提高感染性创面诊治水平需要关注的几个问题

刘毅

doi:10.3760/cma.j.cn501225-20231018-00119

提高感染性创面诊治水平需要关注的几个问题

doi: 10.3760/cma.j.cn501225-20231018-00119

刘毅

兰州大学第二医院烧伤整形与创面修复外科，兰州　　730030

基金项目:

国家自然科学基金地区科学基金项目 82360444

甘肃省高校产业支撑项目 2023CYZC-02

兰州大学第二医院萃英科技创新项目 CY2022-MS-A04

计量
- 文章访问数: 1453
- HTML全文浏览量: 54
- PDF下载量: 47
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-18

Several issues that need attention to improve the diagnosis and treatment level of infectious wounds

Liu Yi

Department of Burns and Plastic SurgeryWound Repair Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China

Funds:

Regional Science Foundation Program of National Natural Science Foundation of China 82360444

Gansu Province University Industry Support Project 2023CYZC-02

Cuiying Technology Innovation Project of Lanzhou University Second Hospital CY2022-MS-A04

摘要

摘要: 创面感染是宿主对病原微生物的炎症反应，它是一个复杂的病理过程，可表现为迅速发生的急性创面感染和迁延的慢性创面感染。感染性创面指发生了感染的急性或慢性创面，它的诊治涉及诸多环节，任何环节出现纰漏都会导致治疗失败。该文就如何提高感染性创面诊治水平，提出细菌生物膜与耐药菌、新材料与新型敷料、特殊类型感染性创面以及各种治疗技术的联合应用等几个需要关注的问题进行讨论，旨在引起广大同行的重视。与此同时，倡导充分关注相关领域的研究成果和不断涌现出的新技术、新理念、新材料、新方法，并将其应用到感染性创面的诊治中，造福广大患者。
- 外科伤口感染 /
- 生物膜 /
- 抗药性，细菌 /
- 感染性创面 /
- 创面修复
Abstract: Wound infection is an inflammatory response of the host to pathogenic microorganisms. It is a complex pathological process that may manifest either as a rapid onset acute wound infection, or as a prolonged chronic wound infection. Infectious wounds refer to acute or chronic wounds where infection has occurred, and their diagnosis and treatment involve many links, any loopholes in any aspect can lead to treatment failure. How to improve the diagnosis and treatment level of infectious wounds? This article proposed and discussed several issues, such as biofilm and drug resistance of bacteria, new materials and new-type dressings, special types of infectious wounds, and the combined application of various treatment techniques that need attention, and intended to attract the attention of peers. At the same time, it advocated for full attention to research results in the relevant fields and continuously emerging new technologies, concepts, materials, and methods, and applying them to the diagnosis and treatment of infectious wounds to benefit the majority of patients.
- Surgical wound infection /
- Biofilms /
- Drug resistance, bacterial /
- Infectious wounds /
- Wound repair
作者声明不存在利益冲突

HTML全文

参考文献(53)

[1]	罗高兴, 周璇. 先进生物材料在创面修复中的应用[J]. 中华烧伤与创面修复杂志, 2024, 40(1): 26-32. DOI: 10.3760/cma.j.cn501225-20231128-00211.
[2]	HurlowJ,BowlerPG.Acute and chronic wound infections: microbiological, immunological, clinical and therapeutic distinctions[J].J Wound Care,2022,31(5):436-445.DOI: 10.12968/jowc.2022.31.5.436.
[3]	于家傲,高欣欣.细菌生物膜与慢性创面感染[J].中华烧伤杂志,2019,35(12):842-847.DOI: 10.3760/cma.j.issn.1009-2587.2019.12.003.
[4]	魏敏,金莉,季怡虹.“伤口感染临床实践:最佳实践原则(2022)”解读[J].创伤外科杂志,2023,25(6):408-412.DOI: 10.3969/j.issn.1009-4237.2023.06.002.
[5]	MulaniMS,KambleEE, KumkarSN,et al. Emerging strategies to combat ESKAPE pathogens in the era of antimicrobial resistance: a review[J]. Front Microbiol, 2019, 10:539. DOI: 10.3389/fmicb.2019.00539.
[6]	朱万招纳米银抗铜绿假单胞菌生物膜作用及其对铜绿假单胞菌感染创面临床疗效的研究银川宁夏医科大学 2022 朱万招. 纳米银抗铜绿假单胞菌生物膜作用及其对铜绿假单胞菌感染创面临床疗效的研究[D].银川:宁夏医科大学,2022.
[7]	王铄链次氯酸溶液抗鲍曼不动杆菌生物膜作用及其对鲍曼不动杆菌感染创面临床疗效的研究银川宁夏医科大学 2023 王铄链. 次氯酸溶液抗鲍曼不动杆菌生物膜作用及其对鲍曼不动杆菌感染创面临床疗效的研究[D].银川:宁夏医科大学, 2023.
[8]	FlemmingHC,BaveyeP,NeuTR,et al.Who put the film in biofilm? The migration of a term from wastewater engineering to medicine and beyond[J].NPJ Biofilms Microbiomes,2021,7(1):10.DOI: 10.1038/s41522-020-00183-3.
[9]	SandozH.An overview of the prevention and management of wound infection[J].Nurs Stand,2022,37(10):75-82.DOI: 10.7748/ns.2022.e11889.
[10]	刘江,吴宝林,朱万招,等.次氯酸对大肠埃希菌生物膜的作用及大肠埃希菌感染创面的临床疗效[J].中华烧伤与创面修复杂志,2022,38(3):242-250.DOI: 10.3760/cma.j.cn501120-20201112-00471.
[11]	JiangH,XiaCL,LinJQ,et al.Carbon nanomaterials: a growing tool for the diagnosis and treatment of diabetes mellitus[J].Environ Res,2023,221:115250.DOI: 10.1016/j.envres.2023.115250.
[12]	Di GiulioM,ZappacostaR,Di LodovicoS,et al.Antimicrobial and antibiofilm efficacy of graphene oxide against chronic wound microorganisms[J].Antimicrob Agents Chemother,2018,62(7):e00547-00518.DOI: 10.1128/AAC.00547-18.
[13]	CuiFC,LiTT,WangDF,et al.Recent advances in carbon-based nanomaterials for combating bacterial biofilm-associated infections[J].J Hazard Mater,2022,431:128597.DOI: 10.1016/j.jhazmat.2022.128597.
[14]	CaoGH,YanJH,NingXX,et al.Antibacterial and antibiofilm properties of graphene and its derivatives[J].Colloids Surf B Biointerfaces,2021,200:111588.DOI: 10.1016/j.colsurfb.2021.111588.
[15]	SongB,ZhangC,ZengGM,et al.Antibacterial properties and mechanism of graphene oxide-silver nanocomposites as bactericidal agents for water disinfection[J].Arch Biochem Biophys,2016,604:167-176.DOI: 10.1016/j.abb.2016.04.018.
[16]	MeiL,ShiYM,MiaoZQ,et al.Photo-initiated enhanced antibacterial therapy using a non-covalent functionalized graphene oxide nanoplatform[J].Dalton Trans,2021,50(24):8404-8412.DOI: 10.1039/d1dt00642h.
[17]	ShariatiA,HosseiniSM,CheginiZ,et al.Graphene-based materials for inhibition of wound infection and accelerating wound healing[J].Biomed Pharmacother,2023,158:114184.DOI: 10.1016/j.biopha.2022.114184.
[18]	ChahalS,MacairanJR,YousefiN,et al.Green synthesis of carbon dots and their applications[J].RSC Adv,2021,11(41):25354-25363.DOI: 10.1039/d1ra04718c.
[19]	XinQ,LiuQ,GengLL,et al.Chiral nanoparticle as a new efficient antimicrobial nanoagent[J].Adv Healthc Mater,2017,6(4).DOI: 10.1002/adhm.201601011.
[20]	MeiL,GaoXR,ShiYM,et al.Augmented graphene quantum dot-light irradiation therapy for bacteria-infected wounds[J].ACS Appl Mater Interfaces,2020,12(36):40153-40162.DOI: 10.1021/acsami.0c13237.
[21]	LiangMJ,WangYB,MaK,et al.Engineering inorganic nanoflares with elaborate enzymatic specificity and efficiency for versatile biofilm eradication[J].Small,2020,16(41):e2002348.DOI: 10.1002/smll.202002348.
[22]	GongXJ,LuWJ,LiuY,et al.Low temperature synthesis of phosphorous and nitrogen co-doped yellow fluorescent carbon dots for sensing and bioimaging[J].J Mater Chem B,2015,3(33):6813-6819.DOI: 10.1039/c5tb00575b.
[23]	YaoS,WangYT,ChiJJ,et al.Porous MOF microneedle array patch with photothermal responsive nitric oxide delivery for wound healing[J].Adv Sci (Weinh),2022,9(3):e2103449.DOI: 10.1002/advs.202103449.
[24]	HusseinKH,AbdelhamidHN,ZouXD,et al.Ultrasonicated graphene oxide enhances bone and skin wound regeneration[J].Mater Sci Eng C Mater Biol Appl,2019,94:484-492.DOI: 10.1016/j.msec.2018.09.051.
[25]	KanY,BondarevaJV,StatnikES,et al.Hydrogel-inducing graphene-oxide-derived core-shell fiber composite for antibacterial wound dressing[J].Int J Mol Sci,2023,24(7):6255.DOI: 10.3390/ijms24076255.
[26]	BaiQ,HanK,DongK,et al.Potential applications of nanomaterials and technology for diabetic wound healing[J].Int J Nanomedicine,2020,15:9717-9743.DOI: 10.2147/IJN.S276001.
[27]	BisharatN,AgmonV,FinkelsteinR,et al.Clinical, epidemiological, and microbiological features of Vibrio vulnificus biogroup 3 causing outbreaks of wound infection and bacteraemia in Israel. Israel Vibrio Study Group[J].Lancet,1999,354(9188):1421-1424.DOI: 10.1016/s0140-6736(99)02471-x.
[28]	JonesMK,OliverJD.Vibrio vulnificus: disease and pathogenesis[J].Infect Immun,2009,77(5):1723-1733.DOI: 10.1128/IAI.01046-08.
[29]	ChoC,ChoiS,KimMH,et al.Vibrio vulnificus PlpA facilitates necrotic host cell death induced by the pore forming MARTX toxin[J].J Microbiol,2022,60(2):224-233.DOI: 10.1007/s12275-022-1448-x.
[30]	LengF,LinSL,WuW,et al.Epidemiology, pathogenetic mechanism, clinical characteristics, and treatment of Vibrio vulnificus infection: a case report and literature review[J].Eur J Clin Microbiol Infect Dis,2019,38(11):1999-2004.DOI: 10.1007/s10096-019-03629-5.
[31]	InoueY,OnoT,MatsuiT,et al.Epidemiological survey of Vibrio vulnificus infection in Japan between 1999 and 2003[J].J Dermatol,2008,35(3):129-139.DOI: 10.1111/j.1346-8138.2008.00432.x.
[32]	Baker-AustinC,OliverJD.Vibrio vulnificus[J].Trends Microbiol,2020,28(1):81-82.DOI: 10.1016/j.tim.2019.08.006.
[33]	Baker-AustinC,OliverJD.Rapidly developing and fatal Vibrio vulnificus wound infection[J].IDCases,2016,6:13.DOI: 10.1016/j.idcr.2016.07.014.
[34]	AriciE,EvaldA,HolmgaardDB,et al.Amputation of an arm due to infection with Vibrio vulnificus after beach holiday[J].Ugeskr Laeger,2017,179(48):V05170403.
[35]	LeeSJ,JungYH,OhSY,et al.Vibrio vulnificus VvhA induces NF-κB-dependent mitochondrial cell death via lipid raft-mediated ROS production in intestinal epithelial cells[J].Cell Death Dis,2015,6(2):1655.DOI: 10.1038/cddis.2015.19.
[36]	LeeNY,LeeHY,LeeKH,et al.Vibrio vulnificus IlpA induces MAPK-mediated cytokine production via TLR1/2 activation in THP-1 cells, a human monocytic cell line[J].Mol Immunol,2011,49(1/2):143-154.DOI: 10.1016/j.molimm.2011.08.001.
[37]	HorsemanMA,SuraniS.A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection[J].Int J Infect Dis,2011,15(3):e157-166.DOI: 10.1016/j.ijid.2010.11.003.
[38]	LevyS.Warming trend: how climate shapes Vibrio ecology[J].Environ Health Perspect,2015,123(4):A82-89.DOI: 10.1289/ehp.123-A82.
[39]	ElmahdiS,DaSilvaLV,ParveenS.Antibiotic resistance of Vibrio parahaemolyticus and Vibrio vulnificus in various countries: a review[J].Food Microbiol,2016,57:128-134.DOI: 10.1016/j.fm.2016.02.008.
[40]	SerratoreP,ZavattaE,FiocchiE,et al.Preliminary study on the antimicrobial susceptibility pattern related to the genotype of Vibrio vulnificus strains isolated in the north-western Adriatic Sea coastal area[J].Ital J Food Saf,2017,6(4):6843.DOI: 10.4081/ijfs.2017.6843.
[41]	StevensDL,BryantAE.Necrotizing soft-tissue infections[J].N Engl J Med,2017,377(23):2253-2265.DOI: 10.1056/NEJMra1600673.
[42]	中华医学会结核病学分会.非结核分枝杆菌病诊断与治疗指南(2020年版)[J].中华结核和呼吸杂志,2020,43(11):918-946.DOI: 10.3760/cma.j.cn112147-20200508-00570.
[43]	SharmaSK,UpadhyayV.Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases[J].Indian J Med Res,2020,152(3):185-226.DOI: 10.4103/ijmr.IJMR_902_20.
[44]	刘毅,吴溯帆,马继光.注射美容新技术[M].北京:清华大学出版社,2022:330-333.
[45]	HashishE,MerwadA,ElgamlS,et al.Mycobacterium marinum infection in fish and man: epidemiology, pathophysiology and management; a review[J].Vet Q,2018,38(1):35-46.DOI: 10.1080/01652176.2018.1447171.
[46]	KulkarniS,MenonA,RodriguesC,et al.Rare case of non-tuberculous mycobacterial infection following repair of pectoralis major avulsion: case report and review of literature[J].J Orthop Case Rep,2022,12(8):9-13.DOI: 10.13107/jocr.2022.v12.i08.2944.
[47]	孔祥力,石凯,薛岩,等.Fournier坏疽的研究进展[J].中华烧伤杂志,2020,36(1):70-76.DOI: 10.3760/cma.j.issn.1009-2587.2020.01.014.
[48]	何睿,齐心,温冰,等.Fournier坏疽的感染特点及负压治疗的效果评价[J].中华创伤杂志,2021,37(5):390-394.DOI: 10.3760/cma.j.cn501098-20201117-00674.
[49]	赵陈雨瑶, 张玉珅, 杨占杰, 等. 肠瘘继发坏死性筋膜炎病例的临床资料分析及死亡危险因素筛查[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 141-150. DOI: 10.3760/cma.j.cn501225-20230923-00088.
[50]	刘世琼,董娜,熊明月,等.深部持续冲洗联合负压封闭引流治疗主干血管损伤术后创面多重耐药菌感染[J].中华创伤杂志,2023,39(6):538-544.DOI: 10.3760/cma.j.cn501098-20230322-00156.
[51]	中华医学会骨科学分会, 沈杰, 陈林, 等. 膜诱导技术治疗感染性骨缺损临床循证指南(2023版)[J]. 中华创伤杂志, 2023, 39(2): 107-120. DOI: 10.3760/cma.j.cn501098-20221010-00671.
[52]	陈涛,曹飞华,张胜林,等.Masquelet技术在糖尿病足致感染性创面中的应用[J].实用手外科杂志,2023,37(1):83-86.DOI: 10.3969/j.issn.1671-2722.2023.01.024.
[53]	刘刚,王杨,左娜,等.负压封闭引流技术联合富血小板纤维蛋白修复巨大皮肤脓肿清创后难愈性创面[J].中国美容医学,2019,28(12):1-3.