Better care of infected Buruli Ulcer wounds may shorten hospital stays

While antibiotic medicines do help patients with wounds caused by Buruli ulcer (BU) disease, many wounds take long to heal. Some patients develop further harmful infections in their BU wounds from other bacteria, which can require surgery or lengthy hospital stays.

Researchers say the choice of antibiotic against these “secondary” bacterial infections is important, as well as how long the patient receives the antibiotic. They also say that good care of BU wounds, infected or not, is key to shortening expensive hospital stays and avoiding surgery.

BU disease, which is caused by the Mycobacterium ulcerans microorganism, is common in tropical regions like West Africa. The disease causes ulcers (wounds) on the skin, and can cause permanent disability and disfigurement without antibiotic treatment.

Researchers don’t know much about secondary infections of these wounds, except that bacteria like Staphylococcus aureus and Pseudomonas aeruginosa are often responsible.

Previous research showed that along with antibiotic treatment, good wound care helps to prevent secondary infections and reduces healing time, and therefore shortens hospital stays. 

Unfortunately though, there are no standard guidelines available for healthcare workers on how exactly to manage secondary infections when they happen. Doctors generally prescribe further antibiotics, but these aren’t always effective.

In this study, researchers wanted to establish a standard set of guidelines to prevent secondary BU wound infections, manage secondary BU wound infection and to generally improve BU wound management. 

They wanted to identify and describe the bacteria causing secondary BU wound infections, by comparing laboratory data and clinical observations from previous studies with their own clinical and laboratory analysis. 

They also investigated how BU wounds are managed, and how wounds that had become infected with other bacteria (secondary infection) are managed.

Their investigation confirmed that healthcare workers need better guidelines about how to use antibiotics to treat secondary infections.They said good wound care is key to preventing expensive and long hospital stays, and to increasing the number of wounds healed without the need for costly surgery.  

Importantly, they recommended better ways to manage infected and uninfected BU wounds. They said antibiotics should be used as little as possible.

This study and analysis was conducted by Ghanaian scientists using case studies and patients from several African countries. 

Abstract

The introduction of antibiotics as first-line treatment of Buruli ulcer (BU) disease in 2004 resulted in improvement in the management of the disease, confirmed by several studies, including a randomised controlled clinical trial (Nienhuis et al., Lancet 375:664–672, 2010). Despite successful outcomes with this treatment regimen, the healing process is still characterized by long hospital stays as a result of delayed healing, in a significant proportion of cases. Clinical observations and subsequent research identified secondary infection of the BU lesions by other bacteria as a cause of wound healing delay, debunking the widely held belief that mycolactone, the macrolide toxin of Mycobacterium ulcerans, has antimicrobial activity and is preventing secondary infection of BU wounds. Secondary infection in BU disease is not well characterized, but the few studies, which described its occurrence identified Staphylococcus aureus and Pseudomonas aeruginosa as the dominant bacterial species responsible for wound infection and provided evidence that delayed wound closure may be associated in some patients with a high wound bioburden. Standard guidelines for managing secondarily infected BU lesions are currently not available, but a common recourse for many clinicians is to prescribe additional antibiotics. Studies describing the antibiogram of isolated secondarily infecting bacteria showed high levels of antibiotic resistance, indicating that antibiotic treatment may not be the best option to manage secondarily infected lesions. Preliminary studies showed that good wound care and good infection prevention and control practices will reduce time to healing and the long hospitalizations associated with post antibiotic management of the disease.

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