Skip to main content

Advertisement

SpringerLink
Log in

Bacterial reduction and shift with NPWT after surgical debridements: a retrospective cohort study

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Surgical debridement, negative-pressure wound therapy (NPWT) and antibiotics are used for the treatment of open wounds. However, it remains unclear whether this treatment regimen is successful in the reduction and shift of the bacterial load.

Methods

After debridement in the operating room, NPWT, and antibiotic treatment, primary and secondary consecutive microbiological samples of 115 patients with 120 open wounds with bacterial or yeast growth in ≥1 swab or tissue microbiological sample(s) were compared for bacterial growth, Gram staining and oxygen use at a level one trauma center in 2011.

Results

Secondary samples had significantly less bacterial growth (32 vs. 89%, p < .001, OR 17), Gram-positive bacteria (56 vs. 78%, p = .013), facultative anaerobic bacteria (64 vs. 85%, p = .011) and Staphylococcus aureus (10 vs. 46%, p = .002). They also tended to include relatively more Coagulase-negative Staphylococci (CoNS) (44 vs. 18%) and Pseudomonas species (spp.) (31 vs. 7%). Most (98%) wounds were successfully closed within 11 days, while wound revision was needed in 4%.

Conclusions

The treatment regimen of combined use of repetitive debridement, irrigation and NPWT in an operating room with antibiotics significantly reduced the bacterial load and led to a shift away from Gram-positive bacteria, facultative anaerobic bacteria, and S. aureus, as well as questionably toward CoNS and Pseudomonas spp. in this patient cohort. High rates of wound closure were achieved in a relatively short time with low revision rates. Whether each modality played a role for these findings remains unknown.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Peinemann F, Sauerland S (2011) Negative-pressure wound therapy: systematic review of randomized controlled trials. Dtsch Arztebl Int 108:381–389

    PubMed  PubMed Central  Google Scholar 

  2. Evans D, Land L (2001) Topical negative pressure for treating chronic wounds: a systematic review. Br J Plast Surg 54:238–242

    Article  CAS  PubMed  Google Scholar 

  3. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553–562

    Article  CAS  PubMed  Google Scholar 

  4. Osterhoff G, Zwolak P, Krüger C et al (2014) Risk factors for prolonged treatment and hospital readmission in 280 cases of negative-pressure wound therapy. J Plast Reconstr Aesthet Surg 67:629–633

    Article  PubMed  Google Scholar 

  5. Streubel PN, Stinner DJ, Obremskey WT (2012) Use of negative-pressure wound therapy in orthopaedic trauma. J Am Acad Orthop Surg 20:564–574

    PubMed  Google Scholar 

  6. Timmers MS, Graafland N, Bernards AT et al (2009) Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis. Wound Repair Regen 17:278–286

    Article  PubMed  Google Scholar 

  7. Orgill DP, Manders EK, Sumpio BE et al (2009) The mechanisms of action of vacuum assisted closure: more to learn. Surgery 146:40–51

    Article  PubMed  Google Scholar 

  8. Timmers MS, Le Cessie S, Banwell P, Jukema GN (2005) The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg 55:665–671

    Article  CAS  PubMed  Google Scholar 

  9. Saxena V, Hwang CW, Huang S et al (2004) Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 114:1086–1096 (discussion 97–98)

    Article  PubMed  Google Scholar 

  10. Birke-Sorensen H, Malmsjo M, Rome P et al (2011) Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer)—steps towards an international consensus. J Plast Reconstr Aesthet Surg 64(Suppl):S1–S16

    Article  PubMed  Google Scholar 

  11. Armstrong DG, Lavery LA, Consortium DFS (2005) Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 366:1704–1710

    Article  PubMed  Google Scholar 

  12. Lone AM, Zaroo MI, Laway BA et al (2014) Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study. Diabet Foot Ankle 5:1–5

    Article  Google Scholar 

  13. Assadian O, Assadian A, Stadler M, Diab-Elschahawi M, Kramer A (2010) Bacterial growth kinetic without the influence of the immune system using vacuum-assisted closure dressing with and without negative pressure in an in vitro wound model. Int Wound J 7:283–289

    Article  PubMed  Google Scholar 

  14. Mouës CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE (2004) Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 12:11–17

    Article  PubMed  Google Scholar 

  15. Lalliss SJ, Stinner DJ, Waterman SM et al (2010) Negative pressure wound therapy reduces pseudomonas wound contamination more than Staphylococcus aureus. J Orthop Trauma 24:598–602

    Article  PubMed  Google Scholar 

  16. Pinocy J, Albes JM, Wicke C, Ruck P, Ziemer G (2003) Treatment of periprosthetic soft tissue infection of the groin following vascular surgical procedures by means of a polyvinyl alcohol-vacuum sponge system. Wound Repair Regen 11:104–109

    Article  PubMed  Google Scholar 

  17. Deva AK, Buckland GH, Fisher E et al (2000) Topical negative pressure in wound management. Med J Aust 173:128–131

    CAS  PubMed  Google Scholar 

  18. Yusuf E, Jordan X, Clauss M et al (2013) High bacterial load in negative pressure wound therapy (NPWT) foams used in the treatment of chronic wounds. Wound Repair Regen 21:677–681

    Article  PubMed  Google Scholar 

  19. Weed T, Ratliff C, Drake DB (2004) Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Ann Plast Surg 52:276–279 (discussion 79–80)

    Article  PubMed  Google Scholar 

  20. Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE (2009) Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma 23:552–557

    Article  PubMed  Google Scholar 

  21. Patzakis MJ, Wilkins J (1989) Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res 243:36–40

    Google Scholar 

  22. Gosselin RA, Roberts I, Gillespie WJ (2004) Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev 1:CD003764

    Google Scholar 

  23. Halawi MJ, Morwood MP (2015) Acute management of open fractures: an evidence-based review. Orthopedics 38:e1025–e1033

    Article  PubMed  Google Scholar 

  24. Werner CM, Pierpont Y, Pollak AN (2008) The urgency of surgical débridement in the management of open fractures. J Am Acad Orthop Surg 16:369–375

    Article  PubMed  Google Scholar 

  25. Skaggs DL, Friend L, Alman B et al (2005) The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Jt Surg Am 87:8–12

    Google Scholar 

  26. Schenker ML, Yannascoli S, Baldwin KD, Ahn J, Mehta S (2012) Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Jt Surg Am 94:1057–1064

    Article  Google Scholar 

  27. Fernandez R, Griffiths R (2012) Water for wound cleansing. Cochrane Database Syst Rev 2:CD003861

    Google Scholar 

  28. Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Irrigation of the wounds in open fractures. J Bone Jt Surg Br 89:580–585

    Article  CAS  Google Scholar 

  29. Edwards CC, Simmons SC, Browner BD, Weigel MC (1988) Severe open tibial fractures. Results treating 202 injuries with external fixation. Clin Orthop Relat Res 230:98–115

    Google Scholar 

  30. Artz CP, Sako Y, Scully RE (1956) An evaluation of the surgeon’s criteria for determining the viability of muscle during débridement. AMA Arch Surg 73:1031–1035

    Article  CAS  PubMed  Google Scholar 

  31. Osterhoff G, Spirig J, Klasen J et al (2014) Perforation and bacterial contamination of microscope covers in lumbar spinal decompressive surgery. Med Princ Pract 23:302–306

    Article  PubMed  Google Scholar 

  32. Grauhan O, Navasardyan A, Hofmann M et al (2013) Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg 145:1387–1392

    Article  PubMed  Google Scholar 

  33. Cattoir V, Nordmann P (2009) Plasmid-mediated quinolone resistance in gram-negative bacterial species: an update. Curr Med Chem 16:1028–1046

    Article  CAS  PubMed  Google Scholar 

  34. Kim PJ, Attinger CE, Steinberg JS et al (2014) The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg 133:709–716

    Article  CAS  PubMed  Google Scholar 

  35. Al-Mayahi M, Cian A, Lipsky BA et al (2015) Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results. J Infect 71:518–525

    Article  PubMed  Google Scholar 

  36. Bedenčič K, Kavčič M, Faganeli N et al (2016) Does preoperative antimicrobial prophylaxis influence the diagnostic potential of periprosthetic tissues in hip or knee infections? Clin Orthop Relat Res 474:258–264

    Article  PubMed  Google Scholar 

  37. Tetreault MW, Wetters NG, Aggarwal V et al (2014) The Chitranjan Ranawat Award: should prophylactic antibiotics be withheld before revision surgery to obtain appropriate cultures? Clin Orthop Relat Res 472:52–56

    Article  PubMed  Google Scholar 

  38. Levy PY, Fournier PE, Fenollar F, Raoult D (2013) Systematic PCR detection in culture-negative osteoarticular infections. Am J Med 126:1143.e25-33

    Article  PubMed  Google Scholar 

  39. Seidel D, Lefering R, Neugebauer EA (2013) Treatment of subcutaneous abdominal wound healing impairment after surgery without fascial dehiscence by vacuum assisted closure™ (SAWHI-V.A.C.®-study) versus standard conventional wound therapy: study protocol for a randomized controlled trial. Trials 14:394

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

A similar version of this abstract (“Bacterial Reduction and Community Shift with Negative-Pressure Wound Therapy: The Relevance of Surgical Debridements in the Operating Room”) was presented as an oral presentation at the 16th European Congress of Trauma and Emergency Surgery (ECTES) of the European Society for Trauma and Emergency Surgery (ESTES) in May 2015 in Amsterdam, The Netherlands. We would like to thank Dr. med. Florian P. Maurer for his advice as well as Dr. med. Matthias A. König, Ms. Verena Wilzeck, and Ms. Carmen Krüger for their help with data acquisition.

Author information

Authors and Affiliations

  1. Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland

    Thorsten Jentzsch, Georg Osterhoff, Pawel Zwolak, Valentin Neuhaus, Hans-Peter Simmen & Gerrolt N. Jukema

  2. Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland

    Burkhardt Seifert

Authors
  1. Thorsten Jentzsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georg Osterhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pawel Zwolak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Burkhardt Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valentin Neuhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hans-Peter Simmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gerrolt N. Jukema
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thorsten Jentzsch.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jentzsch, T., Osterhoff, G., Zwolak, P. et al. Bacterial reduction and shift with NPWT after surgical debridements: a retrospective cohort study. Arch Orthop Trauma Surg 137, 55–62 (2017). https://doi.org/10.1007/s00402-016-2600-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2600-z

Keywords

Search

Navigation