Departments of Supportive Care.
J Clin Microbiol. 2013 Oct;51(10):3368-73. doi: 10.1128/JCM.01277-13. Epub 2013 Aug 7.
The risk of infections and the appearance of symptoms (e.g., odors) represent the main troubles resulting from malignant wounds. The aim of this study was to characterize the balance of bacterial floras and the relationships between biofilms and bacteria and the emergence of symptoms. Experimental research was carried out for 42 days on malignant wounds associated with breast cancer. Investigations of bacterial floras (aerobes, aero-anaerobes, and anaerobes), detection of the presence of biofilms by microscopic epifluorescence, and clinical assessment were performed. We characterized biofilms in 32 malignant wounds associated with breast cancer and bacterial floras in 25 such wounds. A mixed group of floras, composed of 54 different bacterial types, was identified, with an average number per patient of 3.6 aerobic species and 1.7 anaerobic species; the presence of strict anaerobic bacterial strains was evidenced in 70% of the wounds; biofilm was observed in 35% of the cases. Odor was a reliable indicator of colonization by anaerobes, even when this symptom was not directly linked to any of the identified anaerobic bacteria. Bacteria are more likely to be present during myelosuppression and significantly increase the emergence of odors and pain when present at amounts of >10(5) · g(-1). The presence of biofilms was not associated with clinical signs or with precise types of bacteria. No infections occurred during the 42-day evaluation period. This study provides a dynamic description of the bacterial floras of tumoral wounds. The study results highlight the absolute need for new therapeutic options that are effective for use on circulating bacteria as well as on bacteria organized in biofilm.
感染的风险和症状的出现(例如气味)是恶性伤口的主要问题。本研究的目的是描述细菌菌群的平衡以及生物膜与细菌之间的关系,并探讨症状的出现。我们对 42 天内患有乳腺癌相关恶性伤口的患者进行了实验研究。我们进行了细菌菌群(需氧菌、需氧-厌氧菌和厌氧菌)调查、通过显微镜荧光检查生物膜的存在以及临床评估。我们对 32 例与乳腺癌相关的恶性伤口进行了生物膜特征分析,对 25 例此类伤口进行了细菌菌群特征分析。我们鉴定出一种混合菌群,由 54 种不同的细菌类型组成,每位患者的平均需氧菌为 3.6 种,厌氧菌为 1.7 种;70%的伤口中存在严格厌氧菌;35%的病例中观察到生物膜。气味是厌氧菌定植的可靠指标,即使这种症状与任何鉴定出的厌氧菌都没有直接联系。当细菌数量大于 10(5)·g(-1)时,它们更有可能在骨髓抑制期间存在,并显著增加气味和疼痛的出现。生物膜的存在与临床症状或特定类型的细菌无关。在 42 天的评估期间没有发生感染。本研究提供了肿瘤性伤口细菌菌群的动态描述。研究结果强调需要新的治疗方案,这些方案不仅要对循环细菌有效,还要对生物膜中的细菌有效。