All the patients who demonstrated resistance to daptomycin were excluded from the study. Inclusion criteria were the presence of infection in the wound and the sensitivity of the isolated bacteria to daptomycin, demonstrated with bacterial culture and antibiogram. Patients presenting with infected ulcers of any aetiology and of any grade were eligible for this study.
Each patient was pre‐counselled and later provided informed consent. The study was initiated in June 2014, and 33 patients were enrolled until June 2016. This was a prospective study carried out by the Department of Plastic and Reconstructive Surgery of Policlinico Umberto I in Rome, Italy. The demonstration of increased local concentration of the antibiotic could then provide evidence to support the use of VAC therapy in infected sites and alleviate previous reservations about relative contraindications. The rationale of this study is related to the known capacity of VAC therapy to activate the process of neoangiogenesis, increasing the concentration of capillaries in the tissue in which it is applied and enhancing the delivery of the antibiotic to the injury site. The aim of this study is to extend the indication for the use of NPWT in infected wounds by demonstrating the ability of VAC therapy to increase the antibiotic concentration in damaged and infected tissues. Despite this notion, it has not limited the use of this device by many centres for infected wounds. This contraindication is related to the possibility of promoting bacterial growth as a result of leaving the VAC dressing on the bed of an infected wound for several days. Infection is considered one of the contraindications to negative pressure wound therapy (NPWT) 17. There are few published articles regarding the use of VAC therapy on infected wounds 17. VAC therapy is applied in many fields: traumatic and dehiscent surgical wounds, acute and chronic wounds, partial‐thickness burns (grade I and II), sternal osteomyelitis 7, 8, 9 and mediastinitis 10, 11, 12, 13, 14, 15, 16. The negative pressure accelerates the healing process by removing exudates, reducing bacterial load, increasing the growth of granulation tissue, favouring the contraction of the lesion margins and promoting angiogenesis 4, 5, 6. Vacuum‐assisted closure (VAC) therapy is a sophisticated system that produces a humid, closed, sterile and isolated environment 1, 2, 3. The practice to expose a wound to negative atmospheric pressure for a long period of time in order to promote wound healing was first described by Fleischmann et al. Despite the encouraging data, it is necessary to broaden the sample of patients and perform the same study with other antibiotics. The preliminary analysis of the data showed an important increase of antibiotic concentration in the tissue after VAC therapy. Statistical differences were not found between the two groups. The results highlighted a significant increase in the concentration of antibiotics in the study group tissue the improvement was sensibly lower in the control group. Fisher's exact test was used to compare the two groups. A control group was enrolled in which patients followed the same protocol, but they were treated with traditional dressings. At the end of VAC therapy, a second lesion biopsy was performed and analysed to detect tissue concentration of the drug at time 1. Afterwards, the patients were subjected to VAC therapy. A biopsy of the lesion was carried out to detect tissue concentration of the drug at time 0. They were given antibiotic therapy with daptomycin with a specific protocol. Patients who presented with ulcers infected with daptomycin‐sensitive bacteria were eligible to be enrolled in this prospective study. The objective of this study is to extend the indications for VAC therapy to include infected wounds by demonstrating its ability to increase the antibiotic concentration in the damaged and infected tissues. Wound infection is considered a relative contraindication. Vacuum‐assisted closure ( VAC) therapy is a sophisticated system that maintains a closed, humid, sterile and isolated environment.
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