W związku ze wzrostem oporności na antybiotyki wśród drobnoustrojów rola opatrunków o właściwościach antybakteryjnych w leczeniu ran staje się coraz ważniejsza. Takie działanie wykazują opatrunki ze srebrem. Opatrunki te mogą znacząco wspierać proces leczenia ran zarówno ostrych, jak i przewlekłych, w tym także zakażonych. Specjaliści zalecają je do stosowania w praktyce klinicznej ze względu na szereg istotnych właściwości.
Autor: dr hab. n. med. Hanna Tomczak, specjalista w dziedzinie mikrobiologii, Centralne Laboratorium Mikrobiologiczne SK im. H. Święcickiego Uniwersytetu Medycznego im. K Marcinkowskiego w Poznaniu, Zakład Dermatologii i Wenerologii Uniwersytetu Medycznego im. K Marcinkowskiego w Poznaniu
Niskie ryzyko wykształcenia oporności
Drobnoustroje nie wykształcają oporności na srebro, pomimo powszechnego stosowania preparatów zawierających ten pierwiastek. W przeciwieństwie do antybiotyków – srebro wykazuje działanie wielokierunkowe wobec bakterii. Z tego powodu opatrunki ze srebrem stanowią istotną alternatywę dla antybiotyków w terapii zakażonych ran. Kontrola nad środowiskiem mikrobiologicznym w ranie za pomocą tego rodzaju opatrunków pozwala na rezygnację ze stosowania antybiotyku, a w konsekwencji zmniejszenie ryzyka antybiotykooporności. To właśnie antybiotyki stosowane miejscowo generują oporność wśród drobnoustrojów, brak bowiem jakiejkolwiek kontroli nad ich stężeniem w miejscu toczącej się infekcji.
Skuteczne działanie
Opatrunki na bazie srebra mają działanie zarówno bakteriobójcze, jak i bakteriostatyczne. Znalazły zastosowanie w leczeniu ran zakażonych ze względu na to, że nie dopuszczają do nadmiernego namnożenia bakterii w ranie. Dzięki temu kontrolują liczbę drobnoustrojów i ograniczają zakażenie.
Wykorzystywane w opatrunkach jony srebra mają zdolność wiązania się z białkami drobnoustrojów, co prowadzi do zmian w strukturze ich błon i ścian komórkowych. Jony srebra zaburzają funkcjonowanie komórki poprzez zahamowanie produkcji energii, działania enzymów i replikacji komórki, doprowadzając ostatecznie do jej śmierci.
Bardzo istotne jest przeciwbakteryjne działanie jonów srebra w dobie narastającej oporności na antybiotyki. Opatrunki te są niezmiernie pomocne, zwłaszcza gdy szczepy bakterii hodowanych w materiale pobranym z rany wykazują oporność na prawie wszystkie leki przeciwdrobnoustrojowe.
Właściwości antybakteryjne srebra obejmują bardzo szerokie spektrum drobnoustrojów. Uwalniane z opatrunku jony srebra wykazują skuteczne działanie zarówno wobec bakterii Gram-dodatnich, jak i Gram-ujemnych. Srebro wykazuje działanie zarówno w kierunku gronkowców (w tym szczepów metycylinoopornych np. MRSA- methycillin-resistant Staphylococcus aureus), enterokoków (także szczepów VRE- vancomycin-resistant Enterococcus) oraz wielolekoopornych pałeczek Gram-ujemnych, zarówno należących do rodziny Eterobacterales, jak i pałeczek niefermentujących.
Szerokie zastosowanie
Opatrunki na bazie srebra znajdują zastosowanie w leczeniu różnych rodzajów zakażonych ran. Stosowanie produktów na bazie tego pierwiastka daje dobre efekty kliniczne zarówno w leczeniu drobnych uszkodzeń skóry narażonych na potencjalne zakażenie, jak i głębokich ran pourazowych bądź pooperacyjnych, a także rozległych oparzeń. Opatrunki ze srebrem są również powszechnie stosowane w leczeniu trudno gojących się ran przewlekłych, takich jak stopa cukrzycowa, odleżyny i owrzodzenia kończyn dolnych.
Przykładem opatrunku na bazie srebra, który wykazuje wszechstronne zastosowanie, jest Atrauman® Ag firmy HARTMANN. Opatrunek ten jest zalecany do miejscowego leczenia ran już zakażonych (zarówno przewlekłych, jak i ostrych) oraz w prewencji zakażenia ran, szczególnie u pacjentów z upośledzeniem odporności.
Atrauman® Ag zbudowany jest z hydrofobowej siatki poliamidowej, która pokryta jest srebrem metalicznym.
Atrauman® Ag w połączeniu z odpowiednio dobranym opatrunkiem chłonnym, np. Zetuvit® Plus, pozwala skutecznie kontrolować warunki fizjologiczne, zapewniając odpowiednią wilgotność i pH w ranie. Opatrunek „czuwa” także nad martwymi drobnoustrojami oraz ogranicza tworzenie się biofilmu.
Bardzo istotne jest to, że w przeciwieństwie do miejscowo stosowanych antybiotyków opatrunki ze srebrem nie doprowadzają do generowania oporności, nie tylko wśród szczepów patogennych, które z reguły już są oporne na leki przeciwdrobnoustrojowe, ale i tych stanowiących mikrobiotę skóry (kiedyś tzw. florę fizjologiczną).
Źródła:
- Johnson T.R., Gómez B.I., McIntyre M.K., Dubick M.A., Christy R.J., Nicholson S.E., Burmeister D.M. The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing J. Mol. Sci. 2018, 19, 2699; doi:10.3390/ijms19092699 www.mdpi.com/journal/ijms
- Moore K. A new silver dressing for wounds with delayed healing. Wounds UK 2006, Vol 2, No 2
- Ziegler K., Görl R., Effing J., Ellermann J., Mappes M., Otten S., Kapp H., Zoellner P, Spaeth D., Smola H. Reduced cellular toxicity of a new silver-containing antimicrobial dressing and clinical performance in non-healing wounds. Skin Pharmacol Physiol 2006;19(3):140-6. doi: 10.1159/000092594.Epub 2006 Apr 6.
- International consensus, “Appropriate use of silver dressings in wounds. An expert working group consensus”, “Wounds International” 2012.
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She placed the shell to her ear and screamed.
There was a hermit crab inside and it pinched her ear.
She never wants to go back! LoL I know this is totally off topic but
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