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Flashcards in War Wounds Deck (12):
1

Definition of soft tissue wound infection

Must meet at least 1 of the following criteria:

  • Organisms cultured from tissue/drainage site
  • Purulent drainage
  • Abscess or other evidence of infection
  • At least 2 of the following:
    • Localized pain/tenderness
    • Redness
    • Swelling
    • Heat

2

What 3 major organisms are found in the majority of wounds?

Acinetobacter

E. Coli

Pseudomonas

 

(Think "guerilla warfare"... gorilla = A.P.E)

3

What happens to the type of bacteria that infect a wound as time goes on?

As the injury progresses, it goes from a gram (+) problem to a gram (-) one

4

What did widespread treatment of Acinetobacter do?

Lead to the development of multi-drug resistant strains

5

Early lessons from Iraq

aka Microbiology take home points

  • Organisms change over time
    • Gram (-) rods are the predominant problem
    • Appear to travel w/ wounded patients
    • Result in nosocomial spread
  • No indication for pre/post procedure cultures
  • If something doesn't look infected, don't culture it
  • 30% of wounds become infected
    • 20% of these patients experience multiple repeat infections after discharge
  • Recent appreciation for invasive fungal infections

6

Comparative toxicities of antifungal agents (mainly Amphotericin B vs Fluconazole)

AmB is highly nephrotoxic

 

Flu is slightly hepatotoxic

7

Recent trends in war wounds

  • Atypical mycobacterial wound infections
    • requires months of triple drug therapy
    • all from blast patients during OEF (operation enduring freedom)
  • Colistin resistant Acinetobacter
    • most strains have been sensitive to minocycline
    • fortunately, colistin-resistance acinetobacter are not very virulent

8

Difference between OIF and OEF

Iraq:

hot, arid desert

blast injuries inside vehicles

acinetobacter largest concern

 

Afghanistan:

lush, heavy vegetation in some regions

blast injuries while walking

invasive fungal infections were significant concern

9

Empiric Treatment Options when Wounds Appear Infected

Meropenem

Vancomycin

Antifungals

 

Always send tissue or pus for culture (swab is not as good); send tissue for histopathology if fungi are a concern

10

Measures to prevent infection

  • Adequate debridement
    • fluid lavage of open wounds
    • repeat washouts critical
  • Negative Pressure Wound Therapy

11

When to consult ID

  • what you're doing isn't working
  • renal problems or drug allergies limit selection of Abx
  • you're thinking of starting an Abx or Antifungal you're not familiar with

12

How did nosocomial spread of acinetobactor kill people?

Gave elderly people pneumonia