Search Results (23)

Background: Advancements in surgical wound management have led to improved healing and reduced complications. Incisional negative pressure wound therapy (iNPWT) is a technique that applies sub-atmospheric pressure to closed surgical wounds, enhancing blood flow, minimizing edema, and promoting tissue repair. Initially developed for chronic wounds, its use has expanded across multiple surgical specialties, including orthopaedic trauma surgery, to reduce complications such as dehiscence, infection, and prolonged healing. While traditional wound care relies on standard closure methods with simple dressings, iNPWT offers additional mechanical support and may lower the risk of deep surgical site infections (SSIs). This review examines the current evidence on iNPWT’s role in preventing SSIs following surgery for lower extremity fractures to guide clinical decision-making and improve patient outcomes. Methods: A systematic search through PubMed and MEDLINE utilizing our inclusion and exclusion criteria yielded seven randomized controlled trials and randomized prospective cohort studies that were subsequently analyzed to determine iNPWT effectiveness. Results: Of the seven studies, five showed a decreased SSI rate compared to standard wound dressing, with the other two exhibiting an increased infection rate. Conclusions: This review critically examines existing literature on iNPWT, analyzing level I and II studies on deep SSI rates in traumatic fractures. The evidence remains inconclusive on whether iNPWT offers a significant advantage over standard wound dressings, highlighting the need for further research to clarify its efficacy and clinical application. Full article

Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative Pressure Wound Therapy (NPWT), advanced dressings, irrigation techniques, antibiotic regimens, and innovative therapies, in improving wound healing outcomes and reducing infection rates. Materials and Methods: An exhaustive literature search focused on the use of NPWT, dressings, and antibiotics in the care of chronic wounds was conducted following PRISMA guidelines in the PubMed, Scopus, Web of Science, and CINAHL databases. Eligible studies included randomized controlled trials and prospective cohorts assessing interventions for wound care in trauma, surgical, and chronic wound settings. The risk of bias was assessed using the ROB2 tool. Subgroup analyses were performed to evaluate the relative risk (RR) of infections based on the intervention type. Results: The analysis included 17 studies spanning diverse geographical and clinical settings. NPWT demonstrated significant benefits in reducing infection rates compared to control groups (RR: 0.590, 95% CI: 0.458–0.760, and p < 0.001). Although advanced dressings demonstrated clinically relevant benefits as reported across the included studies, the meta-analysis did not reveal statistically significant differences (RR: 0.516, 95% CI: 0.242–1.100, and p = 0.087). Antibiotic therapies significantly reduced infections when administered within 24 h of injury, while low-pressure irrigation techniques effectively minimized bacterial contamination without causing tissue damage. Growth factors and honey-based treatments exhibited promising results in accelerating wound healing and reducing infection risks in chronic wounds. Conclusions: NPWT emerges as a highly effective intervention for infection prevention and wound healing, supported by robust evidence. Advanced dressings and innovative therapies show potential but require further research for conclusive evidence. These findings underscore the importance of tailoring wound care strategies to the clinical context and patient needs. Future research should focus on long-term outcomes and cost-effectiveness analyses to enhance the integration of these therapies into clinical practice. Full article

Background: Negative Pressure Wound Therapy (NPWT) has proven to be an effective intervention in preventing postoperative complications across a range of surgical specialties, including orthopedics, vascular, and abdominal surgery. This study aimed to assess the prophylactic use of NPWT dressing compared to the Standard of Care (SOC) in high-risk patients undergoing oncoplastic and reconstructive breast surgery. Materials and Methods: This preliminary case-control study included 23 high-risk patients, enrolled between September 2023 and February 2024, at San Martino Polyclinic Hospital, Genoa. High-risk patients were defined as those with one or more of the following risk factors: obesity, prior radiotherapy, neoadjuvant chemotherapy, smoking history, diabetes, or corticosteroid use. The surgical procedures evaluated in this study included mastectomy with immediate implant-based breast reconstruction, reduction mammoplasty, and oncoplastic breast surgery following local excision or quadrantectomy. NPWT dressing was applied immediately after skin closure in the operating room, replaced after 2–3 days, and removed 7 days post-procedure. Surgical outcomes assessed included skin flap necrosis, wound dehiscence, infection, implant loss, and delays in adjuvant therapy. Results: A total of 23 patients, aged 45 to 57 years, were enrolled. Eleven patients received NPWT dressing, while twelve were treated with SOC. No complications occurred in the NPWT dressing group, whereas four complications were observed in the SOC group. Of the control group, three patients developed infections, which were treated with oral antibiotics for two, while one required implant replacement surgery. The remaining patient in the control group experienced wound dehiscence, which was successfully managed conservatively on an outpatient basis. Discussion and Conclusions: Our findings suggest that prophylactic NPWT dressing in oncoplastic and reconstructive breast surgery results in a significantly lower rate of wound-related complications. Although this is a preliminary study, it provides a foundation for further research in a larger cohort. These results also prompt a discussion of the cost-effectiveness of NPWT dressing relative to the SOC, given its higher cost. Full article

Hydrogels and microgels are emerging as pivotal platforms in biomedicine, with significant potential in targeted drug delivery, enhanced infection management, and tissue repair and regeneration. These gels, characterized by their high water content, unique structures, and adaptable mechanical properties, interact seamlessly with biological systems, making them invaluable for controlled and targeted drug release. In the realm of infection management, hydrogels and microgels can incorporate antimicrobial agents, offering robust defenses against bacterial infections. This capability is increasingly important in the fight against antibiotic resistance, providing innovative solutions for infection prevention in wound dressings, surgical implants, and medical devices. Additionally, the biocompatibility and customizable mechanical properties of these gels make them ideal scaffolds for tissue engineering, supporting the growth and repair of damaged tissues. Despite their promising applications, challenges such as ensuring long-term stability, enhancing therapeutic agent loading capacities, and scaling production must be addressed for widespread adoption. This review explores the current advancements, opportunities, and limitations of hydrogels and microgels, highlighting research and technological directions poised to revolutionize treatment strategies through personalized and regenerative approaches. Full article

Healthcare-associated infections pose a significant global health challenge, negatively impacting patient outcomes and burdening healthcare systems. A major contributing factor to healthcare-associated infections is the formation of biofilms, structured microbial communities encased in a self-produced extracellular polymeric substance matrix. Biofilms are critical in disease etiology and antibiotic resistance, complicating treatment and infection control efforts. Their inherent resistance mechanisms enable them to withstand antibiotic therapies, leading to recurrent infections and increased morbidity. This review explores the development of biofilms and their dual roles in health and disease. It highlights the structural and protective functions of the EPS matrix, which shields microbial populations from immune responses and antimicrobial agents. Key molecular mechanisms of biofilm resistance, including restricted antibiotic penetration, persister cell dormancy, and genetic adaptations, are identified as significant barriers to effective management. Biofilms are implicated in various clinical contexts, including chronic wounds, medical device-associated infections, oral health complications, and surgical site infections. Their prevalence in hospital environments exacerbates infection control challenges and underscores the urgent need for innovative preventive and therapeutic strategies. This review evaluates cutting-edge approaches such as DNase-mediated biofilm disruption, RNAIII-inhibiting peptides, DNABII proteins, bacteriophage therapies, antimicrobial peptides, nanoparticle-based solutions, antimicrobial coatings, and antimicrobial lock therapies. It also examines critical challenges associated with biofilm-related healthcare-associated infections, including diagnostic difficulties, disinfectant resistance, and economic implications. This review emphasizes the need for a multidisciplinary approach and underscores the importance of understanding biofilm dynamics, their role in disease pathogenesis, and the advancements in therapeutic strategies to combat biofilm-associated infections effectively in clinical settings. These insights aim to enhance treatment outcomes and reduce the burden of biofilm-related diseases. Full article

The increasing prevalence of acute traumas, surgical wounds, and chronic skin wounds poses significant therapeutic challenges for wound treatment. One of the main concerns in wound care is the danger of infection, which is a significant barrier to healing and a cause of higher morbidity and mortality rates. The emergence of drug-resistant bacterial species is becoming more frequent every day. Antimicrobial dressings have become a viable strategy for wound healing and hospital expense savings. Several factors, such as the wound’s localization and state, microbial load, and cost, must be considered when choosing an appropriate antimicrobial dressing. One of the key goals of wound care is infection avoidance. This study addresses the therapeutic challenges of acute traumas, surgical wounds, and chronic skin wounds, focusing on infection prevention and combating drug-resistant bacterial strains. The research explores the development of novel composite wound dressings incorporating hydroxyapatite, known for its osteoconductive properties, and essential oils from basil and cinnamon, recognized for their antimicrobial activity. The study evaluates the impact of these additives on key properties such as surface morphology, water absorption, enzymatic degradation, and mechanical performance. Antimicrobial tests showed that two experimental samples (A1S and A1BS) exhibited significant activity against Escherichia coli but not on Staphylococcus aureus. The results highlight the dressings’ enhanced antimicrobial properties, mechanical strength, and controlled degradation, making them promising candidates for advanced wound healing. Tailored applications were identified, with each dressing composition offering unique benefits for specific wound-healing scenarios based on the balance between flexibility, structural support, and bioactivity. Full article

Surgical site infections (SSIs) are a significant challenge in postoperative care, leading to increased morbidity, extended hospital stays, and elevated healthcare costs. Traditional antimicrobial dressings, such as those containing silver or iodine, have limitations, including cytotoxicity and the potential for antimicrobial resistance. Dialkylcarbamoyl chloride (DACC)-impregnated dressings offer a novel approach, employing a physical mechanism to bind and remove bacteria without the use of chemical agents, thereby reducing the risk of resistance. This review summarizes current evidence on the efficacy of DACC dressings in preventing SSIs and promoting wound healing. Findings from multiple studies indicate that DACC dressings reduce bacterial burden and SSI rates across various surgical procedures, including cesarean sections and vascular surgeries. Additionally, DACC dressings demonstrate potential in managing hard-to-heal wounds, such as diabetic foot ulcers, by reducing bacterial load and biofilm formation. Furthermore, they present advantages in antimicrobial stewardship and cost-effectiveness by minimizing the need for antibiotics and decreasing overall healthcare expenses. However, the current literature is limited by small sample sizes, methodological weaknesses, heterogeneity in study designs, and a lack of long-term data. Future research should focus on high-quality randomized controlled trials across diverse surgical populations, comprehensive cost-effectiveness analyses, and long-term outcomes to establish the full clinical impact of DACC dressings. With further validation, DACC-impregnated dressings could become a critical tool in sustainable postoperative wound care. Full article

The local application of broad-spectrum antibiotics via polymeric drug delivery systems is a promising alternative to their systemic administration in wound healing, prevention and treatment of infections associated with surgical implants. However, low and poorly controlled loading efficiency and 100% burst release are common problems for the materials with weak physical interaction between antibiotics and polymeric matrices. Here, we report a new multifunctional carboxymethyl chitosan (CMC) cryogel, which efficiently prevents bacterial adhesion to the surface, kills bacteria in the solution via controlled release of ciprofloxacin (CIP), and promotes fibroblast proliferation. The suggested approach is based on CIP loading to Zn²⁺-chelated CMC cryogel via the ligand exchange reaction. We have shown that, due to the strong binding of Zn²⁺ to CMC, the antibacterial effect and toxicity to fibroblasts of CMC-Zn-CIP cryogels were mainly determined by the content of loaded CIP, which can be precisely controlled via Zn²⁺ content in cryogel. CMC cryogels containing 20 mgZn/g can be loaded with CIP amounts sufficient to completely suppress the growth of hospital strain Klebsiella oxytoca with MIC of 0.125 µg/mL, while maintaining a fibroblast viability at the level of 85–90%. Full article

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use of new antibiotics are crucial. Due to their nosocomial nature, monitoring and preventing MDR infections are essential. Methods: This study enrolled patients who underwent cardiac surgery from January 2020 to May 2022. The patients included were those 18 years or older who tested positive for MDR intestinal colonization before surgery. Excluded were patients who tested positive after surgery, or were younger than 18, pregnant, or lactating. For each positive patient, the National Surgical Quality Improvement Program (NSQIP) score was calculated. The data collected included age, gender, body mass index (BMI), the type of surgery, the intensive care unit (ICU) length of stay, ICU readmission, mortality, and other infections (pneumonia, bacteremia, or surgical site infection) to establish a control group and postoperative outcome measures. Results: No statistically significant differences were found between the groups regarding the ICU length of stay, new ICU admissions, or mortality. Additionally, there were no differences in the infection rates, such as bacteremia, wound infections, and pneumonia. Conclusions: Preoperative rectal colonization by MDR bacteria does not appear to worsen postoperative outcomes for cardiac surgery patients. These findings suggest that patients with a preoperative MDR-positive rectal sample might undergo cardiac surgery without significantly increased risk. Besides the limitations of this study, pre-surgical antibiotic prophylaxis may not need to be adjusted for patients with preoperative MDR positivity. Full article

Background/Objectives: The general use of triclosan-coated suture material (TCSM) for wound closure to prevent surgical site infections (SSIs) remains controversial. There is no conclusive evidence in the literature to support this and recommendations by professional organizations are contradictory. Therefore, the main objective of the study was to evaluate the 30-day rate of surgical site infections (SSIs) after elective open abdominal surgery using triclosan-coated versus uncoated running sutures (NCSM) for skin closure. Methods: This prospective, randomized, double-blinded study enrolled patients scheduled for open elective abdominal surgery, intraoperatively assigned to either the use of triclosan-coated or non-coated sutures for skin closure. The follow up was 30 days after surgery to detect SSIs. Secondary endpoints were wound dehiscence and reoperation rate due to wound dehiscence within 30 days, all-cause 30-day mortality and length of hospital stay. Potential risk factors for poor wound healing were evaluated in multivariate analysis. Data were analyzed in an intention to treat analysis. Results: In total, 364 patients (171 males [47%]) were randomized, 182 in either group. Six underwent urgent reoperation prior to first visit and were excluded from analysis. In the full analysis set (FAS), 358 were analyzed. SSI within 30 days occurred in 22 [12.2%] patients in the control group compared to 32 [18%] in the study group. The risk difference was not statistically significant (5.8%; 95% confidence interval (CI) −1.6–13.2%; p = 0.128). The wound dehiscence rate within 30 days was 14 of 179 [7.8%] in the NCSM group vs. 19 of 178 [10.7%] in the TCSM group. The difference in re-operation rates due to wound dehiscence was 0 of 179 [2.8%] vs. 5 of 178 [2.8%] in either group and not statistically significant (p = 0.0706). Among all patients recruited, 8 died within 30 days after surgery. Three of them died before the first assessment of the primary endpoint on day 3 and were therefore excluded from the FAS. The 30-day mortality rate was 2 of 180 [1.1%] in the NCSM group vs. 3 of 178 [1.7%] in the TCSM group. The majority of SSIs occurred in the superficial layer of the wound in both study groups (8.9% vs. 9.6%). The median [inter quartile range (IQR)] length of hospital stay was 13 [9.0, 19.2] days in the NCSM group vs. 11 [9.0, 16.8] days in the TCSM group There was a tendency towards shorter hospitalization in the study group (0.72 days [6%]). Conclusions: Our prospective randomized controlled trial could not confirm the superiority of TCSM for skin closure after elective open abdominal surgery in terms of SSI rates in a 30-day follow up period. Therefore, based on our results, a general recommendation for its use in all surgical fields cannot be justified. Full article

Background: Cefazolin may minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence for achieved tissue concentrations. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30 mg/kg every 3 h) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour) during PSF for AIS. Results: Patients were well matched for demographic and perioperative variables. While total drug exposure, measured as area-under-the-curve (AUC), was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent above minimal inhibitory concentration (MIC), both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL, patients in the bolus group spent a median of 1/5 and 1/3 of the typical 6 h operative time below target in subcutaneous and muscle tissue, respectively. Conclusions: We conclude that intraoperative determination of cefazolin tissue concentrations is feasible and both bolus and infusion dosing of cefazolin achieve concentrations in excess of typical MICs. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues. Full article

Wound infection is one of the most important factors affecting wound healing, so its effective control is critical to promote the process of wound healing. However, with the increasing prevalence of multi-drug-resistant (MDR) bacterial strains, the prevention and treatment of wound infections are now more challenging, imposing heavy medical and financial burdens on patients. Furthermore, the diminishing effectiveness of conventional antimicrobials and the declining research on new antibiotics necessitate the urgent exploration of alternative treatments for wound infections. Recently, phage therapy has been revitalized as a promising strategy to address the challenges posed by bacterial infections in the era of antibiotic resistance. The use of phage therapy in treating infectious diseases has demonstrated positive results. This review provides an overview of the mechanisms, characteristics, and delivery methods of phage therapy for combating pathogenic bacteria. Then, we focus on the clinical application of various phage therapies in managing refractory wound infections, such as diabetic foot infections, as well as traumatic, surgical, and burn wound infections. Additionally, an analysis of the potential obstacles and challenges of phage therapy in clinical practice is presented, along with corresponding strategies for addressing these issues. This review serves to enhance our understanding of phage therapy and provides innovative avenues for addressing refractory infections in wound healing. Full article

Mammary gland tumors represent the most frequently diagnosed malignant neoplasm in intact female dogs, and surgical removal represents the current gold standard treatment. To promote wound healing and prevent possible bacterial contamination, perioperative antimicrobials are commonly used in clinical practice, even though there are no publications establishing guidelines for the use of such drugs in canine mastectomy. The aim of the present study was to evaluate the ameliorative effect of fluorescent light energy on the quality of the healing process after mastectomy surgery in female dogs, in the absence of perioperative antimicrobial administration. Nine female dogs received a multiple-gland mastectomy due to gland tumors and received FLE application immediately after surgery and then five days after. The surgical incisions were evaluated by a blind investigator over time using the Modified Hollander Cosmesis and Modified Draize Wound Healing Score systems. Statistical analysis revealed a significant ameliorative effect of FLE in the control of step-off borders, contour irregularities, and excessive distortion. In addition, erythema, edema, and serous discharge were lower for those wounds managed with FLE. These results underscore the advantageous impact of FLE on the healing of post-mastectomy wounds in female dogs, offering the dual benefits of reducing potential infection risks and lessening the home care burden for pet owners. Full article

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of severe surgical site infections (SSI). The molecular epidemiology of MRSA is poorly documented in Ethiopia. This study is designed to determine the prevalence of MRSA and associated factors among patients diagnosed with SSI. A multicenter study was conducted at four hospitals in Ethiopia. A wound culture was performed among 752 SSI patients. This study isolated S. aureus and identified MRSA using standard bacteriology, Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS), and cefoxitin disk diffusion test. The genes mecA, femA, vanA, and vanB were detected through PCR tests. S. aureus was identified in 21.6% of participants, with 24.5% of these being methicillin-resistant Staphylococci and 0.6% showing vancomycin resistance. Using MALDI-TOF MS for the 40 methicillin-resistant Staphylococci, we confirmed that 31 (77.5%) were S. aureus, 6 (15%) were Mammaliicoccus sciuri, and the other 3 (2.5%) were Staphylococcus warneri, Staphylococcus epidermidis, and Staphylococcus haemolyticus. The gene mecA was detected from 27.5% (11/40) of Staphylococci through PCR. Only 36.4% (4/11) were detected in S. aureus, and no vanA or vanB genes were identified. Out of 11 mecA-gene-positive Staphylococci, 8 (72.7%) were detected in Debre Tabor Comprehensive Specialized Hospital. Methicillin-resistant staphylococcal infections were associated with the following risk factors: age ≥ 61 years, prolonged duration of hospital stay, and history of previous antibiotic use, p-values < 0.05. Hospitals should strengthen infection prevention and control strategies and start antimicrobial stewardship programs. Full article

Background: The management of acute surgical pathology implies not only the diagnosis–treatment sequence but also an important preventive component. In the surgical hospital department, wound infection is one of the most frequent complications which must be managed both in a preventive and a personalized manner. To achieve this goal, several factors of negative local evolution, contributing to the slowdown of the healing processes, such as the colonization and contamination of the wounds, need to be emphasized and controlled from the first moment. In this context, knowing the bacteriological status at admission ensures the distinction between the colonization and infection processes and could help to manage in an efficient way the fight against bacterial pathogen infections from the beginning. Methods: A prospective study was performed for 21 months on 973 patients hospitalized as emergencies in the Plastic and Reconstructive Surgery Department within the Emergency University County Hospital of Brasov, Romania. We analyzed the bacteriological profile of the patients from admission to discharge and the bidirectional and cyclic microorganism dynamics both in the hospital and the community microbial environment. Results: Of the 973 samples collected at admission, 702 were positive, with 17 bacterial species and one fungal, with a predominance of Gram-positive cocci at 74,85%. The most frequently isolated strains were Staphylococcus species (86.51% of the Gram-positive/64.7% of the total isolated strains), while Klebsiella at 8.16% and Pseudomonas aeruginosa species at 5.63% were mainly emphasized in the case of Gram-negative bacilli. Two to seven pathogens were introduced after admission, suggesting that the community microbial environment is in a process of evolution and enrichment with hospital pathogens. Conclusions: The high level of positive bacteriological samples and the complex associations of the pathogens found at the admission bacteriological screening sustain the new idea that the pathogenic microorganisms existing in the community microbial environment have started to increasingly influence the hospital microbial environment, in contrast with the previous consideration, which emphasized only the unidirectional relationship between hospital infections and the changing bacteriological characteristics of the community environment. This modified paradigm must become the basis of a new personalized approach to the management of nosocomial infections. Full article