Skrlin Jasenka
Acta Med Croatica. 2016 Mar;70(1):29-32.
The skin microbiome is the aggregate of microorganisms that reside on the surface and in deep layers of the skin. Skin is colonized by bacteria, fungi, viruses and mites, maintaining a balance. Disruption in the ecosystem results in skin infections. Chronic wounds in diabetics, elderly and immobile individuals are at risk of skin organisms to invade and become pathogenic upon breach of the skin barrier. The bacteria of the skin microbiome may contribute to delayed healing and persistent inflammation. Staphylococcus epidermidis is an invasive skin organism that causes infection, i.e. hospital acquired infection (HAl) on medical devices and form biofilm. At the most basic level, biofilm can be described as bacteria embedded in a thick, slimy barrier of sugars and proteins. The biofilm barrier protects the microorganisms from external threats. Biofilms provide a reservoir of potentially infectious microorganisms that are resistant to antimicrobial agents, and their importance in the failure of medical devices and chronic inflammatory condition is increasingly being recognized. Particular research interest exists in the association of biofilms with wound infection and non-healing, i.e. chronic wounds. There is now strong evidence that biofilm is present in the majority of chronic wounds. Specialized microscopic techniques used since 2008 have allowed several research groups to demonstrate that 60% to 90% of chronic wounds have biofilm versus only 6% of acute wounds. While many studies confirm that chronic wounds often contain a polymicrobial flora, controversy remains with regard to whether these organisms directly contribute to non-healing. It seems most likely that individual bacteria themselves are not directly responsible for non-healing wounds. Rather, there is direct correlation between the presence of four or more distinct bacterial species in a wound and non-healing, suggesting that mixed microbial populations are the cause of pathology. The most reliable method to confirm the presence of a biofilm is specialized microscopy, e.g., bright-field, fluorescence in situ hybridization (FISH), and environmental scanning electron microscope (ESEM). Surface wound cultures underestimate total wound microbiota--misleading. Histological staining of deep debrided tissue shows evidence of biofilms. Now it is recognized that the majority of microbial species in chronic wounds are anaerobic bacteria (deep swabbing techniques yield similar findings to biopsies) if samples are processed within two hours. Traditional (wound culture method) cultures have limitations because all microbes (the organisms within the biofilm) cannot be isolated in culture or cannot be detected. Therefore, the most effective methods are molecular
皮肤微生物群是存在于皮肤表面和深层的微生物聚集体。皮肤被细菌、真菌、病毒和螨虫定殖，维持着一种平衡。生态系统的破坏会导致皮肤感染。糖尿病患者、老年人和行动不便者的慢性伤口有皮肤微生物入侵的风险，一旦皮肤屏障被破坏，这些微生物就会致病。皮肤微生物群中的细菌可能会导致愈合延迟和持续炎症。表皮葡萄球菌是一种侵袭性皮肤微生物，可引起感染，如医疗设备上的医院获得性感染（HAI）并形成生物膜。在最基本的层面上，生物膜可以被描述为嵌入在一层厚厚的、黏糊糊的糖和蛋白质屏障中的细菌。生物膜屏障保护微生物免受外部威胁。生物膜提供了一个潜在感染性微生物的储存库，这些微生物对抗菌剂具有抗性，它们在医疗设备故障和慢性炎症中的重要性越来越受到认可。生物膜与伤口感染和不愈合（即慢性伤口）之间的关联尤其受到研究关注。现在有强有力的证据表明，大多数慢性伤口中都存在生物膜。自2008年以来使用的专门显微镜技术使多个研究小组能够证明，60%至90%的慢性伤口有生物膜，而急性伤口只有6%有生物膜。虽然许多研究证实慢性伤口通常含有多种微生物菌群，但这些微生物是否直接导致伤口不愈合仍存在争议。似乎最有可能的是，单个细菌本身并非导致伤口不愈合的直接原因。相反，伤口中存在四种或更多不同细菌物种与伤口不愈合之间存在直接关联，这表明混合微生物群体是病理原因。确认生物膜存在的最可靠方法是专门的显微镜检查，例如明场显微镜、荧光原位杂交（FISH）和环境扫描电子显微镜（ESEM）。表面伤口培养会低估伤口微生物群的总数——具有误导性。深部清创组织的组织学染色显示有生物膜的迹象。现在人们认识到，如果在两小时内处理样本，慢性伤口中的大多数微生物物种是厌氧菌（深部擦拭技术的结果与活检相似）。传统的（伤口培养方法）培养有局限性，因为所有微生物（生物膜内的生物体）无法在培养中分离或无法检测到。因此，最有效的方法是分子方法
