RESUMEN
OBJECTIVE: Chronic wounds are costly and difficult to treat, resulting in morbidity and even mortality in some cases due to a high methicillin-resistant Staphylococcus aureus (MRSA) burden contributing to chronicity. We aimed to observe the antimicrobial activity and healing-promoting effect of a novel photosensitizer Shengtaibufen (STBF)-mediated antibacterial photodynamic therapy (PDT) on MRSA-infected chronic leg ulcers. PATIENTS AND METHODS: This was a retrospective, comparative, single-center clinical study. A total of 32 patients with chronic lower limb wounds infected with MRSA from January 2022 to December 2023 were finally included in this study by searching the electronic medical records of the dermatology department of Huadong Hospital, including a group of red light combined with iodophor (control+iodophor, n=16, receiving red light once a week for 8 weeks and routine dressing change with iodophor once a day) and a group of STBF-mediated PDT (STBF-PDT) combined with iodophor (STBF-PDT+iodophor, n=16, receiving STBF-PDT and routine dressing change with iodophor once a day). STBF-PDT was performed once a week (1 mg/ml STBF, 1 h incubation, 630 nm red light, 80 J/cm2) for 8 weeks. The primary endpoints included wound clinical signs, wound size, wound-related pain, re-epithelialization score, MRSA load and wound-related quality of life (wound-QoL). Any adverse events were also recorded. RESULTS: We found that STBF-PDT+iodophor could effectively alleviate clinical infection symptoms, accelerate wound closure, reduce average biological burden and improve wound-QoL without severe adverse events in comparison to the control+iodophor group. The STBF-PDT+iodophor group obtained a mean percentage reduction of 65.22% in wound size (from 18.96±11.18 cm2 to 6.59±7.94 cm2) and excellent re-epithelialization scores, as compared with a decrease of 30.17% (from 19.23±9.80 cm2 to 13.43±9.32 cm2) for the control+iodophor group. Significant differences in wound area were observed at week 6 (p=0.028*) and week 8 (p=0.002**). The bacterial load decreased by 99.86% (from 6.45 × 107±2.69 × 107 to 8.94 × 104±1.92 × 105 CFU/cm2, p<0.0001) in the STBF-PDT+iodophor group and 1.82% (from 6.61 × 107±2.13 × 107 to 6.49 × 107±2.01 × 107 CFU/cm2, p=0.029) in the control+iodophor group. The wound-QoL in STBF-PDT+iodophor group had a 51.62% decrease in overall score (from 29.65±9.33 at the initial to 14.34±5.17 at week 8, p<0.0001) compared to those receiving red light and routine wound care (from 30.73±17.16 to 29.32±15.89 at week 8, p=0.003). Moreover, patients undergoing STBF-PDT+iodophor exhibited great improvements in all domains of wound-QoL (physical, psychological and everyday-life), whereas the control+iodophor group ameliorated in only one field (everyday-life). CONCLUSION: Our data confirmed that a novel photosensitizer, STBF-mediated PDT, when combined with iodophor, served as a potential modality for MRSA infection and a possible therapy for other drug-resistant microorganisms, and as a promising alternative for chronic cutaneous infectious diseases.
Asunto(s)
Yodóforos , Staphylococcus aureus Resistente a Meticilina , Fotoquimioterapia , Fármacos Fotosensibilizantes , Humanos , Fotoquimioterapia/métodos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Estudios Retrospectivos , Fármacos Fotosensibilizantes/farmacología , Fármacos Fotosensibilizantes/uso terapéutico , Masculino , Femenino , Anciano , Persona de Mediana Edad , Yodóforos/farmacología , Úlcera de la Pierna/tratamiento farmacológico , Úlcera de la Pierna/microbiología , Cicatrización de Heridas/efectos de los fármacos , Enfermedad Crónica , Infecciones Estafilocócicas/tratamiento farmacológico , Medicamentos Herbarios Chinos/farmacología , Medicamentos Herbarios Chinos/uso terapéutico , Anciano de 80 o más Años , Porfirinas/farmacología , Porfirinas/uso terapéuticoRESUMEN
OBJECTIVE: The aim was to evaluate the effectiveness of a marine omega fatty acid-containing multimodal wound matrix (MWM) in reducing bacterial contamination and supporting wound area reduction (WAR) in patients with hard-to-heal wounds of varying aetiologies. METHOD: A prospective, single-site, pilot case series of patients with hard-to-heal wounds. All wounds were considered non-healing prior to inclusion as they had failed to achieve at least 50% WAR after at least four weeks of standard of care (SoC) treatments. Patients were seen once weekly for wound assessments, matrix application and dressing changes. Baseline and weekly fluorescence images, standard wound images and wound measurements were obtained. RESULTS: A total of three patients, two with venous leg ulcers (VLUs) and one with a diabetic foot ulcer (DFU) were enrolled in this pilot study. The mean baseline wound age prior to study enrolment was 24 weeks, with a mean baseline wound size of 8.61cm2. The two VLUs went on to complete closure. The DFU displayed a total WAR of 53% by six weeks, when the patient was lost to follow-up due to a geographical relocation. The mean percentage area reduction of all wounds combined was 82% upon study completion. CONCLUSION: The use of MWM proved to be effective and safe in this patient cohort. The wounds included in this case series failed to enter a healing trajectory with SoC wound therapies. The MWM supported wound closure and reduced bacterial loads in this patient cohort.
Asunto(s)
Pie Diabético , Úlcera Varicosa , Cicatrización de Heridas , Humanos , Proyectos Piloto , Masculino , Femenino , Pie Diabético/terapia , Pie Diabético/microbiología , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Úlcera Varicosa/terapia , Úlcera Varicosa/microbiología , Úlcera de la Pierna/microbiología , Úlcera de la Pierna/terapia , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/microbiología , Anciano de 80 o más Años , Resultado del TratamientoRESUMEN
Primary cutaneous mucormycosis is caused by environmental fungi and may complicate leg ulcers or traumatic wounds even in immunocompetent individuals. This case report highlights recurrent lower limb ulcers and cellulitis in a patient with type two diabetes mellitus, which was unresponsive to conventional antibiotic treatment. Histopathology revealed the diagnosis of cutaneous mucormycosis, and fungal cultures identified Rhizopus variabilis as the causative organism. Initial courses of oral azole antifungals yielded only partial response and he eventually required more aggressive treatment with i.v. amphotericin B and oral posaconazole. Good treatment outcomes for this condition require a high index of clinical suspicion, early histopathological and microbiological diagnosis, targeted systemic antifungal therapy, and surgical debridement if necessary.
Asunto(s)
Antifúngicos , Celulitis (Flemón) , Dermatomicosis , Diabetes Mellitus Tipo 2 , Úlcera de la Pierna , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Mucormicosis/complicaciones , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Masculino , Diabetes Mellitus Tipo 2/complicaciones , Antifúngicos/uso terapéutico , Úlcera de la Pierna/microbiología , Dermatomicosis/diagnóstico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/patología , Rhizomucor/aislamiento & purificación , Anfotericina B/uso terapéutico , Recurrencia , Persona de Mediana Edad , Triazoles/uso terapéutico , Rhizopus/aislamiento & purificaciónRESUMEN
BACKGROUND: Chronic leg ulcers are hard to treat and can be a burden, particularly in resource-limited settings where diagnosis is a challenge. Staphylococcus aureus is among the common bacteria isolated from chronic wounds with a great impact on wound healing, particularly in patients with co-morbidities. Antimicrobial resistance genes and virulence factors in Staphylococcus aureus isolates were assessed to support healthcare professionals to make better therapeutic choices, and importantly to curb the development and spread of antibiotic resistance. METHODS: A cross-sectional study involved both inpatients and outpatients with chronic leg ulcers was conducted from August 2022 to April 2023 in 2 health facilities in Kilimanjaro region in Tanzania. Antimicrobial susceptibility testing was done using the disk diffusion method. Further, whole genome sequencing was performed to study the genotypic characteristics of the isolates. RESULTS: A total of 92 participants were recruited in which 9 participants were only positive for 10 Staphylococcus aureus isolates upon culture. Five STs among 9 isolates were identified. Most of them belonged to ST8 (44%), with 1 isolate does not belong to any ST. Additionally, 50% of the isolates were methicillin-resistant Staphylococcus aureus (MRSA). All S. aureus isolates had almost similar virulence factors such as hemolysin, proteases and evasions that promote toxin production, protease production and host immune evasion respectively. Moreover, all mecA positive S. aureus isolates were phenotypically susceptible to cefoxitin. CONCLUSION: Presence of mecA positive S. aureus isolates which are also phenotypically susceptible to cefoxitin implies the possibility of classifying MRSA as MSSA. This may result in the possible emergence of highly cefoxitin - resistant strains in health care and community settings when subsequently exposed to beta-lactam agents. Therefore, combination of whole genome sequencing and conventional methods is important in assessing bacterial resistance and virulence to improve management of patients.
Asunto(s)
Antibacterianos , Úlcera de la Pierna , Infecciones Estafilocócicas , Staphylococcus aureus , Factores de Virulencia , Secuenciación Completa del Genoma , Humanos , Tanzanía , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/genética , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/patogenicidad , Antibacterianos/farmacología , Masculino , Femenino , Virulencia/genética , Factores de Virulencia/genética , Úlcera de la Pierna/microbiología , Persona de Mediana Edad , Estudios Transversales , Adulto , Farmacorresistencia Bacteriana/genética , Pruebas de Sensibilidad Microbiana , Enfermedad Crónica , Anciano , Genoma BacterianoRESUMEN
INTRODUCTION: Kodamaea ohmeri is an emerging fungus recognised as an important pathogen in immunocompromised hosts, responsible for life-threatening infections. CASE PRESENTATION: We describe a case of a 69-year-old immunocompetent man with a long history of leg skin ulcers infected by K. ohmeri. This is the first case of leg wounds infected by K. ohmeri in an immunocompetent patient. The infection was successfully treated with voriconazole 200 mg daily. CONCLUSION: Though rare, K. ohmeri should be considered in patients with skin ulcers that are poorly responsive to medical treatment, even if not immunocompromised.
Asunto(s)
Antifúngicos , Úlcera de la Pierna , Voriconazol , Humanos , Anciano , Masculino , Antifúngicos/uso terapéutico , Voriconazol/uso terapéutico , Úlcera de la Pierna/tratamiento farmacológico , Úlcera de la Pierna/microbiología , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/patología , Inmunocompetencia , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/microbiología , Úlcera Cutánea/patología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/etiologíaRESUMEN
Introducción: Las úlceras en las piernas son llagas sin sanar o lesiones abiertas de etiología multifactorial. Constituyen una patología importante en la práctica diaria de los profesionales de la salud en todos los niveles de asistencia. Objetivo: Presentar un caso infrecuente con una afección genética hereditaria familiar que provocó lesiones ulcerosas en las extremidades inferiores. Presentación del caso: Paciente masculino de 30 años con lesiones ulcerosas en ambos miembros inferiores, de 18 años de años de evolución, muy dolorosas con signos de infección local severa. Presentó diagnóstico de úlceras inespecíficas en ambos miembros inferiores. Fue ingresado con toma de su estado general, gran limitación de la deambulación, dolor intenso en ambas piernas, lesiones abundantes ulcerosas sucias diseminadas en ambas piernas, de fondo amarillento, con secreción amarilla clara, muy fétida. Se realizó estudio clínico, humoral, imagenológico, microbiológico y anátomo-histopatológico. Conclusiones: Se diagnostica síndrome de úlceras en piernas de carácter familiar y comienzo precoz, de herencia recesiva ligada al cromosoma X. Se requieren estudios a mayor escala para evaluar las contribuciones de los factores genéticos en la génesis de esta enfermedad, los cuales podrían ser la clave para comprender mejor su desarrollo(AU)
Introduction: Leg ulcers are unhealed sores or open lesions of multifactorial etiology. They constitute an important pathology in the daily practice of health professionals at all levels of care. Objective: To report an infrequent case with a familial hereditary genetic condition that caused ulcerative lesions in the lower limbs. Case report: We report the case of a 30-year-old male patient with ulcerative lesions on both lower limbs, 18 years of evolution, very painful with signs of severe local infection. He had diagnosis of nonspecific ulcers in both lower limbs. He was admitted with poor general condition, great limitation of ambulation, intense pain in both legs, abundant dirty yellowish ulcerative lesions scattered on both legs, and light yellow, very foul-smelling discharge. A clinical, humoral, imaging, microbiological and anatomical-histopathological study was performed. Conclusions: The diagnosis was familial leg ulcer syndrome of early onset, recessive inheritance linked to the X chromosome, is diagnosed. Larger scale studies are required to assess the contributions of genetic factors in the genesis of this disease, which could be the key to better understand its development(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/genética , Úlcera de la Pierna/microbiología , Úlcera de la Pierna/tratamiento farmacológicoRESUMEN
Objective: High bacterial load contributes to chronicity of wounds and is diagnosed based on assessment of clinical signs and symptoms (CSS) of infection, but these characteristics are poor predictors of bacterial burden. Point-of-care fluorescence imaging (FL) MolecuLight i:X can improve identification of wounds with high bacterial burden (>104 colony-forming unit [CFU]/g). FL detects bacteria, whether planktonic or in biofilm, but does not distinguish between the two. In this study, diagnostic accuracy of FL was compared to CSS during routine wound assessment. Postassessment, clinicians were surveyed to assess impact of FL on treatment plan. Approach: A prospective multicenter controlled study was conducted by 20 study clinicians from 14 outpatient advanced wound care centers across the United States. Wounds underwent assessment for CSS followed by FL. Biopsies were collected to confirm total bacterial load. Three hundred fifty patients completed the study (138 diabetic foot ulcers, 106 venous leg ulcers, 60 surgical sites, 22 pressure ulcers, and 24 others). Results: Around 287/350 wounds (82%) had bacterial loads >104 CFU/g, and CSS missed detection of 85% of these wounds. FL significantly increased detection of bacteria (>104 CFU/g) by fourfold, and this was consistent across wound types (p < 0.001). Specificity of CSS+FL remained comparably high to CSS (p = 1.0). FL information modified treatment plans (69% of wounds), influenced wound bed preparation (85%), and improved overall patient care (90%) as reported by study clinicians. Innovation: This novel noncontact, handheld FL device provides immediate, objective information on presence, location, and load of bacteria at point of care. Conclusion: Use of FL facilitates adherence to clinical guidelines recommending prompt detection and removal of bacterial burden to reduce wound infection and facilitate healing.
Asunto(s)
Carga Bacteriana/métodos , Pie Diabético/diagnóstico por imagen , Úlcera de la Pierna/diagnóstico por imagen , Imagen Óptica/métodos , Úlcera por Presión/diagnóstico por imagen , Infección de la Herida Quirúrgica/diagnóstico por imagen , Infección de Heridas/diagnóstico por imagen , Anciano , Estudios Transversales , Pie Diabético/microbiología , Femenino , Humanos , Úlcera de la Pierna/microbiología , Masculino , Persona de Mediana Edad , Pruebas en el Punto de Atención , Úlcera por Presión/microbiología , Estudios Prospectivos , Método Simple Ciego , Infección de la Herida Quirúrgica/microbiología , Estados Unidos , Infección de Heridas/diagnósticoRESUMEN
BACKGROUND: Curvularia is a filamentous dematiaceous fungus increasingly recognized as a pathogen in immunocompromised patients. The most common clinical entities associated with this fungus are allergic sinusitis, cutaneous infection and keratitis. In this article, a report on the first clinical case of Curvularia pallescens cutaneous infection in Spain and its treatment is described. CASE REPORT: A 68 year-old man with a history of lung transplantation presented to Dermatology Unit due to a skin lesion in the knee that had been evolving for 6 months. A skin biopsy was performed for its study. In the histopathological study, an intense and non-specific inflammatory reaction in the dermis was observed, and with Grocott stain and periodic acid Schiff abundant septate hyphae and spores were found in the dermis. The culture of the sample revealed a filamentous fungus whose microscopic examination allowed to identify the genus as Curvularia. Using MALDI-TOF mass spectrometry and molecular identification, the fungus was finally identified as Curvularia pallescens. The patient underwent surgical resection of the lesion and was treated with posaconazole, evolving favorably. CONCLUSIONS: The species of Curvularia should be considered causal agents of fungal skin infections in immunosuppressed patients. This clinical case, which showed good clinical response after surgical resection and treatment with posaconazole, is the first described in Spain due to this species.
Asunto(s)
Ascomicetos/aislamiento & purificación , Dermatomicosis/microbiología , Trasplante de Pulmón , Complicaciones Posoperatorias/microbiología , Anciano , Antifúngicos/uso terapéutico , Biopsia , Terapia Combinada , Desbridamiento , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/etiología , Dermatomicosis/cirugía , Humanos , Huésped Inmunocomprometido , Úlcera de la Pierna/tratamiento farmacológico , Úlcera de la Pierna/etiología , Úlcera de la Pierna/microbiología , Úlcera de la Pierna/cirugía , Masculino , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , España/epidemiología , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Triazoles/uso terapéuticoRESUMEN
Fungal infections due to Fusarium species are mostly present in immunocompromised and patients with poorly controlled diabetes mellitus. We report a case of lower extremity skin infection caused by Fusarium species in a 61-year-old woman diagnosed with sickle cell disease. Single skin ulceration caused by Fusarium species can result from fungal inoculation into damaged tissue, so any condition that damages the skin can be considered as a risk factor for inoculation. Long-standing sickle cell disease may develop vaso-occlusion in the skin that can produce lower extremity ulcers and myofascial syndromes. The mechanism is not completely characterized, but compromised blood flow, endothelial dysfunction, thrombosis, inflammation, and delayed healing are thought to contribute to locally compromised tissue that may eventually lead to opportunistic infection such as in our case. Other factors contribute to the pathophysiology of lower extremity ulcers such as diabetes mellitus, with the resulting peripheral vascular ischemia causing poor circulation to the lower extremity, and peripheral neuropathy, which can make patients with diabetes unaware of minor trauma leading to the development of skin infections.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Celulitis (Flemón)/microbiología , Fusarium/aislamiento & purificación , Úlcera de la Pierna/microbiología , Anemia de Células Falciformes/fisiopatología , Femenino , Humanos , Inmunocompetencia , Persona de Mediana Edad , Micosis/microbiologíaAsunto(s)
Úlcera de la Pierna/microbiología , Imagen Óptica/instrumentación , Infecciones por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/metabolismo , Rayos Ultravioleta , Anciano , Proteínas Bacterianas/análisis , Humanos , Úlcera de la Pierna/metabolismo , Masculino , Oligopéptidos/análisis , Infecciones por Pseudomonas/metabolismo , Pseudomonas aeruginosa/aislamiento & purificación , Sideróforos/análisisRESUMEN
The antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardised conditions according to DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, these testing conditions do not adequately simulate the wound bed environment. Thus, the aim of this study was to compare the efficacy of different antiseptics such as octenidine dihydrochloride (OCT), chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHMB), and povidone-iodine under challenge with human wound exudate instead of standardised organic load in an in vitro setting according to DIN EN 13727. Moreover, protein contents, pH, and temperature were compared with standardised testing conditions. The tested antiseptic agents were reduced to different extents based on their bactericidal efficacy, when challenged with human wound exudate compared with standardised conditions. Overall, 0.10% OCT showed the highest effects reaching full efficacy after 30 seconds. CHX and PHMB were the least efficient. Next to the protein content, other components of wound exudate, such as the microflora, seem to influence the efficacy of antiseptics. In summary, the optimisation of in vitro testing conditions in future applications, to more adequately simulate the wound bed environment, will allow a more realistic picture on the potential performance of antiseptics in clinical practice.
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Antiinfecciosos/farmacología , Exudados y Transudados/efectos de los fármacos , Exudados y Transudados/microbiología , Úlcera de la Pierna/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Biguanidas/farmacología , Clorhexidina/análogos & derivados , Clorhexidina/farmacología , Femenino , Humanos , Iminas , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Povidona Yodada/farmacología , Piridinas/farmacología , Técnicas de Cultivo de TejidosAsunto(s)
Úlcera de la Pierna , Anciano , Calcinosis/complicaciones , Calcinosis/cirugía , Femenino , Humanos , Úlcera de la Pierna/complicaciones , Úlcera de la Pierna/microbiología , Úlcera de la Pierna/cirugía , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/cirugía , Staphylococcus aureusRESUMEN
Chronically infected diabetic wounds have a polymicrobial aetiology. However, Salmonella Paratyphi A is a very rare cause of wound infection. A 76-year-old female patient with type II diabetes presented with a wound on the left leg of two months' duration. The wound was painful, erythematous and a thick, foul-smelling discharge was present. There was a history of delayed wound healing. Salmonella Paratyphi A and Pseudomonas aeruginosa were isolated from the wound tissue. The patient was treated with cefuroxime and cloxacillin empirically and following the antibiotic susceptibility testing (ABST) report, ciprofloxacin was given for 10 days. The wound was treated with multiple debridements and topical antiseptic. On follow-up, the patient remained afebrile with subsiding discharge from the ulcer. This is the first reported case of Salmonella Paratyphi A from an infected diabetic ulcer in Sri Lanka and it serves to further define the spectrum of illnesses caused by this uncommon pathogen.
Asunto(s)
Antibacterianos/administración & dosificación , Ciprofloxacina/administración & dosificación , Diabetes Mellitus Tipo 2/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Úlcera de la Pierna/microbiología , Salmonella paratyphi A/aislamiento & purificación , Anciano , Antiinfecciosos Locales/administración & dosificación , Cefuroxima/administración & dosificación , Cloxacilina/administración & dosificación , Desbridamiento , Femenino , Infecciones por Bacterias Gramnegativas/etiología , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Úlcera de la Pierna/etiología , Úlcera de la Pierna/fisiopatología , Pruebas de Sensibilidad Microbiana , Fiebre Paratifoidea/tratamiento farmacológico , Fiebre Paratifoidea/etiología , Fiebre Paratifoidea/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/etiología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Salmonella paratyphi A/efectos de los fármacos , Cicatrización de HeridasRESUMEN
OBJECTIVES: Unyvero i60 ITI multiplex PCR (mPCR) may identify a large panel of bacteria and antibiotic resistance genes. In this study, we compared results obtained by mPCR to standard bacteriology in chronic leg ulcer (CLU) infections. METHODS: A prospective study, part of the interventional-blinded randomized study "ulcerinfecte" (NCT02889926), was conducted at Saint Joseph Hospital in Paris. Fifty patients with a suspicion of infected CLU were included between February 2017 and September 2018. Conventional bacteriology and mPCR were performed simultaneously on deep skin biopsies. RESULTS: Staphylococcus aureus and Pseudomonas aeruginosa were the most detected pathogens. Regarding the global sensitivity, mPCR is not overcome to the standard culture. Anaerobes and slow growing bacteria were detected with a higher sensitivity rate by mPCR than standard culture. CONCLUSION: Unyvero i60 ITI multiplex PCR detected rapidly pathogenic bacteria in infected CLU especially anaerobes and slow growing bacteria and was particularly effective for patients previously treated with antibiotics.
Asunto(s)
Bacterias/aislamiento & purificación , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/microbiología , Reacción en Cadena de la Polimerasa Multiplex/métodos , Anaerobiosis , Bacterias/clasificación , Bacterias/patogenicidad , Farmacorresistencia Bacteriana Múltiple/genética , Femenino , Humanos , Masculino , Reacción en Cadena de la Polimerasa Multiplex/instrumentación , Paris , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/diagnóstico , Sensibilidad y EspecificidadRESUMEN
Presentamos el caso de un varón de 76 años, con antecedentes de hipertensión arterial (HTA), enfermedad pulmonar obstructiva crónica (EPOC), dislipemia, insuficiencia cardiaca, taquicardia paroxística supraventricular y septoplastia, con úlcera dolorosa en cara posterior de la pierna izquierda de dos semanas de evolución, sin clínica previa de claudicación ni pulsos distales en extremidades inferiores (EEII). Se descartaron úlceras mediante anamnesis, claudicometría, arteriografía y biopsia. Se diagnosticó de déficit mixto de inmunoglobulinas e infección sistémica por Aspergillus. Se estableció tratamiento con itraconazol e inmunoglobulinas y mejoró el estado general y de la úlcera
We present the case of a 76-year-old man, with a history of arterial hypertension (AHT), chronic obstructive pulmonary disease (COPD), dyslipidemia, heart failure, supraventricular paroxysmal tachycardia, septoplasty, with a painful ulcer on the left leg (two weeks of evolution), no previous clinical manifestation of claudication and no distal pulses in lower extremities. Ulcers were ruled out by anamnesis, claudicometry, arteriography and biopsy. Then, a mixed immunoglobulin deficit was diagnosed with a systemic infection by Aspergillus. Treatment with itraconazole andm immunoglobulins was established, improving the general condition and the ulcer
Asunto(s)
Humanos , Masculino , Anciano , Itraconazol/uso terapéutico , Antifúngicos/uso terapéutico , Inmunoglobulinas Intravenosas , Aspergilosis/diagnóstico , Aspergilosis/tratamiento farmacológico , Úlcera de la Pierna/tratamiento farmacológico , Úlcera de la Pierna/microbiologíaRESUMEN
OBJECTIVE: Clinical evaluation of signs and symptoms (CSS) of infection is imperative to the diagnostic process. However, patients with heavily colonised and infected wounds are often asymptomatic, leading to poor diagnostic accuracy. Point-of-care fluorescence imaging rapidly provides information on the presence and location of bacteria. This clinical trial (#NCT03540004) aimed to evaluate diagnostic accuracy when bacterial fluorescence imaging was used in combination with CSS for identifying wounds with moderate-to-heavy bacterial loads. METHODS: Wounds were assessed by study clinicians using NERDS and STONEES CSS criteria to determine the presence or absence of moderate-to-heavy bacterial loads, after which the clinician prescribed and reported a detailed treatment plan. Only then were fluorescence images of the wound acquired, bacterial fluorescence determined to be present or absent and treatment plan adjusted if necessary. RESULTS: We examined 17 VLUs/2 DFUs. Compared with CSS alone, use of bacterial fluorescence imaging in combination with CSS significantly improved sensitivity (22% versus 72%) and accuracy (26% versus 74%) for identifying wounds with moderate-to-heavy bacterial loads (≥104 CFU/g, p=0.002). Clinicians reported added value of fluorescence images in >90% of study wounds, including identification of wounds incorrectly diagnosed by CSS (47% of study wounds) and treatment plan modifications guided by fluorescence (73% of study wounds). Modifications included image-guided cleaning, treatment selection, debridement and antimicrobial stewardship. CONCLUSION: Findings from this pilot study suggest that when used in combination with CSS, bacterial fluorescence may: (1) improve the diagnostic accuracy of identifying patients with wounds containing moderate-to-heavy bacterial loads and (2) guide more timely and appropriate treatment decisions at the point-of-care.
Asunto(s)
Carga Bacteriana/métodos , Pie Diabético/diagnóstico por imagen , Imagen Óptica/métodos , Úlcera Varicosa/diagnóstico por imagen , Infección de Heridas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas , ADN Bacteriano/análisis , ADN Ribosómico/análisis , Pie Diabético/microbiología , Femenino , Humanos , Úlcera de la Pierna/diagnóstico por imagen , Úlcera de la Pierna/microbiología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pruebas en el Punto de Atención , Sensibilidad y Especificidad , Úlcera Varicosa/microbiología , Infección de Heridas/diagnósticoRESUMEN
We describe the first Italian case of Shewanella algae septicemia in an immunocompetent patient with chronic leg ulcers. The patient had been exposed to seawater before the onset of symptoms. Despite the absence of severe underlying diseases, the primary soft tissue infection of the leg was complicated by hematogenous dissemination.
Asunto(s)
Infecciones por Bacterias Gramnegativas/microbiología , Inmunocompetencia , Úlcera de la Pierna/microbiología , Sepsis/microbiología , Shewanella , Anciano , Humanos , Italia/epidemiología , Úlcera de la Pierna/epidemiología , MasculinoRESUMEN
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