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SAWC 2004 Abstract Preview

Symposium Update

SAWC 2004 Abstract Preview

Influence of N-acetyl-L-cysteine on biofilm formation by Pseudomonas aeruginosa chronic wound isolates in vitro Alex Cazzaniga, BS; Michael Shelling; John Heaphy; Carlos Ricotti, Jr., MD; Patricia Mertz, BA; and Stephen Davis, BS; University of Miami Department of Dermatology, Miami, Fla. Pseudomonas aeruginosa infections are a major threat to patients with chronic wounds and burns. Our laboratory has shown that clinical isolates form biofilms in vitro and in vivo. Once biofilms are established, phagocytosis and diffusion of antibiotics are impaired; thus, facilitating the colonization and persistent infections. N-acetyl-L-cysteine (NAC) is a non-antibiotic drug that has antimicrobial properties. It is a mucolytic agent that disrupts disulfide bonds and reduces the viscosity of secretions. This study examined the efficacy of NAC on preventing biofilm formation of Pseudomonas aeruginosa chronic wound isolates in vitro. Bacterial suspensions in Tryptic soy broth (TSB) were grown in polystyrene wells and incubated. At 24 hours, the bacteria suspensions were removed and discarded. Wells were gently washed with PBS, air-dried, and heat fixed. Wells were stained with Hucker’s crystal violet solution to quantitate biofilm formation. Excess stain was washed off with PBS and Tween-80 was added to wells. Stained biofilms were removed by sonication and their optical density quantified. They all developed biofilms of varying intensity with unique dose-related responses to the experimental concentrations of NAC. At 4 mg/mL, biofilm formation was completely prevented in all strains examined. This study demonstrated that NAC is effective in preventing biofilm formation of wild type Pseudomonas aeruginosa wound strains. References 1. Olofsson AC, Hermansson M, Elwing H. N-acetyl-L-cysteine affects growth, extracellular polysaccharide production, and bacterial biofilm formation on solid surfaces. Appl Environ Microbiol. 2003;Aug;69(8):4814–4822. 2. Harrison-Balestra, Cazzaniga, Davis, Mertz. A wound-isolated Pseudomonas aeruginosa grows a biofilm in vitro within 10 hours and is visualized by light microscopy. Dermatol Surg. 2003 Jun;29(6):631–635. Prediction of wound healing outcome in 99 patients using skin perfusion pressure and transcutaneous PO2 Takkin Lo, MD, MPH, CHT; Richard Sample, RCP, RRT, CHT; Renee Prins, BS; Johnny Mao, BS; Jeanette Rylander, BS; Sarah Taylor, BS; James Anholm, MD; David Christenson, RCP, RRT, CHT; Patrick Moore, MBA, RCP, RRT; Philip Gold, MD; Loma Linda University Medical Center, Loma Linda, Calif. Purpose: Prediction of wound healing outcome has been done using transcutaneous oxygen partial pressure (tcPO2) for many years. Skin Perfusion Pressure (SPP) provides a recent alternative that is done with a specially designed laser Doppler sensor for blood flow detection. We studied the efficacy and outcome of chronic extremity wounds using SPP compared to tcPO2. Methods: A prospective, comparative study was conducted over a 4-year period at our Wound Treatment Center. Concurrent room-air measurements on corresponding sites were done with SPP and tcPO2 on 99 patients (mean age 63.1 years) with chronic extremity wounds. SPP and tcPO2 values x30mmHg were used to predict a positive outcome, as suggested by the majority of wound literature. Follow-up was conducted at either 6 or 12 months. Results: In our study, 88 of the 99 patients (89%) had wound healing. SPP correctly predicted healing in 81 of the 88 patients (92%) versus tcPO2 that predicted healing in 59 of the 88 patients (67%) [p 3 months duration within a specific geographical area of London, UK; to understand how lymphedema affects the patient and its impact on health and social services. Patients were identified through health professionals delivering care to a population of southwest London. All community staff, hospital wards and specific out-patient services, residential and nursing homes and lymphedema specialists were contacted to provide information. Interviews and clinical examination undertaken in a sample of patients who were identified. to validate the presence of lymphoedema and obtain more detailed information on impact of the disease on patients and health services. In total, 823 patients were identified from a population of 619,000 (1.33 per 1,000) with prevalence rising to 0.5% in the > 65 year olds. Only 64% had received any form of lymphedema treatment. Of the 259 interviewed, one quarter had taken time off from work because of their swelling with 8% having given up work completely. In all, 37% had experienced acute infection (cellulitis) since onset of swelling and 10% had experienced a medical admission for their swelling (mean inpatient stay 11.7 days). Over the previous year 28% had suffered cellulitis and 7% were admitted. Lymphedema is much more common than generally realised with the majority not related to cancer. Many patients receive sub-optimal or no treatment. Complications such as infection create a significant cost implication to health services. Quality of life in patients suffering from lymphedema Peter J. Franks, PhD; Christine J. Moffatt, RN, PhD; Debra C. Doherty, RN; Anne F. Williams, RN; Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK; Caroline M.A. Badger, RN PhD, Lymphoedema Service, St. George’s Hospital Medical School, London, UK; Eunice Jeffs, RN, Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, UK; Nick Bosanquet, MA, Imperial College, London, UK; Peter S. Mortimer, MD, FRCP, Department of Physiological Medicine, St. George’s Hospital Medical School, London, UK Lymphedema is a chronic condition characterised by swelling, usually of one or more limbs, but in some cases trunk, genitalia or face. While there is some evidence of the impact of the disease on specific groups, there is a lack of evidence on how it affects the overall population of patients. As part of an epidemiology study in London, UK, health related quality of life (HRQoL) was examined in patients suffering from lymphedema. Of the 248 interviewed (184, 75% women), 46% had experienced swelling for longer than five years. Results from the SF-36 showed significantly poorer HRQoL in patients with lymphoedema compared with normative data, for physical functioning (difference[d]=21.5, P