Chronic Wound Infection: Bacterial Colonization in the Dermal Pericolostomic Region
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In clinical practice, the authors observe that the rate of infectious complications affecting the pericolostomy region is low, despite the permanent contact of the local skin tissue with the intestinal content.
Several factors can affect the genesis of pericolostomic bacterial colonization, which is facilitated by immediate contact of the local skin area with the enteric content. The impact of the length of time of the colostomy on the bacteria present in the dermis of the pericolostomic region was evident in group 2, where higher values of microorganisms were found compared to the other 3 groups. A reduction of the average values of microorganisms (approximately 250%) occurred in patients in groups 3 and 4 who had a longer colostomy duration (Table 2).
The tissue cultures confirmed what was expected—that the most frequently found bacteria would be Escherichia coli, Bacteroides fragilis, Bacteroides spp, and Peptococcus spp. These organisms are the most common bacteria in fecal material cultures and the main source of bacteria for the colonization of the pericolostomic dermis.8–10 Other bacteria less frequently isolated include Bifidobacterium spp, Staphylococcus epidermidis, Eubacterium spp, Fusobacterium spp, and Pseudomonas aeruginosa. A percentage of these organisms were insufficient to allow for statistical analysis. Experimental data have shown that a level of bacterial growth > 105 organisms per gram of tissue is necessary to cause wound infection.11 These results are the only found on this subject in the literature that employ these methods and define the bacterial flora present in the pericolostomy skin region.
This study was developed with a restricted group of colostomized patients, ie, those who did not present local complications in the ostomy and who were in good health. These factors reduced the risk of local or systemic infection. New studies employing the same methodology, but involving patients with other types of ostomies or even adverse situations, such as pericolostomy complications or systemic involvement, should be developed to extend the knowledge of this surgical condition in a wider group of patients with an ostomy.
The skin of patients with an ostomy is heavily colonized and increases the risk of surgical site infection. Results of this study suggest that enteric bacteria colonize the dermal layer of the abdominal wall in the pericolostomic region, with a sufficient number of microorganisms in tissue to cause local infection. With bacteria in the pericolostomic skin region identified and measured, we can provide colostomized patients adequate treatment in cases of local infection. This is different from what occurs presently, in which antibiotic therapy is used empirically and is often based on the experience of the stomatotherapist or the surgeon, aside from the possibility of reducing the rate of infection with a specific antimicrobial treatment.
1. Londono-Schimmer EE, Leong APK, Phillips RKS. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994;37(9):916–920.
2. Park JJ, Del Pino A, Orsay CP, et al. Stoma complications: the Cook County hospital experience. Dis Colon Rectum. 1999;42(12):1575–1580.
3. Leenen LPH, Kuypers JHC. Some factors influencing the outcome of stoma surgery. Dis Colon Rectum. 1989;32(6):500–504.
4. Hoffman MS, Barton DP, Gates J, et al. Complications of colostomy performed on gynecologic cancer patients. Gynecol Oncol. 1992;44(3):231–234.
5. Pearl RK, Prasad ML, Orsay CP, Abcarian H, Tan AB, Melzl MT. Early local complications from intestinal stomas. Arch Surg. 1985;120(10):1145–1147.
6. Bouillot JL, Aouad K. Traitement chirurgical des complications des colostomies. In: Encyclopedie Médical-Chirurgicale. Techniques Chirurgicales—Appareil Digestif. Paris, France: Scientifiques et Médicales Elsevier; 2002.
7. Burton RC. Postoperative wound infection in colonic and rectal surgery. Br J Surg. 1973;60(5):363–365.
8. Bartlett SP, Burton RC. Effects of prophylactic antibiotics on wound infection after elective colon and rectal surgery. Am J Surg. 1983;145(2):300–309.
9. Simon GL, Gorbach SL. The human intestinal microflora. Dig Dis Sci. 1986;31(9 Suppl):147S–162S.
10. Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984;10(4):185–192.
11. Robson MC. Disturbances of wound healing. Ann Emerg Med. 1988;17(12):1274–1278.