Lund-Nielsen Betina, Adamsen Lis, Gottrup Finn, Rorth Mikael, Tolver Anders, Kolmos Hans Jorn
The University Hospitals Centre for Nursing and Care Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark.
Ostomy Wound Manage. 2011 Jul;57(7):28-36.
Between 5% and 10% of cancer patients develop malignant wounds. In vitro and some clinical studies suggest that silver- or honey-coated dressings may have an antibacterial effect in nonmalignant wounds, but their possible antibacterial effect in malignant wounds remains unknown. A prospective, randomized, single-blind controlled clinical study was conducted to evaluate the bacteriology of malignant wounds and compare the effect of a honey-coated (Group A) to a silver-coated (Group B) dressing on the qualitative bacteriology of malignant wounds. All wound interventions were performed by the same healthcare professional. Swab cultures were obtained at baseline and following a 4-week intervention and were evaluated without information about the patient treatment group. Of the 75 patients with advanced cancer and malignant wounds identified, 67 (34 in group A, 33 in group B; median age 64 years, range 47-92) consented to participate and completed the 4-week study. The majority were women (88%) with breast cancer (79%). No statistically significant differences were found between the type and number of different wound pathogens in the wounds during the course of the study or between Group A and Group B. Neither anti-neoplastic nor antibiotic treatment influenced the presence of wound pathogens. Staphylococci were found in 42%, enteric bacteria in 34%, anaerobic bacteria in 16%, Pseudomonas in 10%, and hemolytic streptococci in 6% of wounds at baseline; in total, 25 different bacterial species were identified. Sixty-one percent (61%) of wounds decreased in size following treatment, but no significant differences were observed between the type and variety of wound pathogens and whether wound size decreased. Although quantitative bacteriological changes may have occurred, the possible antibacterial effect of the honey or silver dressing could not be confirmed in these malignant wounds. Routine wound swabbing of malignant wounds is of little value and should be restricted to cases where signs of infection requiring antibiotic intervention are observed or where resistant organisms require special infection control measures.
5%至10%的癌症患者会出现恶性伤口。体外研究和一些临床研究表明，涂银或涂蜂蜜的敷料可能对非恶性伤口有抗菌作用，但其在恶性伤口中可能的抗菌效果尚不清楚。本研究进行了一项前瞻性、随机、单盲对照临床研究，以评估恶性伤口的细菌学情况，并比较涂蜂蜜敷料（A组）和涂银敷料（B组）对恶性伤口定性细菌学的影响。所有伤口干预均由同一名医护人员进行。在基线时和为期4周的干预后采集拭子培养物，并在不了解患者治疗组信息的情况下进行评估。在确定的75例晚期癌症和恶性伤口患者中，67例（A组34例，B组33例；中位年龄64岁，范围47 - 92岁）同意参与并完成了为期4周的研究。大多数为女性（88%），患有乳腺癌（79%）。在研究过程中，伤口中不同伤口病原体的类型和数量在A组和B组之间未发现统计学上的显著差异。抗肿瘤治疗和抗生素治疗均未影响伤口病原体的存在。基线时，42%的伤口中发现葡萄球菌，34%为肠道细菌，16%为厌氧菌，10%为假单胞菌，6%为溶血性链球菌；总共鉴定出25种不同的细菌种类。61%的伤口在治疗后尺寸减小，但伤口病原体的类型和种类与伤口尺寸是否减小之间未观察到显著差异。尽管可能发生了定量细菌学变化，但在这些恶性伤口中无法证实蜂蜜或银敷料可能的抗菌效果。对恶性伤口进行常规伤口拭子检查价值不大，应仅限于观察到需要抗生素干预的感染迹象或耐药菌需要特殊感染控制措施的情况。
