Wound infection in clinical practice update:2016

This update provides an opportunity to explore contemporary advances in wound infection knowledge and practice. Since 2008, scientific and clinical understanding of chronic wound infection has developed significantly. In particular, awareness of the presence and impact of wound biofilm has advanced enormously; however, understanding of its pathogenesis is yet to be clarified fully. A holistic approach to individuals with, or at risk of, active wound infection remains essential to best practice in prevention, identification and management of wound infection. This is of particular importance in the context of increasing antibiotic resistance. IWII Consensus_

This update is also available as a translation in Latin American Spanish:

IWII Consensus 2016_Web(ES)

Should prophylactic negative pressure wound therapy be used after Caesarean section?

Echebiri and colleagues have recently evaluated the economic benefit of prophylactic negative pressure wound therapy (NPWT) on a closed laparotomy incision after cesarean delivery in comparison with standard postoperative dressing. Their cost-benefit analysis suggests that negative pressure wound therapy should not be used on closed laparotomy incisions of patients with low risk of postcesarean delivery surgical site infections. However, among patients with a high risk of surgical site infections, prophylactic negative pressure wound therapy is potentially cost-beneficial.

To evaluate the economic benefit of prophylactic negative pressure wound therapy on a closed laparotomy incision after cesarean delivery in comparison with standard postoperative dressing.

METHODS: We designed a decision-analytic model from a third-party payer’s perspective to determine the cost-benefit of prophylactic application of negative pressure wound therapy compared with standard postoperative dressing on a closed laparotomy incision after cesarean delivery. Our primary outcome measure was the expected value of the cost per strategy. Baseline probabilities and cost assumptions were derived from published literature. We conducted sensitivity analyses using both deterministic and probabilistic models. Cost estimates reflect 2014 U.S. dollars.

RESULTS: Under our baseline parameters, standard postoperative dressing was the preferred strategy. Standard postoperative dressing and prophylactic negative pressure wound therapy cost $547 and $804 per strategy, respectively. Sensitivity analyses showed that prophylactic negative pressure wound therapy can be cost-beneficial if it is priced below $192; standard postoperative dressing is the preferred strategy among patients with surgical site infection rate of 14% or less. If surgical site infection rates are greater than 14%, prophylactic negative pressure wound therapy could be cost-beneficial depending on the degree of reduction in surgical site infections. At a surgical site infection rate of 30%, the rate must be reduced by 15% for negative pressure wound therapy to become the preferred strategy. Monte Carlo simulation of 1,000 patients in 1 million trials showed that standard postoperative dressing was the preferred cost-beneficial strategy with a frequency of 85%.

CONCLUSION: Our cost-benefit analysis provides economic evidence suggesting that negative pressure wound therapy should not be used on closed laparotomy incisions of patients with low risk of postcesarean delivery surgical site infections. However, among patients with a high risk of surgical site infections, prophylactic negative pressure wound therapy is potentially cost-beneficial.

Latest research from WOUNDS

In a article published in WOUNDS, December 2014, Gibson and colleagues sought to determine whether silver-containing dressings and medical-grade honey gel interfere with one another in measurable ways. The authors conclude that for the purposes of autolytic debridement, the evidence in this study suggest that silver dressings will not interfere with medical honey’s osmotic mechanism, and that the combination will still possess at least the same antimicrobial activity of a non-collagen silver dressing if used.

To download the article go to: http://bit.ly/1Ioqmlu

News updates July/August 2013

News updates for August 2013 have now been uploaded here , including:

  • An updated Cochrane review of adjunctive G-CSF in diabetic foot infections. Cruciani M et al. Cochrane Database Syst Rev. 2013.
  • ROSSINI study results, which demonstrated a baseline wound infection rate of 1:4. Pinkney TD et al. BMJ. 2013.
  • Plus papers on: Risk of MRSA SSI in patients with MRSA colonization (Kalra et al. 2013), and influence of DSWI on survival following cardiac surgery (Colombier , 2013), and more.

A report on the first Wound Infection summit which took place at Kings College Hospital, London on 20 March 2013 can be downloaded here.

The news update for July can be found here.

International Wound Infection Institute – 2012 wound care publication retrospective

A review of interesting publications in the field of wound infection in 2012

 

This 2012 retrospective reviews interesting articles published in the field of wound infection in 2012. Articles include:

  • The new update and review on the TIME (Tissue, Moisture, Infection/Inflammation, Edge of wound) approach to wound bed preparation produced by Professor David Leaper and colleagues.
  • Findings by Maddocks and colleagues at Cardiff Metropolitan University that manuka honey demonstrates bactericidal effects against Streptococcus pyogenes cultures, including biofilms.
  • Updated and new Cochrane reviews on the efficacy of water as a wound cleansing agent, antibiotic prophylaxis for postoperative wound infection, and pre-operative interventions for preventing infection – plus a review of 44 Cochrane Wounds and Peripheral Vascular Diseases Group reviews.
  • Clinical practice guidelines for the diagnosis and treatment of diabetic foot infections, released by the Infectious Diseases Society of America.

Are wound biofilms visible? An interesting controversy

Two letters published in the Journal of Wound Care discuss clinical practice in wound biofilm identification

 

A letter by Richard White (University of Worcester) and Keith Cutting (Perfectus Medical) published in the March 2012 issue of the Journal of Wound Care* stated that while the use of experimental models and circumstantial evidence has established the existence of wound biofilms, as yet there is no conclusive clinical/in vivo proof to support this. In particular, they observe that there is no evidence of visual biofilm identification which is supported by microscopic confirmation. They argue that clinical understanding of wounds and wound biofilms must be based on firm science.

In a response published in the April 2012 issue of the Journal of Wound Care*, Jennifer Hurlow (Plastic Surgery Group) argues that, with a trained eye and clinical experience, wound biofilms can likely be differentiated from slough without the need for in vitro validation. She notes that an increasing number of practices and studies are using clinical cues to identify biofilm presence, and points out that awaiting microscopic confirmation of biofilm presence before taking appropriate action might not be in the best interests of the patient.

*Letters reproduced with permission of the Journal of Wound Care: www.journalofwoundcare.com.