Laboratory

Specialist analysis of the material collected from the patient  enables us to determine the medical condition and the appropriate treatment.

We can draw material from:

  • skin surface,
  • nails,
  • hair,
  • wound and purulent skin lesion.

Prior to having the sample collected for analysis, the patient should make sure that the affected area is prepared appropriately.

Minimum 12 hours before a doctor takes your sample for analysis.

  • do not wash the affected area,
  • do not put any ointments, lotions or cream on it
  • and do not spray it with any substances.

Only in this way, with the area “undisturbed” by any substance,  will the collected sample provide  reliable results.

Within 30 – 45 min. the material is delivered directly to the laboratory where the results are generated within 5 -12 days, depending of the kinds of tests.

Quick and careful  laboratory analyses facilitate the target treatment.

Microbiology

Wound infections are most often caused by bacteria. The isolated bacteria in chronic wounds include   Gram –positive bacteria belonging to the genus Staphylococcus (including Staphylococcus aureus), Enterococcus (including Enterococcus faecalis), as well as Gram – negaive rod-shaped bacteria  of the genus Pseudomonas aeruginosa (common etiological factor of burns and ulcer infection in diabetic foot). The wounds that have been colonised by Streptococcus pyogenes are the ones at risk of infection. Wound infections can also by caused by anaerobic bacteria such as Bacteroides and Clostridium.

Fungi such as Candida , most frequently Candida albicans, can  also reside in wounds while viruses are the least frequently found there.

Staphylococcus and Pseudomonas occur most often  in the moist biofilm where they can form highly-organised colonies and can reside for a long time.

Their movement to new recesses of the wound causes the infection to spread whereas the bacteria entering the bloodstream can lead to generalised infection (sepsis).

Microorganisms in biofilm are exceptionally resistant to local antibiotics. In order to reduce the biofilm dramatically, wound decontamination substance as well as specialist dressing with active chemicals which eradicate bacterial colonies and clear the wound should be applied.

Chronic wounds are often colonized by various bacterial genera many of which persist there. In long-term wounds (where the healing process lasts for over 3 months) we can distinguish  aerobic bacteria (mean 4,3 genera) and anaerobic ones (mean 2,0 genera). Wound healing process is affected by a number of factors such as patient’s general health status, wound type, duration, its blood supply and bacterial flora.

Deep pressure ulcers run the risk of bone tissue inflammation of mixed, aerobic and anaerobic aetiology, and bacterimia. They can also be an undiagnosed cause of inflammation-induced  overall fatigue and fever.

Maltophilia requires particular care in wound management and subsequent treatment owing to a potential presence of multiple medication resistant microorganisms, including MRSA- Staphylococcus aureus, vacomycin-resistant enterococcus (VRE) and Acinetobater baumannii and astenotrophomonas.

Even the smallest wounds can cause serious systemic diseases when infected with e.g. blue pus bacillus (Pseudomonas aeruginosa), Clostridium tetani  or rabies virus. Serious bacterial infections can lead to systemic inflammatory response (sepsis) and can, eventually, cause death.

Wound microbiology phases:

Wound contamination: bacteria present in the wound with no host response

Wound colonisation: bacteria proliferation and minor host immune response. Colonisation does not cause wound deterioration, the healing process is not disturbed.

Wound critical colonisation: a large volume of proliferating bacteria slows wound healing, increases pain but does not intensify the host immune response

Infection: the multitude of bacteria leads to wound deterioration and slowdown of wound healing, it increases pain and triggers strong immune response

Clinical symptoms of wound infection:

  • local redness
  • pain
  • locally increased temperature
  • tissue damage
  • swelling
  • purulent fluid

Wound contamination pathways:

  • direct contact eg. via  non-sterile objects like tools or dirty hands
  • microorganisms from the air or water taking residence in the wound
  • transfer or migration of the host normal flora
Pocket

Copyrights Centrum Stopy Agnieszka Głuszczak