Authors: Branstetter JG, Lalliss SJ, Owens BD, Wenke JC, Brook Army Medical Center, Ft. Sam Houston, TX
Title: Comparison of High Pressure Parallel Flow and Bulb Syringe Irrigation in a Bioluminescent Musculoskeletal Wound Model
Purpose: The purpose of this study was to compare the efficacy of high pressure parallel flow and bulb syringe irrigation with debridement in reducing bacteria within a wound.
Methods: A complex musculoskeletal wound was created on the hind leg of twenty goats. The wound was contaminated with Pseudomonas aeruginosa (lux) bacteria, genetically modified to emit photons, thereby allowing quantification analysis of bacteria with a photon-counting camera system. The wounds were closed and animals were assigned to either the high pressure parallel flow irrigation group or the bulb syringe irrigation group. Each wound was debrided and irrigated at six and 48 hours after wounding and bacterial inoculation. Bacteria quantification was performed with use of a photon-counting camera before and after each treatment. Nine liters of saline was used and surgical sharp debridement was performed for each bulb syringe irrigation procedure. The volume of saline used in the parallel flow group was determined by the surgeon on a case-by-case basis with the criteria being removal of all tissue appearing to be necrotic and adequate lavage was performed.
Results: We identified 11 patients with MRSA osteomyeltis that recieved doses of both vancomycin and daptomycin separately. The serum killing levels for both vancomycin and daptomycin in these patients are shown in figure 2.
Discuassion and Conclusion: This study indicates that daptomycin achieves significantly higher serum bactericidal activity for MRSA isolates in patients with osteomyelitis. This may translate into more effective eradication of MRSA from bone biofilms. Further studies comparing antibiotics for MRSA osteomyelitis and coorelating with clinical outcomes with serum bactericidal levels need to be performed.