Impregnated With Pus

Both sponge-dress and gel-dress reduced the rate of intravascular catheter-related infections [ 1112 ]. Sponge-dress does not allow the continuous inspection of the insertion site and is difficult to apply; however, it showed very low rate of contact dermatitis.

To our knowledge, a direct comparison between sponge-dress and gel-dress has never been performed. An extensive prospective high-quality data collection was performed for two large RCTs [ 1112 ], and these data were used for this post hoc study to compare the rates of intravascular catheter infections, dressing disruptions, and contact dermatitis between sponge-dress and gel-dress.

The similarities among these RCTs with regard to definitions and inclusion criteria allowed us to merge the two databases. The DRESSING1 study investigated the impact of sponge-dress and frequency of dressing changes for preventing catheter-related infections or catheter colonization [ 11 ].

The DRESSING2 study assessed the effect of gel-dress and highly adhesive dressing for preventing catheter-related infections and catheter colonization [ 12 ].

Both sponge-dress and gel-dress decreased the rate of intravascular catheter infection. The studies interventions were neither blinded to the investigators nor to the ICU staff, but they were blinded to the adjudication committee and to the microbiologists who processed the samples of blood and catheter cultures.

Both studies were approved by the national ethic committees; further ethical consent was not required according to the French law for research. Among all participating ICUs, three participated to both studies. The characteristics of patients were similar across studies. This post hoc analysis evaluated data from patients with short-term CVCs and ACs included in both studies. Leaking, soiled, or wet dressings were changed immediately. None of the study catheters was antibiotic- or antiseptic-impregnated.

Decisions to remove catheters were made independently by the physicians caring for each patient. If a patient had a positive blood culture for coagulase-negative staphylococci CoNSthe same pulsotype from the strains recovered from the catheter tip and blood culture was required for a diagnosis of a CRBSI.

Alternatively, two separate peripheral blood cultures had to grow the same microorganism that colonized the catheter tip. The condition of the skin was described on a standardized form by the nurse in charge of the patient at each dressing change and at catheter removal, using the International Contact Dermatitis Research Group system ICDRC; 0, normal skin; 1, mild redness only; 2, red and slightly thickened skin; 3, intense redness and swelling with coalesced large blisters or spreading reaction.

Characteristics of patients and catheters were described as count percent or median interquartile range for qualitative and quantitative variables, respectively.

For the first objective, we used a marginal Cox model for clustered data to take into account a possible clustering effect of multiple catheters per patient. This model takes into account the possible intra-cluster dependence using a robust sandwich covariate estimate and the censored nature of the data. The proportionality of hazard risks for gel-dress versus sponge-dress was tested using Martingale residuals. These models take into account a possible clustering effect of multiple dressings per catheter.

Our group previously Impregnated With Pus risk factors for dressing disruption: therefore, we performed a sensitivity analysis adjusting for well-known dressing disruption risk factors i. For all models, we performed a sensitivity analysis with solely the three ICUs which participated in both studies.

All analyses were performed using SAS version 9. Informed consent was obtained from all individual participants included in the study and whose decision-making capacity was intact. Between anda total of patients, catheters, and 25, dressing changes were observed Fig. ICU: Intensive care unit. Sponge-dress: Chlorhexidine-impregnated sponges. Gel-dress: Chlorhexidine-impregnated dressing. Characteristics of patients and catheters with CHG-impregnated dressings were described in Tables 1 and 2.

The patients were similar between both groups, except for the reasons for ICU admission which were different between sponge-dress and gel-dress. Catheter colonization was slightly increased in the sponge-dress group. MCRI: major catheter-related infection. CRBSI: catheter-related bloodstream infection. Sponge-dress: chlorhexidine-impregnated sponges. Gel-dress: chlorhexidine-impregnated dressing. A sensitivity analysis for the 3 ICU which participated in both studies showed similar results.

We observed dressing changes and dressing disruption Dressing disruption were infrequently observed in gel-dress compared to sponge-dress OR 0. Dressing disruption and contact dermatitis risk. CI: Confidence interval. We observed 1. Gel-dress had an increased risk for contact dermatitis compared to sponge-dress OR 3. Considering only the three ICUs included in both studies, we observed similar results OR for gel-dress 4.

In contrast, if CHG was used for skin antisepsis, gel-dress increased the risk of contact dermatitis compared to standard dressing OR 1. Using high-quality data from two RCTs, this post hoc analysis showed that the daily hazard rate of intravascular catheter infections was similar between gel-dress and sponge-dress.

We observed fewer dressing disruptions among gel-dress compared to sponge-dress, whereas sponge-dress was associated with fewer contact dermatitis. A recent meta-analysis showed that chlorhexidine-impregnated dressings reduced catheter-related bloodstream infections [ 9 ]. To our knowledge, a direct comparison between gel-dress and sponge-dress has never been performed.

This study showed that a non-significant lower rate of infections occurred with gel-dress Impregnated With Pus with sponge-dress, while our data clearly demonstrated a similar rate of infections between both types of CHG-impregnated dressings.

Therefore, we confirmed the data obtained in vitro by Karpanen et al. Dressing disruptions were less frequently observed among gel-dress. This may be explained by the difficulty to appropriately use sponge-dress. Moreover, sponge-dress may fail to contact the skin around the catheter insertion site if the fixation sutures for catheter were very near the entry point [ 12 ]. Even if not confirmed by our MCRI and CRBSI analyses, dressing disruptions may be an important risk factor for catheter-related infections and should therefore be prevented [ 22 ].

Contact dermatitis was more frequently observed when gel-dress was used compared to sponge-dress. This result should be interpreted with caution. Using PVI skin disinfection, gel-dress did not significantly increase the risk of dermal reaction OR of 1. Therefore, we hypothesize that contact dermatitis was triggered by the cumulative exposition to CHG i. In light of these considerations, gel-dress appeared to have a slight benefit in terms of dressing disruptions compared to sponge-dress. Moreover, gel-dress permitted a continuous inspection of the insertion site that may help clinicians in managing intravascular catheters [ 23 ].

A particular attention to contact dermatitis should be paid if CHG is used for skin disinfection and concomitantly CHG-impregnated dressing was applied. After removal of infected bones and necrotic soft tissues, antibiotic-impregnated calcium sulfate was prepared. Then they were dissolved with sterile saline solution and injected into the dead space range from 0.

After operations, the wounds were sutured primarily without tension. In the control group, patients received the same operation expect for the application of antibiotic-loaded calcium sulfate. Continuous variables which were verified of normal distribution and the homogeneity of variance were compared using Independent-Samples T Test; Continuous variables which failed to pass normality test were compared using a Mann—Whitney U test.

From to46 patients 48 limbs met the criteria were included in the study. The preoperative culture results were presented in Table 2. In control group, Staphylococcus aureus was the most common pathogen isolated by culture followed by Escherichia coli and Enterococcus faecalis. Twenty limbs The follow-up outcomes of two groups were presented in Table 3. A yaer-old patient with DFO on left first metatarsophalangeal joint. The metatarsophalangeal joint, partial metatarsal and phalange were removed.

This sterile leakage was demonstrated as a kind of white, foamy, antibiotics-containing fluid. Vancomycin-impregnated calcium sulfate lump was degrading. Superficial ulcer in ankle could be managed with dressing. Although edema was presented, the operative wound healed and the symptoms of infection were Impregnated With Pus. According to the severity of infections and local blood supply, diabetic foot osteomyelitis can be managed with conservative treatment or surgery.

When accompanied with pus, substantial bone necrosis, gangrene, recurrent ulcer or antibiotic-resistant bacteria infection, surgery is recommended to remove necrosis tissues, reduce the antibiotic therapy duration and correct bone deformity to promote healing [ 23 ].

However, even surgical treatment also has its own limitations. Due to the bone removal, biomechanics in foot is inevitably changed, which may lead to the ulcer formation in a new position. Thus, postoperative offloading with customized insoles and shoes was essential to promote healing and prevent infection recurrence.

Furthermore, during infected bone resection, the clear margin of bone and soft tissue is fairly difficult to identify. The exact extent for infected bone resection is largely depended on the intra-operative judgement of the surgeons and thus sometimes lead to the non-healing or recurrence of osteomyelitis.

To eradicate the residual infection, local antibiotic-impregnated calcium sulfate was applied in our study as the high local antibiotic level it produced.

In total, The higher healing rate in CS group is in accordance with the retrospective study of Rajesh M. Jogia et al. Similarly, Noman Shakeel Niazia et al.

Proper explanation of the high healing rate is that much higher antibiotic concentration reached topically can eradicate more residual organisms with the resorption of the calcium sulfate.

Combining with the previously-reported efficacy of antibiotic-impregnated calcium sulfate in eradicating infections and well-controlled variables similar blood supply condition, appropriate wound care and postoperative offloading between two groups in our study, we deem that the small group of patients included may cause the absence of significant differences in the healing rate.

This explains why the healing rates of two groups are not statistically significant. With regard to the recurrence rate, such high topical antibiotic concentration and long therapeutic duration explained that the much lower recurrence rate of antibiotic-impregnated calcium sulfate group than the control group. Rajesh M. However, our study failed to provide evidence that antibiotic-impregnated calcium sulfate will shorten the wound healing duration, which is different from the similar former study.

Martin Varga et al. Fabian G. Krause et al. In this study, however, the mean duration of healing in CS group was 2. Actually, we hypothesize that the prolonged leakage in CS group may interfere with the wound healing, but no previous study was found to support this hypothesis. Prolonged postoperative leakage was found to be the most common complication in calcium sulfate treated patients.

With regular dressing, all wounds achieved healing eventually. The drainage rate is similar with the former studies about chronic osteomyelitis and varies from 4. Other studies have reported the prolonged postoperative leakage in treating chronic osteomyelitis after using antibiotic-impregnated calcium sulfate, but achieving healing with appropriate wound care [ 1331 ].

In fact, prolonged postoperative leakage itself is neither an indication for a second surgery nor did it relate to reinfection of the wound [ 31 ].

Regularly dressing in outpatient is enough in dealing with the postoperative leakage. Vacuum-assisted Closure VAC was not used because we deemed that it might lower the topical antibiotic level when pumping the drainage. During surgical treatment, good soft tissue coverage and primary closure are essential methods in the prevention of postoperative leakage.

Severe side effects were not found excluding postoperative leakage in CS group. The explanation is that the dose of vancomycin or gentamicin administered locally was less than 0. Unfortunately, systemic drug concentration was not obtained to confirm our hypothesis. In their study, Zhang et al. The results showed that the mean blood vancomycin level was still within a safe range for application [ 32 ]. Wahl et al. To our knowledge, our study is the first retrospective comparative study Impregnated With Pus the outcomes of infected bone resection combined with adjunctive antibiotic-impregnated calcium sulfate versus infected bone resection in the treatment of DFO.

The limitations of our study are mainly in two aspects. Firstly, the follow-up duration in two groups may not be enough to show the outcomes of all patients, which may influence the healing rate, recurrence rate and amputation rate in our study.

Furthermore, it is a retrospective study for forefoot DFO with a small group of patients, the additional studies are necessary to confirm our findings. Application of the antibiotic-impregnated calcium sulfate as an adjuvant can be regarded as efficacious for preventing the recurrence of forefoot DFO. However, evidence is not found that the use of antibiotic-impregnated calcium sulfate improves the healing rate, shorten the healing duration or reduce the amputation rate.

Prolonged postoperative leakage as a common complication can be dealt with regular dressing. Risk factors for developing osteomyelitis in patients with diabetic foot wounds.

Diabetes Res Clin Pract. Article Google Scholar. Probing the validity of the probe-to-bone test in the diagnosis of osteomyelitis of the foot in diabetes. Diabetes Care. Senneville E, Robineau O. Treatment options for diabetic foot osteomyelitis.

Expert Opin Pharmaco. Risk factors for foot infections in individuals with diabetes. Lipsky BA. Treating diabetic foot osteomyelitis primarily with surgery or antibiotics: have we answered the question?

Oral antimicrobial therapy for diabetic foot osteomyelitis. Foot Ankle Int. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Effects of vancomycin, daptomycin, fosfomycin, tigecycline, and ceftriaxone on Staphylococcus epidermidis biofilms.

J Orthop Res. Conservative management of diabetic forefoot ulceration complicated by underlying osteomyelitis: the benefits of magnetic resonance imaging.

Diabet Med. Natural extraction of the egg sack or removal of the jigger with dirty pin or needle leaves a tiny pit in the skin which may develop into a sore. Heavy infestation of the results in toes filled with pus, which may lead to infection, inflammation, ulceration, fibrosis, lymphangitis, gangrene, loss of toenail, autoamputation of the digits and death.

Sharing of pins and needles also spreads HIV. Where jiggers attack Hands, feet, knees and other parts of the body. Click here to see a video clip of feet disfigured by jiggers. Click here to see a video clip of jigger-infested hands Impregnated With Pus legs.

Click here to see a video clip of a man rendered unable to walk by jiggers.

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Reprints and Permissions. Buetti, N. Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better?. Crit Care 24, Download citation. Received : 23 May Accepted : 12 July Published : 23 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Research Open Access Published: 23 July Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better? Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion Impregnated With Pus recruited. Results A total of patients and catheters were observed in 16 intensive care units. Conclusions We described a similar infection risk for gel-dress and sponge-dress.

Trials registration These studies were registered within ClinicalTrials. Background Short-term central venous catheters CVCs are instrumental in the care of critically ill patients for the intravenous administration of fluid resuscitation, safe intravenous administration of medications, and support in the monitoring of hemodynamic parameters. Study catheters and dressings This post hoc analysis evaluated data from patients with short-term CVCs and ACs included in both studies.

Dressing disruption was defined by a leakage or soiling and led to an immediate dressing change. Statistical analysis Characteristics of patients and catheters were described as count percent or median interquartile range for qualitative and quantitative variables, respectively. Results Patients, catheters, and dressings Between anda total of patients, catheters, and 25, dressing changes were observed Fig. Full size image. Discussion Using high-quality data from two RCTs, this post hoc analysis Impregnated With Pus that the daily hazard rate of intravascular catheter infections was similar between gel-dress and sponge-dress.

Conclusions Using the largest dataset ever collected from large multicentered RCTs conducted with consistent catheter care, we illustrated that the infection risk was similar for gel-dress and sponge-dress. References 1. Google Scholar 2. Article Google Scholar 3. Article Google Scholar 4. Article Google Scholar 5. Article Google Scholar 6. Article Google Scholar 7. Article Google Scholar 8. Article Google Scholar Chapter Google Scholar View author publications.

Ethics declarations Ethics approval and consent to participate Both studies were approved by the national ethics committee. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Supplementary information. Additional file 1: Table S1.

About this article. Cite this article Buetti, N. Copy to clipboard. Contact us Submission enquiries: Access here and click Contact Us General enquiries: info biomedcentral. However, when carrying out infected bone resection, the completely negative resection margin is relatively difficult to be identified, which may lead to the residue of pathogens. Furthermore, the removal of infected bone sometimes causes the formation of dead space, which will be filled with hematoma soon and provide an environment for the growth of bacteria.

Muscle flap used to be Impregnated With Pus method to obliterate the defects caused by debridement, but it is limited when managing with deeper defects and may disturb the bone healing [ 13 ]. Local antibiotic delivery system has been widely used as an adjuvant after the surgical treatment of osteomyelitis and achieved good results [ 1415 ].

Compared with intravenous route, the local antibiotic delivery has the advantages of more accurate positioning, higher local concentration, less side effects and longer duration. At the same time, it works as a bone substitute which fills the dead space caused by bone resection and reduces the incidence of reinfection.

Polymethyl-methacrylate cement PMMA has acted as an antibiotic carrier to fill the defects caused by debridement since Buchholz successfully applied it in joint prosthesis. However, its non-biodegradable characteristics, the high temperature it produces and a second surgery for removal all limit its application on osteomyelitis especially in DFO [ 16 ]. Nowadays, biodegradable antibiotic-impregnated materials such as calcium sulfate, calcium phosphate, bioactive glasses and collagen are gradually applied as a substitute for PMMA in the management of osteomyelitis.

All materials mentioned above have advantages of biocompatibility and drug compatibility. Among those substitutes, calcium sulfate is most frequently used materials since it enjoyed some eminent advantages. This ideal elution duration makes it more available than collagen too short and calcium phosphate too long to be a bone graft.

Furthermore, it hardly produces the foreign body reaction and helps the formation of new bone. The complications of calcium sulfate are also acceptable, including postoperative drainage and transient hypercalcemia [ 17 ]. Previous studies had reported that satisfying outcomes could be received when using antibiotic-impregnated calcium sulfate as an adjuvant after surgical treatment of DFO. However, few comparative studies had been carried out to confirm those results.

This retrospective study was designed to observe the outcomes of surgical treatment combined with adjuvant antibiotic-impregnated calcium sulfate versus surgical treatment alone in the treatment of DFO and to compare the differences of healing rate, time to healing, osteomyelitis recurrence rate and amputation rate between two groups. This retrospective study focused on patients with DFO treated in our orthopedic department Impregnated With Pus January to June The main inclusion criteria were as follows: 1 patients with DFO underwent surgical bone resection alone or surgical bone resection combined with adjuvant antibiotic-impregnated calcium sulfate.

The main exclusion criteria included: 1 Patients received major amputation or non-surgical treatments. Finally, 46 patients with 48 infected limbs met the criteria were included in the study.

Before admitting to our department for surgical treatment, 46 patients 48 limbs with suspicious DFO suspected by clinical presentation and the active X-ray, MRI or probe-to-bone test results [ 7 ] were sampled using percutaneous bone biopsy [ 18 ] in our diabetic foot unit for culturing and histology test.

Preoperative antibiotic therapy was applied empirically after sampling in the first several days and tailored to culture and susceptibility findings. For patient with negative culture result but accompanied with the presentation of inflammation and positive of histology test, empirical antibiotics were adjusted according to the inflammatory markers. DFO are usually polymicrobial and Staphylococcus aureus has been proven as the most common pathogens in DFO [ 1920 ].

Thus, it is a necessity that empirical treatment of DFO should consist of antibiotics with activity against S. Depending on the calcium sulfate applied or not, 46 patients 48 limbs were divided into two groups: the CS group and the control group.

The characteristics of patients in two groups were presented in Table 1. All surgical procedures were carried out by two experienced surgeons. The surgical treatment performed as the resection of infected bones and removal of the necrotic soft tissues. Healthy bones and soft tissues were preserved as far as possible for minimizing the biomechanical changes and covering the wounds. For postoperative wounds care, patients were suggested to offload in involved limbs.

Routine dressings and skin moisturizers were applied every two days until wound healing or infection recurring. Once wounds achieving healing, patents were educated never walk in shoes that contributed to a foot ulcer. Customized insoles and shoes were recommended to reduce pressure transfer during follow-up. In this single-stage study, we defined the wound healing as complete epithelialization covered the wound and the absent of infection.

Non-healing was defined if the wound was infected before healing and was treated with a second operation or antibiotics. Osteomyelitis recurrence was defined if the appearance of bone infection was presented at the same or adjacent site after wound healing. Patients suffered from non-healing were excluded from the further calculation for recurrence rate even if the wounds eventually healed with subsequent therapy. Surgical procedures were carried out after spinal, nerve block or regional anesthesia.

In the CS group, necrotic granulation tissues, pus and infected soft tissues in the ulcers were removed until the bleeding tissue has been exposed.

Following the removal of ulcers or sinus, the bone procedures were carried out. If osteomyelitis was located in diaphyses, devitalized bones in the base of ulcers were exposed and excised to the level of healthy cancellous and cortical bone. If possible, the bases of metatarsal and phalangeal bones were necessary to be preserved for healthy tendons attaching.

When infections were located in interphalangeal or metatarsophalangeal joints, however, the joints as well as partial distal and proximal bones were needed to be excised. Fibrous tissues, fascia and tendons nearby were also completely removed in case the residue of pathogens. Following bones resection, the defects were irrigated with 0.

If necessary, Kirschner wires were adopted to maintain the bones stable. After removal of infected bones and necrotic soft tissues, antibiotic-impregnated calcium sulfate was prepared. Then they were dissolved with sterile saline solution and injected into the dead space range from 0. After operations, the Impregnated With Pus were sutured primarily without tension.

In the control group, patients received the same operation expect for the application of antibiotic-loaded calcium sulfate. Continuous variables which were verified of normal distribution and the homogeneity of variance were compared using Independent-Samples T Test; Continuous variables which failed to pass normality test were compared using a Mann—Whitney U test.

From to46 patients 48 limbs met the criteria were included in the study. The preoperative culture results were presented in Table 2. In control group, Staphylococcus aureus was the most common pathogen isolated by culture followed by Escherichia coli and Enterococcus faecalis. Twenty limbs The follow-up outcomes of two groups were presented in Table 3. Click here to see a video clip of a jigger-infested woman having difficulty in walking.

Click here to see a video clip of a jigger-infested trying to remove a jigger using a pin. Animals that may be carrying the fleas should also be treated. Victims and their families should also be educated on the need to observe hygiene. Wearing shoes should be encouraged to ensure Impregnated With Pus the flea does not find entry into ones feet.

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9 thoughts on “Impregnated With Pus

  1. International slamming brutal death project featuring Haruka on vocals (Gorevent,Medic Vomiting Pus,Second Resurrection) and Constantine on guitar and drum p.

  2. Impregnated with Pus. Traumatomy. Song. 2 min 53 sec. More by Traumatomy. Extirpation Paradigms. Chapters of Grotesque Torments. Monolith of Absolute Suffering. Transcendental Eviscerating Of Necrogenetic Beasts (Remastered) Transcendental Evisceration of .

  3. To balance the negative permittivity behavior and flexibility, a novel preparation strategy was proposed in this study. The polyurethane sponge (PUS) was impregnated with synthesized sliver nanowires (AgNWs) to achieve flexible AgNWs/PUS composites, and the effect of compressed elastic deformation on negative permittivity was blueskyservices.bizted Reading Time: 9 mins.

  4. Then, a piece of PUS was placed inside it, and incubated at 37 °C for 24 h. Next, it was washed, and cut. Then, one piece of PUS and PUSIAG was separately added to 1 mL of cell suspension (Promastigotes, Amastigote, and WSCs), and then incubated for 1, 2, 3, and 4 days at 37 °C. After incubation times, the quantity of adhered cells was counted, and cell viability was .

  5. Non adherent Moist (Tulle Gras Dressing) - Gauze impregnated with paraffin or similar. May be impregnated with antiseptics or antibiotics: Jelonet, Unitulle Bactigras, Sofra-Tulle: Reduces adhesion to wound. Moist environment aids healing. Does not absorb exudate. Requires secondary dressing May induce allergy or delay healing when impregnated.

  6. The procedure followed is simply that a filter disk impregnated with an antibiotic is applied to the surface of an agar plate containing the organism to be tested and the plate is incubated at 37°C for hours. As the substance diffuses from the filter paper into.

  7. An abscess is a cavity containing pus surrounded by a capsule of thickened, inflamed tissue. Usually an abscess is the result of a bacterial infection. The pus is an accumulation of dead cells from the battle to fight the infection. In humans, skin abscesses are often caused by Staphylococcus infections, but in rabbits, they can be caused by aerobic bacteria (those that .

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