目的 评价负压创面疗法 (negative pressure wound therapy, NPWT)治疗猪铜绿假单胞菌感染创面的效果。方法 取巴马香猪24只,随机分为NPWT组(负压组)和无菌纱布治疗组(对照组),每组12只,在背部建立一个直径5 cm的铜绿假单胞菌感染创面并分别采用相应治疗方法。于建模成功后及治疗的第4、8、12、16天取材进行细菌计数及细菌侵袭深度分析,取1 g创面敷料用于eDNA(Extracellular DNA)分析。结果 开始治疗后负压组创面细菌计数小于对照组,从治疗的第8天开始差异有统计学意义(P<0.05),之后均明显低于对照组,在治疗的第16天时两组细菌计数分别为(1.92±0.79)和(3.50±0.80),以对数lg值表示(P<0.001);生物膜成分eDNA检测显示在治疗的第4、8、12、16天时负压组明显低于对照组(P<0.05)。随着治疗时间的延长,两组创面细菌平均侵袭深度均逐渐减少。但负压组细菌侵袭深度在治疗后的取材时间点上均明显低于对照组(P<0.05),治疗的第16天时细菌侵袭深度分别为(18.2±9.7)μm和(40.0±12.3)μm,差异有统计学意义(P<0.01)。结论 与对照组相比,负压组可降低铜绿假单胞菌感染创面细菌计数,减少创面eDNA成分,降低细菌侵袭深度。这可能是NPWT减轻感染机制之一。
Abstract
Objective To quantitatively analyze the clinical effect of negative pressure wound therapy on Pseudomonas aeruginosa infected wound in a porcine model.Methods Twenty-four Bama miniature pigs were included in this study. All these animals had a wound 5 cm in diameter created on the back and infected with Pseudomonas aeruginosa before they were randomly divided into two groups: negative pressure wound therapy group (NPWT) and sterile gauze treatment group. After the infected model was established, samples were collected for analysis of bacterial count and bacterial invasion depth on day 0, 4, 8, 12 and day16. Wound dressing (weight, 1 g) was also collected for eDNA analysis.Results After treatment, the bacterial count in the NPWT group was lower than that of the control group and the difference was statistically significant from the 8th day (P<0.05). The bacterial counts in the NPWT group and the control group were 1.92±0.79 and 3.50±0.80 respectively(expressed as the logarithm, P<0.001) on the 16th day. The results of eDNA showed that the bacterial count of the NPWT group was significantly lower than that of the control group on the 4th, 8th, 12th and 16th days (P<0.05). With the extension of treatment, the average invasion depth of the two groups was gradually decreased. However, the bacterial invasion depth of the NPWT group was significantly lower than that of the control group on the 4th, 8th, 12th and 16th days (P<0.05). Bacterial invasion depth in the NPWT group and the control group was (18.2±9.7)μm and (40.0±12.3)μm (P<0.01)respectively.Conclusions Compared with conventional gauze treatment group, negative pressure wound therapy can significantly reduce the bacterial count, eDNA amount and invasion depth for Pseudomonas aeruginosa infected wound. This may be one of the mechanisms by which negative pressure wound therapy can promote wound healing.
关键词
感染 /
铜绿假单胞菌 /
负压创面疗法
Key words
infection /
Pseudomonas aeruginosa /
negative pressure wound therapy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Bowler P G. The 10(5) bacterial growth guideline: reassessing its clinical relevance in wound healing[J]. Ostomy Wound Manage, 2003, 49(1):44-53.
[2] Rennie M Y, Lindvere-Teene L, Tapang K, et al. Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study[J]. J Wound Care, 2017,26(8):452-460.
[3] Streubel P N, Stinner D J, Obremskey W T. Use of negative-pressure wound therapy in orthopaedic trauma[J]. J Am Acad Orthop Surg, 2012, 20(9):564-574.
[4] Investigators F, Bhandari M, Jeray K J, et al. A trial of wound irrigation in the initial management of open fracture wounds[J]. N Engl J Med, 2015, 373(27):2629-2641.
[5] Liu X, Zhang H, Cen S, et al. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: a systematic review and meta-analysis[J]. Int J Surg, 2018,53:72-79.
[6] Khamaisi M, Balanson S. Dysregulation of wound healing mechanisms in diabetes and the importance of negative pressure wound therapy (NPWT)[J]. Diabetes Metab Res Rev, 2017, 33(7):289-296.
[7] Arvesen K, Nielsen C B, Fogh K. Accelerated wound healing with combined NPWT and IPC: a case series[J]. Br J Community Nurs, 2017, 22 (Suppl3): S41-S45.
[8] Liu Y, Zhou Q, Wang Y, et al. Negative pressure wound therapy decreases mortality in a murine model of burn-wound sepsis involving Pseudomonas aeruginosa infection[J]. PLoS One, 2014, 9(2): e90494.
[9] Davis K, Bills J, Barker J, et al. Simultaneous irrigation and negative pressure wound therapy enhances wound healing and reduces wound bioburden in a porcine model[J]. Wound Repair Regen, 2013, 21(6):869-875.
[10] Ali E, Raghuvanshi M. Treatment of open upper limb injuries with infection prevention and negative pressure wound therapy: a systematic review[J]. J Wound Care, 2017, 26(12):712-719.
[11] Li T, Zhang L, Han LI, et al. Early application of negative pressure wound therapy to acute wounds contaminated with Staphylococcus aureus: an effective approach to preventing biofilm formation[J]. Exp Ther Med, 2016, 11(3):769-776.
[12] Watters C, Everett J A, Haley C, et al. Insulin treatment modulates the host immune system to enhance Pseudomonas aeruginosa wound biofilms[J]. Infect Immun, 2014, 82(1):92-100.
[13] Burian M, Rautenberg M, Kohler T, et al. Temporal expression of adhesion factors and activity of global regulators during establishment of Staphylococcus aureus nasal colonization[J]. J Infect Dis, 2010, 201(9): 1414-1421.
[14] Lalliss S J, Stinner D J, Waterman S M, et al. Negative pressure wound therapy reduces pseudomonas wound contamination more than Staphylococcus aureus[J]. J Orthop Trauma, 2010, 24(9): 598-602.
[15] Boone D, Braitman E, Gentics C, et al. Bacterial burden and wound outcomes as influenced by negative pressure wound therapy [J]. Wounds, 2010, 22(2): 32-37.
[16] Whitchurch C B, Tolker-Nielsen T, Ragas P C, et al. Extracellular DNA required for bacterial biofilm formation[J]. Science, 2002, 295(5559): 1487.
[17] Li T, Wang G, Yin P, et al. Effect of negative pressure on growth, secretion and biofilm formation of Staphylococcus aureus[J]. Anton Leeuw, 2015,108(4):907-917.
[18] Sugimoto S, Sato F, Miyakawa R, et al. Broad impact of extracellular DNA on biofilm formation by clinically isolated Methicillin-resistant and -sensitive strains of Staphylococcus aureus[J]. Sci Rep, 2018, 8(1): 2254.
[19] Tang L, Schramm A, Neu T R, et al. Extracellular DNA in adhesion and biofilm formation of four environmental isolates: a quantitative study [J]. FEMS Microbiol Ecol, 2013, 86(3): 394-403.
[20] Okshevsky M, Meyer R L. The role of extracellular DNA in the establishment, maintenance and perpetuation of bacterial biofilms [J]. Crit Rev Microbiol, 2015, 41(3): 341-352.
PDF(1216 KB)
