Case Report Open Access

Using V.A.C. Device to Deliver Susceptible Antibiotic through Irrigation Shows Promise in Treating Chronic Wound Infections that Failed Standard Regimens while Avoiding the Toxic Effect of Systemic Therapies

Abstract

Purpose: To describe a successful treatment of a complicated chronic wound infection with a multi- drug resistant organism (MDRO) using susceptible antibiotic irrigation delivered through negative pressure wound therapy (NPWT), a possible alternative to traditional wound therapy.

Summary: A 63-year-old female was admitted and treated for recurrent wound infection of the right breast. Her antimicrobial regimen was changed from cefepime plus vancomycin to tobramycin plus colistimethate plus meropenem following the culture and sensitivity results. She developed severe renal failure after receiving IV colistimethate and IV tobramycin for multiple-drug resistant (MDR) Pseudomonas wound infection. Tobramycin was then administered as irrigation through a Vacuum Assisted Closure (V.A.C.) device, which was changed to amikacin, then colistimethate following the changes in Pseudomonas susceptibility. The patient had complete wound closure and full recovery of renal function at the end of 6-week treatment. Further review of literature in mechanism of antibiotic toxicity and therapeutic use of the V.A.C device indicate that using the V.A.C. device to deliver susceptible antibiotic through irrigation shows promise in treating chronic wound infections that failed standard regimens while avoiding the toxic effect of systemic therapies.

Conclusion: Antibiotic irrigation delivered through negative pressure wound therapy could be a new therapeutic approach to treat MDRO wound infections in patients who cannot tolerate nephrotoxic antibiotics.

Thao D Nguyen*, Simon Huang, Laura Yamasaki, Jae Yang and Byron Williams