Ebright John R
Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI 48201, USA.
Nurs Clin North Am. 2005 Jun;40(2):207-16. doi: 10.1016/j.cnur.2004.09.003.
Chronic pressure ulcers and leg ulcers are common, especially in the elderly, and are a source of much distress and disability. Health care providers must distinguish between clinically unimportant but predictable colonization of these wounds and clinically relevant infection.Infection may present as increased local pain, cellulitis, local abscess,necrotizing fasciitis, osteomyelitis, bacteremia, or sepsis. For most of these conditions, systemic antibiotics are necessary. The use of topical antimicrobial agents as a means of promoting healing in clinically uninfected wounds is a subject of active investigation at this time. Currently, evidence is insufficient to support routine use of anti-microbial agents for this purpose. A quantitative tissue culture taken from the ulcer bed, revealing greater than 10(5) organisms/g of tissue appears to increase the risk of failure of ulcer wound closure by graft or flap. A short course of topical or systemic antibiotics before surgery in these instances is advisable.
慢性压疮和腿部溃疡很常见，尤其是在老年人中，是许多痛苦和残疾的根源。医疗保健提供者必须区分这些伤口临床上不重要但可预测的定植与临床上相关的感染。感染可能表现为局部疼痛加剧、蜂窝织炎、局部脓肿、坏死性筋膜炎、骨髓炎、菌血症或败血症。对于大多数这些情况，全身使用抗生素是必要的。目前，使用局部抗菌剂作为促进临床未感染伤口愈合的手段是一个正在积极研究的课题。目前，证据不足以支持为此目的常规使用抗菌剂。从溃疡床采集的定量组织培养显示，每克组织中有超过10(5)个微生物似乎会增加移植或皮瓣闭合溃疡伤口失败的风险。在这些情况下，术前短期使用局部或全身抗生素是可取的。
