Here - EWMA 2013

Free Paper Session: Infection
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Assessment of perspectives and practices of US wound care
specialists with regard to infection assessment and treatment
Robert Snyder 1 , Lorna McInroy 1 , David Leaper 2 , Rachel Benson 1 , Breda Cullen 1
1 Systagenix (Gatwick, United Kingdom);
2 Cardiff University (Cardiff, United Kingdom).
Aim: To assess the perceptions and methodologies of US wound care specialists in
diagnosing infections in chronic wounds of patients with diabetes.
Methods: The questionnaire was distributed to members of the American Academy of
Wound Management (n=570 response rate 20%). Registered nurses, physical
therapists, physicians, podiatrists, and advances nurse practitioners comprised 85% of
the respondents
Results: The inconsistencies in assessment tools used to diagnose wound infections
were highlighted. When clinical signs of infection are absent, 15% of respondents culture
on first visit, howeverthe majority (74%) would procure cultures when secondary signs
and symptoms were present; indicating culture is primary used to confirm clinical
assessment. Of the perceived gold standard, 32% performed quantitative biopsies and
67.5% stated they did not. Current practices were shown to confirm clinical diagnosis,
but rarely were used to influence treatment decisions initially. As many as 54% of
respondents confirmed they would prescribe a systemic antibiotic without the benefit of
culture or biopsy, and only 43% culture wounds when sensitivities for systemic
antibiotics are required.
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Free Paper Session: Infection
BIOFILM PHENOTYPES ASSOCIATED WITH INFECTION-RELATED WOUND
CONDITIONS IN RAT MODELS
Mayumi Asada 1 , Gojiro Nakagami 1 , Hiroshi Sagara 2 , Takeo Minematsu 1 ,
Hiromi Sanada 1
1 Department of Gerontological Nursing/Wound Care Management, The University of
Tokyo (Tokyo, Japan);
2
Fine Morphological Analysis Group, Institute of Medical Science, The University of
Tokyo (Tokyo, JA (Tokyo, Japan).
Aim: Bacterial cells have several phenotypic characteristics such as planktonic, sessile
and biofilm. Especially, there is no study that showed the relationship between infectionrelated
wound conditions and biofilm phenotypes. We investigated ultrastructural
morphology of biofilms in wounds with different infection-related conditions using animal
models.
Methods: We have previously developed reproducible rat models of four different
infectious statuses including No inoculation (Control), Colonisation, Delayed healing and
Infection (Asada et al, 2012). We created full thickness wounds and inoculated different
concentrations of Pseudomonas aeruginosa dispersion to produce the four model
groups: Control (O.D.600 = 0.0), Colonisation (O.D.600 = 0.5), Delayed healing
(O.D.600 = 0.75) and Infection (O.D.600 = 1.0). Ultrastructure of biofilm in the wound
bed tissues were observed by scanning electron microscopy (SEM).
Results: The Delayed healing group showed delayed wound area reduction compared
to the Control group and the Infection group showed severe and spreading infection with
the obvious signs of infection. The SEM analyses showed sessile communities of rodshaped
bacteria that reside in a complex matrix in the Infection group. Surprisingly, in the
Delayed healing group, we observed that the wound surfaces were covered by the
matrix but could not identify the bacterial cells. We could not find either planktonic nor
biofilm in the tissues from the Control and Colonisation groups.
Conclusions: Each wound that represented different infection-related wound conditions
had distinctive biofilm phenotypes. These data suggest that status of bacterial biofilms
might contribute to wound chronicity or severity of infection.
Conclusions: Secondary signs and symptoms were important; quantitative biopsies
were not typically used in clinical practice and antibiotics were generally over prescribed.
Deterioration of the wound was ranked the highest clinical signs and symptoms of
infections, Deterioration of the wound was ranked the highest clinical sign and symptom
of wound infection. However, in conclusion this survey has highlighted many
inconsistencies in clinical practice which may be eliminated with a ‘litmus test’, as
advocated by the majority of respondents (82%).
FREE PAPER SESSION: INFECTION
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
29