An Effective Negative Pressure Wound Therapy–Compatible Local Antibiotic Delivery Device

Rand, B.; Wenke, Joseph C.

doi:10.1097/bot.0000000000000988

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…Therefore, they concluded that the apparent bacterial reduction after several days of NPWT, as described in other studies, can be attributed to immune- modulating factors (the body's immune system or other antibacterial effects) rather than the direct physical effect induced by negative pressure. Furthermore, other authors stated that the application of NPWT in combination with the use of a local antibiotic depot reduced the antibiotic effectiveness [22] . Lalliss et al (2010), described that the effect of NPWT on bacterial load reduction differs between pathogen types.…”

Section: Discussionmentioning

confidence: 99%

Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence

Sweere

Sliepen

Haidari

et al. 2022

Injury

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Section: Discussionmentioning

confidence: 99%

Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence

Sweere

Sliepen

Haidari

et al. 2022

Injury

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“…This may be particular of importance in those unstable patients who require repeated formal debridement and irrigation or in those patients who are not hemodynamically stable enough to undergo a thorough initial operative debridement. This delivery mechanism may also be useful in those cases where a negative pressure wound dressing is used as it has been shown to be more effective than PMMA beads or a negative pressure wound dressing alone [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most notably, this study only used a single treatment group with an untreated control. While this does impart a degree of potential bias in our results, this study was performed as a follow-up of previous work at our institution that used the same bacteria and model that has evaluated several other treatment modalities with reproducible success [ 10 , 21 , 23 ]. Repeating this study in successfully treated prior groups is not the best stewardship of laboratory animals and funding.…”

Section: Discussionmentioning

confidence: 99%

Local control of polymicrobial infections via a dual antibiotic delivery system

et al. 2018

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BackgroundContaminated traumatic open orthopedic wounds are frequently complicated by polymicrobial contamination and infection. In high-risk wounds, the standard of care comprises debridement and irrigation combined with antibiotics which can be applied directly or combined with systemic antibiotics. Recently, bioabsorbable chitosan sponges have been shown to be an effective single-agent delivery device for local antibiotics with and without negative pressure wound therapy (NPWT). Severely contaminated orthopedic wounds, however, are often complicated by polymicrobial infections, necessitating multiple antibiotic agents. As such, the purpose of this study was to determine if a chitosan sponge would provide a suitable delivery vehicle for multiple antibiotics for the treatment of a polymicrobial infection in a large animal polytraumatic extremity wound model.MethodsA complex polytraumatic extremity wound was created in 11 adult male Boer goats. Each wound was contaminated with a bioluminescent strain of S. aureus (1 ml of 108 colony forming units/ml) and of P. aeruginosa (1 ml of 108 CFU/ml) which are genetically engineered to allow quantification with a photon-counting camera. Six hours following initial wound creation and contamination, wounds were debrided and irrigated with low-pressure normal saline. The animals were randomized into one of two treatments: wet-to-dry dressings alone or a commercially available chitosan sponge loaded with 1 g vancomycin and 1.2 g of tobramycin. Each animal was then recovered and reimaged 48 h later for total bacteria content; tissue samples were taken from the wound bed to determine relative bacterial colonization.ResultsAll animals in the chitosan sponge group saw significant reductions in overall bacterial load of S. aureus and P. aeruginosa (p = 0.001). The bioluminescence was also significantly reduced compared to the wet-to-dry dressing group (p = 0.0001). Furthermore, whereas the antibiotic sponge group displayed near complete eradication of bacteria, the wounds treated with the wet-to-dry dressings alone displayed a significant 2-log increase in total bacteria at 48 h p = 0.0001). S. aureus was the predominant species found in the wounds, comprising 95 and 99% of all bacteria found in the chitosan sponge and wet-to-dry, respectively.ConclusionDual antimicrobial therapy loaded in a chitosan sponge is an effective way to reduce polymicrobial infections traumatic extremity wound.

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“…30 The use of NPWT over these antibiotic delivery methods does not significantly affect the elution and concentration of antibiotics within the wound bed, and in an animal model, the use of these modalities in combination with NPWT significantly reduced the bacterial bio burden compared with NPWT alone. 40,41 Finally, the incorporation of a drain into an incisional NPWT dressing can also be used to help manage dead space. This is particularly useful in wounds that would otherwise be closed primarily, and a deep drain is desired (Fig.…”

Section: Special Modalitiesmentioning

confidence: 99%

Negative pressure wound therapy: Where are we in 2022?

Quacinella¹,

Yong

Obremskey

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Summary: The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures. Many adjuvants have been engineered into newer generations of NPWT devices such as wound instillation of fluid or antibiotics allowing surgeons to further optimize the wound healing environment or aid in the eradication of infection. This review discusses the recent relevant literature on the proposed mechanisms of action, available adjuvants, and the required components needed to safely apply NPWT. The supporting evidence for the use of NPWT in traumatic extremity injuries, infection control, and wound care is also reviewed. Although NPWT has a low rate of complication, the surgeon should be aware of the potential risks associated with its use. Furthermore, the expanding indications for the use of NPWT are explored, and areas for future innovation and research are discussed.

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An Effective Negative Pressure Wound Therapy–Compatible Local Antibiotic Delivery Device

Abstract: Antibiotic delivery to the wound using a chitosan sponge is compatible with NPWT and is more effective than PMMA antibiotic depot. The chitosan sponge works in conjunction with NPWT and may improve the outcomes of open fracture wounds.

Cited by 11 publications

References 17 publications

Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence

Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence

Local control of polymicrobial infections via a dual antibiotic delivery system

Negative pressure wound therapy: Where are we in 2022?

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