Introduction/Purpose Critically ill, immunocompromised patients run a high risk of infection and dehiscence of surgical wounds, where bacterial growth may continue, even after prolonged antibiotic treatment. Because guidelines are not available, we aimed to investigate whether it is safe to close wounds growing multiresistant bacteria. Materials and Methods Immunocompromised patients with a dehiscent and infected abdominal wound were collected from November 2008 to November 2011. Immune deficiency was due to organ transplantation, renal failure, HIV, or multiorgan failure. Patients treated before March 2010, were treated with wound debridement and secondary intention healing. Patients presenting afterwards were treated with the following protocol: serial wound debridement, irrigation, and negative pressure dressing. Once wounds had a clinically acceptable appearance, they were primarily closed, despite positive microbiological cultures. Results 13 patients (mean age 56 years, 8 male) were included, 4 were left to heal by secondary intention, 9 were treated with the protocol mentioned above. 10 patients were transplanted (9 liver, 1 kidney), 1 HIV infected, 2 hemodialysed. All the patients had multiple systemic positive cultures. Wounds swabs and biopsies showed growth of multiresistant Acinetobacter Baumanii (6), enterococcus faecium (3), Staph aureus (2), E.coli (1), Klebsiella Pneumoniae (1) Healing was obtained in 3 of the 4 patients in the secondary intention healing group (mean healing time 81days, one death) and in all the patients of the treated group (mean 28 days). No local or systemic complications related to the wound closure arose (minimum follow-up 6 months). Conclusion Serial debridement, negative pressure dressing, and closure seem to lead to durable healing even in a population of critically ill, immunocompromised patients and in a shorter time than secondary intention healing. Closure of a clinically healthy wound, despite positive microbiological swabs, may be reasonable.
“Is direct surgical closure of a wound contaminated by multiresistant bacteria safe in immunocompromised patients?
Pignatti M;
2012
Abstract
Introduction/Purpose Critically ill, immunocompromised patients run a high risk of infection and dehiscence of surgical wounds, where bacterial growth may continue, even after prolonged antibiotic treatment. Because guidelines are not available, we aimed to investigate whether it is safe to close wounds growing multiresistant bacteria. Materials and Methods Immunocompromised patients with a dehiscent and infected abdominal wound were collected from November 2008 to November 2011. Immune deficiency was due to organ transplantation, renal failure, HIV, or multiorgan failure. Patients treated before March 2010, were treated with wound debridement and secondary intention healing. Patients presenting afterwards were treated with the following protocol: serial wound debridement, irrigation, and negative pressure dressing. Once wounds had a clinically acceptable appearance, they were primarily closed, despite positive microbiological cultures. Results 13 patients (mean age 56 years, 8 male) were included, 4 were left to heal by secondary intention, 9 were treated with the protocol mentioned above. 10 patients were transplanted (9 liver, 1 kidney), 1 HIV infected, 2 hemodialysed. All the patients had multiple systemic positive cultures. Wounds swabs and biopsies showed growth of multiresistant Acinetobacter Baumanii (6), enterococcus faecium (3), Staph aureus (2), E.coli (1), Klebsiella Pneumoniae (1) Healing was obtained in 3 of the 4 patients in the secondary intention healing group (mean healing time 81days, one death) and in all the patients of the treated group (mean 28 days). No local or systemic complications related to the wound closure arose (minimum follow-up 6 months). Conclusion Serial debridement, negative pressure dressing, and closure seem to lead to durable healing even in a population of critically ill, immunocompromised patients and in a shorter time than secondary intention healing. Closure of a clinically healthy wound, despite positive microbiological swabs, may be reasonable.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
