ulceras infectadas.pdf
TRANSCRIPT
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Definio
comunidade residente de microrganismos numecosistema
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Microbioma
Definio
Microbioma Cutneo
O que
qual a sua importncia e relao com ainfeco e o biofilme
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kin microbiom e
Microbioma Cutneo
Populao de micro-organismos residentes nasuperfcie e nas camadas
mais profundas da pele
A pele est colonizada porbactrias,fungos e vrus emperfeito equilbrio
Qualquer disrupo doecosistema resulta eminfeco da pele
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Qual a importncia
deste conceito?Os diabticos,idosos e doentes com mobilidade diminudaesto mais sujeitos a infeco duma lcera crnica
As bactrias do microbioma cutneo podem serresponsveis pela diminuio da capacidade cicatriciale pela persistncia da inflamao
Condies ideais para a formao de biofilmes
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Outros conceitos
Ferida contaminada
Presena de bactrias sem resposta dohospedeiro
Ferida colonizada
Presena de bactrias com multiplicao semresposta inflamatria significativa
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outros conceitos
Colonizao crtica
Bactrias replicantes no tecido,em maiornmero e virulncia,com capacidade deinibio da cicatrizao por competirem pelo
oxignio e nutrientes,e produzirem maiorresposta inflamatria
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patognese da infeco
1$2$'/3"45$ 6+()5$ 782#/,2/."45$
9/))(:/'"45$;'
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Colonizao critica Ecosistema
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biofilme
Estratgia
Cooperao
Sinergia
Quorum sensing
Combater as defesasdo hospedeiro
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diagnstico infeco
Clssicos
Eritema
dor
calor
edema
Adicionais
abcesso
celulite
exsudadopurulento
atraso dacicatrizao.......
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diagnstico infeco
descolorao dos bordos ouleito da ferida
tecido de granulao pobreou frivel
dor ou sensibilidadeintensa
Sinais sistmicos
febre
taquicardia
hipotenso
leucocitose
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diagnstico infeco
Testes analticos
Hemocultura
Bipsia
Zaragatoa
Imagiolgicos
ecografia
RM
novos mtodosusando DNA
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tratamento
No usar antibioterapiasistmica para a colonizaoou biofilme
Se infeco antibioterapiasistmica
Se infeco no usarantibiticos tpicos
Antibioterapia se celulite domembro em volta da lcera
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arvae e r emen o o
tratamento
Biofilme
desbridamento
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tratamento
Antisspticos
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Antissptico
Toda a substncia qumica que destroi ou inibe ocrescimento de microrganismos patognicoslocalizados em tecidos vivos
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Modos de aco
Desnaturao de protenas
Alterao da membrana celular
Modificao da actividade metablica
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classificao
Alcoois
Aldedos
Fenol e derivados
Biguanidas
Halogenados
Prata e derivados
Peroxigenios
compostos de amnio
quaternrio
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Antissptico ideal
Largo espectro de aco
Baixa capacidade de gerar resistncias Baixa toxicidade
Rpido inicio de actividade
No ser irritante nem sensibilizante
No tingir os tecidos
Ser activo na presena de ps, sangue ........Domingo, 15 de Novembro de 15
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MODERN
METHODS
-OF-
Antiseptic Wotind
Treatment
COMPILED
FROM
NOTES
AND
SUGGESTIONS
FROM
THE
FOLLOWING
EMINENT
SURGEONS:
D.
HAYES
AGNE'W, M.
D., I.L,.D.,
Pro/lessor o/
Surgery
in
the
University
oj
Pennsylvania^
Philadelphia, Pa,
A.
C.
BEKNAYS,
M. D., M.
A.,
Surgeon
to
Lutheran
Hospital, and
Consulting
Surgeo?i
to the
City
and
Female Hospital, St, Louis,
Mo.
S.
W.
GROSS, M.
D.,
LL.D.,
Professor
of
the
Priticiples
of
Surgery and Clinical
Surgery
in the
Jefferson
Medical
College
o/ Philadelphia,
HUNTER
McGUIRE, M.
D,,
LL.D.,
Surgeon
to
St. Lukc^s
Hospital,
Richmond,
Va.
THOS.
G.
MORTON, >I.
D.,
Surgeon to
the
Pennsylvania
and Orthopaedic
Hospitals, Philadelphia,
N.
SENN M. D.
Milwaukee Wis.,
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R
D13I
363
\8H
Columtiia
Hnitier^ftp
mtljeCitpoflrttigork
CoUege
of
^tjpjJiciansi
anb
burgeons
^ifararp
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Table
Showing
the
Relative
Value
of
Various
Germicides.
From a
recent
clinical lecture
delivered
by Robert Weir,
M. D.,
at
the New
York
Hospital,
published
in
the
Philadelphia
Medical News Dec.
17,
1887.
(From the
investigations
of Dr.
Weeks,
of
New
York.)*
Antiseptic.
Strength.
Duration
of
exposure
to
destroy
vitality
of
germs.
Corrosive
sublimate,
1
to 500
10
seconds.
Ito
1000
45
Ito
2000
1}^
minutes.
Ito
5000
3
Carbolic acid
1
to
30
15
seconds.
Ito
40
30-60
Ito
60
4
minutes.
Alcohol,
No effect
on
dried
germs;
very
powerful
when
active in
moistened
condition.
absolute
alcohol,
1-12
seconds.
95perct.
20-30
66perct
10-15
minutes.
Salicyclic
acid
(makes
a
stable
solution.)
. .
1
to
600
parts
of
water,
1
Ito
1000
4-5
Chlorine
water,
very
unstable,
best
when
fresh,
1)^
minutes.
hydrogen
bromide,
l-l>a
Boracic
acid had
no
germicidal action whatever;
germs remained uhiff
acted for
W
days.
Iodine
to
saturation
in water did
not
affect
germs
after
48
hours
expostire.
Chloride
of zinc, 1 to
20 in
water,
had
no effect.
Oil
of
turpentine,
Thymol,
Eucalyptol,
Ointments
of
10 per
cent,
of
iodoform
and of
iodol
of
the same strength
had no
effect
after
36
hoiu-s
exposure.
Iodoform
in
power
only
retarded
development
of
germs
after
12
hours
exposure.
Boiling
water,
and
in
fact
heat
from
165.2
deg.
to
212
deg. F.,
destroyed
germ
Ufe on
contact.
Says
Dr.
Weir
:
Whoever
among you
that has
kept
abreast
with
the
current
literature
will not be surprised at two
things met with
in the
list.
First,
that the
fact
taught
us
several
years
since
by
Koch has
been
con-
firmed
by
Dr.
Weeks,
that oily solutions
or mixtures of
the various
anti-
septics
have
no value other
than is
slowly exerted
by
the fatty
matters
themselves;
and
second,
that
iodoform, concerning
the
power
of
which
in
germs
much
has
lately been written,
exerts
its germicide action
but
slowly.
On this point of
the value
of
iodoform
in
controlling
inflamma-
tion
ordinary
and
tuberculous
I
may
say
that
the clinical
experience of
surgeons
is
in favor of its
usefulness,
and
is decidedly
opposed
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presente
Mechanisms of Delayed Wound Healing by CommonlyUsed Antiseptics
Gregory W. Thomas, BS, Leonard T. Rael, MS, Raphael Bar-Or, BS, Richard Shimonkevitz, PhD,Charles W. Mains, MD, Denetta Sue Slone, MD, Michael L. Craun, MD, and David Bar-Or, MD
Background: The cytotoxic effects ofantiseptics on pivotal cell types of the heal-
ing process have been well documented.
The purpose of our investigation was to
explore the ability of subcytotoxic levels of
antiseptics to interfere with fibroblast
function.
Methods: Cell proliferation assays
were performed by culturing fibroblastsin the presence of commonly used anti-
septics. Migration was evaluated using
scratch assays in which monolayers were
wounded and cellular movement was
monitored by digital photography. Matrix
metalloproteinase (MMP) release was an-
alyzed by zymography.
Results: H2
O2
and povidone-iodine
reduced both migration and prolifera-
tion of fibroblasts in a dose-dependent
fashion.Treatmentwithsilver-containing
antiseptics and chlorhexidine exhibited
reductions in proliferation at high con-
centrations, but enhanced growth at
lower doses. Silver-containing com-
pounds and chlorhexidine also proved tobe the least detrimental to migration in
these assays. metalloproteinase release
from the cells was differently affected
depending on the dosage and class of
antiseptic applied.
Conclusions: When debridement ofthe wound bed is not sufficient to reduce
bacterial loads, the application of broad-
spectrum antiseptics maybe indicated.
Our data would suggest that H2
O2
and
iodine are poor choices, potentially re-
tarding the contribution of fibroblasts to
the healing process. Silver sulfadiazine
and chlorhexidine, at levels still proven to
be bactericidal, had fewer detrimental ef-
fects on fibroblast activity in these assays.The silver-containing antiseptics may even
increase the proliferative potential of
these cells in culture.
Key Words: Fibroblasts, Anti-septics, Migration, Proliferation, Matrix
metalloproteinase.
J Trauma.2009;66:8291.
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presente
Antiseptic use is an established,effective element of wound carewhich cannot be ignored.
Professor David Leaper
International Wound
Journal
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presente
In conclusion, after review of the literature, most antiseptics,especially newer formulations, appear to be relatively safeand efficient in preventing infection in human wounds. Theadvantages of antiseptics on wounds may outweigh possible
disadvantages, and their position in wound caremanagement should be reconsidered.
Antiseptics on Wounds: An Area of Controversy Anna Drosou, MD, Anna Falabella, MD,Robert S. Kirsner, MDWounds. 2003;15(5)
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Novas frmulas
Polihexanide
Octenidina
Mel
.........................
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presente
Dakins Solution: Past, Present, and Future
Jeffrey M. Levine MD
Advances in Skin & Wound Care: The Journal for Prevention and Healing
September 2013
Volume26 Number9
Pages 410 - 414
Abstract
ABSTRACT: Dakin's solution has been used for almost a century. It is a dilute solution of sodium
hypochlorite, which is commonly known as household bleach. When properly applied, it can kill
pathogenic microorganisms with minimum cytotoxicity. This article reviews its history and discus
how evolving technology might pave the way for a new role for this antiseptic.
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Alginogel
Meio hmido
Auto-desbridamento contnuo
Actividade bactericida
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