Secondary bacterial infections of buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin

Buruli ulcer (BU), caused by Mycobacterium ulcerans is a chronic necrotizing skin disease. It usually starts with a subcutaneous nodule or plaque containing large clusters of extracellular acid-fast bacilli. Surrounding tissue is destroyed by the cytotoxic macrolide toxin mycolactone produced by microcolonies of M. ulcerans. Skin covering the destroyed subcutaneous fat and soft tissue may eventually break down leading to the formation of large ulcers that progress, if untreated, over months and years. Here we have analyzed the bacterial flora of BU lesions of three different groups of patients before, during and after daily treatment with streptomycin and rifampicin for eight weeks (SR8) and determined drug resistance of the bacteria isolated from the lesions. Before SR8 treatment, more than 60% of the examined BU lesions were infected with other bacteria, with Staphylococcus aureus and Pseudomonas aeruginosa being the most prominent ones. During treatment, 65% of all lesions were still infected, mainly with P. aeruginosa. After completion of SR8 treatment, still more than 75% of lesions clinically suspected to be infected were microbiologically confirmed as infected, mainly with P. aeruginosa or Proteus miriabilis. Drug susceptibility tests revealed especially for S. aureus a high frequency of resistance to the first line drugs used in Ghana. Our results show that secondary infection of BU lesions is common. This could lead to delayed healing and should therefore be further investigated

Diabetic foot infections: a team-oriented review of medical and surgical management

As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting

Systematic review: a resource that allows for the incorporation of evidence into nursing practice

A revisão sistemática é um recurso importante da prática baseada em evidências, que consiste em uma forma de síntese dos resultados de pesquisas relacionados com um problema específico. O presente artigo tem como objetivo oferecer subsídios que proporcionem reflexões para a construção e/ou aplicação de revisões sistemáticas no cenário da enfermagem. Fundamentados na literatura, apresentamos as fases que compõem uma revisão sistemática e aspectos relevantes a serem considerados para a utilização desse recurso.La revisión sistemática es un recurso importante de la práctica basada en evidencias, que consiste en una forma de síntesis de los resultados de las investigaciones relacionadas con un determinado problema. El presente artículo tiene como objetivo ofrecer elementos que permitan reflexionar sobre la construcción y/o aplicación de revisiones sistemáticas en el ámbito de la enfermería. Basados en la literatura, presentamos las etapas que componen una revisión sistemática y los aspectos relevantes que deben ser considerados para la utilización de este recurso.Systematic review is an important resource in evidence-based practice, which consists in a form of synthesizing the research results related to a specific problem. This article aimed to offer subsidies for reflections with a view to the construction and/or application of systematic reviews in the nursing environment. Based on the literature, authors presented the phases comprising a systematic review and the relevant aspects that must be considered for using this resource