Medical Service, Department of Veterans Affairs Medical Center, Dayton, OH 45428, USA.
Clin Dermatol. 2010 Sep-Oct;28(5):519-26. doi: 10.1016/j.clindermatol.2010.03.009.
Chronic wound infections are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Wound infection may initially be manifest as bacterial colonization, and it is only when colonization is combined with other factors, such as decreased vascular supply, intrinsic virulence of specific bacteria (eg, Staphylococcus aureus), and host immune factors, that true infection occurs. The microbiology of chronic wounds is complex, and it is difficult to discern which bacteria are culpable. Deep cultures or quantitative biopsies of wound tissue may be necessary. In some instances, such as in the presence of certain mycobacteria, isolation of specific organisms confirms causation. In many instances, it is appropriate to treat these wounds empirically with a combination of topical antiseptics and systemic antibiotics, especially in the presence of invasive infections.
慢性伤口感染可导致严重的发病率,并显著增加医疗保健成本。伤口感染最初可能表现为细菌定植,只有当定植与其他因素(如血管供应减少、特定细菌(如金黄色葡萄球菌)的固有毒力和宿主免疫因素)结合时,才会发生真正的感染。慢性伤口的微生物学很复杂,很难确定哪些细菌是罪魁祸首。可能需要对伤口组织进行深部培养或定量活检。在某些情况下,例如存在某些分枝杆菌时,分离出特定的病原体可确认病因。在许多情况下,尤其是在存在侵袭性感染的情况下,应根据经验使用局部防腐剂和全身抗生素联合治疗这些伤口。