Woo Kevin Y, Sibbald R Gary
Wound Healing Clinic, Women's College Hospital, Toronto, Ontario, Canada.
Ostomy Wound Manage. 2009 Aug 1;55(8):40-8.
All chronic wounds are colonized by micro-organisms. Although the presence of bacteria is not necessarily harmful, and may be beneficial in some instances, accurate evaluation of wound-related bacterial damage and infection is crucial. A cross-sectional validation study involving 112 patients was conducted to estimate the specificity and sensitivity of clinical assessment variables individually and in combination to determine the presence and quantity of bacteria in the wound. The average age of study participants was 66 years (range 33 to 95 years) and most had leg (44) and foot (68) ulcers of approximately 6 months' duration. Wounds were evaluated using a mnemonic developed to evaluate the presence or absence of clinical signs of critical colonization (NERDS) or infection (STONEES) and results compared to semi-quantitative swab cultures. Wounds with debris, increased exudate, and friable tissue were found to be five times more likely to have scant or light bacterial growth; whereas, wounds with elevated temperature were eight times more likely to have moderate or heavy bacterial growth. When combining any three clinical signs, the sensitivity was 73.3% for scant or light and 90% for moderate and heavy bacterial growth and the specificity was 80.5% and 69.4%, respectively. Considering the importance of this clinical diagnosis, studies to examine the predictive validity of these assessment variables and culture results are warranted.
所有慢性伤口都有微生物定植。虽然细菌的存在不一定有害，在某些情况下可能还有益，但准确评估与伤口相关的细菌损害和感染至关重要。开展了一项涉及112名患者的横断面验证研究，以单独或综合评估临床评估变量的特异性和敏感性，从而确定伤口中细菌的存在情况和数量。研究参与者的平均年龄为66岁（范围33至95岁），大多数人患有腿部（44例）和足部（68例）溃疡，病程约6个月。使用一种助记法对伤口进行评估，该助记法用于评估严重定植（NERDS）或感染（STONEES）的临床体征是否存在，并将结果与半定量拭子培养结果进行比较。发现有碎片、渗出液增加和组织脆弱的伤口，细菌生长稀少或轻度的可能性高出五倍；而温度升高的伤口，细菌生长中度或重度的可能性高出八倍。当综合任何三种临床体征时，对于细菌生长稀少或轻度的情况，敏感性为73.3%，对于中度和重度细菌生长的情况，敏感性为90%，特异性分别为80.5%和69.4%。考虑到这种临床诊断的重要性，有必要开展研究来检验这些评估变量和培养结果的预测效度。
