Clinical Scientific and Medical Affairs, Smith & Nephew Advanced Wound Management, Hull, UK.
Clinical Resolutions, Hessle, UK.
Int Wound J. 2018 Dec;15(6):1025-1032. doi: 10.1111/iwj.12969. Epub 2018 Aug 17.
Antimicrobial resistance is an ever-increasing global concern, with the era of untreatable infection becoming a reality. Wound care is no exception, with increasing issues of antibiotic-resistant infections across different wound types and care settings. Antibiotic resistance and stewardship have been the priority for most strategic interventions so far; however, in wound care, alternative or supplementary strategies using antiseptics should be considered. Antiseptics such as silver can provide effective cidal activity across a broad range of wound pathogens, assuming they are used at the correct level for an appropriate duration. Evidence summarised in this manuscript suggests that effective antiseptics, such as nanocrystalline silver, have an increasing body of evidence in support of their use to minimise transmission of antibiotic-resistant organisms as part of institutional infection control procedures and, in addition, through appropriate early use and stewardship on local wound infections, in conjunction with local procedures, to minimise the need for systemic antibiotic therapy. Engagement, alignment, and collaboration between wound care professionals and wider related teams and governments on antimicrobial stewardship, and the potential role of antiseptics within this, will help to generate further evidence for such interventions in the fight against antimicrobial-resistant infections in wound care.
抗菌药物耐药性是一个日益严重的全球性问题，无法治愈的感染时代已经成为现实。伤口护理也不例外，不同类型的伤口和护理环境中越来越多的抗生素耐药感染问题。到目前为止，抗生素耐药性和管理一直是大多数战略干预措施的重点；然而，在伤口护理中，应考虑使用防腐剂等替代或补充策略。防腐剂如银可以对广泛的伤口病原体提供有效的杀菌活性，只要它们在适当的时间内以正确的水平使用。本文总结的证据表明，有效的防腐剂，如纳米银，有越来越多的证据支持将其用于减少抗生素耐药生物的传播，作为机构感染控制程序的一部分，此外，通过在局部伤口感染时早期使用和管理，结合当地程序，尽量减少对全身抗生素治疗的需求。伤口护理专业人员和更广泛的相关团队以及政府之间在抗菌药物管理方面的参与、协调和合作，以及防腐剂在这方面的潜在作用，将有助于为这些干预措施在伤口护理中对抗抗菌药物耐药感染产生更多的证据。
