Association of biofilm and microbial metrics with healing rate in older adults with chronic venous leg ulcers.

IF 3.8 3区 医学 Q2 CELL BIOLOGY
Wound Repair and Regeneration Pub Date : 2024-11-01 Epub Date: 2024-10-19 DOI:10.1111/wrr.13230
Philip S Stewart, Junglyun Kim, Garth James, Fan Yi, Joyce Stechmiller, Michael Weaver, Debra L Kelly, Steve Fisher, Gregory Schultz, Debra Lyon
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Abstract

The presence of microbial biofilms in many human chronic wounds led to the hypothesis that biofilms delay healing of these wounds. We tested this hypothesis in a population of 117 older individuals with venous leg ulcers who were receiving standardised therapy, including frequent debridement. Debridement specimens were analysed for the amount of bacterial biomass by two independent methods: a microscopic approach that scored the relative size and number of bacterial aggregates, interpreted as a biofilm metric, and conventional enumeration by agar plating for viable bacteria. The plating protocol yielded three distinct values: the total viable bacterial count, bleach-tolerant bacteria, and the log reduction in viable bacteria upon bleach treatment. Wound healing rates over an 8-week observation period were calculated as the rate of decrease of the equivalent diameter of the wound. There was no statistically significant association between wound healing and the biofilm metric in any of the three analyses performed (p ≥0.15). In all three statistical tests, wound healing was associated with the log reduction caused by bleach treatment (p ≤0.004); wounds that harboured bacteria that were more bleach-susceptible healed more slowly. A refinement of the model of chronic wound infection pathogenesis is proposed in which dormant bacteria constitute a persistent nidus and outgrowth of metabolically active cells impairs healing. This model constitutes a new hypothesis as metabolic activity was not directly measured in this investigation.

患有慢性静脉腿部溃疡的老年人的生物膜和微生物指标与愈合率的关系。
许多人类慢性伤口中都存在微生物生物膜,因此我们提出了生物膜会延迟伤口愈合的假设。我们在 117 名患有静脉腿部溃疡的老年人中测试了这一假设,这些人正在接受标准化治疗,包括频繁的清创。我们采用两种独立的方法对清创标本进行了细菌生物量分析:一种是显微镜方法,对细菌聚集体的相对大小和数量进行评分,将其解释为生物膜指标;另一种是传统的琼脂平板培养法,对有活力的细菌进行计数。琼脂平板法得出三个不同的数值:总存活细菌数、耐漂白剂细菌数和漂白剂处理后存活细菌减少对数。在为期 8 周的观察期内,伤口愈合率按伤口等效直径的下降率计算。在进行的三项分析中,伤口愈合与生物膜指标之间均无统计学意义(P≥0.15)。在所有三项统计检验中,伤口愈合与漂白剂处理造成的对数减少有关(p ≤0.004);伤口上滋生的细菌对漂白剂的敏感性更高,伤口愈合更慢。我们对慢性伤口感染的发病模型进行了改进,其中休眠细菌构成了一个持久的巢穴,而新陈代谢活跃细胞的生长会影响伤口的愈合。这个模型是一个新的假设,因为在这项调查中没有直接测量新陈代谢活动。
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来源期刊
Wound Repair and Regeneration
Wound Repair and Regeneration 医学-皮肤病学
CiteScore
5.90
自引率
3.40%
发文量
71
审稿时长
6-12 weeks
期刊介绍: Wound Repair and Regeneration provides extensive international coverage of cellular and molecular biology, connective tissue, and biological mediator studies in the field of tissue repair and regeneration and serves a diverse audience of surgeons, plastic surgeons, dermatologists, biochemists, cell biologists, and others. Wound Repair and Regeneration is the official journal of The Wound Healing Society, The European Tissue Repair Society, The Japanese Society for Wound Healing, and The Australian Wound Management Association.
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