact is not well known. Its incidence is poorly known, and it is a serious infection with an estimated mortality of around 25%. It is with this in mind that we report 2 clinical cases with a literature review.&#x0D; Case 1: An 88-year-old patient with a double chamber pacemaker was admitted for febrile syndrome with a fever at 39.2°. Transthoracic and transesophageal echocardiography (TOE) found an image of vegetation on the aortic valve measuring 9mm, located on the noncoronary cusp, and overflowing on the right coronary cusp. An inflammatory syndrome was found on blood tests. Blood culture, wound swab culture, and bacteriological study of material after removal revealed Staphylococcus Aureus Meti S. The patient was initially put on Vancomycin with a loading dose of 2g / 24h then 1g / 24h, and the pacemaker was extracted.&#x0D; Case 2: A 68-year-old with a double chamber pacemaker (PM) was admitted for fever at 39 ° c with suppuration of the PM pocket. Echocardiography identified an image on the tricuspid valve measuring 14x8 mm evoking vegetation given the context. Two blood cultures and swabs isolated a Staphylococcus aureus. The patient was administered Triaxon 2g / day for 4 weeks and gentamycin 180 mg for 15 days. The pacemaker was removed.&#x0D; Pacemaker Infective endocarditis is rare, poorly understood, very serious, and potentially fatal, accounting for up to about 7% in some case series. In half of the cases, they affect the endocavitary leads, but also the valves, and in 45% of cases the infection of the pocket. The average age is 65 years. The clinical symptoms are disparate making the diagnosis more difficult, it must be evoked in case of unexplained fever in a patient implanted with a Pacemaker. Bactericidal dual therapy should be administered after blood cultures in case of strong suspicion of infective endocarditis (IE) and adapted after identification of the germ in question. Most authors are adamant about extracting any pacemaker whenever possible.

EPIDEMIOLOGY OF SURGICAL SITE INFECTION IN A TERTIARY CARE CENTRE IN NORTH INDIA

Background and Objective- Surgical site infections are one of the most common cause of nosocomial infections and second most common cause of maternal mortality next to PPH. Surgical site infection being a relatively serious problem in our health institution, there are scanty published reports on the risk factors that are involved in SSIs in our local hospitals necessitatingfurther research to identify the indispensable factors responsible for high infection rate Methodology- Data were collected prospectively using predefined data collection forms which was developed after review of literature to identify risk factors for SSI. The form included patients demographic features, potential risk factors for SSI. A surveillance system as suggested by the CDC NHSN criteriawere used for diagnosing SSI. SSI was defined as a wound swab culture confirmed infection at the site of surgery within 30 days after an operation . SSI was defined as per NHSN criteria. Data was collected daily on all study participants after obtaining informed written consent, and followed them until discharge. The post discharge surveillance was done by actual patient visit in majority of patients (81%) or by mobile phones Results- Increasing age , increasing parity , anemia , hypertension , diabetes and poor nutrition, obesity were found to be independent risk factors for development of SSI. Conclusion- A proper assessment of identifiable risk factors that predisposes to SSI and their correction may help reduce SSI rates.

COMPARATIVE STUDY OF GRANULATION TISSUE FORMATION IN DIABETIC FOOT ULCER BY PHENYTOIN VS POVIDONE DRESSING

Background– Foot ulcers and infections are the most common reason for hospital admission in people with diabetes. Gingival hyperplasia is a typical adverse effect of phenytoin (diphenylhydantoin) treatment for epilepsy. It was possible that phenytoin may be used to stimulate the healing of wounds due to its stimulating impact on connective tissue. Aims and objectives of this study to compare granulation tissue formation by topical agents(phenytoin &amp; povidone). 100 patients with diabetic foot ulcer admitted in Gene Method- ral Surgery at Dr S.N. Medical College, Jodhpur(Rajasthan) were randomly assigned into two groups, the study group consisting of 50 patients who were treated with phenytoin dressing and 50 patients into control group who were treated with povidone dressing, assessment of granulation tissue formation done at the end of 14th day Result- The rate of granulation tissue in phenytoin group was 90.84% as compared to control group which was 80.08% which was statistically signicant (p value &lt; 0.0001). Wound swab cultures repeated on day 14th revealed that there was 86% negative culture in phenytoin group when compared to control group of 68% which also was statistically signicant. The mean hospital stay for the patient in phenytoin group was 26.46 days and in control group, it was 31.22 days. Conclusion- By promoting broblast proliferation and reducing collagenase activity, phenytoin dressing effectively accelerates the development of granulation tissue. By virtue of its inherent antibacterial activity and indirectly through their effects on anti-inammatory cells and neovascularization, it not only accelerates granulation tissue but also decreases bacterial load as compared to conventional dressing. Phenytoin helps to improve overall results by preparing the foot ulcer for early grafting

Wound swab quality grading is dependent on Gram smear screening approach

Superficial skin swab collections are inherently low-quality and may be of little clinical value due to their poor sensitivity and specificity. Clinical microbiology laboratories can use Gram smears to screen and differentiate higher and lower quality specimens to direct the extent of potential pathogen work up, including antimicrobial susceptibility testing (AST). We compared the impact of two different smear grading approaches to our current reporting practices for superficial wound swab cultures. Two variations of the Q score methodology (low power under 10X (QS10) and high power under 100X (QS100) were compared to our existing oil immersion method (OM100) (100X). We further evaluated the QS100 method by scoring superficial swab smears previously screened by OM100 from cultures submitted between November 2018 and December 2019. No significant difference in the number of low-quality specimens (N = 50) was identified by QS10 or QS100 grading (N = 9; 18%; N = 8; 16% respectively). Among 968 additional QS100 screened smears, 67 (6.9%) low quality swabs were identified and 7.4% fewer organisms (76/1020 organisms) would require reporting with AST. Implementing the Q score for superficial wound swab cultures would provide minimal improvements in their clinical relevance, laboratory quality and efficiency in our laboratory due to the low number of poor-quality swabs received.

Microbiological Findings and Clinical Outcomes in Ugandan Patients with Infected Burn Wounds.

Nosocomial wound infections are a dreaded complication in patients with burns. However, access to the necessary microbiological diagnostics is impaired in low-resource settings. This prospective observational cohort study aimed to describe the bacterial pathogens, resistance profiles and clinical outcomes of patients with wound infections admitted to the largest specialized unit for burns and plastic surgery in Uganda. Blood and wound swab cultures were taken for bacterial species identification and antibiotic susceptibility testing. A total of 140 patients (female: n = 62, 44.3%) with a median age of 26 (IQR 7-35) years were included between October 2020 and April 2022, of which the majority (n = 101, 72.2%) had burn wounds (72.3% Grade 2b, 14.9% Grade 3). Gram-negative Enterobacterales, Pseudomonas spp. and Acinetobacter spp. were most commonly isolated from wound swabs and nearly all isolates were multidrug resistant with very limited treatment options. While the clinical outcome was favorable in 21 (15%) study participants, the majority were left with disabilities (minor: n = 41, 29.3%, moderate: n = 52, 37%, major: n = 14 (10%)). Twelve (8.6%) study participants died, mostly of Gram-negative sepsis. Our findings highlight the urgent need for routine access to microbiological diagnostics to improve patient care and local surveillance efforts on antimicrobial resistance.

Chlorhexidine (2.5%)–alcohol versus povidone-iodine (10%) alcohol for surgical site antisepsis in cesarean section in a tertiary care hospital – A prospective observational and analytical study

Background: Rising trends of cesarean section globally demand identification of most suitable pre-operative antiseptic agent to minimize surgical site infections (SSI) and its consequences. Aims and Objectives: The aims of this study were to determine, compare, and analyze SSI developing following the use of chlorhexidine (2.5%)–alcohol and povidone-iodine (10%) alcohol as pre-operative antiseptic agents in cesarean section. Materials and Methods: A prospective, observational, and analytical study was conducted in a tertiary care center for 1 year, where 300 women receiving pre-cesarean surgical site antisepsis with chlorhexidine (2.5%)–alcohol were compared with another 300 receiving povidone-iodine (10%) alcohol. Results: The two study groups were compared in terms of various sociodemographic and clinical parameters which might act as confounding factors and were found to be similar. As compared to women receiving povidone-iodine (10%) alcohol, women receiving chlorhexidine (2.5%)–alcohol had significantly lesser incidence of overall (P&lt;0.001), superficial (P&lt;0.001), and deep (P&lt;0.05) SSI, infections developing at 48 h–5 days (P&lt;0.001) and at 5 days–30 days (P&lt;0.05). There was no significant difference among the two groups with respect to wound swab culture reports and post-SSI inflammatory markers. As compared to the povidone-iodine group, in the chlorhexidine group, a significantly (P&lt;0.05) greater percentage healed with meager dressing and a significantly (P&lt;0.05) lesser percentage required secondary suturing and readmissions and had a significantly (P&lt;0.05) lesser mean duration of hospital stay. Conclusion: Chlorhexidine (2.5%)–alcohol appears to be a better pre-operative surgical site anti-septic agent than povidone-iodine (10%) alcohol in cesarean section.