Microbiology of wound

Colonizers of skin wound

Wound is a nutritious, moist warm
environment for colonization proliferation of
microbes.
Majority are aerobic and anaerobic
microorganisms that originate predominantly
from mucosal surfaces such as those of the
oral cavity and gut.

Wound
 Factors determining diversity of
microbes in wound ( often polymicrobial )

Wound type,
depth,
location,
level of tissue perfusion ( O2#, nutrients, immune
cells ),
host immune response.
the presence of foreign material and devitalized
( ischaemic, hypoxic or necrotic ) tissue
#A significant reduction in the killing capacity of PMNs at a pO2 of <30 mm Hg has been
reported
 Wound infection
Occurs when virulence factors expressed by
microbes in wound outcompete the host
immune system and subsequent invasion and
dissemination of microorganisms in viable
tissue provokes a series of local and systemic
host responses.
Characteristic local responses are :
- purulent discharge,
- painful spreading erythema ( cellulitis )
 Risk of surgical wound infections
Based on the susceptibility of a surgical wound
to microbial contamination.
Clean surgery : 1 to 5% risk .
Dirty procedures ( e.g organ space
involvement) are significantly more
susceptible to endogenous contamination:
27% risk.
 Both acute and chronic wounds are
susceptible to contamination and colonization
by a wide variety of aerobic and anaerobic
microorganisms.
 Sources of wound contamination
Surrounding skin ( normal flora such as CONS,
micrococci, diphtheroids, and
propionibacteria), and
Environment ( in the air or introduced by
traumatic injury )
Endogenous sources involving mucous
membranes (primarily the GIT, oropharyngeal,
and genitourinary mucosae)
 Minimizing post op wound
infection
1. Adequate asepsis
2. Adequate antisepsis
3. Preservation of the local host defenses .
 Asepsis
Utilization of effective infection control
procedures (e.g., air filtration, skin barrier
garments, disinfection) to minimize exogenous
microbial contamination during surgery.
 Antisepsis
Antiseptics on the operative site ,
Antibiotic prophylaxis at a time point just prior to
surgery that will ensure adequate tissue levels of
antibiotic during surgery.
Ensuring good aseptic, skilled surgical techniques
and minimizing the duration of surgery.
Prolonging ab prophylaxis is NOT a substitute to
good surgical technique!!!
 Optimizing the local wound conditions.

Removing any devitalized tissue to

reestablish blood flow to the wound
reducing the microbial load.
 Bite wound
Brook reported 74% of 39 human and animal
bite wounds contained a polymicrobial aerobic-
anaerobic microflora ( predominantly S.aureus,
Peptostreptococcus spp., and Bacteroides spp. )
Less common potential pathogens such as
Pasteurella multocida, Capnocytophaga
canimorsus, Bartonella henselae, , Prevotella
and Eikenella corrodens .
 Management of bite wounds
High-pressure irrigation to reduce the
microbial load,
Debridement , and
Antibiotic high-risk wounds such as punctures.
 Burn wound
Common organisms P. aeruginosa, S. aureus,
E. coli, Klebsiella spp., Enterococcus spp., and
Candida spp.
Management :
- topical and systemic antibiotics,
- aggressive debridement,
- adequate nutrition
 Diabetic foot ulcer
Polymicrobial ( S. aureus, CONS, Streptococcus
spp., P. aeruginosa, Enterococcus spp.,
coliform bacteria, anaerobes )
Inability of neutrophils to deal with invading
microbes effectively.
 Decubitus ulcer ( pressure sore )
About 25% of decubitus ulcers have
underlying osteomyelitis, and bacteremia is
also common.
Polymicrobial ( aerobes + anaerobes )
Management of infected decubitus ulcers: -
- aggressive surgical debridement,
- broad-spectrum antibiotics.
 Wound culture results
Microbiological results may be helpful but can
often be misleading, especially with
polymicrobially infected wounds containing
numerous potential pathogens.
 Diagnosis of infection in
polymicrobially infected wounds
Should be based primarily on clinical signs:
heat,
pain,
erythema,
edema,
suppuration, and
Fever.
 Controversies of wound sampling
Value
Types of wound to be sampled
technique
 Wound tissue sampling
The acquisition of deep tissue during biopsy
following initial debridement and cleansing of
superficial debris is recognized as being the
most useful method.
Should send 5 to 6 samples of deep tiisue
biopsy ( especially those associated with
implant ). Less than that culture reports would
not be representative and could be very
misleading.
 Swab sampling
Superficial microbiology does not necessarily
reflect that of deeper tissue ,
Subsequent cultures do not correlate with the
presence of pathogenic bacteria .
If a swab sample is taken inappropriately (i.e., prior
to wound cleansing and removal of devitalized
superficial debris), the resulting culture has been
considered to reflect only surface contamination.
Hence misleading or useless.
 Indication for swabs
Only wounds that are clinically infected or
those that have no clinical signs of infection
but are deteriorating (e.g., diabetic foot
ulcers) or have a long history of failure to heal
(primarily chronic wounds) should be sampled
for microbiological analysis.
 Indiscriminate swabbing of wounds that do
not require sampling causes an unnecessary
drain on labor and financial resources.
Thank you