(And it IS kind of like edema, if you think of 1+ is being a little edema (or few RBC's) and 4+ being a lot of edema (or a lot of RBC's). In my experience, they'll be more than happy to talk to you, even if you're just a student at clinicals.

Not having that information would make it difficult for an outsider to interpret results accurately.Īs such, it is ALWAYS the best policy to call the lab. The house physicians just know what the facility lab policies are and interpret the results accordingly. The lab where I worked just used 'Rare', 'Small', 'Medium', 'Large' and 'Packed' there was a little number chart on the wall and you just counted the RBC's then looked on the chart to find which category the count fell into and that's what you reported.Īlso, the counts for some things are per LPF, and some are per HPF (low and high power fields). Like BaberK said, at her lab 4+ would '49 RBCs per HPF'. Every lab has their own way of reporting things out. We further hypothesise that, in the presence of resistant organisms, tailored antibiotic regimens lead to faster resolution of infection and increase healing rates.Hi. We hypothesise that wound debridement decreases the risk of developing resistant organisms by surgically removing the infected tissue. Antibiotic regimens for resistant bacteria often require intravenous administration and have higher rates of adverse effects. This study documents the presence of AR GNO in deep tissue after wound debridement. Patients had been hospitalised on the wound programme’s inpatient unit an average of 3♵ times over the previous 3 years. There was a high rate of chronic disease: 63% of patients were diabetic and 9% were immunosuppressed from human immunodeficiency virus, post‐transplant medications or chemotherapy. Of the 30 patients with positive cultures, 50% were 65 years or older, 30% lived in a nursing home and 23% were bedbound. Twenty‐two cultures (65%) were polymicrobial infections. Of 10 patients with resistant Gram‐negative organisms in bone cultures, 9 had pathology specimens, of which 5 showed histopathology consistent with osteomyelitis. Twenty‐five cultures were obtained in the operating room and five in the outpatient or bedside setting. Of the 30 patients, 12 had venous stasis ulcers 7 ischaemic wounds 5 pressure ulcers 5 diabetic foot ulcers and 1 pyoderma. Of the patients with carbapenem‐resistant acinetobacter, all isolates were resistant to cephalosporins and fluoroquinolones. Eleven patients had resistance to more than one of these classes, and two patients had resistance to all three classes. Of the 19 patients with antibiotic‐resistant pseudomonas, 12 had resistance to fluoroquinolones, 5 to carbapenems and 15 to third‐generation cephalosporins. There were 7 patients with resistant acinetobacter, 8 with klebsiella and 19 with pseudomonas. Four patients had more than one of these organisms. Thirty of 336 total patients (8♹%, 95% CI: 8♷–9♲%) had deep tissue cultures with antibiotic‐resistant acinetobacter, pseudomonas and/or klebsiella. Diphtheroids and coagulase‐negative staphylococcus were not included in assessment of polymicrobial infection. (6) Intermediate sensitivity was considered to be resistant. Clinical indications for wound debridement included infection or failure to heal in a non ischaemic wound.Īntibiotic resistance was defined as resistance to carbapenems in acinetobacter strains (5), resistance to third‐generation cephalosporins in klebsiella strains and resistance to fluoroquinolones, third‐generation cephalosporins, or carbapenems in pseudomonas strains. Cultures were included in analysis if they were derived from deep tissue obtained after sharp excisional debridement of all grossly necrotic and non viable tissue.

For each patient, all cultures that had been obtained at our institution were reviewed. We reviewed records of bacterial wound cultures for all patients seen over a 6‐month period at an urban wound healing programme. We performed a chart review to determine the prevalence of AR GNO in deep tissue of non healing and infected wounds after sharp debridement had been performed. Past studies have shown that antibiotic‐resistant Gram‐negative organisms (AR GNO) colonise the surface of chronic wounds 1, 2, 3, 4. Antibiotic‐resistant Gram‐negative bacteria in deep tissue cultures

Gram negative rods in wound culture