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Medicine: Evidence-Based Research: Plenary Session
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Abstract This session will present new evidence-based data from recently performed clinical trails to be chosen before the meeting. (Presentation 23.1) Antimicrobial sensitivity of chronic wounds Brian Hobbs, Catherine R. Ratliff, PhD, APRN-BC, George T. Rodeheaver, PhD Currently, there is little information in the literature to help guide the clinician in selecting which topical antibiotic would be most effective in reducing the bacterial bioburden in a chronic wound. The microbiology laboratory should provide topical antibiotic susceptibly testing to provide guidance on the most appropriate topical antibiotic. However, standard sensitivity tests are not appropriate for topical antibiotics. This study used a previously published needle extrusion method to evaluate the sensitivity of chronic wound bacteria to topical antimicrobial agents. Eleven topical antimicrobial agents were ranked according to their efficacy, which was measured by the number of times each topical antibiotic drug displayed the largest zone of bacterial growth inhibition. Over the course of 8 weeks, 78 quantitative swab samples were collected from the surface of chronic wounds on patients visiting the chronic wound clinic. Fifty-one of the samples showed sufficient growth to perform antimicrobial susceptibility testing. The top three performing topical antimicrobial agents were Doxycycline Gel (10%), a triple antimicrobial gel (Polymyxin B Sulfate per gram, Nitrofurantoin, and Nystatin), and Mupirocin Ointment (2% Mupirocin). Colistin Gel (Polymyxin E), Gentamicin Ointment, Bacitracin Ointment, double antibiotic ointment, triple antibiotic ointment, and Silver Sulfadiazine cream never displayed the largest zone of inhibition in the 51 antimicrobial sensitivity tests. These agents are not recommended for use in chronic wounds. This study showed that the needle extrusion method of topical antimicrobial sensitivity testing in chronic wounds is one way to evaluate the appropriate topical antimicrobial therapy for patients with chronic wounds. References Bill TJ, Ratliff CR, Donovan AM, Knox LK, Morgan RF, Rodeheaver GT. Quantitative swab culture versus tissue biopsy: a comparison in chronic wounds. Ostomy Wound Manage. 2001;47(1):34–37. Rodeheaver GT, Gentry S, Saffer L, Edlich RF. Topical antimicrobial cream sensitivity testing. Surg Gynecol Obstet. 1980;151(6):747–752. |
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