负压吸引加碘伏冲洗对于糖尿病足创面生物膜的影响
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摘要
目的:探讨生物膜在糖尿病足(diabetic foot,DF)患者创面愈合时的影响及初步的干预方法。方法:选取2016年8月至2018年8月住院接受负压吸引加碘伏冲洗治疗且资料完整的DF患者,对于治疗期间清创提取的分泌物标本进行细菌培养。选取部分病例,取创面基底组织进行革兰染色及阿辛蓝染色在光学显微镜下观察。取同一创面基底组织在透射电子显微镜下观察。所有数据录入SPSS 24.0统计软件进行统计分析。结果:细菌培养阳性结果的阳性率为58.3%,最常见的细菌为金黄色葡萄球菌、粪肠球菌和表皮葡萄球菌。在光学显微镜和透射电子显微镜下观察到细菌生物膜。通过负压吸引加碘伏冲洗治疗干预后,住院治疗30 d的愈合率为68.3%。DF治疗周期中位数为20 d,四分位间距(9,35)d。干预30 d后白细胞均值为(6.920±3.149)×109个/L。结论:DF创面感染时在光镜和透射电镜下证实疑似物质为细菌生物膜。负压吸引加碘伏冲洗治疗可以减少细菌生物膜在创面的生存机会。
Objective:To explore the effect of biofilm on wound healing in diabetic foot(DF)patients and preliminary intervention.Methods:Patients with DF who were hospitalized from August 2016 to August 2018 and received negative pressure suction and iodophor washing were selected for bacterial culture of secretion specimens isolated from debridement during treatment. Gram staining and alcian blue staining were used to observe the basal tissues of the wound in some cases under optical microscope,and the basal tissues of the same wound were also observed under transmission electron microscopy. All data were entered into SPSS 24.0 software for statistical analysis. Results:The results of positive bacterial culture had a positive rate of 58.3%,and Staphylococcus aureus,Enterococcus faecalis,and Staphylococcus epidermidis were the most common bacteria. Bacterial biofilms were observed under both optical and transmission electron microscopes. After the intervention of negative pressure suction and iodophor washing,the healing rate was 68.3% after 30 days of hospitalization. The median duration of treatment for DF was 20 days(interquartile range:9-35 d). The mean white blood cell count was(6.920±3.149)×109/L after 30 days of intervention. Conclusion:The suspected substance was confirmed as bacterial biofilm by optical and transmission electron microscopy in DF wound infection. Negative pressure suction plus iodophor washing can reduce the chance of survival of bacterial biofilm in wounds.
Objective:To explore the effect of biofilm on wound healing in diabetic foot(DF)patients and preliminary intervention.Methods:Patients with DF who were hospitalized from August 2016 to August 2018 and received negative pressure suction and iodophor washing were selected for bacterial culture of secretion specimens isolated from debridement during treatment. Gram staining and alcian blue staining were used to observe the basal tissues of the wound in some cases under optical microscope,and the basal tissues of the same wound were also observed under transmission electron microscopy. All data were entered into SPSS 24.0 software for statistical analysis. Results:The results of positive bacterial culture had a positive rate of 58.3%,and Staphylococcus aureus,Enterococcus faecalis,and Staphylococcus epidermidis were the most common bacteria. Bacterial biofilms were observed under both optical and transmission electron microscopes. After the intervention of negative pressure suction and iodophor washing,the healing rate was 68.3% after 30 days of hospitalization. The median duration of treatment for DF was 20 days(interquartile range:9-35 d). The mean white blood cell count was(6.920±3.149)×109/L after 30 days of intervention. Conclusion:The suspected substance was confirmed as bacterial biofilm by optical and transmission electron microscopy in DF wound infection. Negative pressure suction plus iodophor washing can reduce the chance of survival of bacterial biofilm in wounds.
引文
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[15] Antonioli L,Blandizzi C,Pacher P,et al. Rethinking communication in the immune system:the quorum sensing concept[J]. Trends Immunol,2019,40(2):88-97.
[16] Herzog R,Peschek N,Frohlich KS,et al. Three autoinducer molecules act in concert to control virulence gene expression in Vibrio cholerae[J]. Nucleic Acids Res,2019,47(6):3171-3183.
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[18] Kalia VC,Patel SKS,Kang YC,et al. Quorum sensing inhibitors as antipathogens:biotechnological applications[J]. Biotechnol Adv,2019,37(1):68-90.
[2] Peters EJ,Lipsky BA. Diagnosis and management of infection in the diabetic foot[J]. Med Clin North Am,2013,97(5):911-946.
[3] Lavigne JP,Sotto A. Microbial management of diabetic foot osteomyelitis[J]. Future Microbiol,2017,12:1243-1246.
[4] Schierle CF,De la Garza M,Mustoe TA,et al. Staphylococcal biofilms impair wound healing by delaying reepithelialization in a murine cutaneous wound model[J]. Wound Repair Regen,2009,17(3):354-359.
[5] Jeffcoate WJ,Vileikyte L,Boyko EJ,et al. Current challenges and opportunities in the the prevention and management of diabetic foot ulcers[J]. Diabetes Care,2018,41(4):645-652.
[6] Wilkinson HN,McBain AJ,Stephenson C,et al. Comparing the effectiveness of polymer debriding devices using a porcine wound biofilm model[J]. Adv Wound Care(New Rochelle),2016,5(11):475-485.
[7] Bhattacharya M,Berends ETM,Chan R,et al. Staphylococcus aureus biofilms release leukocidins to elicit extracellular trap formation and evade neutrophil-mediated killing[J]. Proc Natl Acad Sci U S A,2018,115(28):7416-7421.
[8] Braun LR,Fisk WA,Lev-Tov H,et al. Diabetic foot ulcer:an evidence-based treatment update[J]. Am J Clin Dermatol,2014,15(3):267-281.
[9] Motiei M,Sadan T,Zilony N,et al. Gold nanoparticles for tracking bacteria clearance by regulated irrigation and negative pressure-assisted wound therapy[J]. Nanomedicine(Lond),2018,13(15):1835-1945.
[10] Han G,Ceilley R. Chronic wound healing:a review of current management and treatments[J]. Adv Ther,2017,34(3):599-610.
[11] Hall-Stoodley L,Stoodley P,Kathju S,et al. Towards diagnostic guidelines for biofilmassociated infections[J]. FEMS Immunol Med Microbiol,2012,65(2):127-145.
[12] Volmer-Thole M,Lobmann R. Neuropathy and diabetic foot syndrome[J]. Int J Mol Sci,2016,17(6):E917.
[13] Andrews KL,Houdek MT,Kiemele LJ. Wound management of chronic diabetic foot ulcers:from the basics to regenerative medicine[J].Prosthet Orthot Int,2015,39(1):29-39.
[14] Ganesh K,Sinha M,Mathew-Steiner SS,et al. Chronic wound biofilm model[J]. Adv Wound Care(New Rochelle),2015,4(7):382-388.
[15] Antonioli L,Blandizzi C,Pacher P,et al. Rethinking communication in the immune system:the quorum sensing concept[J]. Trends Immunol,2019,40(2):88-97.
[16] Herzog R,Peschek N,Frohlich KS,et al. Three autoinducer molecules act in concert to control virulence gene expression in Vibrio cholerae[J]. Nucleic Acids Res,2019,47(6):3171-3183.
[17] Niederholtmeyer H,Chaggan C,Devaraj NK. Communication and quorum sensing in nonliving mimics of eukaryotic cells[J]. Nat Commun,2018,9(1):5027.
[18] Kalia VC,Patel SKS,Kang YC,et al. Quorum sensing inhibitors as antipathogens:biotechnological applications[J]. Biotechnol Adv,2019,37(1):68-90.