Here - EWMA 2013

POSTER: CASE STUDY
Poster: Case Study
P 362
MULTIDRUG RESISTAN ACINETOBACTER BAUMANII INFECTING AN AVULSE
WOUND. A CASE REPORT
Roxana Ziri Castro 1 , Paul Harb 1 , Eduardo Salas 1
1 Centro Medico El Valle (Nueva Esparta, VE).
Background: Acinetobacter baumannii is usually associated with nosocomial
pneumonia or bacteremia. Skin and soft-tissue infection (SSTI) due to A. baumannii is
uncommon but is gaining importance as a cause of such infections, affecting
compromised hosts.
Methods: We describe a case of a 46-year-old male patient with multiple trauma,
without comorbilities, that was admitted in our hospital 25 days after the injury with an
avulse wound complicated with A. baumannii-associated SSTI in left lower limb. We also
reviewed published literature of other cases of A. baumannii skin and soft-tissue
infection (SSTI) and its specific treatment.
Results: This patient suffered multiple trauma in a car accident with an avulse infected
wound in his leg by A. baumannii multidrug resistant and other pathogens, that required
several surgical debridement, multiple tissue cultures and bacterial characterization,
specific antimicrobial therapy, Wound Bed Preparation, reconstructive Dermal Graft and
physiotherapy. He was discharged in good conditions, with satisfactory aesthetical and
functional results to continue with an ambulatory 2 moth follow-up until the healing
process was completed.
Conclusions: The treatment of SSTI caused by resistant bacterias relies into a
combination of surgical and antimicrobial treatment. A. baumannii continues to increase
as aetiologyc agent so it should be taken in account. Clinicians must be aware of its role
in SSTI in compromised host.
P 363
MAKING A DIFFERENCE: FROM IMMINENT AMPUTATION TO COMPLETE
HEALING
Poster: Case Study
Marianne Christensen 1 , Karsten Fogh 1
1 Dept. of Dermatology, Aarhus University Hospital (Aarhus, Denmark).
Aim: We describe a patient case with severe combined arterial and venous insufficiency
initially set up for amputation, but as a consequence of a combined multifactorial effort
she healed during 7 months of conservative treatment.
Methods: 85 year old woman with combined arterial and venous insufficiency (toe
pressure of 10 mmHg) with no possibility of revascularisation. As a consequence she
was set up for amputation. However, at the leg ulcer clinic of the department of
dermatology conservative treatment was considered and a combined effort was initiated
aiming at: smoke cessation, pain management, venous surgery, debridement, negative
pressure wound therapy, intermittent pneumatic compression and later moist wound
treatment combined with compression. The patient was adequately supported by her
family and social network.
Results: During a period of 7 months the patient’s situation improved markedly resulting
in complete healing of large circular deep wounds of her left leg, smoke cessation, pain
reduction to an NRS of 0, increase in toe pressure from 10 mmHg to 40 mmHg and a
marked improvement in quality of life.
Conclusions: A combined intervention resulted in a dramatic change for this lady,
wounds healed, pain disappeared together with a substantial improvement in quality of
life. A general statement from the patient: “I got my life back”. This clearly indicates that a
combined and multifactorial effort can make a difference between an imminent
amputation and complete healing. However, such a process requires a successful
collaboration between the treatment system and a motivated patient support by a social
network.
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
211