The influence of maggot debridement therapy on the bacterial flora of hard-to-heal wounds.

IF 1.5 4区医学 Q3 DERMATOLOGY

Journal of wound care Pub Date : 2024-10-02 DOI:10.12968/jowc.2020.0168

Monika Gieroń, Małgorzata Słowik-Rylska, Monika Kucharczyk, Sylwia Cyran-Stemplewska, Bartłomiej Gieroń, Grzegorz Czerwonka, Dorota Kozieł, Beata Kręcisz

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引用次数: 0

Abstract

Objective: Maggot debridement therapy (MDT) is increasingly being used in clinical practice as an alternative treatment for hard-to-heal (chronic) wounds. Among the many benefits of using MDT is its antimicrobial effect. Maggots secrete substances that are known to have antibacterial properties against both Gram-negative and Gram-positive bacteria. Clinically, this results in the effective eradication of pathogenic species and consequently, a faster healing process. The aim of this study was to evaluate the effect MDT has on the bacterial flora of hard-to-heal ulcers.

Method: Patients with venous, mixed arteriovenous, decubitus, diabetic and neuropathic wounds were treated with larvae of Lucilia sericata enclosed in bags. Dressings were applied to the wounds for 72 hours. Before and after the therapy, a swab was taken from the wound, and bacterial diversity and bacterial growth scores were assessed. While 16 patients were treated only once, the treatment had to be repeated in four cases until the wounds were fully debrided.

Results: Bacteria of the species Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus and Enterococcus faecalis were the most common strains observed. Of the 20 patients treated, the total number of bacterial strains decreased in eight wounds, but increased in five wounds, while no difference was observed in nine wounds. The average number of bacterial strains in wounds decreased after MDT. A lower incidence of alarm pathogens was also reported. In cases where multiple applications of larvae were administered, greater decreases in bacterial growth scores were observed than in cases with a single application of dressing (37.5% vs 18.1%, respectively). In 18 cases, after disinfection of the wound by larvae, it was reinfected by strains not detected before. Wounds healed completely after MDT in two patients.

Conclusion: In this study, MDT changed the bacterial diversity of hard-to-heal wounds. The larvae reduced overall bacterial growth scores and acted on both Gram-positive and Gram-negative bacteria as well as on alarm pathogens. Cleaned wounds appeared to become vulnerable to infection by opportunistic bacteria. The bacterial burden decreased as the number of applications of biological dressings increased.

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蛆虫清创疗法对难愈合伤口细菌菌群的影响。

目的：蛆虫清创疗法（MDT）作为一种治疗难愈合（慢性）伤口的替代疗法，正越来越多地应用于临床实践。使用蛆虫清创疗法的诸多好处之一是其抗菌效果。蛆虫分泌的物质对革兰氏阴性菌和革兰氏阳性菌都有抗菌作用。在临床上，这能有效消灭致病菌，从而加快愈合过程。本研究旨在评估 MDT 对难愈合溃疡细菌群的影响：方法：对患有静脉、动静脉混合溃疡、褥疮、糖尿病和神经性溃疡的患者使用装在袋子里的蚕蛹幼虫进行治疗。伤口敷药 72 小时。在治疗前后，从伤口上取下拭子，对细菌多样性和细菌生长评分进行评估。虽然有 16 名患者只接受了一次治疗，但有 4 例患者必须重复治疗，直到伤口完全清创为止：结果：铜绿假单胞菌、变形杆菌、金黄色葡萄球菌和粪肠球菌是最常见的细菌。在接受治疗的 20 名患者中，有 8 个伤口的细菌菌株总数有所减少，但有 5 个伤口的细菌菌株总数有所增加，而有 9 个伤口的细菌菌株总数则没有差异。MDT 治疗后，伤口中细菌菌株的平均数量有所减少。据报告，报警病原体的发病率也有所降低。与单次使用敷料的病例相比，多次使用幼虫敷料的病例的细菌生长评分下降幅度更大（分别为 37.5% 和 18.1%）。在 18 个病例中，用幼虫对伤口进行消毒后，又重新感染了之前未检测到的菌株。两名患者的伤口在 MDT 后完全愈合：在这项研究中，MDT 改变了难愈合伤口的细菌多样性。幼虫降低了细菌生长的总评分，对革兰氏阳性菌和革兰氏阴性菌以及警报病原体都有作用。清洗过的伤口似乎更容易受到机会性细菌的感染。随着生物敷料使用次数的增加，细菌负担也在减少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of wound care DERMATOLOGY-

CiteScore

2.90

自引率

10.50%

发文量

215

期刊介绍： Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.