Etiological Analysis Of Infections In Chronic Wounds And Effect Of Negative Pressure Wound Therapy With Instillation(NPWTi)

Objective To analyze the distribution characteristics of etiology of chronic wounds infection,and the efficacy of negative pressure wound therapy with instillation(NPWTi)in the clinical.In order to provide references for treating chronic wounds.Methods Selected patients diagnosed as chronic wounds in department of burn plastic surgery in Anhui Provincial Hospital between May 2015 and October 2017.According to the inclusion and exclusion criteria,a total of 70 patients were included in the study,48 cases of lower extremities,8 cases of upper extremity,6 cases of thoracoabdominal,5 cases of lumbar and back and 3 cases of head and neck.The causes included 27 cases of trauma,18 cases of diabetes or other self-disease,10 cases of pressure sore,9 cases of burn,and 6 cases of other reasons.The bacterial culture and drug sensitivity of the wounds were analyzed retrospectively,and the sites of the wounds and the causes of the wounds were classified.Then compared the cleaning time,treatment times,complications and wounds healing effect in two groups who were treated with NPWTi or NPWT,to evaluate the efficacy of NPWTi.Results80 pathogenic bacteria were cultivated in 70 cases,of which 4 cases were negative for bacterial culture,and the positive rate of bacterial culture in wounds was94.29%(66/70).There were 8 cases infection by 2 bacteria mixed,and 3 cases with 3 bacteria mixed.There were 34 Gram-positive bacteria(34/80;42.50%),46 Gram-negative bacteria(46/80;57.50%),and no fungi were cultivated.The main bacteria were distributed in Staphylococcus aureus(20/80;25%),Pseudomonas aeruginosa(16/80;20%)and Escherichia coli(10/80;12.50%).The distribution of pathogenic bacteria with different locations and different etiologies in chronic infectious wounds are difference.The common pathogens in lower limbs and trauma chronic wounds are mainly Gram-negative bacteria.Staphylococcus aureus,Pseudomonas aeruginosa,Escherichia coli,and Acinetobacter Bauman showed widespread resistance to many antibiotics.63 cases were treated with NPWT and were divided into group NPWTi(30 cases)and standard NPWT group(33 cases)in the 70 patients.There was no significant difference between the two groups(P > 0.05)in the general data,the risk factors,the wounds site,the cause and the area of the wounds.Compared two groups with wounds cleaning time(11d vs 13d),treatment time(1.70 vs 2.27),blocking rates(9.8% vs 24%),dry rate of foam rates(5.8% vs 26.7%),the difference has statistical significance(P < 0.05).The surface area of the two groups was narrower than that before.After comparison,it was found that the reduction of the area of the two groups was statistically significant(P < 0.05).There was no significant difference between the two groups of wound repair methods(P > 0.05).The excellent rates of wounds repair in the two groups were above 80%,and there was no significant difference(P > 0.05).Conclusions The main pathogenic bacteria of the chronic wounds infection are Gram-negative bacteria,which are mainly distributed in Staphylococcus aureus,Pseudomonas aeruginosa and Escherichia coli.There are also differences in the distribution of pathogenic bacteria with different locations and different etiologies of the chronicwounds.The common pathogens in lower limbs and trauma chronic wounds are mainly Gram-negative bacteria.Staphylococcus aureus,Pseudomonas aeruginosa,Escherichia coli,and Acinetobacter Bauman showed widespread resistance to many antibiotics.When compared in local treatment of chronic wounds,NPWTi can effectively shorten the wounds cleaning time,reduce the number of treatment,reduce the incidence of complications such as foam plugging and dry,prolong the usable time,save medical resources,and does not affect the final wounds repair effect.Therefore,it can be widely used in clinical.