Albaugh Karen W, Biely Scott A, Cavorsi Joseph P
Neumann University, Aston, PA 19014, USA.
Ostomy Wound Manage. 2013 May;59(5):34-43.
High levels of persistent bacteria may contribute to wound chronicity and delayed healing. A prospective study was conducted to: 1) evaluate the effect of applying vancomycin topically on appropriately cultured chronic lower leg wounds, specifically methicillin-resistant Staphylococcus aureus (MRSA) and Gram-positive bacteria, and 2) evaluate its effect in combination with a cellulose dressing on healing. Twenty-three (23) outpatients (11 men, 12 women, average age 65 years [range 39-89 years]) with lower extremity wounds (15 venous ulcers, six chronic open wounds with a history of diabetes, and two chronic open trauma wounds) averaging 43.58 weeks' (range 5-121 weeks) duration and swab-cultured positive for MRSA or Gram-positive bacteria were provided 1 g vancomycin delivered by a cellulose dressing and changed every 72 hours. Patients served as their own control, and all wounds were debrided once a week. Wound surface area and bacterial and exudate levels were recorded weekly during the 3-week pretreatment period and compared to 3-week treatment period levels. Patients were followed until healed. Mean change in wound surface area was +14.5% (SD 71.91) per week before and -24.6% (SD 13.59) during the vancomycin treatment period (P = 0.014), average exudate levels decreased from 2.75 (range 1-4) to 1.81 (range 0-3) (P = 0.016), and the number of patients with positive wound cultures for MRSA or Gram-positive bacteria decreased from 23 to four after the 3-week study period. All wounds healed after an average of 8.18 weeks (SD 4.76, range 2-17 weeks). The results of this study suggest topical vancomycin applied using a dressing that retains moisture reduces wound bacterial load and may facilitate healing. Randomized, controlled clinical studies to evaluate the effectiveness and efficacy of this treatment modality and explore the relationship between wound culture results and healing are warranted.
高水平的持续性细菌可能导致伤口慢性化和愈合延迟。进行了一项前瞻性研究，目的是：1）评估局部应用万古霉素对经适当培养的慢性小腿伤口，特别是耐甲氧西林金黄色葡萄球菌（MRSA）和革兰氏阳性菌的影响；2）评估其与纤维素敷料联合使用对愈合的影响。23名门诊患者（11名男性，12名女性，平均年龄65岁[范围39 - 89岁]）患有下肢伤口（15例静脉溃疡，6例有糖尿病史的慢性开放性伤口，2例慢性开放性创伤伤口），平均病程43.58周（范围5 - 121周），拭子培养MRSA或革兰氏阳性菌呈阳性，给予1克由纤维素敷料递送的万古霉素，每72小时更换一次。患者作为自身对照，所有伤口每周清创一次。在3周的预处理期每周记录伤口表面积、细菌和渗出物水平，并与3周治疗期的水平进行比较。对患者进行随访直至伤口愈合。万古霉素治疗期间伤口表面积的平均变化在治疗前为每周 +14.5%（标准差71.91），治疗期间为 -24.6%（标准差13.59）（P = 0.014），平均渗出物水平从2.75（范围1 - 4）降至1.81（范围0 - 3）（P = 0.016），3周研究期后MRSA或革兰氏阳性菌伤口培养阳性的患者数量从23例降至4例。所有伤口平均在8.18周（标准差4.76，范围2 - 17周）后愈合。本研究结果表明，使用保持湿润的敷料局部应用万古霉素可降低伤口细菌载量，并可能促进愈合。有必要进行随机对照临床研究，以评估这种治疗方式的有效性和疗效，并探讨伤口培养结果与愈合之间的关系。
