1. ULOGA ANTISEPTIKA I STRATEGIJA UKLANJANJA BIOFILMA KRONIČNE RANE
- Author
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Nastja, Kucisec-Tepes
- Subjects
Wound Healing ,kronična rana ,biofilm ,antiseptici ,Debridement ,Biofilms ,Chronic Disease ,Pseudomonas aeruginosa ,Anti-Infective Agents, Local ,Wound Infection ,chronic wound ,antiseptics ,Humans - Abstract
Kronična rana ne cijeli u očekivanom razdoblju jer je zaostala u upalnoj fazi cijeljenja. Razlog tome je prisutnost nekrotičnog tkiva, velikog broja mikroorganizama - dominantno bakterija koje izlučuju biofi lm - uz ishemiju, hipoksiju i edem. Biofilm je prisutan u 90 % kroničnih i 6 % akutnih rana. Biofilm je korporativna zajednica mikroba adheriranih na površine (rana) kojom upravljaju quorum sensing molekule. Zajednica je okružena s hidratantnim matriksom od ekstracelularnih polimernih sastojaka (slime) koji štite mikrobe od djelovanja antibiotika, antiseptika, obrane makroorganizma i stresa. Primarni uzrok kroniciteta rane je biofi lm, jer uzrokuje permanentnu upalu, odgođeno formiranje granulacijskog tkiva, migraciju epitelnih stanica i rezervoar je mikroba koji uzrokuju infekciju kronične rane. Cilj dobre kliničke prakse jest da omogući cijeljenje kronične rane u očekivanom razdoblju. Za postizanje cilja nužno je reducirati i cjelovito ukloniti biofi lm iz rane i prevenirati njegovu rekonstrukciju. To se postiže primjenom antibiofi lm aktivnih spojeva i postupcima koji će razgraditi quorum sensing molekule, degradirati ekstracelularne polimerne sastojke (EPS) i blokirati prihvaćanje za površine. Suvremena istraživanja ukazala su da primjena antiseptika ima učinak u prevenciji infekcije i potpora je ciljanom liječenju. Činjenica je da su samo neki antiseptici primjenjivi za kronične rane i aktivni na biofi lmove primarnih uzročnika infekcije Staphylococcus spp, Streptococcus spp, Pseudomonas aeruginosa. Učinkoviti antiseptici su oktenidin dihidroklorid, poliheksanidi, povidon jodin i kadeksomer, nanokristalno srebro i manuka-tip meda. Nepokoreni biofi lm je perzistentan problem kroničnih i kroničnih inficiranih rana. Činjenica je da ni jedan pojedinačni terapijski postupak, kao ni pojedini antiseptik, ne mogu cjelovito uništiti biofilm. To je razlog da suvremeni postupci liječenja i skrbi o kroničnoj rani primjenjuju multimodalnu strategiju u obliku kombinacije mehaničko-kemijskih postupaka: debridement, antiseptici, antimikrobne potporne obloge. Debridmanom se otvara terapijski „prozor“ za djelovanje antiseptika i antibiotika tijekom 72 sata što omogućuje uklanjanje biofi lma i aktivno uništavanje sesilnih i planktonskih bakterija. Tim se postupkom onemogućuje i reformacija biofi lma. Postupci se moraju intenzivno ponavljati, antiseptici i potporne obloge izmjenjivati ovisno o stadiju ležišta rane i komorbiditetnim čimbenicima bolesnika. Rezultati kliničkih studija ukazuju da samo takav proaktivan pristup kroničnoj rani omogućuje cijeljenje u očekivanom razdoblju., Chronic wound does not heal within the expected time frame because it remains in the infl ammation phase of healing. The reason for this is the presence of necrotic tissue and a large number of microorganisms, primarily bacteria that secrete the biofi lm, along with ischemia, hypoxia and edema. Biofilm is present in 90% of chronic wounds and 6% of the acute ones. Biofi lm is a corporative association of microbes which adhere to the surface of the wound, guided by quorum sensing molecules. The association is surrounded by a moisturizing matrix of extracellular polymeric substances (slime) which protect the microbes from the impact of antibiotics, antiseptics, macro-organism defense and stress. Biofilm is the primary cause of the wound chronicity because it causes permanent inflammation, delayed granulation tissue formation and migration of epithelium cells, thus providing a reservoir of microbes that lead to infection of the chronic wound. The aim of good clinical practice is to enable healing of a chronic wound within the expected time frame. In order to achieve this aim, it is necessary to reduce and thoroughly remove the biofi lm from the wound and prevent its reappearance. This is achieved by the application of active anti-biofilm compounds and procedures that disintegrate the quorum sensing molecules, degrade the extracellular polymeric substances and block adherence to the surfaces. Recent researches have shown that the application of antiseptics is effective in the prevention of infection and is a support to targeted treatment. However, the fact is that only some antiseptics are applicable to chronic wounds and can have an impact on biofilms of the primary infective agents such as Staphylococcus spp., Streptococcus spp., and Pseudomonas aeruginosa. Effective antiseptics are octenidine dihydrochloride, polyhexanides, povidone and cadexomer iodine, nanocrystal silver and Manukatype honey. Immobile biofi lm is a persistent problem of chronic and chronic infected wounds. In fact, there is no isolated therapeutic procedure or an individual antiseptic that can fully destroy the biofilm. For this reason, modern strategy in the management of chronic wound applies a multimodal approach which combines mechanical-chemical procedures such as debridement, antiseptics, and antimicrobial supportive compresses. Debridement creates a therapeutic ‘window’ for the action of antiseptics and antibiotics in a 72-hour period, which enables removal of the biofi lm and active destruction of the sessile and planktonic bacteria. This approach also prevents de novo formation of the biofilm. The above procedures must be intensively repeated, and antiseptics and supportive compresses changed, depending on the phase of the wound bed and comorbidity factors in the patient. The results of clinical studies show that only such a proactive approach to chronic wound enables achievement of healing within the expected period of time.
- Published
- 2016