Ulceras Infectadas PDF

lcera Crnica
Infectada
Vtor Marques
Domingo, 15 de Novembro de 15
Microbioma
Definio
comunidade residente de microrganismos num

ecosistema
Microbioma
Definio
Microbioma Cutneo
O que
qual a sua importncia e relao com a
infeco e o biofilme
Microbioma
Cutneo
Skin microbiome
Populao de microorganismos residentes na
superfcie e nas camadas
mais profundas da pele
A pele est colonizada por
bactrias,fungos e vrus em
perfeito equilbrio
Qualquer disrupo do
ecosistema resulta em
infeco da pele
Factors affecting the skin microbiome
Factores que afectam o

microbioma cutneo
Qual a importncia
deste conceito?
Os diabticos,idosos e doentes com mobilidade diminuda
esto mais sujeitos a infeco duma lcera crnica
As bactrias do microbioma cutneo podem ser
responsveis pela diminuio da capacidade cicatricial
e pela persistncia da inflamao
Condies ideais para a formao de biofilmes
Infeco da
ferida
Conceitos importantes
Definio
Invaso e
multiplicao
com resposta
do hospedeiro e
leso tecidual
Outros conceitos
Ferida contaminada
Presena de bactrias sem resposta do
hospedeiro
Ferida colonizada
Presena de bactrias com multiplicao sem
resposta inflamatria significativa
outros conceitos
Colonizao crtica
Bactrias replicantes no tecido,em maior
nmero e virulncia,com capacidade de
inibio da cicatrizao por competirem pelo
oxignio e nutrientes,e produzirem maior
resposta inflamatria
patognese
da
infeco
Patognese do processo infeccioso
AUSENCIA DE
SINTOMAS
Colonizao
Adeso
Multiplicao
Infeco
Invaso
Disseminao
PRESENA DE
SINTOMAS
biofilme
Colonizao critica
Ecosistema
biofilme
Estratgia
Cooperao
Sinergia
Quorum sensing
Combater as defesas
do hospedeiro
diagnstico infeco
Clssicos
Adicionais
Eritema
abcesso
dor
celulite
calor
exsudado
purulento
edema
atraso da
cicatrizao.......
diagnstico infeco
descolorao dos bordos ou
leito da ferida
tecido de granulao pobre
ou frivel
dor ou sensibilidade
intensa
Sinais sistmicos
febre
taquicardia
hipotenso
leucocitose
diagnstico infeco
Testes analticos
Imagiolgicos
Hemocultura
ecografia
Bipsia
RM
Zaragatoa
novos mtodos
usando DNA
Tratamento
controvrsias
objectivos
time
importante
controlar o biofilme
a contaminao
a infeco
tratamento
No usar antibioterapia
sistmica para a colonizao
ou biofilme
Se infeco antibioterapia
sistmica
Se infeco no usar
antibiticos tpicos
Antibioterapia se celulite do
membro em volta da lcera
Larvae debridement of biofilm
tratamento
Biofilme
desbridamento
SA35556 3 day mature biofilm culture

on Pigskin explant
SA35556 biofilm
tratamento
Antisspticos
Antissptico
Toda a substncia qumica que destroi ou inibe o

crescimento de microrganismos patognicos
localizados em tecidos vivos
Modos de aco
Desnaturao de protenas
Alterao da membrana celular
Modificao da actividade metablica
classificao
Alcoois
Peroxigenios
Aldedos
compostos de amnio
quaternrio
Fenol e derivados
Biguanidas
Halogenados
Prata e derivados
...............
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 ........
passado,presente
e futuro
MODERN METHODS
-OF-
Antiseptic Wotind Treatment
COMPILED FROM NOTES AND SUGGESTIONS FROM THE

FOLLOWING EMINENT SURGEONS:
D.
Pro/lessor
HAYES AGNE'W,
o/ Surgery in the University
oj"
M.
D., I.L,.D.,
Pennsylvania^ Philadelphia, Pa,
A. C. BEKNAYS, M. D., M. A.,

Surgeon to Lutheran Hospital, and Consulting Surgeo?i
City and Female Hospital, St, Louis, Mo.
Passado
to the
W. GROSS, M.
D., LL.D.,
Professor of the Priticiples of Surgery and Clinical Surgery in the Jefferson Medical
S.
College
o/ Philadelphia,
HUNTER McGUIRE,
Surgeon
to St.
THOS.
Surgeon
to the
M.
D,, LL.D.,
Lukc^s Hospital, Richmond, Va.
G.
MORTON,
>I. D.,
Pennsylvania and Orthopaedic Hospitals, Philadelphia,
Milwaukee, Wis.,
363
R D13I
\8H'
Columtiia (Hnitier^ftp
mtljeCitpoflrttigork
CoUege of
^tjpjJiciansi
^ifararp
anb burgeons
Table Showing the Relative Value of Various Germicides.

From a recent clinical lecture delivered by Robert Weir, M. D., at
the
New York
17, 1887.
Hospital, published in the Philadelphia Medical

(From the investigations of Dr. Weeks, of
Corrosive sublimate,
"
"
"
"
Carbolic acid
"
"
"
"
"
to
destroy vitality of germs.

10 seconds.
500
Ito 1000
Ito 2000
Ito 5000
to
Ito
Ito
"
45
1}^ minutes.
"
15 seconds.
30
"
4 minutes.
60
effect on dried germs; very powerful
30-60
40
No
when
Alcohol,
New York.)*
Duration of exposure to
Strength.
Antiseptic.
News Dec.
active in moistened condition.
absolute alcohol, 1-12 seconds.

20-30
95perct. "
"
10-15 minutes.
66perct
"
"
Salicyclic acid
(makes a stable
solution.)
. .
"
to 600 parts of water, 1
Ito 1000
4-5
"
Chlorine water, very unstable, best when fresh, 1)^ minutes.

"
"
"
"
l-l>a
hydrogen bromide,
Boracic acid had no germicidal action whatever; germs remained uh iff acted for
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

with in the list.
current literature will not be surprised at two things met

First, that the fact taught us several years since by Koch has been confirmed by Dr. Weeks, that oily solutions or mixtures of the various antiseptics 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 inflammation
ordinary and tuberculous I may say that the clinical experience of
surgeons
is
in favor of its usefulness,
and
is
decidedly opposed to the
Dr. Carrel
Soluto de
Dakin
Passado?
Presente
presente
The Journal of TRAUMA! Injury, Infection, and Critical Care
Mechanisms of Delayed Wound Healing by Commonly

Used 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 of
antiseptics on pivotal cell types of the healing 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 fibroblasts
in the presence of commonly used antiseptics. Migration was evaluated using
scratch assays in which monolayers were
wounded and cellular movement was
monitored by digital photography. Matrix
metalloproteinase (MMP) release was analyzed by zymography.
Results: H2O2 and povidone-iodine

reduced both migration and proliferation of fibroblasts in a dose-dependent
fashion. Treatment with silver-containing
antiseptics and chlorhexidine exhibited
reductions in proliferation at high concentrations, but enhanced growth at
lower doses. Silver-containing compounds and chlorhexidine also proved to
be 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 of
the wound bed is not sufficient to reduce
bacterial loads, the application of broadspectrum antiseptics maybe indicated.

Our data would suggest that H2O2 and
iodine are poor choices, potentially retarding the contribution of fibroblasts to
the healing process. Silver sulfadiazine
and chlorhexidine, at levels still proven to
be bactericidal, had fewer detrimental effects on fibroblast activity in these assays.
The silver-containing antiseptics may even
increase the proliferative potential of
these cells in culture.
Key Words: Fibroblasts, Antiseptics, Migration, Proliferation, Matrix
metalloproteinase.
J Trauma. 2009;66:8291.
ound bed management in an era of multidrug-resistant

bacteria can be precarious, but is critical in the treatment of acute injuries and to postoperative care.
Inappropriate
can increase both recovery times
Domingo, 15 de
Novembro de management
15
ment of healthy granulation tissue. Under most circumstances,

debridement alone will reduce bacterial loads with the added
benefit of removing necrotic tissue that may otherwise increase
inflammation and delay healing.4 When debridement is not
presente
Professor David Leaper
International Wound
Journal
Antiseptic use is an established,

effective element of wound care
which cannot be ignored.
presente
Antiseptics on Wounds: An Area of Controversy Anna Drosou, MD, Anna Falabella, MD,
Robert S. Kirsner, MD
Wounds. 2003;15(5)
In conclusion, after review of the literature, most antiseptics,

especially newer formulations, appear to be relatively safe
and efficient in preventing infection in human wounds. The
advantages of antiseptics on wounds may outweigh possible
disadvantages, and their position in wound care
management should be reconsidered.
Novas frmulas
Polihexanide
Octenidina
Mel
.........................
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 discuss
how evolving technology might pave the way for a new role for this antiseptic.
Henry Drysdale Dakin

Passado?
eTalk : Dakin's Solution
htt
Figure 3. NURSE APPLYING THE CARREL

PROCEDURE
Dr Carrel demonstrated efficacy of his techniques with clinical observations and quan
measured outcomes, including time for wound closure, decrease in amputations, and
He also provided a cost analysis that showed how decreased disability from use of h
savings paid by the state.13 Dr Carrel made the groundbreaking claim, "[horizontal e
prevent, in the greater number of cases, infection of wounds and to abolish, almost e
Passado?
contact Cynthia Fleck | quote
Cynthia Fleck
po
Futuro
Bacterifagos
Alginogel
Alginogel
Meio hmido
Auto-desbridamento contnuo
Actividade bactericida
Os dogmas
devem ser
evitados
Obrigado

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lcera Crnica

comunidade residente de microrganismos num

Factors affecting the skin microbiome

Factores que afectam o

Larvae debridement of biofilm

SA35556 3 day mature biofilm culture

Toda a substncia qumica que destroi ou inibe o

Antiseptic Wotind Treatment

COMPILED FROM NOTES AND SUGGESTIONS FROM THE

o/ Surgery in the University

A. C. BEKNAYS, M. D., M. A.,

Pennsylvania and Orthopaedic Hospitals, Philadelphia,

Table Showing the Relative Value of Various Germicides.

Hospital, published in the Philadelphia Medical

destroy vitality of germs.

active in moistened condition.

absolute alcohol, 1-12 seconds.

Chlorine water, very unstable, best when fresh, 1)^ minutes.

Says Dr. Weir

"Whoever among you that has kept

abreast with the

current literature will not be surprised at two things met

ordinary and tuberculous I may say that the clinical experience of

in favor of its usefulness,

decidedly opposed to the

Mechanisms of Delayed Wound Healing by Commonly

Results: H2O2 and povidone-iodine

bacterial loads, the application of broadspectrum antiseptics maybe indicated.

ound bed management in an era of multidrug-resistant

ment of healthy granulation tissue. Under most circumstances,

Antiseptic use is an established,

In conclusion, after review of the literature, most antiseptics,

Henry Drysdale Dakin

eTalk : Dakin's Solution

Figure 3. NURSE APPLYING THE CARREL

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