Ultraviolet Light C in the Treatment of Chronic Wounds with MRSA: A Case Study
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Outcome measures. To determine the magnitude of bacterial burden in wounds for this case study, clinicians used a standardized protocol for administering a semiquantitative swab.28-31 The lab results from the semiquantitative swab are reported as type and relative amount of bacteria present ? eg, no growth (0), occasional growth (scant), light growth (1+), moderate growth (2+), or heavy growth (3+). Other outcome measures included taking photographs and assessing changes in wound appearance using the Pressure Sore Status Tool (PSST).32 The PSST is a pen-and-paper tool consisting of 13 domains that assess the composition of wound bed; wound size, depth, and exudate; and the condition of the periulcer skin and wound edge. Scores assigned on a scale of 1 to 5 to each of the individual domains of the PSST are totaled to derive a total score ranging between 13 and 65, with 13 representing a completely healed wound. The PSST has previously been shown to produce valid and reliable assessments of wound appearance.32
A 77-year-old man had multiple leg ulcers due to a combination of venous and arterial insufficiency related to his previous occupation that involved prolonged standing. His long history of venous insufficiency included numerous corrective surgical procedures, including vein stripping. He presented with hypertension, bilateral leg edema, and significantly impaired bilateral lower extremity blood flow with ankle brachial indices (ABI) of 0.53 and 0.61 of the left and right leg, respectively. He ambulated with a cane and had limited mobility and impaired muscle pump function in both lower extremities. The extreme pain reported by this patient not only limited his mobility, but also caused significant sleep disturbances, leading to mild depression. Current medications included: pentoxifylline (400 mg tid), enalapril maleate (2.5 mg bid), and acetaminophen (500 mg qid).
At his initial wound evaluation in July 1998, the patient presented with a total of six large superficial ulcers located in the medial and lateral lower leg region bilaterally. These ulcers ranged in size from approximately 1.54 cm2 to 30 cm2. He reported that the ulcers developed following surgery to repair an abdominal aneurysm.
After 2 years of standard wound care and many topical antimicrobial and oral antibiotic treatments, five lower extremity wounds remained in the lateral and medial aspect of the right lower leg as well as the medial aspect of the left lower leg. Before enrolling in this case study, the patient tried oral antibiotics on a recurring basis (ciprofloxacin in July 1998, November 1998, May 1999, June 1999, and August 1999; clarithromycin in June 1999 and August 1999). In addition, several different topical antimicrobials were tried, including mupirocin (Bactroban®, SmithKline Beecham Pharmaceuticals, Mississauga, Ontario, Canada), cadexomer iodine (Iodosorb®, Perstorp Pharma, Lund, Sweden), and nanocrystalline silver dressings (Acticoat™, Westaim Biomedical Corp, Exeter, NH, Fort Saskatchewan, Alberta, Canada) in combination with mechanical debridement. In general, the patient found it difficult to tolerate the application of topical antimicrobials because they exacerbated his pain.
At the time of this study, the patient's wounds were superficial with no undermining and had attached edges and loosely adherent slough. Only minimal granulation tissue was present. Examination of the dressings showed that his wounds were producing copious amounts of purulent yellow exudate. Furthermore, significant erythema surrounded the wounds. Semiquantitative bacterial cultures obtained before treatment revealed the presence of three types of bacteria: methicillin-resistant S. aureus (MRSA) in his right medial lower ulcer and a combination of Pseudomonas aeruginosa and S. aureus in his left medial ulcer.
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