Kucisec-Tepes Nastja
Akademija medicinskih znanosti Hrvatske, Zagreb, Hrvatska.
Acta Med Croatica. 2013 Oct;67 Suppl 1:51-8.
An integral follow-up of the patient starting with medical history, present status and the wound itself will lead us to decide which plan of prevention, care and treatment will be efficient. The interaction of host immune abnormalities and growth of the microbial population invading the wound have a significant impact on the clinical presentation and direction of the development of the wound. Infection of a chronic wound is a consequence of a large number and composition of microbe populations in the tissue, along with the presence of virulence factors depending on the type and representation in the biofilm as a factor of greatest importance, the synergy of various microbial communities of aerobes-anaerobes in various combinations, and the host immune response. The basic procedures in preventing the development of infection from the colonization status are reduction of the total mass of microbes along with necrotic tissue, removal or destruction of virulent factors such as the biofilm, destruction of the synergy of various microbial communities, and increasing the level and quality of the host immune response. Prevention of the chronic wound infection demands numerous strategies or procedures, which should be applied simultaneously, but must rapidly and frequently follow each other in succession. Therefore, various methods are being applied depending on the indications, such as mechanical washing and cleaning, application of antiseptics, debridement, vacuum-assisted closing of the wound, oxygenation, moist wound healing - active and passive compresses, methods of removal or destruction of the biofilm, application of specific cells, i.e. factors of growth, and removal of mechanical stress. Antibiotics are not used in the prevention of chronic wound infection. They are used only in a targeted fashion when infection has been proven and the agent identified, as well as its sensitivity to antibiotics obtained from target samples. An ideal prevention would be a method that would prevent the development of the wound and be applied while the skin is still intact. Irrespective of all knowledge accumulated so far, the good clinical practice has not yet fully defined preventive measures for the care and prevention of chronic wound infection, and, likewise, these measures are not universally accepted. The aim of preventive procedures is at the same time the battle against microbes and the underlying disease that caused the development of chronic wound, with the aim of preventing the development of infection.
从病史、当前状况以及伤口本身开始对患者进行全面的随访，将有助于我们决定哪种预防、护理和治疗方案是有效的。宿主免疫异常与侵入伤口的微生物群体生长之间的相互作用，对伤口的临床表现和发展方向具有重大影响。慢性伤口感染是组织中微生物群体的数量和组成、毒力因子的存在（取决于生物膜中的类型和表现，这是最重要的因素）、需氧菌 - 厌氧菌各种组合的不同微生物群落的协同作用以及宿主免疫反应的结果。从定植状态预防感染发展的基本程序是减少微生物总量以及坏死组织，去除或破坏诸如生物膜等毒力因子，破坏各种微生物群落的协同作用，以及提高宿主免疫反应的水平和质量。预防慢性伤口感染需要多种策略或程序，这些策略或程序应同时应用，但必须迅速且频繁地相继进行。因此，根据适应症应用了各种方法，如机械冲洗和清洁、应用防腐剂、清创、伤口负压封闭、氧合、湿性伤口愈合 - 主动和被动敷料、去除或破坏生物膜的方法、应用特定细胞即生长因子以及去除机械应力。抗生素不用于预防慢性伤口感染。仅在已证实感染并确定病原体及其对从目标样本获得的抗生素的敏感性时，才以有针对性的方式使用抗生素。理想的预防方法是一种能够在皮肤仍完好无损时应用并预防伤口发展的方法。尽管到目前为止已经积累了所有知识，但良好的临床实践尚未完全确定慢性伤口感染护理和预防的预防措施，同样，这些措施也未被普遍接受。预防程序的目的同时是对抗微生物和导致慢性伤口发展的潜在疾病，以防止感染的发展。
