The use of qualitative and quantitative characteristics of the microbiota of acute wounds for a differentiated approach to the preoperative preparation tactics choice for autodermoplasty

Abstract

Objectives. To evaluate the possibility of using qualitative and quantitative indicators of microbiological examination of wound discharge to determine a differentiated approach to the choice of tactics for preparing acute wounds for skin grafting (SG). Material and methods. Qualitative and quantitative indicators of microbiological examination of swabs from acute wounds of 176 patients (wound duration up to 21 days), that was performed in the dynamics of the use of various methods of wound treatment, were analyzed. Results. The absence of clinical signs of inflammation, a negative culture result substantiated the possibility of performing SG in 23.8% of patients (n=42) after only conservative preparation. The presence of E. faecalis, coagulase-negative staphylococci in wounds determines the possibility of using mechanical debridement in 48.9% of patients (n=86), the effectiveness of which was proved by the successful outcome of SG. Isolation from wounds of S. aureus, P. aeruginosa, A. baumannii, K. pneumoniae, P. mirabilis in the amount of >105 CFU/ml is an indication for the use of ultrasonic and mechanical debridement. Combined debridement was more often performed for wounds lasting from 11 to 21 days (42% vs 20.6% and 21.7% for wounds lasting 5-10 days and up to 4 days, χ2=6.48; p=0.01 ). The skin graft failure (5.1% of patients, n=9) determined the need to take into account isolates of S. aureus, P. aeruginosa, A. baumannii, isolated in the amount of ≤105 CFU/ml. Conclusions. When determining the procedure for acute wound preparation, it is necessary to take into consideration not only the presence of clinical signs of inflammation, but also the qualitative and quantitative characteristics of the microbiota. Pheno- and genotypic markers reflecting the pathogenic potential of the isolates are additional criteria for choosing the wound debridement method.

Keywords

• acute wound
• microbiological culture
• interpretation of results
• pathogenic potential
• wound debridement
• skin grafting.