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- W1528161502 abstract "The recent report of an increasing number of Acinetobacter baumannii bloodstream infections among service members injured in Iraq/Afghanistan operations prompted this investigation.1 The number of such infections and the resistance of A baumannii infections to multiple antibiotics suggested the need to consider and address the wounds and their treatment as a possible cause of septicemia and to suggest an alternative method to decrease or eliminate colonized or contaminated wounds as a potential source of A baumannii sepsis.The present guidelines for care of open combat casualty wounds are as follows:The standard care for the type of wounds we are seeing from Iraq include vigorous and complete early irrigation and debridement (Figs (Figs11–3). The wounds are packed with saline-soaked Kling or fine mesh gauze and left alone for 4 days (Fig (Fig4).4). The only reason to take down the dressing and inspect the wound is foul odor, discharge, bleeding, or fever that cannot be explained without inspecting the wound. At 4 days, the patient is returned to the operating room for a dressing change. If the wound has that “sticky” appearance without any areas of necrosis and need for further extensive debridement, a Delayed Primary Closure (DPC) is done. If the wound does not appear clean, it is debrided, irrigated, and packed again (sometimes with Dakin's solution or whatever solution the surgeon chooses) and the 4-day clock restarted (judgement call). Those wounds that fail DPC or are so large that a DPC is not in the plan are treated by wet-to-dry dressing changes. As soon as the wounds appear clean, Dakin's solution (or whatever solution is used to clean the wound) is switched to normal saline.2Figure 1Patient with burns, traumatic amputation left foot and lower leg, and multiple soft tissue injuries secondary to blast (Afghanistan, 2003).Figure 3Surgical team in action (Afghanistan, 2003).Figure 4Normal saline–soaked dressing being applied to open abdominal wound (Afghanistan, 2003).Normal saline solution possesses no inherent antibacterial activity, and therefore cannot be expected to decrease or control bacterial growth in open wounds. Likewise, simple inspection of such wounds is unreliable in predicting successful DPC.3 Because systemic antibiotics are ineffective in reducing bacterial counts in granulating wounds, the use of a topical antibacterial agent that is active in controlling or reducing bacterial proliferation in open wounds may substantially decrease wound sepsis as a source of morbidity and may have a beneficial effect on overall management.4,5 Furthermore, the addition of microbiological quantification within the wounds (quantitative bacteriology or swab techniques) may provide valuable information regarding efficacy of treatment and the likelihood of successful DPC.6,7The efficacy of 5% mafenide acetate solution (5% Sulfamylon Solution [Bertek Pharmaceutical Inc, Research Triangle Park, NC]) and 1% silver sulfadiazine cream (Silvadene [Kendall Company, Mansfield, Mass]) was tested against A baumannii derived from burn isolates at the Shriners' Burn Institute, Galveston, Tex, in order to determine whether these topical antibacterial agents, successfully employed in burn care, might be effective adjuncts in controlling A baumannii wound infections in traumatic war wounds." @default.
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- W1528161502 date "2005-02-22" @default.
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- W1528161502 title "The potential benefit of 5% Sulfamylon Solution in the treatment of Acinetobacter baumannii-contaminated traumatic war wounds." @default.
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