伤口护理中外用杀菌剂的治疗指标:系统回顾

IF 1.7 4区 医学 Q3 DERMATOLOGY Advances in Skin & Wound Care Pub Date : 2024-10-03 DOI:10.1097/ASW.0000000000000233
Ryan S Q Geng, R Gary Sibbald, Jacqueline Slomovic, Olivia Toksarka, Gregory Schultz
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引用次数: 0

摘要

摘要:慢性伤口给医疗保健系统带来沉重负担,并明显降低了患者从事日常生活活动的能力。导致伤口愈合受损的一个主要因素是细菌生物负荷。随着抗生素耐药性的增加和抗生素研发进程的放缓,替代抗菌策略显得尤为重要。本系统性综述的目的是确定从慢性伤口中常分离出的细菌种类的局部杀菌治疗指数值。治疗指数是引起哺乳动物细胞毒性的最低浓度与最低杀菌浓度的比值。数值越高,表明安全性越高,临床疗效越好。我们在 Medline 和 Embase 中进行了系统的文献检索,共收录了 37 篇报道慢性伤口中常见细菌的最低杀菌浓度及其在哺乳动物细胞中的细胞毒性浓度的文章。本研究收录的外用杀菌剂的治疗指数普遍较低,大多数在 0.5-3.0 之间。次氯酸对大肠杆菌(5.49)、金黄色葡萄球菌(6.31)和绿脓杆菌(8.81)的治疗指数值最高,而聚六亚甲基双胍对耐甲氧西林金黄色葡萄球菌(12.1)的治疗指数值最高。由于有个别证据表明存在局部抗菌药耐药性和抗生素交叉耐药性,因此局部抗菌药可能需要采用抗生素管理原则。抗菌剂的选择不应仅以治疗指数值为依据,而应根据患者的具体情况而定,并考虑到可能包括隐性感染在内的伤口愈合情况。
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Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review.

Abstract: Chronic wounds place a heavy burden on healthcare systems and markedly reduce the ability of patients to engage in activities of daily living. One major factor contributing to impaired wound healing is bacterial bioburden. With the rise in antibiotic resistance and the slowdown in antibiotic development pipelines, alternative antimicrobial strategies are important. The objective of this systematic review is to determine the topical antiseptic therapeutic index values for bacterial species commonly isolated from chronic wounds. The therapeutic index is a ratio of the lowest concentration that causes mammalian cell cytotoxicity over the minimum bactericidal concentration. Higher values indicate greater safety and potential clinical benefit. A systematic literature search was performed in Medline and Embase, resulting in the inclusion of 37 articles that reported on the minimum bactericidal concentration in bacterial species commonly isolated from chronic wounds and their cytotoxicity concentrations in mammalian cells. The therapeutic indices for the topical antiseptics included in this study were generally low, with most ranging between 0.5-3.0. The highest therapeutic index values for Escherichia coli (5.49), Staphylococcus aureus (6.31) and Pseudomonas aeruginosa (8.81) were achieved by hypochlorous acid, whereas the highest therapeutic index values for methicillin resistant S aureus (12.1) was achieved by polyhexamethylenebiguanide. Antibiotic stewardship principles may need to be applied to topical antiseptics due to some isolated evidence of topical antiseptic resistance and cross-resistance to antibiotics. The choice of antiseptic should not be made solely based on therapeutic index values, but individualized to the patient, with consideration for the wound healing condition that may include covert infection.

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来源期刊
Advances in Skin & Wound Care
Advances in Skin & Wound Care DERMATOLOGY-NURSING
CiteScore
2.50
自引率
12.50%
发文量
271
审稿时长
>12 weeks
期刊介绍: A peer-reviewed, multidisciplinary journal, Advances in Skin & Wound Care is highly regarded for its unique balance of cutting-edge original research and practical clinical management articles on wounds and other problems of skin integrity. Each issue features CME/CE for physicians and nurses, the first journal in the field to regularly offer continuing education for both disciplines.
期刊最新文献
Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review. Omega Fatty Acid-Based Therapy for Healing of Recalcitrant Wounds in Patients with Complex Comorbidities. A Catheter Securement Strategy for Patients with Epidermolysis Bullosa. Examining the Effect of Oral Health on Nutrition Status and Wound Healing. Healing with Systematic Wound Management after Minimally Invasive Treatment of Axillary Osmidrosis.
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