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Infected Pressure Ulcers: microbiology, staging and clinic
- 1. Infected Pressure Ulcers: microbiology, staging and clinic Michaela Carletti, Paola Bernaschi UOS Microbiology – “Bambino Gesù”
- 2. «Evaluating microbiologically infected wounds is not linear as in samples taken from sterile sites»
- 3. The majority of wounds are colonized with aerobic and anaerobic microrganisms «indigenous»
- 6. The Biofilm
- 7. Contamination, colonisation Critical colonisation Infection host resistance adhesion exopolymeric substances progression, accumulation (quorum sensing) detachment, dissemination Gram + aerobes Gram +, Gram - aerobes Gram +, Gram – aerobes/anaerobes yeast Bacteria are present on the wound surface (contaminated). A steady state of replicating organisms are attaching to the wound tissue and multiplying but they are not associated with tissue damage or delayed healing (colonization). The bacterial burden in the wound bed is increasing. Initiates the body’s immune response (inflammation). The wound is no longer healing at the expected rate: wound size is not decreasing. Bacteria are present within the wound and have spread to the deeper and surrounding tissue. They are multiplying and causing tissue damage. There is an associated host inflammatory response that has now spread to the deeper tissue and surrounding skin. The wound is painful and may increase in size with potential satellite areas of breakdown.
- 9. Microbia l diversity Presence of pathogens Microbia l load Non microbial factors
- 10. DIAGNOSIS
- 11. pretreatment Gram inoculation on solid and liquid media identification and study of susceptibility report Colonies colony counting
- 12. New Horizons: Molecular Technology
- 14. Microbial load, diversity and presence of pathogenic organisms Small subunit of the ribosome in prokaryotes Variable and highly conserved sequences Broad Range PCR - 16S rRNA
- 15. Broad Range PCR and Clinical Diagnosis Intracellular bacteriaBacteria that grow unlikely on culture media Antibiotic therapy “The value of the contribution depends mainly on criteria used to select patients”
- 16. The Contibutions and Limits of Broad Range PCR
- 17. “Who’s there?” ... not... ”What is it doing?”
- 19. Mass Spectrometry MALDI-TOF Analysis of microorganisms intrinsic protein Mass spectrum: expression of proteins pattern Comparison with reference spectra The correspondence is represented by a numeric value
- 20. Mass spectrum is like a fingerprint
- 22. low cost work flow: greater efficiency fast more precise identification at the species lev more identifiable species
- 24. PCR-ESI MS polymerase chain reaction – electrospray ionization mass spectrometry
- 26. Appropriateness
- 33. Move swab in a zig zag pattern using enough pressure to obtain fluid from within the wound
- 34. The Lab Report