Controversies and challenges of chronic wound infection diagnosis and treatment

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden. Vascular impairment represents the main cause of chronic ulceration, while the infection is the most frequent complication. Chronic infections persist and progress despite an adequate antimicrobial regimen and are typically caused by monoor polymicrobial biofilms. The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains, with the risk of life-threatening septic complications, especially in immunocompromised individuals. In this article, we perform a thorough literature review, in order to answer the main controversies regarding the involvement of planktonic Corresponding author: Cornelia Nitipir, MD Department of Oncology, “Elias” University Emergency Hospital, Bucharest, Romania e-mail: nitipir2003@yahoo.com REZUMAT Controverse æi provocãri în diagnosticul æi tratamentul infecåiilor de la nivelul plãgilor cronice Pe parcursul ultimului deceniu, plãgile cronice, precum ulcerele venoase sau arteriale, ulcerele diabetice, escarele æi plãgile chirurgicale cu vindecare întârziatã, au captat atenåia comunitãåii medicale, datoritã prevalenåei în creætere æi a costurilor ridicate de tratament. Insuficienåa vascularã reprezintã principala cauzã de apariåie a ulceraåiilor cronice, în timp ce infecåia este cea mai frecventã complicaåie. Infecåiile cronice persistã æi progreseazã în ciuda unui tratament antimicrobian adecvat æi sunt de obicei cauzate de biofilme monosau polimicrobiene. Colonizarea bacterianã persistentã a plãgilor, precum æi utilizarea pe termen îndelungat a antibioticelor predispun spre dezvoltarea infecåiilor nosocomiale cu tulpini rezistente, situaåie în care complicaåiile septice implicã un risc vital, în special la indivizii imunocompromiæi. În acest articol, efectuãm o revizuire aprofundatã a literaturii ætiinåifice, pentru a rãspunde principalelor controverse privind implicarea microorganismelor planctonice æi/sau biofilmelor în procesul de vindecare a plãgilor cronice. De asemenea, ne propunem sã analizãm utilitatea tratamentului antimicrobian în ulcerele cu vindecare întarziatã æi sã stabilim principalele sale obiective, spre a obåine beneficiul terapeutic maximal. Cuvinte cheie: infecåie cronicã, plagã cronicã, biofilm, antibiotic, antiseptic Controversies and challenges of chronic wound infection diagnosis and treatment Mara Mãdãlina Mihai1,2, Cãlin Giurcãneanu2,3, Liliana Gabriela Popa2,3, Cornelia Niåipir4, Mircea Ioan Popa1 1Department of Microbiology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2Department of Dermatology and Allergology, “Elias” University Emergency Hospital, Bucharest, Romania 3Department of Dermatology and Allergology, Faculty of Medicine, “Carol Davila” University of Medicine d Pharmacy, Bucharest, Romania 4Department of Oncology, “Elias” University Emergency Hospital, Bucharest, Romania Modern Medicine. 2015, Vol. 22, No. 4 : 375-381 Copyright© Celsius