FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Epidemiology, Diagnosis and Management of Infected Chronic Wounds
A.A.L.M. Rondas 1 , J.G.M.A. Schols 2 , RJ.G. Halfens 3 , E.E. Stobberingh 4
1 De Zorggroep, Venlo, The Netherlands. Email: a.rondas@maastrichtuniversity.nl, 2 FHML-department
General Practice, Maastricht University, The Netherlands. 3 Department of Health Care and Nursing
Science, School for Public Health and Primary Care, Maastricht University, The Netherlands. 4 Academic
Medical Centre, Maastricht, The Netherlands.
Introduction
Chronic wounds affect more than 1% of the U.K.
population and cost society at least ₤1 billion per year
[1], so the costs, both financial and emotional are high.
At this moment there are no data on the number and
costs of chronic wounds in the Netherlands.
Although an accurate history may help to determine the
initial etiology of a chronic wound, chronicity of dermal
wound healing is often related to secondary factors such
as infection or vascular insufficiency [2]. Chronic
wounds contain a bacterial load that is different from the
load found in acute, potentially contaminated, surgical
and traumatic wounds [3]. In chronic wounds the signs
of local infection and even systemic infection can be
subtle or misleading. Therefore, already in1969, Robson
proposed bacterial quantification as a potential
technique to diagnose infection [4]. This strategy,
however, has evolved into the excessive and
indiscriminative tendency to culture chronic wounds,
under the false hope that this will identify underlying
infection. Wound cultures mostly will be positive and this
finding subsequently has led to further promoting this
false belief [5]. Moreover, this has invariably fostered
the use of systemic broad-spectrum antibiotics with the
associated risk of antibiotic resistance. The PhD study
that will be presented, examines the number of
(infected) chronic wounds in the Netherlands. Following
the review of the literature on obtaining a culture
specimen of a chronic wound, a more targeted and
efficient method for wound culturing will be presented.
Finally, the PhD study aims to validate the clinical
symptoms of infected chronic wounds as published in
the international guidelines of EWMA and WUWHS [6,
7].
Methods
Following the methodology of the Dutch National
Prevalence Measurement of Care problems (LPZ) [8],
the prevalence of (infected) chronic wounds will be
assessed via a specifically developed module on
(infected) chronic wounds which recently has been
pilot tested. A systematic review has been conducted
on the method to obtain in a validated way a culture
specimen of an infected chronic wound. An empirical
study will be performed to assess the clinical
symptoms of an infected chronic wound [7].
Additionally, the symptoms mentioned in the current
international standards [6,7] will be validated by taking
a swab and a biopsy of the wound at the same time.
63
Results
The following preliminary results will be presented:
1. The prevalence of (infected) chronic wounds as
assessed in the pilot study together with data on the
feasibility of the newly developed LPZ module.
2. The results of the systematic review on obtaining
culture specimens of an infected chronic wound.
3. The design of the planned empirical study on
validating the symptoms mentioned in the current
international standards.
Discussion
The total research project will further reveal the clinical
relevance of infected chronic wounds and related to
this the importance of an adequate strategy to manage
them. Clear clinical and relevant microbiological
confirmation of the presence of infection of a chronic
wound is crucial for targeting an effective and efficient
intervention, and to prevent the current practice of
often unnecessary prescription of antibiotics.
Clinical relevance
When the clinical diagnosis of infection of chronic
wounds is made more accurately, it is conceivable that
the actual arbitrary practice of prescribing antibiotics
will reduce, and that the problem of antibiotic
resistance may decrease.
Conflict of Interest
None.
References
[1] Thomas DW, Harding KG. Wound healing. British Journal of
Surgery 89:1203-1205, 2002.
[2] Mostow EN. Diagnosis and classification of chronic wounds.
Clinics in Dermatology 12:3-9,1994.
[3] Bowler PG. The 10 5 bacterial growth guideline: reassessing its
clinical relevance in wound healing. Ostomy & Wound Management
49:44-53, 2003.
[4] Robson MC, Heggers JP. Bacterial quantification of open
wounds. Military Medicine 134:19-24,1969.
[5] Bowler PG, Duerden B, Armstrong D. Wound microbiology and
associated approaches to wound management. Clinical
Microbiology Reviews 14:244-68, 2001.
[6] European Wound Management Association. Position Document:
Identifying criteria for wound infection London: Medical education
Partnership Ltd., 2005.
[7] WUWHS: Infection. Principles of Best Practice Wound infection
in clinical practice. An international consensus. London: MEP Ltd.,
2008.
[8] Halfens RJG, Meijers JMM, Du Moulin MFMT, van Nie NC,
Neyens JCL,Schols JMGA. Rapportage resultaten Landelijke
Prevalentiemeting Zorgproblemen. Maastricht: Datawyse/
Universitaire Pers Maastricht, 2010.
Copyright © 2011 by EPUAP