Biofilm Management in Wound Care.
Biofilm Management in Wound Care.
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DOI：
10.1097/prs.0000000000008142
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发表时间：
2021-08-01
影响因子：
3.6
通讯作者：
Gordillo GM
中科院分区：
文献类型：
--
作者：
Sen CK;Roy S;Mathew-Steiner SS;Gordillo GM
阅读本文后，参与者应该能够：1。了解生物膜感染的基础知识，能够区分浮游和生物膜的生长模式。2. 具有传统的和新兴的抗生素膜疗法及其作用模式的工作知识，因为它与伤口护理有关。3. 了解与测试和营销抗生素膜策略相关的挑战，以及这些策略可能具有有效价值的背景。美国疾病控制与预防中心估计，由具有生物膜表型的细菌引起的人类传染病占65%，而美国国立卫生研究院的估计接近80%。生物膜是一种敌对的微生物聚集体，因为在它们的聚合物基质茧内，它们可以免受抗菌剂治疗和宿主防御的攻击。生物膜感染的伤口，即使闭合，也表现出功能缺陷，如细胞外基质缺陷和屏障功能受损，这很可能导致伤口再犯。侵袭性伤口感染的处理通常包括全身抗菌药物治疗，同时由无法观察生物膜的外科医生决定将伤口清创至健康组织床。在生物膜状态下细菌假阴性培养的极高发生率导致伤口感染的漏诊。在不进行伤口清创的情况下使用局部和肠外抗菌药物治疗对减少生物膜感染的影响有限，这仍然是伤口护理中的一个主要问题。目前对伤口生物膜感染的治疗基于有限的早期数据。在大多数情况下，这些数据来自缺乏宿主免疫防御的有限实验系统。在决定选择商业产品来管理伤口生物膜感染时，重要的是批判性地认识相关实验系统的作用机制和意义。在这项工作中，我们批判性地回顾了不同类别的抗生物膜产品，重点是它们的优势和局限性，从已发表的文献中可以看出。
After reading this article, the participant should be able to: 1. Understand the basics of biofilm infection and be able to distinguish between planktonic and biofilm modes of growth. 2. Have a working knowledge of conventional and emerging antibiofilm therapies and their modes of action as it pertains to wound care. 3. Understand the challenges associated with testing and marketing antibiofilm strategies and the context within which these strategies may have effective value. The CDC estimates for human infectious diseases caused by bacteria with a biofilm phenotype is 65% and NIH estimates is closer to 80%. Biofilm are hostile microbial aggregates because within their polymeric matrix cocoons, they are protected from antimicrobial therapy and attack from host defenses. Biofilm infected wounds, even when closed, show functional deficits such as deficient extracellular matrix and impaired barrier function, which are likely to cause wound recidivism. The management of invasive wound infection often includes systemic antimicrobial therapy in combination with debridement of wounds to a healthy tissue bed as determined by the surgeon who has no way of visualizing the biofilm. The exceedingly high incidence of false negative cultures for bacteria in a biofilm state leads to missed diagnoses of wound infection. The use of topical and parenteral antimicrobial therapy without wound debridement have had limited impact on decreasing biofilm infection, which remains a major problem in wound care. Current claims to manage wound biofilm infection rest on limited early-stage data. In most cases, such data originate from limited experimental systems that lack host immune defense. In making decisions on the choice of commercial products to manage wound biofilm infection it is important to critically appreciate the mechanism of action and significance of the relevant experimental system. In this work, we critically review different categories of anti-biofilm products with emphasis on their strengths and limitations as evident from the published literature.