Formação do biofilme em ferida cutânea e seu comportamento diante das intervenções: revisão integrativa / Biofilm formation in cutaneous wounds and its behavior in the face of interventions: an integrative review

RESUMO Objetivo identificar na literatura a formação do biofilme e o seu comportamento diante das intervenções em feridas cutâneas. Métodos revisão integrativa, realizada nas bases de dados Cumulative Index to Nursing and Allied Health Literature , Literatura Latino-Americana e do Caribe em Ciências da Saúde, EMBASE, Scopus, The Cochrane Library Collaboration , MEDLINE/PubMed e Science Direct, sem delimitação temporal. Foram selecionados 19 estudos. Avaliação das informações ocorreu de forma descritiva, confrontando com os achados pertinentes. Resultados os estudos da amostra foram publicados no idioma inglês e contemplaram três tipos de pesquisa de biofilme: dois clínicos, seis in vitro e 11 in vivo (animal). Incluíram-se três temas: criação de modelo biofilme (n=4), avaliação do biofilme (n=3), comportamento do biofilme diante de intervenções para o seu manejo (n=12). Conclusão efeitos prejudiciais do biofilme na cicatrização de feridas foram confirmados. Diversas intervenções foram capazes de reduzir e eliminar o biofilme nos modelos in vitro e in vivo . Contribuições para a prática constatou-se que avaliação clínica da lesão não permite identificar o biofilme, inclusive quando presente encontra-se abaixo da superfície da lesão. Este achado suscita reflexão por parte dos enfermeiros a respeito das intervenções adotadas para a remoção do biofilme.

ABSTRACT Objective to identify in the literature the biofilm formation and its behavior when faced with interventions in cutaneous wounds. Methods an integrative review, carried out in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, EMBASE, Scopus, The Cochrane Library Collaboration, MEDLINE/PubMed and Science Direct databases, without temporal delimitation. Nineteen studies were selected. The information was evaluated descriptively, comparing it with the pertinent findings. Results the sample studies were published in English and included three types of biofilm research: two clinical, six in vitro and 11 in vivo (animal). Three themes were included: biofilm model creation (n=4), biofilm assessment (n=3), biofilm behavior before interventions for its management (n=12). Conclusion the detrimental effects of biofilm on wound healing have been confirmed. Several interventions were able to reduce and eliminate biofilm in in vitro and in vivo models. Contributions to practice it was found that clinical evaluation of the lesion does not allow the identification of biofilm, even when present; it is below the surface of the lesion. This finding raises reflection on the part of nurses regarding the interventions adopted for the removal of biofilm.

Therapeutic strategies for chronic wound infection / 中华创伤杂志(英文版)

Chronic wounds have always been a tough fight in clinical practice, which can not only make patients suffer from pain physically and mentally but also impose a heavy burden on the society. More than one factor is relevant to each step of the development of chronic wounds. Along with the in-depth research, we have realized that figuring out the pathophysiological mechanism of chronic wounds is the foundation of treatment, while wound infection is the key point concerned. The cause of infection should be identified and prevented promptly once diagnosed. This paper mainly describes the mechanism, diagnosis and therapeutic strategies of chronic wound infection, and will put an emphasis on the principle of debridement.

Research progress about photothermal nanomaterials with targeted antibacterial properties and their applications in wound healing / 生物医学工程学杂志

With the development of photothermal nanomaterials, photothermal therapy based on near-infrared light excitation shows great potential for the bacterial infected wound treatment. At the same time, in order to improve the photothermal antibacterial effect of wound infection and reduce the damage of high temperature and heat to healthy tissue, the targeted bacteria strategy has been gradually applied in wound photothermal therapy. In this paper, several commonly used photothermal nanomaterials as well as their targeted bacterial strategies were introduced, and then their applications in photothermal antibacterial therapy, especially in bacterial infected wounds were described. Besides, the challenges of targeted photothermal antibacterial therapy in the wound healing application were analyzed, and the development of photothermal materials with targeted antibacterial property has prospected in order to provide a new idea for wound photothermal therapy.

Antibacterial properties and healing effects of Melipona scutellaris honey in MRSA-infected wounds of rats

ABSTRACT PURPOSE : To investigate the antimicrobial, immunological and healing effects of Melipona scutellaris honey on infected wounds of rat skin. METHODS: Twenty four Wistar rats were distributed in four groups (6-each). The uninfected skin wounds of group I rats were treated daily with saline for 7 days. Uninfected wounds (group II) rats were treated with honey. In group III (treated with saline) and group IV (treated with honey) wounds were inoculated with MRSA ATTC43300. The first bacterial culture was performed 24 hours later. In the 7th day new culture was done, and wound biopsies were used for cytokines dosage and histopathology. RESULTS: In group I and III rats the CFU/g count of S. aureus in wounds was zero. In group II rats the CFU/g counts in the wound tissue were significantly higher than in wounds of group IV rats. The density histopathological parameters and the expression of TNF-α, IL1-β, Il-6 were significantly higher on wounds of group IV then in the other groups. CONCLUSION: Honey of Melipona scutellaris was effective in the management of infected wounds, by significant bacterial growth inhibition, enhancement of cytokine expression, and positively influenced the wound repair.

Principais microrganismos encontrados e produtos empregados em lesões tissulares contaminadas: revisão integrativa / Main microorganisms found and products used in contaminated tissular lesions: an integrative review / Principales microorganismos encontrados y productos empleados en lesiones tisulares contaminadas: revisión integrada

OBJETIVO: Realizar revisão integrativa para analisar as evidências científicas referentes à identificação dos microrganismos comumente isolados em lesões tissulares contaminadas e aos principais produtos utilizados nas mesmas. MÉTODO: Revisão integrativa a partir da busca com os descritores Úlcera de Perna, Infecção, Bactéria e Enfermagem, nas bases de dados LILACS, IBECS, MEDLINE, Cochrane e SciELO, incluindo artigos publicados entre 2003 e 2013. RESULTADOS: Foram selecionados 14 artigos, sendo sete observacionais e sete estudos experimentais. DISCUSSÃO: Staphylococcus aureus e Pseudomonas aeruginosa foram os microrganismos mais prevalentes nas lesões tissulares avaliadas, seguidos por Enterobacter, Klebsiella pneumoniae e Acinetobacter. Os principais produtos utilizados foram alginato de prata, sulfadiazina de prata, luz ultravioleta e papaína, efetivos na diminuição da carga bacteriana de lesões contaminadas. CONCLUSÃO: A identificação precoce da presença de microrganismos nas lesões permite a decisão da propedêutica adequada a ser realizada.

AIM: To make an integrative review to examine the scientific evidences relating to the identification of microorganisms commonly isolated in contaminated tissular lesions and the main products used on them. METHOD: This is an integrative review originating from the search with the descriptors Leg ulcer, infection, bacteria and Nursing, in the databases LILACS, IBECS, MEDLINE, Cochrane and SciELO, including articles published between 2003 and 2013. RESULTS: A total of 14 articles were selected, of which seven were observational and the other seven were experimental studies. DISCUSSION: Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent microorganisms in the evaluated tissular lesions, followed by Enterobacter, Klebsiella pneumoniae and Acinetobacter. The main products used were silver alginate, silver sulfadiazine, ultraviolet light and papain, which are effective in reducing the bacterial load of infected injuries. CONCLUSION: The early identification of the presence of microorganisms in lesions allows the decision in terms of the appropriate propaedeutics to be performed.

OBJETIVO: Realizar una revisión integrada para analizar las evidencias científicas referentes a la identificación de los microorganismos comunmente aislados en lesiones tisulares contaminadas y a los principales productos utilizados en las mismas. MÉTODO: Revisión integrada a partir de una búsqueda usando los descriptores Úlcera de Pierna, Infección, Bactéria y Enfermería, en las bases de datos LILACS, IBECS, MEDLINE, Cochrane y SciELO, incluyendo artículos publicados entre 2003 y 2013. RESULTADOS: Fueron seleccionados 14 artículos, siendo siete de observación y siete estudios experimentales. DISCUSIÓN: Staphylococcus aureus y Pseudomonas aeruginosa fueron los microorganismos más imperantes en las lesiones tisulares evaluadas, seguidos por Enterobacter, Klebsiella pneumoniae y Acinetobacter. Los principales productos utilizados fueron alginato de plata, sulfadiazina de plata, luz ultravioleta y papaína, efectivos en la diminución de la carga bacteriana de lesiones contaminadas. CONCLUSION: La identificación precoz de la presencia de microorganismos en las lesiones permite la decisión de la propedéutica adecuada a ser realizada.

Amniotic membrane as a biological dressing in infected wound healing in rabbits

PURPOSE: To investigate amniotic membrane as a biological dressing in infected wound healing in rabbits. METHODS: The use of preserved amniotic membranes (AMs) was examined using 15 rabbits with experimentally induced wound infections on their backs. Healing was histologically evaluated during different phases including inflammation, granulation, epithelialization, and fibroplasia. The animals were distributed into three groups for histological study at seven, 14, 21, and 28 days post-wound induction. Group A did not receive treatment: the wound was left exposed and dry; Group B received a daily exposure treatment with collagenase; and Group C received one AM, which also remained exposed. RESULTS: A marked reduction of the inflammatory phase was observed in Group C at 21 days, and the granulation phase of this healing increased at 14 days. Epithelialization was similar among the three groups, and fibroplasia was more pronounced in Group C at 14 days. Furthermore, gradual collagen organization also began for the animals in Group B at 14 days. CONCLUSION: The amniotic membrane did not significantly alter the inflammation, epithelialization, or fibroplasia phases but did increase angiogenesis up to Day 14 compared with the dry dressing and collagenase treatments. .

Potencial antimicrobiano do óleo de coco no tratamento de feridas / Potential antimicrobial coconut oil in the treatment of wounds

Novos meios de controle da infecção em feridas surgem na saúde pública pelas implicações no cuidado, desenvolvimento de tecnologias e produtos relacionados aos curativos e controle dos microrganismos. A inovação tecnológica no tratamento de feridas pauta-se em plantas com propriedades antimicrobianas e cicatrizantes com relato etnobotânico. Estudo experimental in vitro desenvolvido no Laboratório de Pesquisa em Tratamento de Feridas, entre março e setembro de 2011 que investigou o potencial antimicrobiano do extrato oleoso do coco na perspectiva da prevenção da infecção e tratamento de feridas, utilizando 3 extratos do coco alagoano (dois artesanais e um industrializado) frente a 14 microrganismos para verificação da atividade antimicrobiana. Todos os extratos apresentaram atividade contra Staphylococcus aureus, contudo para o Staphylococcus epidermidis e Enterobacter cloacae apenas com os óleos artesanais. Necessita-se de ensaios para purificação dos extratos e identificação da substância inibidora dos microrganismos bem como a realização de estudos in vivo em feridas utilizando modelo animal.

Terapia con presión negativa vs. cierre convencional en fracturas abiertas con heridas complejas / Negative pressure therapy vs. conventional closure in open fracture with complex wounds

El objetivo evaluar la utilidad del tratamiento de heridas con presión negativa (TPN) en el entorno de alta energía fracturas abiertas de miembros inferiores y comparar el tiempo de cierre con respecto al protocolo de cierre diferido de estas lesiones. Se trata de una serie consecutiva retrospectiva en el hospital IVSS de Ciudad Ojeda, Clínica Paraíso y Hospital Corómoto de Maracaibo, Población: 8 pacientes consecutivos que acudieron entre el 2010 y 2011 con 7 fracturas abiertas grado III y 1 heridas contaminadas postquirúrgicas, Las heridas abiertas asociadas a fractura fueron tratadas cada una con TPN antes del cierre de la herida o la cobertura definitiva y se comparo con 7 pacientes con fracturas abiertas con cierre diferido de acuerdo al protocolo aplicado en la institución para el manejo de estás lesiones, se midió el tiempo de cierre, la tasa de infección y tasa de reoperación de ambas series. El tiempo promedio de cierre con TPN fue de 5 días en rango que oscilo entre 4 y 12 día en comparación con el cierre de acuerdo al protocolo con un promedio de 28 días. No se reporto infecciones durante y posterior a su uso. El uso de TPN es eficaz para el control de heridas por fracturas abiertas y al cierre y drenaje de heridas postquirúrgicas infectadas, reduce el tiempo de cierre y no se consiguió complicaciones a su uso

The objective to evaluate the usefulness of treating wounds with negative pressure (NPWT) in the high-energy environment of open fractures of lower limbs and to compare the time close to the protocol of delayed closure of these lesions. This is a retrospective consecutive series in the hospital IVSS of Ciudad Ojeda, Clínica Paraíso y Hospital Corómoto de Maracaibo, Population: 8 consecutive patients presenting between 2010 and 2011 with 7 grade III open fractures and contaminated wounds 1 postsurgical wounds associated with open fractures were treated each with NPWT before wound closure or definitive coverage was compared with 7 patients with open fractures with delayed closure according to the protocol implemented in the institution for the management of these lesions, we measured the closure time, the rate of infection and reoperation rate of both series. The average closing time with NPWT was 5 days in range of between 4 and 12 days compared with the closure according to the protocol with an average of 28 days. No infections were reported during and after use. The use of NPWT is effective for control of open fractures and wounds to close and infected postoperative wound drainage, reduce the closing time and got no complications with its use

Infección de fracturas tibiales abiertas con y sin fijación externa provisional: Hospital de San José 2008 - 2009 / Infection of tibia open fractures with and without provisional external fixation: Hospital de San José 2008 - 2009

La infección relacionada con la fractura abierta de tibia constituye una complicación importante ya que tiene relación directa con el pronóstico y el resultado funcional. En nuestro hospital se desconoce su incidencia y si ocurre con mayor frecuencia con el uso de fijador externo. Se realizó estudio observacional tipo cohorte prospectiva en pacientes mayores de 16 años que ingresaron al servicio de ortopedia y traumatología del Hospital de San José con diagnóstico de fractura abierta de tibia en el período abril 2008 a abril 2009. Hubo seguimiento desde su ingreso hospitalario hasta los controles posteriores. Se evaluaron un total de 71 casos en los cuales predominaron el sexo masculino (84,5%) y el accidente de tránsito como mecanismo de trauma (78,8%). La incidencia total de infección en la población a estudio fue de 9,8% y el germen aislado con mayor frecuencia fue Staphylococcus aureus en (57,1%). Todos los infectados fueron manejados con fijación externa provisional y en su mayoría fueron grado IIIA en la clasificación de Gustilo (36,6%), siendo las fracturas II y III en las que se presentó con mayor frecuencia. Concluimos que todos los casos de infección se documentaron con fijación externa y debe ser considerada en el manejo de estos pacientes.

Infection associated to open tibia fractures is considered an important complication for it is directly related to prognosis and functional results. Its incidence is unknown in our hospital and is mainly associated with the use of an external fixator. An observational prospective cohort study was conducted in patients older than 16 years of age admitted to the orthopedics and traumatology service at the Hospital de San José with a diagnosis of open tibia fracture, between April 2008 and April 2009. Follow-up was carried out from admission to control visits. A total number of 71 cases were assessed with male predominance (84,5%) and car accident as trauma mechanism (78,8%). Total incidence of infection in the study population was 9,8% and the most frequently identified organism was Staphillococcus aureus in 57,1%. All affected patients had been managed with a provisional external fixation and most of them were categorized grade IIIA on the Gustillo classification (36,6%). The majority were grade II and III fractures. We conclude that all cases of infection were associated to external fixation, thus, it must be considered in the management of these patients.

Atividade antibacteriana in vitro de géis com diferentes concentrações de papaína / In vitro antibacterial activity of gels with different papain concentrations

A papaína é uma enzima proteolítica proveniente do mamão, Carica papaya Linn., e é muito empregada na indústria alimentícia, cosmética e farmacêutica. Objetivou-se determinar a atividade antibacteriana in vitro de géis com diferentes concentrações de papaína frente às bactérias padrão: Staphylococcus aureus (ATCC 6538) e Echerichia coli (ATCC 10538), bem como 4 Pseudomonas aeruginosa hospitalares. Alíquotas de 2,0ml dos inóculos bacterianos (metade da escala 1,0 de McFarland) foram semeadas em duplicata na superfície de placas de Petri. Os géis com as diferentes concentrações de papaína foram gotejados na superfície dos meios de cultura pela técnica de gotejamento e a incubação realizada a 35ºC por 24 horas. A leitura dos resultados da atividade antibacteriana foi efetuada pela mensuração dos halos de inibição ao redor das gotas dos géis de papaína. Apenas o gel de papaína a 10% foi capaz de inibir o crescimento do S. aureus e de 2 P. aeruginosa. Em conclusão, de acordo com a literatura a papaína apresenta ação proteolítica sobre os tecidos mortos, porém apenas a formulação em gel a 10% apresentou atividade antibacteriana in vitro. Assim, antes de utilizar alguma substância ou produto contra microrganismos é necessário saber se a mesma apresenta realmente atividade antimicrobiana.

The papain is a proteolytic enzyme from papaya, Carica papaya Linn., and it is so used in food, cosmetic and pharmaceutical industry. The aim of this study was to determine in vitro antibacterial activity of gels with different papain concentrations against standard bacteria: Staphylococcus aureus (ATCC 6538) and Echerichia coli (ATCC 10538), as well as 04 hospital Pseudomonas aeruginosa. Aliquots of 2.0ml from bacterial inocula (0.5 McFarland scale) were seeded in duplicate onto Petri plates? surface. The papain gels with different concentrations were dropped onto culture medium surface by the drop technique and the incubation realized at 35ºC for 24 hours. The results of antibacterial activity were obtained by measuring of growth inhibition halos around the drops of papain gels. Only the papain gel 10% was able to inhibit S. aureus and 2 P. aeruginosa growth. In conclusion, according to literature the papain has action on dead tissues, but only the gel formulation 10% presented in vitro antibacterial activity. So, before using any substance or product against microorganisms it is necessary to know if it really has antimicrobial activity.

La papaína es una enzima proteolitica de la papaya, Carica papaya Linn., y es muy utilizado en la industria del alimento, cosmética y farmacéutica. La puntería de este estudio era determinar la actividad anti-bacteriana in vitro de geles con diversas concentraciones de la papaína contra bacterias estándares: Staphylococcus aureus (ATCC 6538) y Echerichia coli (ATCC 10538), así como 4 Pseudomonas aeruginosa del hospital. Alícuotas de 2,0ml de inóculos bacterianos (0,5 de la escala McFarland) fueron sembradas por duplicado en la superficie de placas de Petri. Los geles con diferentes concentraciones de papaína fueron goteados en la superficie de los medios de cultura por la técnica de goteo y la incubación se celebró a 35ºC por 24 horas. La lectura de los resultados fue hecha por la medición de los halos de inhibición alrededor de las gotas de geles. Solamente el gel el 10% de la papaína fue capaz de inhibir inhibir el crecimiento de S. aureus y de 2 P. aeruginosa. En la conclusión, según la literatura la papaína tiene acción en tisúes muertos, pero solamente la formulación el 10% del gel presentó actividad anti-bacteriana in vitro. Así pues, antes de usar cualquier sustancia o producto contra microorganismos es necesario saber si realmente tiene actividad anti-microbiana.

Recomendaciones para el manejo de mordeduras ocasionadas por animales / Guidelines for management of animal bites

Las mordeduras producidas por animales domésticos, silvestres o mascotas exóticas, son un problema que no está bien dimensionado en nuestro medio; sin embargo, representan un motivo de consulta frecuente. Se revisa la epidemiología, enfrentamiento inicial y recomendaciones para el manejo de mordeduras ocasionadas por perros y gatos; por la gran importancia que han ido adquiriendo en el último tiempo se revisan las mordeduras producidas por hámsters, ratones, conejos, hurones, perros de la pradera, simios, murciélagos, aves, iguanas y animales de granja.

epidemiology of burn wound infections in patients hospitalized in burn center of Hamedan, Western Iran

A total of 465 burned patients with wound infections who admitted to referral burns center of Hamedan Imam Khomeiny hospital from July 1998 to June 2001 were retrospectively studied. The required data including age, sex, season, causes of burns, burn size of wounds and types of organisms isolated from patients [wounds and blood], was recorded in a questionnaire. The susceptibility of the isolates to eight routine antibiotics was tested by disc diffusion method.The data was analyzed by SPSS and EP16 software package. Out of 465 burn wound infections 73.1% of isolates were Gram-negative bacilli and 26.9% were Gram-positive cocci. Pseudomonas aeruginosa [32.7%], Klebsiella pneumoniae [21.8%] and Staphylococcus aureus [21.2%] were the most common isolates. In 28.7% of patients, blood culture became positive, Klebsiella pneumoniae [30.4%], Pseudomonas aeruginosa [26.9%], were predominant isolates. 57.3% of patients were males and the most frequency of burn patients belonged to age group 0-9 years old [28.6%], most of the burns occurred during summer. Boiled water, fuel oil flames and firewood flames were the commonest causative agent for burns, respectively. The most effective antibiotics against isolates were ciprofloxacin, ceftizoxime, amikacin and gentamicin, while most of isolates showed high resistance to ampicillin, tetracycline and carbenicillin. Present results indicated that Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus were predominant isolates with high resistance to tested antibiotics. These data can be used to evaluate the effects of changes in burn treatment and antimicrobial resistance development in relation to antibiotic usage

Comparison of efficacy of honey versus silver sulfadiazine and acetate mafenid in the treatment of contaminated burn wounds in piggies

Introduction: Heat injury, with creation of conclusive necrosis in skin layers, prepares an environment suitable for bacterial infection as a result of low tissue perfusion and high protein content. Gram negative bacteries especially Pseudomonas Auroginosa have been recognized as the main creative organisms of wound infection mortality. Mankind has been interested in remedial role of honey since long.Materials and Sixty Indian piggies were categorized in three equal groups. A part of their body, approximately 8.5cm2, was burned with water steam [3 degree of burn]. Then, a number of 108 microorganisms of Pseudomonas Auroginosa were inoculated in the wound area. Each group was treated with group-specialized drug for a period of one month. [Honey- silver sulfadiazine 1%-acetat mafenid 8.5%]. In special days, according to determined schedule, animals' weight, as well as burn condition and extent were recorded and quantitative and qualitative cultural specimens were prepared periodically. The results were analyzed by statistical software of Spss10. Out of three groups, the group of honey had the mortality at least equal with two other groups[30% with comparison of 40% and 45%], the most formation of granulation tissue in a time of 10 days [90% with comparison of 35% and 44%], the smallest remaining wound at the end of study[percent of dwindle in size 62% in honey group with comparison of 29% and 22%] and the least of contamination in prepared specimens[20% in 10th day of burn with comparison of 95% and 100%]. Utilization of topical honey in treatment of deep and infectious burn in piggies not only accelerates the healing procedure but has antimicrobial effect at least equal to valuable acetate mafenid drug

Heridas crónicas y úlceras por presión, cura avanzada en ambiente húmedo / Chronic wounds and pressure ulcers, advanced cure in a humid environment

Las lesiones tipo heridas crónicas (HC) y úlceras por presión (UPP) constituyen un importante desafío al que se enfrentan los profesionales de la salud en el proceso de atención tanto en la internación como en el tratamiento ambulatorio. Para el abordaje del cuidado de HC y UPP se deben contemplar sus tres dimensiones en forma integral: el estado general del paciente, la lesión, el entorno de cuidados. En el presente artículo se focaliza al tratamiento local de las lesiones brindando un plan de cuidados basados en principios de cura en ambiente húmedo