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At least 19 recordsLinked to original sources
PubMed2024

Development of a clinical metagenomics workflow for the diagnosis of wound infections.

BACKGROUND: Wound infections are a common complication of injuries negatively impacting the patient's recovery, causing tissue damage, delaying wound healing, and possibly leading to the spread of the infection beyond the wound site. The current gold-standard diagnostic methods based on microbiological testing are not optimal for use in austere medical treatment facilities due to the need for large equipment and the turnaround time. Clinical metagenomics (CMg) has the potential to provide an alternative to current diagnostic tests enabling rapid, untargeted identification of the causative pathogen and the provision of additional clinically relevant information using equipment with a reduced logistical and operative burden. METHODS: This study presents the development and demonstration of a CMg workflow for wound swab samples. This workflow was applied to samples prospectively collected from patients with a suspected wound infection and the results were compared to routine microbiology and real-time quantitative polymerase chain reaction (qPCR). RESULTS: Wound swab samples were prepared for nanopore-based DNA sequencing in approximately 4 h and achieved sensitivity and specificity values of 83.82% and 66.64% respectively, when compared to routine microbiology testing and species-specific qPCR. CMg also enabled the provision of additional information including the identification of fungal species, anaerobic bacteria, antimicrobial resistance (AMR) genes and microbial species diversity. CONCLUSIONS: This study demonstrates that CMg has the potential to provide an alternative diagnostic method for wound infections suitable for use in austere medical treatment facilities. Future optimisation should focus on increased method automation and an improved understanding of the interpretation of CMg outputs, including robust reporting thresholds to confirm the presence of pathogen species and AMR gene identifications.

Humans↗
PubMed1977

Wound infection following appendicectomy: the effect of extraperitoneal wound drainage and systemic antibiotic prophylaxis.

The value of extraperitoneal wound drainage and a 3-day course of prophylactic systemic cephaloridine used both separately and together have been assessed in a prospective controlled randomized trial involving 246 patients undergoing appendicectomy at the Leicester Royal Infirmary. Extraperitoneal wound drainage was shown to reduce significantly the incidence of postoperative wound infection in patients with a gangrenous or perforated appendix (P less than 0-025). Prophylactic cephaloridine significantly reduced the overall incidence of wound infection (P less than 0-02) and was also effective when the appendix was gangrenous or perforated (P less than 0-01). A highly significant reduction in wound infection was achieved when the appendix was gangrenous or perforated by the addition of wound drainage to the antibiotic regimen (P less than 0-001).

Adolescent↗
PubMed1977

Surgical wound infection: a comparison between dressed and undressed wounds.

At the University College Hospital, Ibadan, the conventional method of surgical wound dressing is the use of air-tight and relatively water-tight cotton-gauze-elastoplast dressing. This is usually left in place for seven to ten days unless there is evidence of wound infection, in which case the wound is inspected and redressed using the time-consuming sterile technique, in which a box of sterile instruments may have to be shared amongst about 25 surgical patients. A group of 100 patients was randomly selected and this group divided into two. In the first group, A, the surgical wounds were dressed in the usual manner and dressings left for seven to ten days unless there was any evidence of infection. In the second group, B, the wound was left undressed and "uncared" for 24 to 36 hours after surgery. The comparison of the two groups shows that the time-consuming aseptic method of changing and dressing surgically incised wounds 24 to 36 hours after surgery, does not cut down on the rate of wound infection and is probably unnecessary. This may be due to early formation of fibrin at the wound site which offers a protection against invasion of the wound by bacteria. Typhoid perforation of the terminal ileum gave rise to wound infection in all the cases (100%) in the two groups.

Bandages↗
PubMed1977

Factors affecting the incidence of wound infection in Neurosurgery.

A prospective survey of wound infection in a continuous series of 357 patients undergoing operations at a neurosurgical unit was made. The incidence of wound infection was 4.7 percent. Causative organisms were isolated in only 29.4 percent of the clinically infected cases. The type of suture material used did not affect the infection rate and neither did the coincidental use of steroids in the high doses employed in neurosurgical practice. Re-exploration does not carry an increased risk of infection. Use of systemic or topical antibiotics or both was not found to confer any protection against wound infection.

Anti-Bacterial Agents↗
PubMed1979

Wound infection associated with Vibrio alginolyticus.

A 42-year-old man had an infected ulcerated lesion of the anterior aspect of the right lower extremity. Vibrio alginolyticus was twice isolated from the lesion. Emphasis is placed on the clinical and laboratory characteristics of this organism and its differentiation from other halophilic vibrios.

Adult↗
PubMed1979

Mycotic wound infections. A new challenge of the surgeon.

Fungal wound infections have become more common because of the increased use of immunosuppressive and antineoplastic agents, prosthetic devices and grafts, broad-spectrum antibiotics, and hyperalimentation. Severe burns, renal failure, and other debilitating conditions also predispose to invasive mycoses. An aggressive diagnostic approach is particularly important, and tissue biopsy specimens are often necessary to establish a diagnosis. Meticulous surgical technique and minimization of the predisposing factors are crucial in the prevention of these infections, and prophylactic antimycotic agents may be of value in selected high-risk patients. Some mycotic wound infections can be managed effectively without systemic therapy; but when systemic agents are needed, combination antifungal therapy may provide improved results without increased drug toxicity.

Adult↗
PubMed1978

Surveillance for postoperative wound infections: practical aspects.

Intensive surveillance for postoperative wound infections was conducted for one month on three separate occasions at the Veterans Administration Hospital, West Haven, Connecticut. The mean wound infection rates for clean, clean-contaminated, contaminated, and dirty wounds were 6, 11, 17 and 18%, respectively. During the second survey, the clean-contaminated rate was 25% and was significantly higher than at other periods (p less than 0.05). Most of these infections occurred on a single surgical subspecialty service. The methods used to conduct intensive wound surveillance and the need for close liaison between the infection control team and the surgical service is emphasized. Current problems with wound surveillance are reviewed.

Connecticut↗
PubMed1977

A trial of cephalothin sodium in colon surgery to prevent wound infection.

A double-blind trial of preoperative and perioperative cephalothin sodium in patients undergoing colonic surgery was carried out to test the value of this drug in reducing wound infection rates. Two studies were performed. In the first trial, 1 gm of cephalothin sodium or a placebo was given intravenously at the beginning of operation, and 1 gm one hour later. In the second trial, the dose of cephalothin or placebo was increased to 2 gm. There was no significant reduction in wound infections in either study in the groups receiving cephalothin, although over two thirds of the organisms cultured from the infected wounds were sensitive to cephalothin. It is suggested that meticulous attention to technique to avoid gross contamination remains the most important factor in the prevention of wound infections after colon surgery.

Cephalothin↗
PubMed2026

Reversed unidirectional transport in a Janus polyurethane/alginate dressing for directional postbiotic delivery to infected wounds.

Probiotic-derived postbiotics exhibit significant potential for infected wound control; however, their effective and localized delivery at wound sites remains a challenge. This study developed a polyurethane/alginate composite nonwoven via electrospinning to establish a postbiotic delivery platform for Bifidobacterium bifidum BD-1 (PU/Alg/BD-1). The beaded fibrous hydrophobic PU layer and hydrophilic Alg layer form a wettability gradient, enabling reversed unidirectional fluid transport toward the wound interface while inhibiting backflow. In vitro results showed that PU/Alg/BD-1 exhibited significant antibacterial activity against Staphylococcus aureus and Escherichia coli and good cytocompatibility with a hemolysis rate of <5%. Targeted metabolomic analysis revealed multiple organic acids in the BD-1 metabolites, which contributed to its antibacterial activity. In vivo microbial analysis verified that PU/Alg/BD-1 effectively reduced the relative abundance of Staphylococcus at the wound site while increasing the proportions of Corynebacterium and Psychrobacter. This microbial modulation contributed to infection control in a rat full-thickness infected wound model, accompanied by a shift in the macrophage phenotype and the downregulation of inflammatory factors including IL-6, TNF-&#x3b1;, and TGF-&#x3b2; in the PU/Alg/BD-1 group. Compared with the blank control, conventional gauze, PU/Alg, and BD-1 groups, PU/Alg/BD-1 significantly promoted wound contraction and re-epithelialization and enhanced collagen deposition. Hence, this study provides an effective material construction strategy for the application of probiotic-derived postbiotics to promote wound healing, demonstrates the potential of BD-1 to regulate the wound microenvironment and accelerate healing, and thereby offers a novel approach for the treatment of infected wounds.

Journal Article↗
PubMed1979

A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy.

One hundred patients undergoing appendicectomy through a right iliac fossa incision were randomized to receive normal saline or 500 mg metronidazole as an intravenous infusion during the operation. One patient in the saline group developed an erythematous rash. There were 13 wound infections (as defined by the discharge of pus), 12 (out of 51) in the saline group and 1 (out of 49) in the metronidazole group. Bacteroides spp. were frequently cultured from the lumen of removed appendices and from pus obtained from infected wounds. This work supports the value of metronidazole but suggests that a single-dose regimen is adequate for prophylaxis.

Adolescent↗
PubMed1979

Tinidazole in the prevention of wound infection after elective colorectal surgery.

During the first six months of 1978, 71 patients were the subject of a controlled trial of the use of tinidazole for the prevention of wound infection after elective colonic surgery. The trial design was prospective, randomized and double-blind with tinidazole or placebo given at the last oral intake before operation. The objective endpoint of the trial was the presence or absence of wound infection manifested by pus. All patients underwent a standard preoperative preparation of bowel washouts, and a standardized surgical technique included, in all cases, the use of wound drainage. At the end of the trial there were three wound infections in 40 patients who were given tinidazole, and eleven wound infections in 31 patients who were given placebo. The difference in wound infection rate between these two groups is significant (x2 with Yates correction = 7.3; P less than 0.01).

Clinical Trials as Topic↗
PubMed1979

One-dose antibiotic prophylaxis against wound infection after appendicectomy: a randomized trial of clindamycin, cefazolin sodium and a placebo.

Two hundred and fifty patients were admitted to a prospective randomized trial of single dosage prophylaxis against wound infection after appendicectomy. There were 12 exclusions, 72 patients received placebo, 81 received 600 mg i.m. clindamycin phosphate and 85 received 1 1 g i.m. cefazolin sodium, the agent being given in the anaesthetic room. Clindamycin produced a significant reduction in the overall rate of wound infection from 33 per cent in the controls to 17 per cent. In cases with a gangrenous or perforated appendix the infection rate in controls was 78 per cent; this was reduced to 44 per cent by a single dose of clindamycin. Cefazolin significantly reduced the number of aerobic organisms isolated from wound infections, but did not significantly reduce the incidence of wound infection. We conclude that anaerobic organisms are more important than faecal aerobic organisms in the pathogenesis of wound infection after appendicectomy.

Adult↗
PubMed1979

[Nonspecific prophylaxis and therapy of Pseudomonas aeruginosa wound-infections with paramunization using a mouse-model (author's transl)].

The effectiveness of paramunization as a antigen nonspecific method to activate mechanisms against wound-infections due to Pseudomonas aeruginosa was studied using a model of direct infection of mice with a "mice-pathogenic" Ps. aeruginosa strain on artificially set wounds. Active paramunization by means of a biological inducer "PIND-AVI" (M-HP 438) significantly reduced the mortality rate between treated and placebo animals. The best results were obtained by parenteral prophylactic application. A four times repeated injection of PIND-AVI before the wound-infection reduced the mortality rate from 80% (placebo animals) to 26.6%. Almost equally good results were obtained by clinically useful therapeutic application of the preparation. A four times repeated treatment of the mice after wound infection lead to a decrease of mortality rates from 86.6% to 36.6%. The paramunization inducer PIND-AVI caused no side effect in any of the experiments. The mode of inducer action in Pseudomonas aeruginosa wound infections appears to be complex. Increased phagocytosis by nonspecific opsonisation, increased macrophage activity and concurrent stimulation of the lymphopoetic system could possible occur. On the other hand the nonspecific action of mediators could also play a role due to the inducer stimulated T-cells and cellular antigens of Pseudomonas aeruginosa. However both mechanisms in cooperation with specific and nonspecific humoral factors are probably interacting together. To what extent a simultaneous synthesis resp. release of endogeneous interferon plays a role is not known.

Administration, Intranasal↗
PubMed1978

Group C streptococcal surgical wound infections transmitted by an anorectal and nasal carrier.

Streptococcus equisimilis (Lancefield group C), an unusual cause of nosocomial surgical infection, was isolated from two orthopedic postoperative wound infections. Both operations had been performed by the same surgeon within a three-day period. Examination of the surgeon revealed perianal dermatitis from which S. equisimilis was isolated. The organism was also recovered from the surgeon's nose and rectum. The wound infections responded to treatment with penicillin derivatives. The surgeon was successfully treated with topical bacitracin and oral penicillin and vancomycin. This report documents the pathogenicity of the C Streptococcus in postoperative infection and suggests a possible nosocomial source of the organism.

Adolescent↗
PubMed1978

Wound infections due to group A streptococcus traced to a vaginal carrier.

An epidemic of surgical wound infections caused by group A Streptococcus affecting 18 patients in a community hospital was studied. Onset of symptoms shortly after surgery (median time, 16 hr) in 17 patients suggested acquisition of infection in the operating room, and a case-control investigation linked the presence during surgery of one particular nurse with postoperative streptococcal infection. During the first month of the epidemic, the nurse had streptococcal cellulitis of the finger and may thus have directly contaminated wounds or dressings. However, the last six wound infections occurred after her skin lesions had resolved and after nasopharyngeal and skin cultures were repeatedly negative for group A streptococci. Subsequent investigation showed that the nurse was colonized vaginally with group A streptococci of the same M and T types found in the infected patients and that this organism was disseminated into her immediate environment by airborne or droplet spread. Vaginal as well as rectal carriers of streptococci should be sought whenever outbreaks of streptococcal wound infection in which a cutaneous or nasopharyngeal carrier cannot be readily identified.

Carrier State↗