INTRODUCTION: It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group. PATIENTS AND METHODS: For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration. RESULTS: The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years. CONCLUSION: Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).
- MeSH
- Anti-Bacterial Agents * pharmacokinetics administration & dosage MeSH
- Exudates and Transudates metabolism microbiology MeSH
- Surgical Wound Infection * MeSH
- Cardiac Surgical Procedures * adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Aged MeSH
- Sternotomy * adverse effects MeSH
- Sternum surgery MeSH
- Negative-Pressure Wound Therapy * methods MeSH
- Vancomycin * administration & dosage pharmacokinetics MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- MeSH
- Gastroenteritis diagnosis etiology virology MeSH
- Central Nervous System Infections diagnosis etiology classification MeSH
- Respiratory Tract Infections diagnosis etiology classification MeSH
- Urinary Tract Infections diagnosis etiology classification MeSH
- Wound Infection diagnosis classification MeSH
- Pregnancy Complications, Infectious diagnosis etiology classification MeSH
- Communicable Diseases * diagnosis etiology classification microbiology MeSH
- Foodborne Diseases diagnosis etiology classification MeSH
- Blood-Borne Pathogens MeSH
- Publication type
- Review MeSH
BACKGROUND: Surgical site infection (SSI) is the most consistently reported complication of cranioplasty. No material showed a categorical superiority in the incidence of infection. Porous polyethylene (PE) is considered a low risk material regarding SSI. However, the literature data are very limited. Thus, our objective was to verify the assumed low incidence of SSI after PE cranioplasty in patients at high risk of SSI. The primary objective was the infection rate, while secondary objectives were implant exposure, revision and cosmetic results. METHOD: Patients who underwent three-dimensional (3D) personalized PE cranioplasty in the period 2014-2023 were evaluated prospectively. Only patients with an increased risk of SSI, and a satisfactory clinical conditions were included in the study. RESULTS: Thirty procedures were performed in 30 patients. Cranioplasty was performed 23 times after hemispheric decompressive craniectomy, five times after limited size craniotomy and two times after bifrontal decompressive craniectomy. Risk factors for the development of infection were 18 previous SSIs, 16 previous repeated revision surgeries, four intraoperatively opened frontal sinuses and two times radiotherapy. Neither infection nor implant exposure was detected in any patient. All patients were satisfied with the aesthetic result. In two cases, a revision was performed due to postoperative epidural hematoma. CONCLUSIONS: Three-dimensional personalized PE cranioplasty is associated with an extremely low incidence of SSI even in high-risk patients. However, our conclusions can only be confirmed in larger studies.
- MeSH
- Decompressive Craniectomy adverse effects methods MeSH
- Adult MeSH
- Surgical Wound Infection * epidemiology etiology MeSH
- Craniotomy adverse effects methods MeSH
- Skull surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Polyethylene MeSH
- Porosity MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Plastic Surgery Procedures * methods adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. Participants were divided into two groups: a control group (n=50), which received standard sterile gauze dressing with an iodine-based disinfectant, and an intervention group (n=50), treated with the ciNPWT system (Vivano® by HARTMANN) for 5 days postoperatively. The primary outcome was the incidence of SSI within one year after surgery. Secondary outcomes included the influence of factors such as age, sex, smoking status, and hernia size on SSI occurrence. The study was approved by the Ethics Committee at the University Hospital Ostrava, adhering to the ethical standards of the Helsinki Declaration. Results: The incidence of SSI was lower in the ciNPWT group compared to the standard care group (4% vs. 12%), though this difference did not reach statistical significance. No significant effect of sex or smoking status on SSI was observed. The control group had a shorter mean length of hospital stay. Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.
- MeSH
- Surgical Mesh * MeSH
- Adult MeSH
- Incidence MeSH
- Surgical Wound Infection * prevention & control epidemiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Herniorrhaphy * methods adverse effects MeSH
- Polypropylenes * MeSH
- Aged MeSH
- Negative-Pressure Wound Therapy * methods MeSH
- Hernia, Ventral * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Keywords
- abdominální katastrofa,
- MeSH
- Drainage methods MeSH
- Wound Healing * physiology MeSH
- Surgical Wound Infection surgery drug therapy complications MeSH
- Nutritional Support MeSH
- Bandages classification standards MeSH
- Critical Care MeSH
- Sepsis drug therapy complications physiopathology MeSH
- Negative-Pressure Wound Therapy MeSH
- Moving and Lifting Patients MeSH
- Publication type
- Review MeSH
Skin and soft tissue infections (SSTIs) represent a significant healthcare challenge, particularly in the context of increasing antibiotic resistance. This study investigates the efficacy of a novel therapeutic approach combining bacteriophage (phage) therapy with a gum Karaya (GK)-based hydrogel delivery system in a porcine model of deep staphylococcal SSTIs. The study exploits the lytic activity and safety of the Staphylococcus phage 812K1/420 of the Kayvirus genus, which is active against methicillin-resistant Staphylococcus aureus (MRSA). The GK injectable hydrogels and hydrogel films, developed by our research group, serve as effective, non-toxic, and easy-to-apply delivery systems, supporting moist wound healing and re-epithelialization. In the porcine model, the combined treatment showed asynergistic effect, leading to a significant reduction in bacterial load (2.5 log CFU/gram of tissue) within one week. Local signs of inflammation were significantly reduced by day 8, with clear evidence of re-epithelialization and wound contraction. Importantly, no adverse effects of the GK-based delivery system were observed throughout the study. The results highlight the potential of this innovative therapeutic approach to effectively treat deep staphylococcal SSTIs, providing a promising avenue for further research and clinical application in the field of infections caused by antibiotic-resistant bacteria.
- MeSH
- Phage Therapy * methods MeSH
- Wound Healing drug effects MeSH
- Hydrogels * administration & dosage chemistry MeSH
- Wound Infection * therapy microbiology drug therapy MeSH
- Methicillin-Resistant Staphylococcus aureus * drug effects MeSH
- Disease Models, Animal * MeSH
- Swine MeSH
- Plant Gums chemistry MeSH
- Staphylococcus Phages MeSH
- Staphylococcal Infections * therapy drug therapy MeSH
- Animals MeSH
- Check Tag
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Chronic Disease therapy MeSH
- Dermatologic Agents therapeutic use MeSH
- Wound Healing * MeSH
- Wound Infection therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Cat-Scratch Disease therapy MeSH
- Bandages MeSH
- Skin Care methods MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Leg Ulcer * therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Antimicrobial Peptides pharmacology therapeutic use MeSH
- Wound Infection * drug therapy MeSH
- Humans MeSH
- Burns * drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
Following the COVID-19 infection, the sternum dislocation and wound dehiscence resulted in an infection complicating the recovery of an immunosuppressed patient after bilateral lung transplantation. Anaerobic culture (96 h) of milky cloudy wound secretion resulted in the growth of pinpoint haemolytic colonies identified as Metamycoplasma hominis (formerly Mycoplasma hominis). The search for the endogenous source of the infection found the bacterium exclusively in the patient's sputum, making a possible link to donor lung M. hominis colonization. Unfortunately, the donor samples were no longer available. The wound infection was successfully treated with 17 days of clindamycin despite the continuous PCR detection of M. hominis in the sputum after the end of the treatment.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- COVID-19 diagnosis MeSH
- Immunocompromised Host MeSH
- Surgical Wound Infection * microbiology drug therapy diagnosis MeSH
- Clindamycin therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Mycoplasma hominis * genetics isolation & purification MeSH
- Mycoplasma Infections * microbiology diagnosis drug therapy MeSH
- SARS-CoV-2 genetics isolation & purification MeSH
- Sputum microbiology MeSH
- Lung Transplantation * adverse effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
