Wound Bioburden and Infection-Related Complications in Diabetic Foot Ulcers

Biological Research for Nursing - Tập 10 Số 1 - Trang 44-53 - 2008
Sue E. Gardner1, Rita A. Frantz2
1University of Iowa College of Nursing, Iowa City, Iowa, , Center for Research in the Implementation of Innovative Strategies in Practice (CRSP), Iowa City VA Medical Center, Iowa City, Iowa
2University of Iowa College of Nursing, Iowa City, Iowa,

Tóm tắt

The identification and diagnosis of diabetic foot ulcer (DFU) infections remains a complex problem. Because inflammatory responses to microbial invasion may be diminished in persons with diabetes, clinical signs of infection are often absent in persons with DFUs when infection is limited to localized tissue. In the absence of these clinical signs, microbial load is believed to be the best indicator of infection. Some researchers, however, believe microbial load to be insignificant and type of organism growing in the ulcer to be most important. Previous studies on the microbiology of DFUs have not provided enough evidence to determine the microbiological parameters of importance. Infection-related complications of DFUs include wound deterioration, osteomyelitis, and amputation. Risk factors for amputation include age, peripheral vascular disease, low transcutaneous oxygen, smoking, and poor glycemic control. These risk factors are best measured directly with physiological measures of arterial perfusion, glycemic control, sensory neuropathy, plantar pressures, and activity level and by controlling off-loading. DFU bioburden has not been examined as a risk factor for infection-related complications. To address the relationship between wound bioburden and the development of infection-related complications in DFUs, tightly controlled prospective studies based on clearly defined, valid measures of wound bioburden and wound outcomes are needed. This article reviews the literature and proposes a model of hypothesized relationships between wound bioburden—including microbial load, microbial diversity, and pathogenicity of organisms—and the development of infection-related complications.

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Tài liệu tham khảo

10.2337/diacare.22.7.1029

10.2337/diacare.22.8.1354

10.7547/87507315-85-10-533

10.1016/0002-9343(87)90894-1

10.1016/0022-4804(86)90044-2

Baxter, C.R., 1992, Nursing RSA Verpleging, 7, 16

Bendy, R.H., 1964, Antimicrobial Agents and Chemotherapy, 4, 147

10.5935/0305-7518.19860028

Boulton, A. J. M. (Ed.) (1997). Late sequelae of diabetic neuropathy. In Diabetic neuropathy (pp. 63-75). Carnforth, Lancashire, UK: Marius Press.

10.1046/j.1524-475X.1999.00007.x

10.1016/S0140-6736(05)67698-2

Bowler, P.G., 1998, Wounds, 10, 170

Bowler, P.G., 2003, Ostomy/Wound Management, 49, 44

10.1128/CMR.14.2.244-269.2001

10.1001/archinte.1983.00350110079019

Centers for Disease Control and Prevention., 2004, National diabetes fact sheet: General information and national estimates on diabetes in the United States

10.1093/infdis/135.Supplement.S65

10.1136/jcp.34.7.701

10.1055/s-0029-1211996

Dow, G. (2001). Infection in chronic wounds. In D. Krasner, G. Rodeheaver , & R. G. Sibbald (Eds.), Chronic wound care: A clinical source book for healthcare professionals (pp. 343-356). Wayne, PA: HMP Communications.

El-Tahawy, A.T., 2000, Saudi Medical Journal, 21, 344

Foster, A.V.M., 1998, Diabetes Medicine, 15, S10

Fotieo, G.G., Journal of Rehabilitation Research and Development, 36, 55

Gardner, S.E. & Frantz, R.A. (2003). Wound bioburden. In S. Baronoski, & E. A. Ayello (Eds.), Wound care essentials: Practice principles (pp. 91-116). Philadelphia : Lippincott, Williams & Wilkins.

10.1046/j.1524-475x.2001.00178.x

Gardner, S.E., 2005, Wounds, 17, 203

Gardner, S.E., 2004, Wounds, 16, 251

10.1111/j.1743-6109.2006.00162.x

10.1093/clinids/20.Supplement_2.S283

Gilchrist, B., 1994, Nursing Times, 90, 55

Gilchrist, B. (1997). Infection and culturing. In D. Krasner, & D. Kane (Eds.), Chronic wound care: A clinical source-book for healthcare professionals (pp. 109-114). Wayne, PA: Health Management Publications.

10.2337/diacare.19.6.638

Greenberg, R. Daniels, S. Flanders, W. Eley, J. & Boring, J. (Eds.) (1996). Diagnostic testing. In Medical epidemiology (pp. 75-83). Norwalk: Appleton & Lange.

10.1016/S0736-4679(02)00564-4

10.1016/S0022-5223(19)36516-X

10.1016/0196-6553(90)90167-Q

10.1093/clinids/20.Supplement_2.S289

10.1016/0741-5214(93)90678-F

10.1016/0002-9610(75)90516-4

10.1016/0002-9610(94)90008-6

10.2337/diacare.26.5.1435

10.1097/00005373-197602000-00002

10.1086/313461

10.1086/424846

10.1001/archinte.1990.00390160058013

10.1001/archderm.1978.01640240007002

10.7326/0003-4819-85-4-461

10.1016/S0733-8635(18)30226-2

10.2337/diacare.13.5.513

10.1007/BF01639650

Prabhakar, P., 1981, Tropical and Geographical Medicine, 33, 249

Reiber, G.E., 1995, Lower extremity foot ulcers and amputations in diabetes

10.1002/dme.1996.13.s1.6

10.7326/0003-4819-117-2-97

Reiber, G.E., 2001, Journal of Rehabilitation Research and Development, 38, 309

10.1093/milmed/134.1.19

10.1053/jhin.2000.0903

10.1128/JCM.12.3.413-420.1980

10.1093/clinids/6.Supplement_1.S171

10.1001/jama.293.2.217

10.1016/j.diabres.2006.05.021

Steed, D.L. (2001). Diabetic wounds, Assessment, classification, and management. In D. Krasner, G. Rodeheaver, & R. G. Sibbald (Eds.), Chronic wound care: A clinical source book for healthcare professionals (pp. 575-581). Wayne, PA: Health Management Publications.

10.1016/S0749-0690(18)30160-5

10.1097/00004045-199903000-00008

10.12968/jowc.1996.5.6.277

U.S. Department of Health and Human Services., 1994, Treatment of pressure ulcers. (AHCPR Publication No. 95-0652 Agency for Health Care Policy and Research, Public Health Service)

10.1001/archinte.1986.00360220079017

10.1080/17453679209169732

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Biological Research for Nursing

Tập 10 Số 1

44-53

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