Infection and Colonization in Epidermolysis Bullosa
Section snippets
Wounds and bacteria: contamination, colonization, and infection
Ulceration of the skin in epidermolysis bullosa (EB) invariably leads to the presence of bacteria, although the extent to which this happens and its clinical implications vary greatly.1 It is useful to consider bacterial load in a wound as a continuum (Fig. 1).2 At one end there is contamination, with bacteria over the wound surface, usually as a result of inoculation from hands, fomites, or airborne contamination: in this situation bacteria do not impede healing of the wound and no treatment
Colonization and infection in EB
There are no good data concerning the incidence of critical colonization or wound infection in EB but, anecdotally, this is a sizeable problem, particularly for patients with more severe and generalized forms who have large numbers of chronic wounds.1, 6 These wounds cause considerable morbidity, including pain, exudate and odor, and may demand many hours of dressing changes on a daily basis; they are also responsible for a significant economic burden, necessitating large quantities of often
Investigation of wound infections in EB
Although the gold standard for identifying pathogens in an infected wound is a skin biopsy for culture and sensitivity, this is rarely indicated in clinical practice. Instead, a swab should be taken from the wound bed after any necrotic debris or exudate has been cleaned off. If the wound is dry, the swab should first be moistened with sterile saline or transport medium. Light pressure should be applied to the tip of the swab as it is passed across the wound bed in a zig-zag pattern and at the
Management of colonization and infection of EB wounds
Contamination of EB wounds can be considered inevitable and, because it does not generally interfere with healing, no specific treatment is required beyond using an appropriate atraumatic dressing (Fig. 2). Once a wound becomes critically colonized and fails to heal, steps should be taken to try and reduce the bioburden, usually with topical antimicrobials or specialized dressings.6 Frank infection almost always requires systemic antibiotic therapy, often in conjunction with topical measures (
Summary
Contamination and colonization of EB wounds is extremely common and is not generally a problem requiring treatment unless healing is becoming impaired, suggesting critical colonization. Topical measures are often sufficient to keep colonization down to a level at which exudate and odor are controlled and wound healing is not impaired. The diagnosis of infection of an EB wounds should be made clinically, and usually requires systemic treatment.
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Cited by (48)
Type VII Collagen Deficiency in the Oncogenesis of Cutaneous Squamous Cell Carcinoma in Dystrophic Epidermolysis Bullosa
2023, Journal of Investigative DermatologyOverview and summary of antimicrobial wound dressings and its biomedical applications
2023, Antimicrobial Dressings: The Wound Care ApplicationsPredominance of Staphylococcus Correlates with Wound Burden and Disease Activity in Dystrophic Epidermolysis Bullosa: A Prospective Case-Control Study
2022, Journal of Investigative DermatologyCitation Excerpt :Wounds in RDEB are present from birth onward and provoke permanent bacterial exposure. Culture studies have shown a high prevalence of wound colonization, mainly with Staphylococcus aureus (Levin et al., 2021; Mellerio, 2010; Santin et al., 2021; van der Kooi-Pol et al., 2013). An influence of bacterial colonization on the development of squamous cell carcinoma, a common and potentially lethal complication of RDEB, has been suggested (Hoste et al., 2015).
Epidermolysis Bullosa in Spain: Observational Study of a Cohort of Patients Treated in a National Referral Center
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2021, International Journal of Biological MacromoleculesCitation Excerpt :The wound might be categorized by various approaches, including its cause, location, symptoms, severity, and degree of tissue loss. It might also be classified as a clean, infected, contaminated, or colonized wound [4]. Following injury, a cascade of events occurs to re-establish normal tissue [5].
Aberrant recruitment of leukocytes defines poor wound healing in patients with recessive dystrophic epidermolysis bullosa
2020, Journal of Dermatological Science
The author acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust.