Definition of a wound infection
At least 1: 1) Organisms cultured from affected site, 2) Purulent drainage at affected site, 3) Evidence of infection seen during invasive procedure/pathology 4) 2+ symptoms: pain, tenderness, redness, swelling or heat.
How does the microbiology of a wound change over time
Starts w/gram + infection (coag - staph), moves to gram - infections (acinetobacter and enterobacter) around 5 days later. Several weeks later the gram + come back.
Where was acinetobacter in wounded warriors coming from during OEF and OIF?
MTF down range, mostly nosocomial in the US.
How can acinetobacter affect US health care facilities?
It can cause fatalities in older sicker patients.
Aside from acinetobacter, what other resistant bacteria can be spread by wounded warriors? What other organisms are common?
Carbapenemase-producing klebsiella pneumoniae. ESBL E. coli. Atypical mycobacterium. Note that fungal infections also show up in war wound infections.
Anti-fungal agents used to treat fungal infections in war wounds.
AmphoB and voriconazole. Note that side effects are brutal in this combination: kidney problems, chest pain and electrolyte problems.
Crazy drug that acinetobacter is resistant to
Colistin, basically some are resistant to all antibiotics.
Empiric treatment options for wound infections
Meropenem (gram -), vancomycin (gram +) and anti-fungals if coming from lush region. Always send tissue or pus for culture so treatment can be narrowed. Remember that treatment should be limited to the time before the wound is cleaned and debrided.
Hospital infection prevention
Hand washing, ICU cleaning, Isolation precaution, chorussing and antibiotic control
When to consult ID for a wound infection?
Renal problems, allergies, colistin, tigecycline, amphoB or voriconazole.