Ultraviolet Light C in the Treatment of Chronic Wounds with MRSA: A Case Study
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In Case 1, before and during UVC treatment, the wounds contained an antibiotic-resistant strain of S. aureus, MRSA; following UVC treatment protocol, these wounds had a moderate level (2+) of S. aureus. This apparent change in type of bacteria present in chronic wounds following UVC treatment has been observed previously by this research team and also has been reported by others (J. McCulloch, personal communication). The mechanism for this change in swab results from primarily MRSA to S. aureus is uncertain; however, it can be postulated that UVC has the ability to render MRSA more susceptible to oral antibiotics.
The semiquantitative swab is the preferred method for bacterial determination in this case study because it is economically feasible and easily administered by staff. When the swabbing technique is compared with tissue biopsy, Levine et al28 found a linear relationship between the swab and biopsy counts of viable bacteria in the same wound: 105 organisms by biopsy were equal to 106 organisms by swab culture. Herruzo-Cabrera et al35 concluded in their study that when the semiquantitative swab approach was evaluated, the following were demonstrated: sensitivity of 97.8%, specificity of 86.9%, positive predictive value of 90.7%, and a negative predictive value of 96.8%. The researchers concluded that semiquantitative cultures are useful for surveillance of infection and equivalent to quantitative biopsy cultures.
The three patients described in this case report were on-and-off antibiotics numerous times. Two of these patients received oral antibiotics during the UVC treatments. The prescription of oral antibiotic therapy was left to the discretion of the individual's attending physician (not the same individual in all three cases). As outlined in a recent article by Sibbald et al,27 oral antibiotics are not always indicated for chronic wounds with localized infection.
The frequency of UVC treatments administered varied for the individual cases presented in this report. The UVC protocol was changed based on a number of practical issues, including the frequency of dressing changes and proximity of the patient to the wound treatment center. The patients described in Case 2 and Case 3 were both residents of a local facility and received daily dressing changes. Therefore, it was feasible to administer daily UVC treatments. The patient presented in Case 1 was living at home some distance from the wound center, and wound dressings, including compression wraps, were changed less frequently. For this individual, the most feasible treatment protocol was UVC treatments given on alternate days over a 2-week period, followed by weekly UVC treatments for 1 month. The results showed that individuals who received more frequent UVC treatments required only 1 week of UVC treatments to achieve complete wound closure; whereas, the individual who had UVC treatments less often required more than 6 weeks of UVC treatment to eradicate MRSA from the wound bed. However, many other factors likely contributed to the extended UVC treatment protocol required for Case 1. The individual had a greater pretreatment bacterial bioburden with multiple types of bacteria, his ulcers were present for an extended duration of time, and he had multiple ulcers ? all of which were much larger than those in either of the two other cases. Therefore, the authors are unable to assess the influence of different UVC treatment schedule on the results obtained in the present study.
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