Pseudomonas Replies
Scott Williams
Description
Collection
Title:
Pseudomonas Replies
Creator:
Scott Williams
Date:
3/23/2007
Text:
Thanks to all who responded with great information. This pt's ulcer has been present for 40 yrs and I was curious how others out there tackled this issue. Thanks again,
Scott Williams CP, LP
Scott Sabolich Prosthetics & Research
Pseudomonas infections are characterized by the presence of a grey-green discharge and a distinctive foul odor. It was a difficult organism to kill with antibiotics back when I was an LPN 30 years ago and it could only have developed greater resistance to antibiotics since then. It sounds like it is a chronic infection so the degree of inflammation and swelling present may not be all that great. You will have to expect continuing wound drainage and provide room for absorbent dressings if you are to put this limb into a socket. I cannot say that it seems like a good idea to do that. The warm moist and dark environment in a prosthetic socket will be ideal for the infection to flourish.
Do not use a liner due to the bacteria locking into the materials.
At the outset, I need to tell you that I am a Pedorthist with a degree in microbiology. While I do not have the exact experience you ask for, I have known some amputees in that category. Pseudomonas is resistant to most antibiotics, but a collection of them given at sublethal doses can bring the infection causing the ulcer under control. The first thing to consider is dealing with the wound and getting it healed up and the infection gone. Irritation of the stump (residuum) by a prosthesis and spreading the infection is an issue when it is infected. Once the ulcer clears, there should be no further issues.
I am R-BK from a 1969 motorcycle accident. Amputation was immediate due to trauma. I had an infection on my distal stump that while treated with Lincocin (antibiotic) 500mg Q.I.D. for many months, was finally unresponsive. The infection was remedied via stump revision in 1970. Mine was difficult to treat back then. I suspect today it might be more difficult. Has your patient discussed revision with their physician? In my case, no problems since I was not offered a prosthesis until the infection was no longer a problem. I confess I had no interest in revision surgery but it was, in the last analysis, the fix.
I have a patient with the same condition. This has been on-going for months. The open wound is barely a cm across and is round, at the very distal aspect of a TF amputation on the incision and has continued to drain for months. The fluid has been clear. I have delayed prosthetic care do to this . I am very interested in any replies you get that may let me know whether to begin with a prosthesis or not. Any information will help.
I did a patient like that three years ago. The knees and the ankle joints were infected and I remember the doctor saying that he would eventually have to be amputated and that it was a losing battle. Assessment of the orthopedic surgeon is very important at all the stages of orthotic treatment but orthotics should be provided for stability of the joints.
I was an Orthopaedic Physician Assistant prior to my prosthetic career many years and a few wars ago. Pseudomonas was quite prevalent during my OR days and as a cast tech in orthopaedic long bone injuries. One of those quite distinctive aromas that once you smell it, you will always recognize it. For amputees, critical to remember that warmth, moisture and darkness of the socket is the perfect medium for growth. Supplementing the wound care of the physician, making it simple is always best. We now have the luxury of incorporating some of the more recent innovations that the industry is moving towards in interface options. ALWAYS, ALWAYS minimize the growth medium environment first. Suggest never putting a sheath next to their skin, even if they have a dressing. Never use any absorbant. Clinicians will make the mistake of thinking if they have a dressing, gel liners or pelite type liners will work. No, they really don't. Bacteria surrounds a wound and travels through the
air radius much more than direct drainage. I personally find good old POLYETHYLENE sockets with a 5-8ply fit and a lamb's wool distally works best. Change the lamb's wool daily. Place a silver Knit Rite liner/liner onto the limb for a more antimicrobial initial interface. Apply the other socks overtop. Suction suspension would be best to draw out the contaminant into the dressing/liner/liner via the negative pressure. Patient MUST be compliant to changing the stump sock, at least, twice a day, and of course, leave the limb off as much as possible. Practicing in the real Iowa farmer world, this method has proven to be sufficient when following the physicians orders for wound care. Next, for the socket, it must be disinfected daily NOT with just antibacterial soap, it must be cleaned with a stronger germicidal disinfectant. I had them use SIMPLE GREEN SPRAY. Wiped it out took a wet wash cloth to wipe out residue and let it dry prior to donning. If the physician declares that
the patient is to leave the limb off until it is healed completely, you may want to personally discuss these options if nothing else to let them do this just to go to the bathroom. Of course, the patient's compliance was always a factor.
I have had some experience with infection and liners. If the patient were to pack the opening (the ulcer) with silver impregnated cloth he would probably see some significant improvement. Bacteria can not live in the presents of silver. Dr. Becker and Orthopedic surgeon has written many articles on the subject. It is the same theory being used these days by putting silver in residual limb socks and other liner materials. I personally have seen excellent results with the use of silver impregnated fabric to treat various bacteria associated with prosthetic usage.
Have the patient get some colloidal silver from the health food store and take an eyedropper full in an eight oz glass of water every other day along with the current treatment. The silver can be applied directly onto the ulceration without dilution. There is no toxicisity rating for silver after many extensive studies. It also has no taste. If you find some that looks yellow it may have a small amount of iodine in it to help keep it in solution longer otherwise it will settle out. Silver is used extensively as an antibacterial in babies eyes and on burn patients
Scott Williams CP, LP
Scott Sabolich Prosthetics & Research
Pseudomonas infections are characterized by the presence of a grey-green discharge and a distinctive foul odor. It was a difficult organism to kill with antibiotics back when I was an LPN 30 years ago and it could only have developed greater resistance to antibiotics since then. It sounds like it is a chronic infection so the degree of inflammation and swelling present may not be all that great. You will have to expect continuing wound drainage and provide room for absorbent dressings if you are to put this limb into a socket. I cannot say that it seems like a good idea to do that. The warm moist and dark environment in a prosthetic socket will be ideal for the infection to flourish.
Do not use a liner due to the bacteria locking into the materials.
At the outset, I need to tell you that I am a Pedorthist with a degree in microbiology. While I do not have the exact experience you ask for, I have known some amputees in that category. Pseudomonas is resistant to most antibiotics, but a collection of them given at sublethal doses can bring the infection causing the ulcer under control. The first thing to consider is dealing with the wound and getting it healed up and the infection gone. Irritation of the stump (residuum) by a prosthesis and spreading the infection is an issue when it is infected. Once the ulcer clears, there should be no further issues.
I am R-BK from a 1969 motorcycle accident. Amputation was immediate due to trauma. I had an infection on my distal stump that while treated with Lincocin (antibiotic) 500mg Q.I.D. for many months, was finally unresponsive. The infection was remedied via stump revision in 1970. Mine was difficult to treat back then. I suspect today it might be more difficult. Has your patient discussed revision with their physician? In my case, no problems since I was not offered a prosthesis until the infection was no longer a problem. I confess I had no interest in revision surgery but it was, in the last analysis, the fix.
I have a patient with the same condition. This has been on-going for months. The open wound is barely a cm across and is round, at the very distal aspect of a TF amputation on the incision and has continued to drain for months. The fluid has been clear. I have delayed prosthetic care do to this . I am very interested in any replies you get that may let me know whether to begin with a prosthesis or not. Any information will help.
I did a patient like that three years ago. The knees and the ankle joints were infected and I remember the doctor saying that he would eventually have to be amputated and that it was a losing battle. Assessment of the orthopedic surgeon is very important at all the stages of orthotic treatment but orthotics should be provided for stability of the joints.
I was an Orthopaedic Physician Assistant prior to my prosthetic career many years and a few wars ago. Pseudomonas was quite prevalent during my OR days and as a cast tech in orthopaedic long bone injuries. One of those quite distinctive aromas that once you smell it, you will always recognize it. For amputees, critical to remember that warmth, moisture and darkness of the socket is the perfect medium for growth. Supplementing the wound care of the physician, making it simple is always best. We now have the luxury of incorporating some of the more recent innovations that the industry is moving towards in interface options. ALWAYS, ALWAYS minimize the growth medium environment first. Suggest never putting a sheath next to their skin, even if they have a dressing. Never use any absorbant. Clinicians will make the mistake of thinking if they have a dressing, gel liners or pelite type liners will work. No, they really don't. Bacteria surrounds a wound and travels through the
air radius much more than direct drainage. I personally find good old POLYETHYLENE sockets with a 5-8ply fit and a lamb's wool distally works best. Change the lamb's wool daily. Place a silver Knit Rite liner/liner onto the limb for a more antimicrobial initial interface. Apply the other socks overtop. Suction suspension would be best to draw out the contaminant into the dressing/liner/liner via the negative pressure. Patient MUST be compliant to changing the stump sock, at least, twice a day, and of course, leave the limb off as much as possible. Practicing in the real Iowa farmer world, this method has proven to be sufficient when following the physicians orders for wound care. Next, for the socket, it must be disinfected daily NOT with just antibacterial soap, it must be cleaned with a stronger germicidal disinfectant. I had them use SIMPLE GREEN SPRAY. Wiped it out took a wet wash cloth to wipe out residue and let it dry prior to donning. If the physician declares that
the patient is to leave the limb off until it is healed completely, you may want to personally discuss these options if nothing else to let them do this just to go to the bathroom. Of course, the patient's compliance was always a factor.
I have had some experience with infection and liners. If the patient were to pack the opening (the ulcer) with silver impregnated cloth he would probably see some significant improvement. Bacteria can not live in the presents of silver. Dr. Becker and Orthopedic surgeon has written many articles on the subject. It is the same theory being used these days by putting silver in residual limb socks and other liner materials. I personally have seen excellent results with the use of silver impregnated fabric to treat various bacteria associated with prosthetic usage.
Have the patient get some colloidal silver from the health food store and take an eyedropper full in an eight oz glass of water every other day along with the current treatment. The silver can be applied directly onto the ulceration without dilution. There is no toxicisity rating for silver after many extensive studies. It also has no taste. If you find some that looks yellow it may have a small amount of iodine in it to help keep it in solution longer otherwise it will settle out. Silver is used extensively as an antibacterial in babies eyes and on burn patients
Citation
Scott Williams, “Pseudomonas Replies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/228010.
