蛆虫疗法治疗耐药性感染:科学证据、临床接受度和实践之间的脱节。

IF 1.5 4区 医学 Q3 DERMATOLOGY Journal of wound care Pub Date : 2024-07-02 DOI:10.12968/jowc.2021.0340
Joseph Coombes, John Gammon, Yamni Nigam
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引用次数: 0

摘要

目的:从业人员和科学家正在重新审视被边缘化的伤口护理疗法,以找到既能应对日益严重的抗菌药耐药性(AMR)问题,又不影响患者治疗效果的策略。据估计,蛆虫疗法(MT)仅占英国国民健康服务伤口护理支出的 0.02%。本研究旨在揭示尽管蛆虫疗法价格低廉、清创和消毒效果显著,但为何没有被更多地使用,尤其是在AMR感染的情况下,并确定如何才能确保今后更有效地使用蛆虫疗法,以改善患者的治疗效果并控制日益严重的AMR问题:本次调查采用系统综述和荟萃分析首选报告项目框架,对使用 MT 对付 AMR 感染的案例研究进行了定性综述,并对随机对照试验 (RCT) 进行了定量分析:分析表明,MT 对各种感染和伤口类型都非常有效,与传统疗法相比效果更佳。MT使用率较低的部分原因可能是记录在案的 "恶心因素"(通常与蛆虫有关),以及对MT的成本、疗效和可及性的误解。为了克服这些因素,需要对 MT 在各种临床表现中的范围和疗效进行更多的 RCT 研究,并开展专业和公众参与活动:MT是一种未得到充分利用的疗法,尤其是在AMR感染方面,在这些情况下扩大其使用似乎是有必要的。MT可在保持现有抗菌药物疗效方面发挥重要作用,在制定抗菌药物管理计划时应加以考虑:本研究得到了斯旺西大学斯旺西就业能力学院(内部资助)的支持。作者无利益冲突需要声明。
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Maggot therapy for resistant infections: the disconnect between scientific evidence, clinical acceptance and practice.

Objective: Practitioners and scientists are re-examining marginalised wound care therapies to find strategies that combat the growing problem of antimicrobial resistance (AMR) without compromising patient outcomes. Maggot therapy (MT) makes up just an estimated 0.02% of UK's National Health Service spending on wound care. This study aims to uncover why MT is not used more often, despite its affordability and high level of efficacy for both debridement and disinfection, particularly in the context of AMR infections, and to determine what can be done to ensure MT is more effectively used in the future to improve patient outcomes and manage the growing problem of AMR.

Method: For this investigation, a qualitative review of case studies using MT against AMR infections and a quantitative analysis of randomised control trials (RCTs) were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework.

Results: Analysis showed that MT is highly effective against a range of infections and wound types, and compares well against conventional therapies. The low use of MT may be due in part to the documented 'yuck factor', often associated with maggots as well as misconceptions around the cost, efficacy and accessibility of MT. To overcome these factors, more RCTs on the spectrum and efficacy of MT across various clinical manifestations are needed, as well as professional and public engagement campaigns.

Conclusion: MT is an underused therapy, particularly regarding AMR infections, and expanding its use in these circumstances appears warranted. MT could play a vital role in conserving the efficacy of the existing pool of antimicrobials available and should be considered in the development of antimicrobial stewardship programmes.

Declaration of interest: This work was supported by the Swansea Employability Academy, Swansea University (internal funding). The authors have no conflicts of interest to declare.

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来源期刊
Journal of wound care
Journal of wound care DERMATOLOGY-
CiteScore
2.90
自引率
10.50%
发文量
215
期刊介绍: Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.
期刊最新文献
Using patient-reported experiences to inform the use of foam dressings for hard-to-heal wounds: perspectives from a wound care expert panel. Wound healing after surgical therapy for multiple myeloma: a case-control study. A dedicated wound care module for third-year baccalaureate nurses: does it increase their knowledge and confidence? A new portable negative pressure wound therapy device: a prospective study investigating clinical outcomes. Biofilms and antibacterial sutures.
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