Bowler Philip G
Research and Development, ConvaTec Global Development Centre, Deeside Industrial Estate, Deeside, Flintshire, CH5 2NU, UK.
Ostomy Wound Manage. 2003 Jan;49(1):44-53.
The microbiology of wounds is a key determinant in healing and clinicians generally accept that a level of microbial (ie, bacterial) growth greater than 100,000 viable organisms per gram of tissue can be used to diagnose infection. Although other factors that predispose a wound to infection are widely recognized, today's wound care practitioners are influenced primarily by the 10 5 guideline, with treatment being based on the microbial count in deep or superficial tissue. However, to appropriately manage microbially challenged wounds (eg, heavily colonized and clinically infected), a more balanced awareness of the broader issues relating to micro-organisms and wounds is needed. The types of micro-organisms, their interactions with each other and with the wound environment, the local conditions, and host resistance are all key factors that collectively influence healing. From a microbiological perspective, successful wound healing is dependent on maintaining a host-manageable bioburden. If local conditions favor microbial growth, a wound may fail to heal and become infected, requiring topical antiseptics or antibiotics to supplement the host inflammatory response and restore balance in favor of the host. This paper provides a critical examination of the 10 5 guideline to enhance clinician understanding and utilization of a commonly applied diagnostic consideration.
伤口微生物学是伤口愈合的关键决定因素，临床医生普遍认为，每克组织中微生物（即细菌）生长数量超过100,000个活生物体，可用于诊断感染。虽然导致伤口感染的其他因素已广为人知，但如今的伤口护理从业者主要受每克组织中微生物数量达10的5次方这一指导原则的影响，治疗方案基于深层或表层组织中的微生物计数。然而，为了妥善处理受到微生物挑战的伤口（例如，严重定植和临床感染的伤口），需要对与微生物和伤口相关的更广泛问题有更全面的认识。微生物的种类、它们彼此之间以及与伤口环境的相互作用、局部状况和宿主抵抗力都是共同影响伤口愈合的关键因素。从微生物学角度来看，伤口的成功愈合取决于维持宿主可控制的生物负荷。如果局部条件有利于微生物生长，伤口可能无法愈合并发生感染，这就需要使用局部防腐剂或抗生素来辅助宿主的炎症反应，并恢复有利于宿主的平衡。本文对每克组织中微生物数量达10的5次方这一指导原则进行了批判性审视，以增进临床医生对这一常用诊断考量因素的理解和应用。
