Clinically Addressing Biofilm in Chronic Wounds
Clinically Addressing Biofilm in Chronic Wounds
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DOI：
10.1089/wound.2011.0333
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发表时间：
2012-06-01
影响因子：
4.9
通讯作者：
Wolcott, Randy
中科院分区：
文献类型：
--
作者：
Attinger, Christopher;Wolcott, Randy
背景：慢性伤口是指在伤口愈合的炎症阶段被抑制而不能进一步发展的伤口。超过90%的慢性伤口含有细菌和真菌，它们生活在生物膜结构中。问题：每一种微生物的聚集都会形成一种具有不同特征的生物膜，因此临床方法必须针对特定的生物膜进行定制。定义该生物膜的特征，然后设计针对该生物膜的治疗方案目前正在定义中。基础/临床科学进展：生物膜在形成后48-96小时对治疗操作产生抗性。通过有规律地反复攻击它，人们迫使生物膜重新附着和改造，在此期间，它对抗生素和宿主防御很敏感。使用聚合酶链反应（PCR）识别构成特定生物膜的多种细菌和真菌，可以进行定向治疗操作，例如应用特定的局部抗生素和杀菌剂，以提高清创的有效性。临床护理相关性：大多数慢性伤口含有生物膜，使伤口愈合的炎症阶段永久化。结合清创与使用PCR鉴定生物膜内的细菌和真菌允许更有针对性的治疗操作，以消除给定的生物膜。结论：目前正在评估除清创外的治疗方案以解决生物膜问题。使用PCR来指导辅助治疗操作可能会增加处理慢性伤口生物膜的有效性。
Background: A chronic wound is a wound that is arrested in the inflammatory phase of wound healing and cannot progress further. Over 90% of chronic wounds contain bacteria and fungi living within a biofilm construct.The Problem: Each aggregation of microbes creates a distinct biofilm with differing characteristics so that a clinical approach has to be tailored to the specifics of a given biofilm. Defining the characteristics of that biofilm and then designing a therapeutic option particular to that biofilm is currently being defined.Basic/Clinical Science Advances: Biofilm becomes resistant to therapeutic maneuvers at 48-96 h after formation. By repeatedly attacking it on a regular schedule, one forces biofilm to reattach and reform during which time it is susceptible to antibiotics and host defenses. Identifying the multiple bacteria and fungi that make up a specific biofilm using polymerase chain reaction (PCR) allows directed therapeutic maneuvers such as application of specific topical antibiotics and biocides to increase the effectiveness of the debridement.Clinical Care Relevance: Most chronic wounds contain biofilm that perpetuate the inflammatory phase of wound healing. Combining debridement with using PCR to identify the bacteria and fungi within the biofilm allows for more targeted therapeutic maneuvers to eliminate a given biofilm.Conclusion: Therapeutic options in addition to debridement are currently being evaluated to address biofilm. Using PCR to direct adjunctive therapeutic maneuvers may increase the effectiveness of addressing biofilm in a chronic wound.