Department of Dermatology, Ernst Moritz Arndt University, Greifswald, Germany.
Int Wound J. 2013 Dec;10 Suppl 1(Suppl 1):9-14. doi: 10.1111/iwj.12175.
Wounds, especially chronic wounds, represent a global problem costing millions of dollars per year in developed countries and are characterised by microbial complications including local or overt infection, delayed healing and spread of multiresistant germs. Therefore, antimicrobial wound management is a major challenge that continues to require new solutions against microbes and their biofilms. As systemic antibiotics can barely penetrate into wound biofilms and topically applied ones can easily lead to sensitisation, antisepsis is the method of choice to treat germs in wounds. This brief review discusses the role of antiseptics in reducing bioburden in chronic wounds. Balancing antimicrobial potency and tolerability of antiseptic procedures is critical in wound therapy. However, antiseptics alone may not be able to achieve wound healing without addressing other factors regarding the patient's general health or the wound's physical environment. Although the precise role of bioburden in chronic wounds remains to be evaluated, planktonic as well as biofilm-bound microbes are indications for antiseptic intervention. Octenidine dihydrochloride and polyhexanide are the most effective, as well as best tolerated, antiseptics in wound management today, and new strategies to reduce bacterial wound burden and support the body's immune response are being developed.
伤口，尤其是慢性伤口，是一个全球性的问题，在发达国家每年耗费数百万美元，其特征为微生物并发症，包括局部或显性感染、愈合延迟和多耐药菌的传播。因此，抗菌性伤口管理是一个重大挑战，需要针对微生物及其生物膜不断开发新的解决方案。由于全身应用抗生素难以穿透伤口生物膜，局部应用则容易导致过敏，因此消毒是治疗伤口中细菌的首选方法。本文简要综述了防腐剂在减少慢性伤口生物负荷方面的作用。在伤口治疗中，平衡防腐剂的抗菌效力和耐受性至关重要。然而，如果不解决患者整体健康状况或伤口物理环境等其他因素，仅使用防腐剂可能无法实现伤口愈合。尽管生物负荷在慢性伤口中的确切作用仍有待评估，但浮游生物和生物膜结合的微生物是防腐剂干预的指征。双氯己定和聚己双胍是目前伤口管理中最有效且耐受性最好的防腐剂，正在开发新的策略来降低细菌的伤口负担并支持机体的免疫反应。
