Anastomotic false aneurysms with aortic Dacron graft after twenty-five years

One of the early diamond crimped knitted polyester (Dacron) grafts was surgically excised after implantation for 25 years in the aorto-billiac position because of false aneurysm formation at the three anastomotic sites. The sutures were no longer visible. While the areas around the false aneurysm were poorly incorporated, the graft limbs were well encapsulated with some endothelial-like cells on the luminal surface. The integrity of the graft was well preserved despite mild fraying and the disruption of one stitch.     

Comparative study of the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds

BackgroundChronic wounds are of many etiologies and difficult to treat. Many commercial products to manage such wounds are available, which claim to have good outcomes. Aim of this study was to compare the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds.MethodsPatients with chronic wounds were randomly placed in two groups-Group A (Ionic Silver Solution) and Group B (Super Oxidized Solution) with 30 patients each. The dressings were continued until the wound healed completely or the wound was ready for a definitive procedure. Wound parameters were recorded as per Bates Jensen Wound Assessment Tool (BJWAT) Score.ResultsFIfty patients completed the study. The scores were compared at the initiation and endpoint of treatment. The pretreatment total for BJWAT was 916 and 924 in group A and group B respectively, which was not statistically significant. Post-treatment improvement was noticed in both the groups and the score decreased to 510 and 675 in group A and group B respectively (p = 0.001). Ionic Silver Solution and Super Oxidized Solution both were found to be effective in improving the overall wound condition. However, Ionic Silver Solution was found to be more effective than Super Oxidized Solution in the healing of chronic wounds. Complete healing was noticed in a small number (6%) of patients. These agents can therefore best prepare the wounds for early surgical intervention.ConclusionBoth the agents were found to be safe and useful in the management of chronic wounds. However, Ionic Silver Solution was found to be more effective than the super oxidized solution in this study.     

三种细菌生物被膜中超广谱β-内酰胺酶的检测

目的检测肺炎克雷伯氏菌、大肠埃希氏菌、铜绿假单胞菌三种细菌的生物被膜(biofilm,BF)中超广谱β-内酰胺酶(Extended-spectrumβ-lactamases,ESBLs)的产生。方法用改良平板培养法在硅胶膜上建立肺炎克雷伯氏菌、大肠埃希氏菌、铜绿假单胞菌BF的体外模型。用银染法及扫描电镜对BF进行鉴定。用双纸片试验检测ESBLs,等电聚焦电泳测定β-内酰胺酶的等电点。结果三种细菌的各30株中,BF肺炎克雷伯氏菌组(A2组)中ESBLs的产生率最高(14株,46.7%),其浮游菌组(A1组)检出8株(26.7%);BF大肠埃希氏菌组(B2组)有10株(33.3%)产生ESBLs,其浮游菌组(B1组)检出6株(20.0%);BF铜绿假单胞菌组(C2组)有3株(10%)产ESBLs,其浮游组(C1组)为2株(6.7%)。浮游菌组中ESBLs的产生率低于BF菌组,其中肺炎克雷伯氏菌及大肠埃希氏菌的BF组和浮游菌组的检出率之间有显著差异(P<0.05)。A2组共检出14株产生ESBLs,有4种ESBLs,等电点分别为8.2(4株)、7.6(8株)、6.3(1株)和5.6(1株),A1组检出8株产生ESBLs,为3种ESBLs,等电点分别为8.2(2株)、7.6(5株)和5.6(1株);B2、B1组检出2种相同等电点分别为7.6(B1组4株,B2组6株)、8.2(B1组2株,B2组4株)的ESBLs;C1、C2组检出一种等电点为6.4的ESBLs(C1组2株,C2组3株)。以pI为7.6的β-内酰胺酶的检出率最高,其     

Gallstones Containing Bacteria are Biofilms: Bacterial Slime Production and Ability to Form Pigment Solids Determines Infection Severity and Bacteremia

Objective Gallstone bacteria provide a reservoir for biliary infections. Slime production facilitates adherence, whereas β-glucuronidase and phospholipase generate colonization surface. These factors facilitate gallstone formation, but their influence on infection severity is unknown. Methods Two hundred ninety-two patients were studied. Gallstones, bile, and blood (as applicable) were cultured. Bacteria were tested for β-glucuronidase/phospholipase production and quantitative slime production. Infection severity was correlated with bacterial factors. Results Bacteria were present in 43% of cases, 13% with bacteremia. Severe infections correlated directly with β-glucuronidase/phospholipase (55% with vs 13% without, P < 0.0001), but inversely with slime production (55 vs 8%, slime <75 or >75, P = 0.008). Low slime production and β-glucuronidase/phospholipase production were additive: Severe infections were present in 76% with both, but 10% with either or none (P < 0.0001). β-Glucuronidase/phospholipase production facilitated bactibilia (86% with vs 62% without, P = 0.03). Slime production was 19 (±8) vs 50 (±10) for bacteria that did or did not cause bacteremia (P = 0.004). No bacteria with slime >75 demonstrated bacteremia. Conclusions Bacteria-laden gallstones are biofilms whose characteristics influence illness severity. Factors creating colonization surface (β-glucuronidase/phospholipase) facilitated bacteremia and severe infections; but abundant slime production, while facilitating colonization, inhibited detachment and cholangiovenous reflux. This shows how properties of the gallstone biofilm determine the severity of the associated illness. Presented at the annual meeting of the Society for Surgery of the Alimentary Tract, held May 20–24, 2006 in Los Angeles, California.     

Anti-biofilm efficacy of a lactoferrin/xylitol wound hydrogel used in combination with silver wound dressings

With an epidemic increase in obesity combined with an ageing population, chronic wounds such as diabetic foot ulcers, pressure ulcers and venous leg ulcers are an increasing clinical concern. Recent studies have shown that bacterial biofilms are a major contributor to wound bioburden and interfere with the normal wound healing process; therefore, rational design of wound therapies should include analysis of anti‐biofilm characteristics. Studies using the combined treatment of bacterial biofilms with the innate immune molecule lactoferrin and the rare sugar‐alcohol xylitol have demonstrated an antimicrobial capacity against a clinical wound isolate. Studies presented here used a colony‐drip‐flow reactor biofilm model to assess the anti‐biofilm efficacy of a lactoferrin/xylitol hydrogel used in combination with commercially available silver‐based wound dressings. Log reductions in biofilm viability are compared with a commercially available wound hydrogel used in combination with the silver‐based wound dressings. For both a single species biofilm and a dual species biofilm, the lactoferrin/xylitol hydrogel in combination with the silver wound dressing Acticoat? had a statistically significant reduction in biofilm viability relative to the commercially available wound hydrogel. This study also demonstrated a statistical interaction between the lactoferrin/xylitol hydrogel and the silver wound dressing.     

Verlaufsformen und Mikrobiologie der bakteriellen Osteomyelitis

Zusammenfassung Wegen der vielfältigen klinischen Präsentation der Osteomyelitis werden diese Patienten von Ärzten verschiedenster Fachrichtungen gesehen. Verschiedene Klassifikationen spiegeln die Konzepte zur Diagnostik und Therapie der Osteomyelitis wider. Ursprünglich wurde die Osteomyelitis nur in eine akute und eine chronische eingeteilt. Die klassische Einteilung nach Waldvogel berücksichtigt die Pathogenese. Nach Wagner wird beim diabetischen Fuß der fließende Übergang von der Weichteilinfektion zur Osteomyelitis und zur Gangrän beschrieben. Die Einteilung nach Cierny-Mader nützt v. a. der Therapie durch den Traumatologen/Orthopäden. Das Erregerspektrum ist abhängig von Art der Osteomyelitis, geographischer Epidemiologie, Patientenalter, Komorbidität, mikrobiologischer Technik und Infektionsdauer. S. aureus spielt bei jeder Form die wichtigste Rolle. Bei Bildung von Biofilm und small-colony variants neigt der Keim zu Persistenz und Rezidiv. Die Antibiotikaresistenz nimmt seit 20 Jahren zu. Nicht nur die In-vitro-Resistenz, sondern auch die Wirkung der Antibiotika auf nichtwachsende und adhärierende Keime bei Implantatinfektionen sind wichtig. Zur optimalen Antibiotikatherapie sollte immer der Keimnachweis versucht werden.     

Clinical safety and effectiveness evaluation of a new antimicrobial wound dressing designed to manage exudate,infection and biofilm

The objective of this work was to evaluate the safety and effectiveness of a next‐generation antimicrobial wound dressing (NGAD; AQUACEL ^® Ag+ Extra™ dressing) designed to manage exudate, infection and biofilm. Clinicians were requested to evaluate the NGAD within their standard protocol of care for up to 4 weeks, or as long as deemed clinically appropriate, in challenging wounds that were considered to be impeded by suspected biofilm or infection. Baseline information and post‐evaluation dressing safety and effectiveness data were recorded using standardised evaluation forms. This data included wound exudate levels, wound bed appearance including suspected biofilm, wound progression, skin health and dressing usage. A total of 112 wounds from 111 patients were included in the evaluations, with a median duration of 12 months, and biofilm was suspected in over half of all wounds (54%). After the introduction of the NGAD, exudate levels had shifted from predominantly high or moderate to low or moderate levels, while biofilm suspicion fell from 54% to 27% of wounds. Wound bed coverage by tissue type was generally shifted from sloughy or suspected biofilm towards predominantly granulation tissue after the inclusion of the NGAD. Stagnant (65%) and deteriorating wounds (27%) were shifted to improved (65%) or healed wounds (13%), while skin health was also reported to have improved in 63% of wounds. High levels of clinician satisfaction with the dressing effectiveness and change frequency were accompanied by a low number of dressing‐related adverse events (n = 3; 2·7%) and other negative observations or comments. This clinical user evaluation supports the growing body of evidence that the anti‐biofilm technology in the NGAD results in a safe and effective dressing for the management of a variety of challenging wound types.     

铜绿假单胞菌QS系统对大鼠皮肤溃疡面生物被膜形成的影响

目的 对比野生型铜绿假单胞菌及LasI和RhlI突变株铜绿假单胞菌感染大鼠皮肤溃疡创面后生物被膜形成的差异,探讨铜绿假单胞菌LasI及Rhll基凶在活体生物被膜形成中的作用.方法 制备大鼠皮肤溃疡模型,共60个创面,分成3组,前两组分别接种导人绿色荧光蛋白(GFP)质粒的野牛型铜绿假单胞菌及LasI和RhlI突变株铜绿假单胞菌,另一组不接种细菌作为空白对照组.分别于术后1、3 7 10 d切取标本,每个标本分成两等份,分别进行细菌学检测和光学显微镜及荧光显微镜观察二组上皮化及生物被膜形成情况.结果 除了第7天外,在第1、3、10天感染了野牛型铜绿假单胞菌创而组织内细菌数多于LasI及RhlI缺陷组的细菌数.空白对照组细菌数则更少,且野生组上皮化较慢,生物被膜较厚.结论 活体内LasI及RhlI基因缺损的铜绿假单胞菌生物被膜形成能力及组织感染能力均低于野生株.