Abstract：
A wound offers an ideal environment for the growth and proliferation of a variety of microorganisms which, in some cases, may lead to localised or even systemic infections that can be catastrophic for the patient; the development of biofilms exacerbates these infections. Over the past few decades, there has been a progressive development of antimicrobial resistance (AMR) in microorganisms across the board in healthcare sectors. Such resistant microorganisms have arisen primarily due to the misuse and overuse of antimicrobial treatments, and the subsequent ability of microorganisms to rapidly change and mutate as a defence mechanism against treatment (e.g., antibiotics). These resistant microorganisms are now at such a level that they are of grave concern to the World Health Organization (WHO), and are one of the leading causes of illness and mortality in the 21st century. Treatment of such infections becomes imperative but presents a significant challenge for the clinician in that treatment must be effective but not add to the development of new microbes with AMR. The strategy of antimicrobial stewardship (AMS) has stemmed from the need to counteract these resistant microorganisms and requires that current antimicrobial treatments be used wisely to prevent amplification of AMR. It also requires new, improved or alternative methods of treatment that will not worsen the situation. Thus, any antimicrobial treatment should be effective while not causing further development of resistance. Some antiseptics fall into this category and, in particular, polyhexamethylene hydrochloride biguanide (PHMB) has certain characteristics that make it an ideal solution to this problem of AMR, specifically within wound care applications. PHMB is a broad-spectrum antimicrobial that kills bacteria, fungi, parasites and certain viruses with a high therapeutic index, and is widely used in clinics, homes and industry. It has been used for many years and has not been shown to cause development of resistance; it is safe (non-cytotoxic), not causing damage to newly growing wound tissue. Importantly there is substantial evidence for its effective use in wound care applications, providing a sound basis for evidence-based practice. This review presents the evidence for the use of PHMB treatments in wound care and its alignment with AMS for the prevention and treatment of wound infection.
摘要：
伤口为各种微生物的生长和增殖提供了理想的环境，在某些情况下,可能导致局部或甚至全身感染，这对患者来说可能是灾难性的;生物膜的发展加剧了这些感染。在过去的几十年里，在医疗保健行业中，微生物耐药性（AMR）正在逐步发展。这种抗性微生物的出现主要是由于滥用和过度使用抗菌治疗，以及随后微生物作为抵抗治疗的防御机制而迅速变化和突变的能力(例如，抗生素）。这些抗性微生物现在处于世界卫生组织(世卫组织)严重关注的水平，是21世纪疾病和死亡的主要原因之一。此类感染的治疗变得势在必行,但对临床医生提出了重大挑战,因为治疗必须是有效的,但不能增加具有AMR的新微生物的开发。抗微生物管理（AMS）的策略源于需要抵消这些抗性微生物，并要求明智地使用当前的抗微生物治疗来防止AMR的放大。它还需要新的，改进或替代治疗方法，不会使情况恶化。因此，任何抗菌治疗都应该是有效的，同时不会导致耐药性的进一步发展。一些防腐剂属于这一类，特别是,聚六亚甲基盐酸盐双胍（PHMB）具有一定的特性，使其成为AMR这一问题的理想解决方案，特别是在伤口护理应用。PHMB是一种广谱抗微生物剂，可以杀死细菌，真菌,寄生虫和某些具有高治疗指数的病毒，并广泛用于诊所，家和工业。它已经使用了很多年，并没有被证明会导致耐药性的发展;它是安全的（非细胞毒性），不会对新生长的伤口组织造成损害.重要的是，有大量证据表明其在伤口护理应用中的有效使用，为循证实践提供了坚实的基础。这篇综述提供了在伤口护理中使用PHMB治疗及其与AMS相结合的证据，以预防和治疗伤口感染。
