Ulceras infectadas.pdf

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Domingo, 15 de Novembro de 15


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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

to theDomingo, 15 de Novembro de 15


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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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Ulceras infectadas.pdf