I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
The Effects of Salt Concentration and Growth Phase on MRSA Solar and Germicidal Ultraviolet Radiation Resistance
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A ntimicrobial drugs are used continuously and extensively all over the world. While much of their use is warranted, considerable employment of these agents is inappropriate. The Centers for Disease Control and Prevention (CDC) estimates in the US that many prescriptions are unnecessary: 30% are prescribed for ear infections, 50% for sore throats, and the majority for the common cold.1 Drugs are overused in animal and poultry feed and also greatly misused in over-the-counter sales in much of the world. All of this contributes greatly to the development of drug resistance. One organism that is becoming an increasing problem worldwide is methicillin-resistant Staphylococcus aureus (MRSA).2
With the widespread emergence of organisms like MRSA, emphasis has increased on the need to develop alternative treatments for chronic wounds such as diabetic ulcers and pressure ulcers. One such alternative treatment method employs ultraviolet (UV) radiation. Ultraviolet radiation can be conveniently categorized into germicidal (UV C, with a wavelength of 190 nm to 290 nm) and solar (UV B and UV A, with wavelength ranges of 290 nm to 320 nm and 320 nm to 400 nm, respectively). Although essentially all UV C radiation is screened out by the stratospheric ozone layer, substantial UV A and B radiation still reaches the Earth’s surface.3 A range of in vitro and in vivo studies has been conducted involving germicidal and solar UV radiation as an adjunctive therapy to the use of antimicrobials in the treatment of various skin disorders.2,4-8 Taken together, these studies reveal the potential of UV radiation as an adjunctive treatment. The authors extended these studies by quantifying UV inactivation rates under differing physicochemical and growth conditions. In addition, the response of MRSA and the Gram-negative bacterium, Pseudomonas aeruginosa, a common cause of wound and burn infections, was compared.
Literature Review
For the last 20 years or so, outbreaks of MRSA have been associated with healthcare facilities such as hospitals and nursing homes. During this time span, this problem has been become much more prevalent. Recent studies document the situation.9–16 In hospital neurosurgical populations, MRSA infection is a growing problem; most cases are hospital-acquired, are often associated with extended lengths of stays, and many involve wound infections. Often these MRSA patients are discharged before eradication of the infection was achieved.9 The results of one study, conducted after MRSA was observed in a tertiary hospital and a geriatric institution where isolates were recovered from pressure ulcers, suggested nosocomial acquisition and highlight the need for epidemiological analysis to control dissemination of MRSA in such facilities.10 Another report documented the frequent transmission of MRSA from colonized hospital employees to their households.11
References:
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2. Thai TP, Houghton PE, Keast DH, Campbell RN, Woodbury MG. Ultraviolet light C in the treatment of chronic wounds with MRSA: a case study. Ostomy/Wound Manage. 2002;48(11):52–60.
3. Martin EL, Reinhardt RL, Baum LL, Becker MR, Shaffer JJ, Kokjohn TA. The effects of ultraviolet radiation on the moderate halophile Halomonas elongata and the extreme halophile Halobacterium salinarum. Can J Microbiol. 2002;46:180–187.
4. Conner-Kerr TA, Sullivan PK, Gaillard J, Franklin ME, Jones RM. The effects of ultraviolet radiation on antibiotic resistant bacteria in vitro. Ostomy/Wound Manage. 1998;44(10):50–56.
5. Sullivan PK, Conner-Kerr TA, Smith ST. The effects of UVC irradiation on Group A streptococcus in vitro. Ostomy/Wound Manage. 1999;45(10):50-54,56–58.
6. Sullivan PK, Conner-Kerr TA. A comparative study of the effects of UVC irradiation on select prokaryotic and eucaryotic wound pathogens. Ostomy/Wound Manage. 2000;46(10):28–34.
7. Wills EE, Anderson TW, Beattie BL, Scott A. A randomized placebo-controlled trial of ultraviolet light in the treatment of superficial pressure sores. J Am Geriatr Soc. 1983;31(3):131–133.
8. Nussbaum EL, Biemann I, Mustard,B. Comparison of ultrasound/ultraviolet-C and laser for treatment of pressure ulcers in patients with spinal cord injury. Phys Ther. 1994;74(9):824–825.
9. Gnanalingham KK, Elsaghier A, Kibbler C, Shieff C. The impact of methicillin-resistant Staphylococcus aureus in a neurosurgical unit: a growing problem. J Neurosurg. 2003;98(1):8–13.
10. Ruiz De Gopegui E, Oliver A, Ramirez A, Gutierrez O, Andreu C,Perez JL. Epidemiological relatedness of methicillin-resistant Staphylococcus aureus from a tertiary hospital and a geriatric institution in Spain. Clin Microbiol Infect. 2004;10(4):339–342.
11. Eveillard M, Martin Y, Hidri N, Boussougant Y, Joly-Guillou ML. Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households. Infect Control Hosp Epidemiol. 2004;25(2):114–120.
12. Lee MC, Rios AM, Aten MF, Mejias A, Cavuoti D, McCracken GH, Hardy RD. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J. 2004;23(2):123–127.
13. Dietrich DW, Auld DB, Mermel LA. Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children. Pediatrics. 2004;113(4):E347–E352.
14. CDC. Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections — Los Angeles County, California, 2002-2003. MMWR. 2003;52(5):88.
15. CDC. Methicillin-resistant Staphylococcus aureus infections among competitive sports participants - Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR. 2003;52(33):793–795.
16. CDC. Methicillin-resistant Staphylococcus aureus infections in correctional facilities — Georgia, California, and Texas, 2001-2003. MMWR. 2003;52(41):992–995.
17. Chapple RM, Inglis B, Stewart PR. Lethal and mutational effects of solar and UV radiation on Staphylococcus aureus. Arch Microbiol. 1992;157:242–248.
18. Akiyama H, Yamasaki O, Kanzaki H, Tada J, Arata J. Effects of various salts and irradiation with UV light on the attachment of Staphylococcus aureus strains. J Dermatol Sci. 1998;16:216–225.
19. El-Adhami W, Daly S, Stewart PR. Biochemical studies on the lethal effects of solar and artificial ultraviolet radiation on Staphylococcus aureus. Arch Microbiol. 1994;161:82-87.
20. Faergemann J, Larko O. The effect of UV-light on human skin microorganisms. Acta DermVenereol. (Stockh.). 1987;67:69–72.
21. Shaffer JJ, Jacobsen LM, Schrader JO, Lee KW, Martin EL, Kokjohn TA. Characterization of Pseudomonas aeruginosa bacteriophage UNL-1, a bacterial virus with a novel UV-A-inducible DNA damage reactivation phenotype. Appl Environ Microbiol. 1999;65(6):2606–2613.
22. Miller RV, Jeffrey W, Mitchell D, Elasri M. Bacterial responses to ultraviolet light. ASM News. 1999;65(8):535–541.
23. Simonson CS, Kokjohn TA, Miller RV. Inducible UV repair potential of Pseudomonas aeruginosa PAO. J Gen Microbiol. 1990;136:1241–1249.
24. Deutmeyer CM. The effects of ultraviolet radiation on three moderately halophilic bacteria and an extreme halophile at various salt concentrations, coupled with determination of the presence of the recA protein in five moderately halophilic bacterial species. MS Thesis. 2001. School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Neb.
25. Walker GC. Mutagenesis and inducible responses to deoxyribonucleic acid damage in Escherichia coli. Microbiol Rev. 1984;48(1):60–93.
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