sodium-hypochlorite and Soft-Tissue-Infections

Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.. Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007-2009.. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths.. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group (P = .03 vs controls), 55% of those in the mupirocin and chlorhexidine group (P = .05), and 63% off those in the mupirocin and bleach group (P = .006). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group (P = .40 vs controls), 54% in the mupirocin and chlorhexidine group (P = .51), and 71% in the mupirocin and bleach group (P = .02). At 1 and 4 months, recurrent SSTIs were reported by 20% and 36% of participants, respectively.. An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over a 4-month period. High rates of recurrent SSTI suggest that factors other than endogenous colonization are important determinants of infection. Trial registration. ClinicalTrials.gov identifier: NCT00513799.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Carrier State; Child; Child, Preschool; Chlorhexidine; Combined Modality Therapy; Community-Acquired Infections; Female; Humans; Infant; Male; Mupirocin; Nose; Patient Compliance; Patient Education as Topic; Sodium Hypochlorite; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Young Adult

Possibilities of modern methods of maths statistics for comparative evaluation of efficacy of different methods of treatment of patients with suppurative-inflammatory diseases of maxillo-facial region were analyzed and an integral index of treatment efficacy was suggested. Application of the integral index of treatment efficacy showed that intravenous injection of sodium hypochlorite and autohemotherapy with oxidized blood led to the closest apposition of cluster center of these patients to the cluster center of healthy persons. It testifies to greater efficacy of such treatment of the disease in comparison to the other methods.

Topics: Adolescent; Adult; Blood Transfusion, Autologous; Cluster Analysis; Face; Factor Analysis, Statistical; Female; Hemostasis; Humans; Jaw Diseases; Male; Middle Aged; Oxidants; Sodium Hypochlorite; Soft Tissue Infections; Suppuration; Treatment Outcome

Topics: Bacterial Infections; Fasciitis, Necrotizing; Humans; Hypochlorous Acid; Male; Middle Aged; Quality of Life; Sodium Hypochlorite; Soft Tissue Infections; Treatment Outcome

An early-stage decision clinicians often make in the management of complex wounds is which method of wound preparation will be appropriate for the patient. This decision can be affected by numerous wound and patient risk factors that present challenges and may make surgical debridement difficult in patients with complex wounds. Recently, negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a novel reticulated open-cell foam dressing with through holes (ROCF-CC) was shown to aid in the loosening and removal of thick exudate and nonviable tissue from wounds.. The authors present their experiences of using NPWTi-d with ROCF-CC, along with rationales for wound care decisions.. Patients received antibiotics and surgical debridement when appropriate. Therapy selection and parameters were based on a decision-tree model for wound care management that takes into consideration patient and wound information. Most patients received NPWTi-d with ROCF-CC for a duration of 5 to 8 days; however, 1 patient received NPWTi-d with ROCF-CC for more than 30 days due to the wound extent and severity. Therapy consisted of instilling saline or quarter-strength sodium hypochlorite solution with dwell times of 3 to 10 minutes, followed by 2 hours or 3.5 hours of NPWT either at -100 mm Hg or -125 mm Hg.. There were 6 patients (3 men, 3 women; average age, 58.5 years) treated. Wound types included 3 pressure ulcers, 1 necrotizing soft tissue infection, 1 perianal abscess, and 1 large abdominal wound. Patient comorbidities included obesity, type 2 diabetes, and radiation therapy. In all cases, progression of wound healing was observed with no complications. This method produced viable granulation tissue and wound bed preparation; however, patients were not followed to closure or grafting.. These cases help support the use of NPWTi-d with ROCF-CC as a viable option for wound care providers in the early-stage management of complex wounds.

Topics: Abdominal Abscess; Anus Diseases; Bandages; Critical Care; Critical Illness; Disinfectants; Female; Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Pilot Projects; Pressure Ulcer; Saline Solution; Sodium Hypochlorite; Soft Tissue Infections; Treatment Outcome; Wound Healing

Topics: Carrier State; Chlorhexidine; Female; Humans; Male; Mupirocin; Sodium Hypochlorite; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus