Microbiology of Wounds

409 Pages·2010·16.75 MB·English

by  Steven Percival

MICROBIOLOGY
OF
WOUNDS
© 2010 Taylor and Francis Group, LLC
© 2010 Taylor and Francis Group, LLC
MICROBIOLOGY
OF
WOUNDS
Edited by
Steven Percival and Keith Cutting
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
© 2010 Taylor and Francis Group, LLC
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© 2010 Taylor and Francis Group, LLC
Steven L. Percival would like to dedicate this book to
Carol, Alex, Tom, Mum, Dad, Nigel, and Emma.
Keith F. Cutting would like to dedicate this book to
Maud, Amelia, and Henry, and to all the patients
who have allowed me to learn from them.
© 2010 Taylor and Francis Group, LLC
© 2010 Taylor and Francis Group, LLC
Contents
Preface.......................................................................................................................ix
Editors .......................................................................................................................xi
Contributors ...........................................................................................................xiii
Chapter 1 An Introduction to the World of Microbiology and Biofilmology .......1
Steven L. Percival, John G. Thomas, and David Williams
Chapter 2 Human Skin and Microbial Flora ......................................................59
Rose A. Cooper and Steven L. Percival
Chapter 3 An Introduction to Wounds ................................................................83
Michel H.E. Hermans and Terry Treadwell
Chapter 4 Burn Wound Management ...............................................................135
Michel H.E. Hermans
Chapter 5 Cell Biology of Normal and Impaired Healing ................................151
Keith Moore
Chapter 6 The Microbiology of Wounds ..........................................................187
Steven L. Percival and Scot E. Dowd
Chapter 7 Types of Wounds and Infections ......................................................219
Randall D. Wolcott, Keith F. Cutting, Scot E. Dowd, and
Steven L. Percival
Chapter 8 Biofilms and Significance to Wound Healing ..................................233
Keith F. Cutting, Randall D. Wolcott, Scot E. Dowd, and
Steven L. Percival
Chapter 9 Wounds, Enzymes, and Proteases ....................................................249
Steven L. Percival and Christine A. Cochrane
vii
© 2010 Taylor and Francis Group, LLC
viii Contents
Chapter 10 Wound Healing Immunology and Biofilms .....................................271
Emma J. Woods, Paul Davis, John Barnett, and Steven L. Percival
Chapter 11 Antimicrobial Interventions for Wounds .........................................293
Steven L. Percival, Rose A. Cooper, and Benjamin A. Lipsky
Chapter 12 Wound Dressings and Other Topical Treatment Modalities in
Bioburden Control ............................................................................329
Richard White
Chapter 13 Factors Affecting the Healing of Chronic Wounds:
An Iconoclastic View .......................................................................345
Marissa J. Carter and Caroline E. Fife
Index ...........................................................................................................................373
© 2010 Taylor and Francis Group, LLC
Preface
Chronic wounds are a serious public health issue. The incidence and prevalence of
the different types of chronic wounds are largely unknown worldwide, but 13 years
ago George1 estimated the worldwide burden of wounds to be:
• Surgical wounds, 40 to 50 million
• Leg ulcers, 8 to 10 million
• Pressure ulcers, 7 to 8 million
• Burns, 7 to 10 million
In the United States alone, the estimated number of chronic wounds includes 1 to
2 million diabetic foot ulcers, 1 to 2 million venous leg ulcers, 3 to 5 million pressure
ulcers, and 1% surgical site infections. One of the underlying pathologies known to
increase the prevalence of chronic wounds is diabetes mellitus. Diabetes mellitus in
the Western world is growing continuously at a double-digit rate. However, this fig-
ure is not truly representative of the extent of the problem. Figures from the Centers
for Disease Control and Prevention (CDC) state that there are approximately 24 mil-
lion patients with diabetes mellitus (24 million diabetics). Cutaneous wounds in the
United States alone cost society over $25 billion annually.
The management of infected wounds remains an area of confusion and hence
great debate. No definition or authoritative clinical guidelines of what constitutes an
infected wound exists. Terminology in wound care such as colonization, critical colo-
nization, biofilm, and other descriptions of bacterial behavior on the surface of the
wound are not clearly defined. Even the term infection requires redefining in light of
recently generated insight into the prevalence and behavior of the biofilm phenotype.
In addition, many of the concepts concerning wound infections are not backed up with
meaningful scientific support. Consequently many terms used in wound care have led
to confusion and unnecessary or inappropriate management of chronic wounds.
It is well established that wound healing is dynamic, infinitely complex, non-
linear, and prodigiously individualized to the context of the patient. Understanding
the intricacies of chronic wounds becomes even more complex when one considers
the myriad of host variables that contribute to the disease state.
The plausible common barrier that may impair many of these wounds from heal-
ing is chronic infection as a result of biofilm infection. Chronic biofilm-based infec-
tions constitute 80% of all human infection. Accordingly, acute infections remain
as the minority census of all infectious disease. The definition of acute infection is
based on clinical characteristics of rapid onset and aggressive bacterial behavior,
which responds rapidly and completely to antibiotics or the host immune response.
Chronic infections are persistent and recalcitrant. It is interesting to note that acute
and chronic infections have not been clearly differentiated on a molecular level and
may be explained by bacteria pursuing widely divergent survival strategies only now
becoming elucidated through research.
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© 2010 Taylor and Francis Group, LLC