Burnet Michael, Metcalf Daniel G, Milo Scarlet, Gamerith Clemens, Heinzle Andrea, Sigl Eva, Eitel Kornelia, Haalboom Marieke, Bowler Philip G
Synovo GmbH, Paul Ehrlich Straße 15, 72076 Tuebingen, Germany.
ConvaTec Ltd., First Avenue, Deeside Industrial Park, Deeside CH5 2NU, UK.
Diagnostics (Basel). 2022 Oct 4;12(10):2408. doi: 10.3390/diagnostics12102408.
Wound infection is traditionally defined primarily by visual clinical signs, and secondarily by microbiological analysis of wound samples. However, these approaches have serious limitations in determining wound infection status, particularly in early phases or complex, chronic, hard-to-heal wounds. Early or predictive patient-derived biomarkers of wound infection would enable more timely and appropriate intervention. The observation that immune activation is one of the earliest responses to pathogen activity suggests that immune markers may indicate wound infection earlier and more reliably than by investigating potential pathogens themselves. One of the earliest immune responses is that of the innate immune cells (neutrophils) that are recruited to sites of infection by signals associated with cell damage. During acute infection, the neutrophils produce oxygen radicals and enzymes that either directly or indirectly destroy invading pathogens. These granular enzymes vary with cell type but include elastase, myeloperoxidase, lysozyme, and cathepsin G. Various clinical studies have demonstrated that collectively, these enzymes, are sensitive and reliable markers of both early-onset phases and established infections. The detection of innate immune cell enzymes in hard-to-heal wounds at point of care offers a new, simple, and effective approach to determining wound infection status and may offer significant advantages over uncertainties associated with clinical judgement, and the questionable value of wound microbiology. Additionally, by facilitating the detection of early wound infection, prompt, local wound hygiene interventions will likely enhance infection resolution and wound healing, reduce the requirement for systemic antibiotic therapy, and support antimicrobial stewardship initiatives in wound care.
传统上，伤口感染主要通过视觉临床体征来定义，其次通过对伤口样本进行微生物学分析来确定。然而，这些方法在确定伤口感染状态方面存在严重局限性，尤其是在早期阶段或复杂、慢性、难以愈合的伤口中。伤口感染的早期或预测性患者源性生物标志物将有助于更及时、适当地进行干预。免疫激活是对病原体活动最早的反应之一，这一观察结果表明，免疫标志物可能比通过调查潜在病原体本身更早、更可靠地指示伤口感染。最早的免疫反应之一是先天免疫细胞（中性粒细胞）的反应，这些细胞通过与细胞损伤相关的信号被招募到感染部位。在急性感染期间，中性粒细胞产生氧自由基和酶，这些物质直接或间接破坏入侵的病原体。这些颗粒酶因细胞类型而异，但包括弹性蛋白酶、髓过氧化物酶、溶菌酶和组织蛋白酶G。各种临床研究表明，总体而言，这些酶是早期发病阶段和已确诊感染的敏感且可靠的标志物。在现场护理时检测难以愈合伤口中的先天免疫细胞酶，为确定伤口感染状态提供了一种新的、简单且有效的方法，与临床判断的不确定性以及伤口微生物学的可疑价值相比，可能具有显著优势。此外，通过促进早期伤口感染的检测，及时进行局部伤口卫生干预可能会提高感染的消退率和伤口愈合速度，减少全身抗生素治疗的需求，并支持伤口护理中的抗菌管理举措。
