{"title":"【压疮感染的特征】。","authors":"N Kučišec-Tepeš","doi":"","DOIUrl":null,"url":null,"abstract":"<p><p>Pressure ulcer is a localized injury of the skin and/or adjacent tissue, usually above bone protrusions. It is a result of pressure\nor pressure combined with shear stress, friction and humidity. With regard to long life and delayed healing, it is a chronic\nwound. Pressure ulcer appears as a consequence of a combination of micro-embolism, ischemia and myonecrosis. These\npathophysiological processes provide an ideal medium for proliferation of microorganisms, predominantly bacteria, and development\nof infection. Progression in the development of pressure ulcer is a dynamic process manifesting in phases, each\nof which is characterized by its own physiological-anatomical peculiarities and microbiological status. An open lesion without\nprotective barrier becomes contaminated immediately, and, shortly afterwards, colonized by physiological microflora of the\nhost and microbes from the environment. In the absence of preventive measures, the wound becomes critically colonized\nand infected. The characteristic of chronic wound/pressure ulcer is that it is colonized, and the infection develops depending\non various factors in 5% to 80% of cases. The ability of microbes to cause infection depends on a number of factors,\nwhich include the pathogen and the host. The number and quantity of virulent factors, microbes, determines the virulence\ncoefficient, which is responsible for overcoming the host’s immune system and development of infection. In the development\nof pressure ulcer infection, two essential microbial factors predominate, i.e. the presence of adhesin and association with\nbiofilm. Thus, pressure ulcer infection as a chronic wound is characterized by a polymicrobial and heterogeneous population\nof microbes, domination of biofilm phenotype as a primary factor of virulence present in 90% of cases, phenotype hypervariability\nof species, and resistance or tolerance of the etiological agents to all types of biocides. The most significant virulence\nfactor is biofilm. It is a corporative community of microbes with a clear architecture managed by quorum sensing molecules.\nIt is through them that the communication between species takes place, the phenotype and virulence change, and resistance\ndevelops at the level of genome. The formation of biofilm takes place in several stages, and the speed is measured in hours.\nMicroorganisms in the biofilm are protected from the action of the host’s immune system and, likewise, they are tolerant or\nresistant to antibiotics, antiseptics, and stress. Bacteria causing pressure ulcer infection are characterized as opportunistic,\nbut also primarily pathogenic. The dominance and combination of species depend on the duration, localization and stage\nof pressure ulcer. The predominant etiological agents are Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas\naeruginosa and Peptostreptococcus spp. Nowadays, multiple-resistant strains predominate, such as MRSA, Acinetobacter\nspp. and Pseudomonas spp. A chronic wound such as pressure ulcer is ideal for the development of infection, especially\nif targeted preventive measures are not applied. The diagnosis of infection is complex and is based on the combination of\nprimary and secondary clinical symptoms, tissue in the wound, status of the wound environment, inflammation markers,\nand results of microbiological examination of targeted samples – biopsies, which are the gold standard. In reaching the\ndiagnosis of infection, it is crucial to differentiate critical colonization from deep tissue infection, which is based on clinical\ncriteria called NERDS-STONEES. The frequency of pressure ulcer infection is 5% to 80%, and biofilm is present in 90% of\ncases. Due knowledge of the epidemiology of pressure ulcer and follow up of complications such as infection make the basis\nfor the understanding of chronic wound, efforts to improve necessary care, prevention of development and application of a\ncombination of treatment strategies.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[CHARACTERISTIC FEATURES OF PRESSURE ULCER INFECTION].\",\"authors\":\"N Kučišec-Tepeš\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Pressure ulcer is a localized injury of the skin and/or adjacent tissue, usually above bone protrusions. It is a result of pressure\\nor pressure combined with shear stress, friction and humidity. With regard to long life and delayed healing, it is a chronic\\nwound. Pressure ulcer appears as a consequence of a combination of micro-embolism, ischemia and myonecrosis. These\\npathophysiological processes provide an ideal medium for proliferation of microorganisms, predominantly bacteria, and development\\nof infection. Progression in the development of pressure ulcer is a dynamic process manifesting in phases, each\\nof which is characterized by its own physiological-anatomical peculiarities and microbiological status. An open lesion without\\nprotective barrier becomes contaminated immediately, and, shortly afterwards, colonized by physiological microflora of the\\nhost and microbes from the environment. In the absence of preventive measures, the wound becomes critically colonized\\nand infected. The characteristic of chronic wound/pressure ulcer is that it is colonized, and the infection develops depending\\non various factors in 5% to 80% of cases. The ability of microbes to cause infection depends on a number of factors,\\nwhich include the pathogen and the host. The number and quantity of virulent factors, microbes, determines the virulence\\ncoefficient, which is responsible for overcoming the host’s immune system and development of infection. In the development\\nof pressure ulcer infection, two essential microbial factors predominate, i.e. the presence of adhesin and association with\\nbiofilm. Thus, pressure ulcer infection as a chronic wound is characterized by a polymicrobial and heterogeneous population\\nof microbes, domination of biofilm phenotype as a primary factor of virulence present in 90% of cases, phenotype hypervariability\\nof species, and resistance or tolerance of the etiological agents to all types of biocides. The most significant virulence\\nfactor is biofilm. It is a corporative community of microbes with a clear architecture managed by quorum sensing molecules.\\nIt is through them that the communication between species takes place, the phenotype and virulence change, and resistance\\ndevelops at the level of genome. The formation of biofilm takes place in several stages, and the speed is measured in hours.\\nMicroorganisms in the biofilm are protected from the action of the host’s immune system and, likewise, they are tolerant or\\nresistant to antibiotics, antiseptics, and stress. Bacteria causing pressure ulcer infection are characterized as opportunistic,\\nbut also primarily pathogenic. The dominance and combination of species depend on the duration, localization and stage\\nof pressure ulcer. The predominant etiological agents are Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas\\naeruginosa and Peptostreptococcus spp. Nowadays, multiple-resistant strains predominate, such as MRSA, Acinetobacter\\nspp. and Pseudomonas spp. A chronic wound such as pressure ulcer is ideal for the development of infection, especially\\nif targeted preventive measures are not applied. The diagnosis of infection is complex and is based on the combination of\\nprimary and secondary clinical symptoms, tissue in the wound, status of the wound environment, inflammation markers,\\nand results of microbiological examination of targeted samples – biopsies, which are the gold standard. In reaching the\\ndiagnosis of infection, it is crucial to differentiate critical colonization from deep tissue infection, which is based on clinical\\ncriteria called NERDS-STONEES. The frequency of pressure ulcer infection is 5% to 80%, and biofilm is present in 90% of\\ncases. Due knowledge of the epidemiology of pressure ulcer and follow up of complications such as infection make the basis\\nfor the understanding of chronic wound, efforts to improve necessary care, prevention of development and application of a\\ncombination of treatment strategies.</p>\",\"PeriodicalId\":35756,\"journal\":{\"name\":\"Acta Medica Croatica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2016-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Medica Croatica\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Medica Croatica","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
[CHARACTERISTIC FEATURES OF PRESSURE ULCER INFECTION].
Pressure ulcer is a localized injury of the skin and/or adjacent tissue, usually above bone protrusions. It is a result of pressure
or pressure combined with shear stress, friction and humidity. With regard to long life and delayed healing, it is a chronic
wound. Pressure ulcer appears as a consequence of a combination of micro-embolism, ischemia and myonecrosis. These
pathophysiological processes provide an ideal medium for proliferation of microorganisms, predominantly bacteria, and development
of infection. Progression in the development of pressure ulcer is a dynamic process manifesting in phases, each
of which is characterized by its own physiological-anatomical peculiarities and microbiological status. An open lesion without
protective barrier becomes contaminated immediately, and, shortly afterwards, colonized by physiological microflora of the
host and microbes from the environment. In the absence of preventive measures, the wound becomes critically colonized
and infected. The characteristic of chronic wound/pressure ulcer is that it is colonized, and the infection develops depending
on various factors in 5% to 80% of cases. The ability of microbes to cause infection depends on a number of factors,
which include the pathogen and the host. The number and quantity of virulent factors, microbes, determines the virulence
coefficient, which is responsible for overcoming the host’s immune system and development of infection. In the development
of pressure ulcer infection, two essential microbial factors predominate, i.e. the presence of adhesin and association with
biofilm. Thus, pressure ulcer infection as a chronic wound is characterized by a polymicrobial and heterogeneous population
of microbes, domination of biofilm phenotype as a primary factor of virulence present in 90% of cases, phenotype hypervariability
of species, and resistance or tolerance of the etiological agents to all types of biocides. The most significant virulence
factor is biofilm. It is a corporative community of microbes with a clear architecture managed by quorum sensing molecules.
It is through them that the communication between species takes place, the phenotype and virulence change, and resistance
develops at the level of genome. The formation of biofilm takes place in several stages, and the speed is measured in hours.
Microorganisms in the biofilm are protected from the action of the host’s immune system and, likewise, they are tolerant or
resistant to antibiotics, antiseptics, and stress. Bacteria causing pressure ulcer infection are characterized as opportunistic,
but also primarily pathogenic. The dominance and combination of species depend on the duration, localization and stage
of pressure ulcer. The predominant etiological agents are Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas
aeruginosa and Peptostreptococcus spp. Nowadays, multiple-resistant strains predominate, such as MRSA, Acinetobacter
spp. and Pseudomonas spp. A chronic wound such as pressure ulcer is ideal for the development of infection, especially
if targeted preventive measures are not applied. The diagnosis of infection is complex and is based on the combination of
primary and secondary clinical symptoms, tissue in the wound, status of the wound environment, inflammation markers,
and results of microbiological examination of targeted samples – biopsies, which are the gold standard. In reaching the
diagnosis of infection, it is crucial to differentiate critical colonization from deep tissue infection, which is based on clinical
criteria called NERDS-STONEES. The frequency of pressure ulcer infection is 5% to 80%, and biofilm is present in 90% of
cases. Due knowledge of the epidemiology of pressure ulcer and follow up of complications such as infection make the basis
for the understanding of chronic wound, efforts to improve necessary care, prevention of development and application of a
combination of treatment strategies.
期刊介绍:
ACTA MEDICA CROATICA publishes original contributions to medical sciences, that have not been previously published. All manuscripts should be written in English.