PDF(Pubmed)
Abstract：
BACKGROUND: Each year, millions of Americans develop truncal pressure ulcers (PUs) which can persist for months, years, or until the end of life. Despite the negative impact on quality of life and escalating costs associated with PUs, there is sparse evidence supporting validated and efficacious treatment options. As a result, treatment is based on opinion and extrapolation from other wound etiologies. The ideal reconstructive plan maximizes the patient\'s nutritional status, incorporates the basic tenets of wound bed preparation (debridement, offloading, proper moisture balance, reduction of bacterial burden), and employs diagnostics to guide therapeutic intervention. The use of combination therapies can potentially overcome several of the barriers to wound healing. Negative pressure wound therapy (NPWT), a commonly used modality in the management of PUs, facilitates healing by stimulating the formation of granulation tissue and promoting wound contraction; however, NPWT alone is not always effective. Clinical studies examining microbial bioburden in PUs determined that most ulcers contain bacteria at levels that impede wound healing (>104 CFU/g).
OBJECTIVE: Thus, we hypothesized that adding an anti-microbial agent to decrease both planktonic and biofilm bacteria in the wound would increase the efficacy of NPWT.
METHODS: In this prospective study, twenty patients with recalcitrant PUs that previously failed NPWT were treated with a biofilm-disrupting agent (Blast-X, Next Science, Jacksonville, FL, USA) in combination with NPWT. Fluorescence imaging was used to follow bacterial burden and guide therapy.
RESULTS: In total, 45% of the PUs reduced in size over the course of the four-week study, with a resolution of bacterial fluorescence in the NPWT dressing and wound bed seen in an average of three weeks.
CONCLUSIONS: The combination of an antibiofilm agent and NPWT reduced bacterial levels and improved wound healing in recalcitrant PUs.
OBJECTIVE: Thus, we hypothesized that adding an anti-microbial agent to decrease both planktonic and biofilm bacteria in the wound would increase the efficacy of NPWT.
METHODS: In this prospective study, twenty patients with recalcitrant PUs that previously failed NPWT were treated with a biofilm-disrupting agent (Blast-X, Next Science, Jacksonville, FL, USA) in combination with NPWT. Fluorescence imaging was used to follow bacterial burden and guide therapy.
RESULTS: In total, 45% of the PUs reduced in size over the course of the four-week study, with a resolution of bacterial fluorescence in the NPWT dressing and wound bed seen in an average of three weeks.
CONCLUSIONS: The combination of an antibiofilm agent and NPWT reduced bacterial levels and improved wound healing in recalcitrant PUs.
摘要：
背景：每年，数以百万计的美国人发展为躯干压疮（PU），可以持续数月，年,或者直到生命的尽头。尽管生活质量受到负面影响，与PU相关的成本不断上升，很少有证据支持有效的治疗方案.因此,治疗是基于其他伤口病因的意见和推断。理想的重建计划最大限度地提高患者的营养状况，结合了伤口床准备的基本原则(清创术，卸载,适当的水分平衡，减少细菌负担)，并采用诊断来指导治疗干预。组合疗法的使用可以潜在地克服伤口愈合的若干障碍。负压伤口治疗（NPWT），一种常用的PU管理方式，通过刺激肉芽组织的形成和促进伤口收缩来促进愈合;然而，NPWT本身并不总是有效的。检查PU中微生物生物负载的临床研究确定，大多数溃疡含有阻碍伤口愈合水平的细菌（>104CFU/g）。
目标：因此，我们假设添加抗微生物剂以减少伤口中的浮游和生物膜细菌将增加NPWT的功效。
方法：在这项前瞻性研究中，用生物膜破坏剂（Blast-X，下一篇科学杰克逊维尔,FL,美国）与NPWT结合使用。荧光成像用于跟踪细菌负荷和指导治疗。
结果：总计，在为期四周的研究过程中，45％的PU尺寸减小，在平均三周内观察到NPWT敷料和伤口床中的细菌荧光分辨率。
结论：抗生物膜剂和NPWT的组合降低了细菌水平，并改善了顽固性PU的伤口愈合。
目标：因此，我们假设添加抗微生物剂以减少伤口中的浮游和生物膜细菌将增加NPWT的功效。
方法：在这项前瞻性研究中，用生物膜破坏剂（Blast-X，下一篇科学杰克逊维尔,FL,美国）与NPWT结合使用。荧光成像用于跟踪细菌负荷和指导治疗。
结果：总计，在为期四周的研究过程中，45％的PU尺寸减小，在平均三周内观察到NPWT敷料和伤口床中的细菌荧光分辨率。
结论：抗生物膜剂和NPWT的组合降低了细菌水平，并改善了顽固性PU的伤口愈合。
