Wound culture isolated antibiograms and caregiver‐reported skin care practices in children with epidermolysis bullosa

Background/Objectives

Many patients with epidermolysis bullosa (EB) require intensive daily wound care and individualized treatment plans. Understanding patient's home skin care routines and emerging antibiotic resistance patterns in EB wounds is necessary to optimize treatment recommendations. The objective was to identify patterns of antimicrobial resistance in EB wounds and characterize patient's home practices of skin care and bathing.

Methods

This was an observational study of 23 children with EB at an outpatient pediatric dermatology practice in New York City from 2012 to 2014. Information on individual bathing and skin care practices and wound cultures was collected as part of routine examinations and an institutional review board–approved antibiogram protocol.

Results

Sixty wound cultures were collected from 23 patients. Eleven organisms were isolated, most commonly methicillin‐susceptible Staphylococcus aureus, methicillin‐resistant S. aureus, Streptococcus species, and Pseudomonas aeruginosa. Six patients (26%) were colonized with methicillin‐resistant S. aureus. Over the course of the study, 13 patients (56%) were found to have mupirocin‐resistant S. aureus. More than half of participants reported mupirocin or bacitracin use. Fewer than half indicated that they regularly used dilute bleach or dilute vinegar as part of their bathing routine.

Conclusion

Numerous organisms, including resistant bacteria, are known to colonize the wounds of individuals with EB. Mupirocin resistance was prevalent and more than half of the participants reported its use. Testing for mupirocin resistance may be considered for certain patients. These observations may help guide questions for future longitudinal multicenter studies with the goal of optimizing EB wound care recommendations.     

Facilitated wound healing using transparent film dressing following Mohs micrographic surgery

Fifty-eight patients participated in a controlled evaluation that compared a transparent film dressing (TFD [Bioclusive]) with a combination of conventional dry gauze dressing (Curity) and antibiotic ointment (Polysporin) in the treatment of fresh skin wounds following Mohs micrographic surgery. The TFD group showed a faster rate of wound contraction and reepithelialization and a shorter total healing time. The TFD was rated better with regard to comfort, ease of use, and ease of dressing removal. At six-month follow-up, the TFD group had scars that were softer, smoother, and showed less thickening and anatomic deformities. Better cosmetic appearance and greater patient acceptance were also noted with the TFD.     

Cadexomer-iodine ointment shows stimulation of epidermal regeneration in experimental full-thickness wounds

The use of iodine in wound healing is still controversial. Both wound healing-stimulating effects and toxic effects leading to impaired wound healing have been reported. In order to study the direct effects of iodine on wound healing without interference of infectious pathogens, we investigated wound-healing parameters in noninfected experimental full-thickness wounds in the pig. Topical iodine treatment with an ointment consisting of a combination of iodine and cadexomer (modified starch), was compared with cadexomer ointment, the vehicle without iodine, and with treatment with saline. Treatment lasted for 30 days, followed by 30 days of wound assessment. The rate of epithelialization, wound contraction, systemic iodine absorption and several immunohistochemical markers were evaluated. All 36 wounds healed without macroscopic signs of wound infection and reepithelialized within 21 days. During the first 9 days of treatment, wounds treated with cadexomer-iodine ointment showed significantly more epithelialization than the wounds treated with either cadexomer or saline. In addition, the epidermis of wounds treated with cadexomer-iodine ointment had significantly more epithelial cell layers from day 12 to day 30, and these wounds stained for chondroitin sulphate proteoglycans in the newly formed basement membrane zone, which was not observed with the other treatments. No negative effects of cadexomer- iodine ointment on the formation of granulation tissue, neovascularization or wound contraction were observed. During the treatment systemic iodine absorption was physiologically acceptable. These results showed that treatment with cadexomer-iodine-containing ointment had positive effects on epidermal regeneration during the healing of full-thickness wounds in the pig compared with ointment alone or saline treatment. Received: 14 April 1997     

Management of minor acute cutaneous wounds: importance of wound healing in a moist environment

Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds – which indeed are much more numerous than chronic wounds – is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose – although there is still a lack of data from systematic studies on the effectiveness of these preparations.     

Effect of silver-containing hydrofiber dressing on burn wound healing: A meta-analysis and systematic review

Background

Silver sulfadiazine is commonly used to treat local burn wounds. Aquacel-Ag is a hydrogen fiber dressing containing ionic silver that reduces burn wound infection and promotes antimicrobial activity. It is necessary to compare the efficacy of the two in the healing of burns.

Aims

The aim of this study was to systematically evaluate the effect of Aquacel-Ag on burn wound healing.

Methods

A computerized search of CNKI, VIP, Wanfang, SinoMed, PubMed, Cochrane Library, EMbase, Science Direct, Web of Science, Wiley Online Library, and Open Access Library databases was performed from January 1, 2000 to December 31, 2021 for randomized controlled clinical trials. The trials on Aquacel-Ag dressing and silver sulfadiazine in the treatment of burns were selected. Meta-analysis was performed using Review Manager 5.0 software.

Results

Eleven articles were finally included, with 794 burn patients. Meta-analysis results showed that compared with patients treated with silver sulfadiazine, burn patients treated with Aquacel-Ag dressing had shorter wound healing time [MD = −2.49, 95% CI (−5.64–0.65), p = 0.12], significantly lower tumor necrosis factor-α (TNF-α) level [MD = −0.52, 95% CI (−0.82–0.22), p = 0.0008], higher wound healing rate [MD = 8.41, 95% CI (3.39–13.43), p = 0.001], fewer dressing changes [MD = −3.27, 95% CI (−4.90–1.63), p < 0.0001].

Conclusion

Aquacel-Ag dressing can shorten wound healing time and effectively reduce inflammatory reactions in burn patients compared with silver sulfadiazine, but their safety still needs further exploration and analysis.     

Preparation and evaluation of an innovative antibacterial bi-layered composite dressing for skin wound healing

Aim of the studyThe aim of the current study was to develop collagen-based bi-layered composite dressings with antibacterial property and evaluate the efficiency for wound healing.Materials and methodsA bi-layered composite wound dressing was fabricated using two marine biomacromolecules (collagen and chitosan or carboxymethyl chitosan). Non-crosslinked and N-Ethyl-N'-(3-dimethylaminopropyl) carbodiimide/N-Hydroxy succinimide (EDC/NHS) cross-linked collagen sponges fabricated by vacuum freeze-drying technology was used as the inner layer. The medical spun-laced nonwoven coated with chitosan and carboxymethyl chitosan was used as the outer layer. The antibacterial activities against E. coli and S. aureus were evaluated by the inhibition zone assay. Deep second-degree scald model was performed to evaluate the efficiency of bi-layered composite dressings for wound healing.ResultsIn view of comprehensive evaluation of appearance and in vitro antibacterial activity, medical spun-laced nonwoven coated with 3% of chitosan solution was chosen to be used as the optimized preparation conditions to produce the outer layer of composite dressing, which acted as a barrier against microorganisms and provided mechanical support. Furthermore, the results of wound closure and histopathological analysis indicated that EDC/NHS cross-linked collagen-based bi-layered composite dressing was superior to non-crosslinked and commercial products, which stimulated the wound healing process and accomplished deep second-degree scalded skin healing within a time span of 28 days.ConclusionThe EDC/NHS cross-linked collagen-based bi-layered composite dressing had immense potential to be applied for an ideal wound dressing for more efficient and faster wound healing. Therefore, the findings provided the essential theoretical basis for great potential of collagen-based composite dressing used in wound healing applications.     

On the significance of negative‐pressure wound therapy with instillation in dermatology

Methods used in the treatment of acute and chronic wounds undergo constant evolution, reevaluation, and innovation. While negative‐pressure wound therapy (NPWT) is an established treatment modality, the combination of NPWT and instillation of normal saline as well as solutions with active antiseptic components for topical treatment of the wound bed represents a novel approach. The well‐known effects of NPWT may thus be combined with those of local antisepsis. They include a decrease in wound area, induction of granulation tissue, and reduction in bacterial colonization. To date, studies have focused on NPWT with instillation for orthopedic/surgical indications, whereas clinical data in dermatosurgery is limited to case reports or small case series. There are as yet no randomized prospective studies investigating NPWT with instillation in the treatment of skin disorders. The goal of this review is to present the method of NPWT with instillation, to highlight its mode of action as well as possible complications and contraindications, and to review the recent literature. In summary, there is increasing evidence that both simple and complicated wounds may be effectively treated with NPWT with instillation, resulting in markedly accelerated tissue granulation and thus earlier defect closure.     

Effects of TLC‐Ag dressings on skin inflammation

The TLC‐Ag dressings, a combination of technology lipido‐colloid and silver salts, are used to promote healing in wounds with risks or signs of local infection, thanks to the antimicrobial properties of the silver salts. Nanocrystalline silver dressings containing nanocrystalline silver, also used to improve wound healing, present both antimicrobial and anti‐inflammatory effects. The aim of this study was to investigate the anti‐inflammatory effects of TLC‐Ag dressings in a model of chronic skin inflammation induced by repeated application of 12‐O‐tetradecanoylphorbol‐13‐acetate to the skin of hairless mice, in comparison with TLC dressing, Silcryst nanocrystalline dressing, desonide cream 0.05%, a corticoid cream used as positive control, and gauze. Daily treatments of the mice began 7 days after the start of induction of chronic skin inflammation and lasted for 7 days. A macroscopic score was performed daily during the treatment period until the mice killing on day 15 and skin samples were taken for histopathological analysis. TLC‐Ag reduced significantly the macroscopic score of chronic skin inflammation from day 10 in comparison with gauze and TLC dressing, similarly to Silcryst nanocrystalline dressing and desonide cream, which presented the best anti‐inflammatory effects. No significant differences were observed between TLC dressing and gauze. TLC‐Ag reduced significantly the microscopic score of chronic skin inflammation in comparison with TLC dressing and gauze, similarly to Silcryst nanocrystalline dressing but significantly less than desonide cream. These results demonstrate that TLC‐Ag dressings present significant anti‐inflammatory effects on chronic skin inflammation. They can improve wound healing, due to both the antimicrobial and anti‐inflammatory properties.     

Non‐invasive assessment of healing of bacteria infected and uninfected wounds using optical coherence tomography

Background/purpose: Bacterial infection is one of the main predisposing factors for the delay in wound healing. To facilitate a timely decision for correct therapy, it is important to accurately monitor the morphological changes in the infected wounds using noninvasive tools. In the present study, we have explored the use of optical coherence tomography (OCT) for monitoring the healing of superficial wounds infected with Staphylococcus aureus in mice under in vitro and in vivo conditions and studied the changes in collagen birefringence in the infected wounds. Methods: The tape stripping method was used for generating superficial skin wounds in mice and wounds were infected with S. aureus. For in vitro studies, infected and uninfected wound tissues were resected, back scattered intensity and birefringence changes in collagen during wound healing were studied on the 2, 4 and 10th day of postinfection using polarization‐sensitive (PS) OCT and images were compared with histology. Real‐time OCT was used for studying the kinetics of healing of infected wounds under in vivo conditions. Results: From the PS‐OCT images, different phases of wound healing such as inflammation, reepithelialization and collagen remodeling could be identified. The edematic regions appeared prominent in infected wounds. Compared with uninfected wounds, reepithelization and collagen remodeling phases of wound healing were delayed significantly in the infected wounds. These changes were comparable with the different stages of wound healing observed under in vivo conditions. Conclusion: OCT imaging can provide a rapid assessment of the morphological changes associated with bacteria‐infected and uninfected wounds and thereby aid in timely treatment planning.     

Effect of ethanolic extract of Melia dubia leaves on full‐thickness cutaneous wounds in Wistar rats

In recent years, the therapeutic effects of phyto‐principles have been appreciated for their promising effects on wound healing. Melia dubia (Malabar neem) possesses anti‐cancer, anti‐diabetic, anti‐tumor, anti‐inflammatory, antioxidant, antibacterial, and fungicidal properties. Here, we studied the wound healing efficacy of ethanolic extract of M. dubia leaves on cutaneous wound healing for the first time. The ethanolic extract of M. dubia was applied topically on the wounds of the experimental rats until the wounds heal completely. Wounds of the control rats were treated with PBS. Granulation tissues formed on wound surfaces of the excision wound were harvested on days 4 and 8 and analyzed to determine the total collagen and hexosamine content. Total collagen and hexosamine were significantly (p < .001) higher in M. dubia treated rats compared to control. The rate of wound closure was significantly higher (p < .001) and period of epithelialization was shorter in M. dubia treated rats. Incision wound tissue was used for the tensile strength measurement. Tensile strength was improved in M. dubia treated wound tissues. Results concluded that the topical application of ethanolic extracts of M. dubia improved the rate of wound contraction and tensile strength by increased synthesis of collagen.     

Rapid,economical healing of two large Mohs surgery wounds with transforming powder dressing

As dermatology has evolved into a medical/surgical specialty, care for the patient with difficult postsurgical wounds has emerged as an aspect of practice for an increasing number of dermatologists. Here, we present a transforming powder dressing which yielded fast, cost‐effective healing of two such wounds, while also relieving the patient and his family of any wound care responsibility.     

新型弹力加压敷料较传统材料对体表创伤包扎效果研究

目的对比分析应用新型弹力加压敷料与传统材料包扎体表创伤的临床疗效。方法利用大、中、小三种型号的弹力加压敷料,用以包扎全身各部位体表伤口。同时与普通棉垫、绷带相对照,比较急救医护人员包扎操作所用的时间以及伤口包扎止血的效果。结果弹力加压敷料可完成普通棉垫、绷带所有的包扎任务,急救医护人员操作的时间明显短于使用普通棉垫、绷带,P〈0．05,伤口的止血效果与普通棉垫、绷带差异无统计学意义,P〉0．05。结论此弹力加压敷料可有效地、快速地、牢固地对全身各部位体表伤口进行包扎,易于操作,可在院外急救中发挥良好的包扎作用。     

Evaluation of a new povidone-iodine-impregnated polyethylene oxide gel occlusive dressing

Forty-five surgical wounds were closed by suture technic and then treated with either a polyethylene oxide gel (POG) dressing or a povidone-iodine-impregnated polyethylene oxide gel (PVPI-POG) dressing. In the control group with the POG dressing alone, three wound infections, representing 25% of those patients, were encountered. In the PVPI-POG dressing group no wound infections were encountered. Wound healing, in terms of reduced inflammation and faster epidermal approximation, appeared better in the PVPI-POG dressing group.     

Successful and safe use of 2 min cold atmospheric argon plasma in chronic wounds: results of a randomized controlled trial

Background The development of antibiotic resistance by microorganisms is an increasing problem in medicine. In chronic wounds, bacterial colonization is associated with impaired healing. Cold atmospheric plasma is an innovative promising tool to deal with these problems. Objectives The 5‐min argon plasma treatment has already demonstrated efficacy in reducing bacterial numbers in chronic infected wounds in vivo. In this study we investigated a 2‐min plasma treatment with the same device and the next‐generation device, to assess safety and reduction in bacterial load, regardless of the kind of bacteria and their resistance level in chronic wounds. Methods Twenty‐four patients with chronic infected wounds were treated in a prospective randomized controlled phase II study with 2 min of cold atmospheric argon plasma every day: 14 with MicroPlaSter alpha device, 10 with MicroPlaSter beta device (next‐generation device) in addition to standard wound care. The patient acted as his/her own control. Bacterial species were detected by standard bacterial swabs and bacterial load by semiquantitative count on nitrocellulose filters. The plasma settings were the same as in the previous phase II study in which wounds were exposed for 5 min to argon plasma. Results Analysis of 70 treatments in 14 patients with the MicroPlaSter alpha device revealed a significant (40%, P < 0·016) reduction in bacterial load in plasma‐treated wounds, regardless of the species of bacteria. Analysis of 137 treatments in 10 patients with the MicroPlaSter beta device showed a highly significant reduction (23·5%, P < 0·008) in bacterial load. No side‐effects occurred and the treatment was well tolerated. Conclusions A 2‐min treatment with either of two cold atmospheric argon plasma devices is a safe, painless and effective technique to decrease the bacterial load in chronic wounds.     

A rat model of polymicrobial infection in full-thickness excision wounds

AimA reproducible animal model is required to study the pathophysiology of wound infections and for development of effective therapeutic interventions. The objective of this study was to produce an infected skin wound model utilizing the cecal microbiota in non-immunocompromised rats.Materials and methodsAn excision wound was created on the dorsal surface of rats and inoculated with different concentration of cecal slurry (CS). Wound progression was investigated macroscopically by wound scoring and imaging. The rats were sacrificed on day 6 and microbial load, myeloperoxidase activity, histopathology, and scanning electron microscopy (SEM) were performed in wound tissue.ResultsInoculation of CS into excision wounds caused significantly (p < 0.05) delayed wound healing in comparison to non-infected wounds as revealed by slow wound closure (9.1 to 12.83%). A significant (p < 0.05) difference in wound score was observed between the infected and non-infected wounds. A significantly (p < 0.05) high microbial load (~10 ⁹ CFU/gm) was observed in infected wound which was supported by the presence of intensive bacterial colonization with sparse development of amorphous material on wound tissue during SEM analysis. A maximum increase of 1.76-fold in myeloperoxidase activity was observed in the infected wounds in comparison to non-infected wounds. Histopathology revealed increased amount of cellular infiltration, hematoma formation, and presence of bacterial aggregates in deep tissues.ConclusionThe study reports a reproducible and relevant clinical model of wound infection where cecal microbiota was used as a source of infection. This model can provide a suitable platform for evaluation of new therapeutic interventions.     

Novel antibiotic-eluting wound dressings: An in vitro study and engineering aspects in the dressing's design

Wound dressings aim to restore the milieu required for skin regeneration by protecting the wound from environmental threats, including penetration of bacteria, and by maintaining a moist healing environment. A wide variety of wound dressing products targeting various types of wounds and different aspects of the wound healing process are currently available on the market. Ideally, a dressing should be easy to apply and remove, and its design should meet both physical and mechanical requirements; namely water absorbance and transmission rate, handleability and strength. In this article, our novel biodegradable antibiotic-eluting wound dressings are described and the engineering aspects in the design are emphasized. These unique new wound dressings are based on a polyglyconate mesh, coated with a porous Poly(dl-lactic-co-glycolic acid) matrix. They demonstrated excellent mechanical and physical properties and desired release profiles of antibiotic drugs which enable bacterial inhibition. Hence, a new generation of wound dressings is now emerging with clear benefits. These include better protection against infection and reducing the need for frequent dressing changing.     

Mechanism of Oleogel‐S10: A triterpene preparation for the treatment of epidermolysis bullosa

Epidermolysis bullosa (EB) is a group of rare heterogeneous, genetic disorders. Currently, there is no effective pharmacological or genetic therapy for all EB subtypes. Dry extract from birch bark and betulin upregulate some pro‐inflammatory mediators and downregulate others. The increase in pro‐inflammatory cytokines is temporary and attenuated over long‐term treatment. This inflammatory stimulus is thought to be prerequisite for a secondary anti‐inflammatory response. Dry extract from birch bark and its active marker substances have also been shown to increase the migration of primary human keratinocytes, accelerate wound closure, and promote differentiation of keratinocytes in vitro and in vivo—processes that are essential for reepithelialization and maintenance of the skin barrier. Comprehensive clinical data are available to support the use of Oleogel‐S10 in the treatment of partial thickness wounds of different etiologies, and a proof‐of‐concept Phase 2 study in patients with dystrophic EB has suggested the potential for faster reepithelialization of wounds treated with Oleogel‐S10.     

Bone marrow cells differentiate into wound myofibroblasts and accelerate the healing of wounds with exposed bones when combined with an occlusive dressing

BACKGROUND: The usefulness of bone marrow cells in accelerating wound healing has not been evaluated despite increasing evidence that bone marrow contains mesenchymal stem cells that have multipotentiality to differentiate into various types of cells after they enter the microenvironment of a specific tissue (niche). OBJECTIVES: To determine the effects of bone marrow cells and occlusive dressings in promoting wound healing in rats. METHODS: We investigated by grafting, biopsy and immunohistochemistry whether various types of cells derived from green fluorescent protein (GFP)-transgenic rats would differentiate into wound component cells when administered topically on the wounds of rats. We also investigated whether topical application of bone marrow cells with an occlusive dressing would accelerate the healing of wounds with exposed bones, as measured by planimetry. RESULTS: GFP-labelled bone marrow cells contained multipotent stem cells that sufficiently differentiated into wound myofibroblasts presenting with alpha-smooth muscle actin in granulation tissue. Other types of cells, including myocytes, adipocytes, peripheral blood cells from buffy coat and dermal fibroblasts, did not express myofibroblast characteristics morphologically or immunohistochemically. Application of bone marrow cells and an occlusive dressing accelerated the repair of wounds with exposed bones, compared with an occlusive dressing only or with the topical administration of bone marrow cells plus a semidry to dry dressing. CONCLUSIONS: Our study indicates that bone marrow cells accelerate the healing of wounds at least in part through their differentiation into wound myofibroblasts. Thus, treatment of wounds with bone marrow cells and a supportive occlusive dressing is effective in promoting the formation of healthy granulation tissue and also for the preparation of an ideal wound bed.     

A first prospective randomized controlled trial to decrease bacterial load using cold atmospheric argon plasma on chronic wounds in patients

Background Bacterial colonization of chronic wounds slows healing. Cold atmospheric plasma has been shown in vitro to kill a wide range of pathogenic bacteria. Objectives To examine the safety and efficiency of cold atmospheric argon plasma to decrease bacterial load as a new medical treatment for chronic wounds. Patients and methods Thirty‐eight chronic infected wounds in 36 patients were treated in a prospective randomized controlled phase II study with 5 min daily cold atmospheric argon plasma in addition to standard wound care. The patient acted as his or her own control. Bacterial species were detected by standard bacterial swabs and semiquantitative changes by nitrocellulose filters. Plasma setting and safety had been determined in a preceding phase I study. Results Analysis of 291 treatments in 38 wounds found a highly significant (34%, P < 10^?6) reduction of bacterial load in treated wounds, regardless of the type of bacteria. No side‐effects occurred and the treatment was well tolerated. Conclusions Cold atmospheric argon plasma treatment is potentially a safe and painless new technique to decrease bacterial load of chronic wounds and promote healing.     

Wound Dressings: Selecting the Most Appropriate Type

Appropriate wound dressing selection is guided by an understanding of wound dressing properties and an ability to match the level of drainage and depth of a wound. Wounds should be assessed for necrosis and infection, which need to be addressed prior to selecting an ideal dressing. Moisture-retentive dressings include films, hydrogels, hydrocolloids, foams, alginates, and hydrofibers and are useful in a variety of clinical settings. Antimicrobial-impregnated dressings can be useful in wounds that are superficially infected or are at higher risk for infection. For refractory wounds that need more growth stimulation, tissue-engineered dressings have become a viable option in the past few decades, especially those that have been approved for burns, venous ulcers, and diabetic ulcers. As wounds heal, the ideal dressing type may change, depending on the amount of exudate and depth of the wound; thus success in wound dressing selection hinges on recognition of the changing healing environment.