Date of Award

Fall 12-15-2019

Document Type

DNP Project

Project Team Faculty Member

Mary Lee Barron

Project Team Faculty Member

Lisa Green


Actinomyces Europaeus, actinomyces, wounds, refractory wounds


Why Won’t This heal? Actinomyces and Wounds

Christina Wagener, MSN, Steve Kalish, MD, Mary Lee Barron, PhD, APRN, FNP-BC, FAANP

An incidental finding of Actinomyces europaeus in a refractory healing abscess presents an opportunity to close a knowledge and treatment gap. After finding Actinomyces species in multiple patients within a twenty-month period in an independent hospital in Chicago, IL, the probability exists that Actinomyces is becoming more prevalent in subcutaneous wounds. Chronic, non-healing wounds cause multiple negative consequences including financial, psychological and physical losses and possibly death.

Actinomyces is a Gram-positive, filamentous, non-acid-fast and anaerobic-to-microaerophilic bacteria first identified in 1997 and found in the oropharynx and reproductive track of females (White & Woolley, 2018). Typical wound cultures miss Actinomyces bacterium because it is a rare finding outside usual habitat, time to grow, and wound cultures do not traditionally include anaerobic testing (Kononen & Wade, 2015). Treatment guidelines from the Centers of Disease Control for subcutaneous abscesses include incision, drainage and culturing; protocols do not include testing for Actinomyces (CDC, 2007). Treatment protocols for Actinomyces are unique because of the use of long-term penicillin (Barberis et al., 2017; CDC, 2007; Sharkawy & Chow, 2018).

An educational quality improvement project on the identification, risk factors, testing and treatment for Actinomyces species was presented to clinicians in an independent hospital. Pre- and post-education survey results, frequency of requests for Actinomyces testing, and positive results were collected. Pre- and post-educational intervention surveys were evaluated using a paired T-Test. Frequency of cultures as well as positive culture results were used to evaluate the utilization of the testing as well as the occurrence of the bacteria. A statistically significant educational outcome showed an increase in knowledge, awareness, and identification of the appropriate testing and treatment protocols for refractory wounds. Since October 2017, 17 specimens were cultured for Actinomyces; 41% (n=7) were positive. Actinomyces species may be prevalent in refractory wounds. Additional multi-site studies as well as updating the treatment algorithm related to subcutaneous wounds/abscesses should be considered.

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