Wound Microbiology and Associated Approaches to Wound Management

Abstract

The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds

Diagnosis and Treatment of Diabetic Foot Infections

“…Acute infections in patients who have not recently received antimicrobials are often monomicrobial (almost always with an aerobic grampositive coccus), whereas chronic infections are often polymicrobial [31,36,43,51]. Cultures of specimens obtained from patients with such mixed infections generally yield 3-5 isolates, including gram-positive and gram-negative aerobes and anaerobes [14,34,37,38,40,41,[52][53][54][55][56][57][58]. The pathogenic role of each isolate in a polymicrobial infection is often unclear.…”

“…Some argue that many apparently uninfected diabetic foot ulcers are actually subclinically infected-that is, they contain a high "bioburden" of bacteria (usually defined as 110 5 organisms per gram of tissue) that results in "critical colonization" levels and impairs wound healing [54,[109][110][111][112][113][114]. Available published evidence does not support the use of antibiotics for the management of clinically uninfected ulcerations, either to enhance wound healing or as prophylaxis against infection [115,116].…”

A study of wound infections in two health institutions in Ile-Ife, Nigeria

“…(Bowler et al, 2001). Infection in a wound delays healing and may cause wound breakdown, herniation of the wound and complete wound dehiscence.…”

“…In spite of technological advances that have been made in surgery and wound management, wound infection has been regarded as the most common nosocomial infection especially in patients undergoing surgery (Dionigi et al, 2001). It is an important cause of illness resulting in a prolongation of hospital stay, increased trauma care, treatment costs, and general wound management practices become more resource demanding (Bowler et al, 2001).…”

The antibacterial potency of the medicinal maggot, Lucilia sericata (Meigen): Variation in laboratory evaluation

“…Under our conditions ES was equally able to reduce the viability of inocula of 20 µl and 100 µl (10 5 CFU/ml) (unpublished data). Therefore the main focus of our investigation was to assess the effects of different larval concentrations and varying nutrients on the antibacterial potency of L. sericata ES against three organisms commonly found in the wound environment, Staphylococcus aureus, E. coli and P. aeruginosa (Bowler et al, 2001). These results were then utilised to test a new liquid culture assay method with which to standardise future work.…”