İnfeksiyon: Antiseptik Solüsyonların Kronik Yarada Yeri
Özet
Kronik yara enfeksiyonları, cilt bariyerinin bozulması ve mikroorganizmaların biyofilm oluşturarak yerleşmesi sonucu meydana gelen önemli bir sağlık sorunudur. Tedavide antibiyotik direnci ciddi bir risk oluşturduğundan, yüzeyel enfeksiyonlarda geniş antimikrobiyal spektruma sahip topikal antiseptikler önemli alternatiflerdir. Bu antiseptikler yara temizliği, irrigasyon ve bakteri yükünü azaltma işlevi görerek biyofilm oluşumunu önler. Yazıda povidon iyodin, klorheksidin, hidrojen peroksit, asetik asit, triklosan, alkol, gümüş bileşikleri ve hipokloröz asit gibi ajanlar kimyasal yapıları ve etki mekanizmalarına göre sınıflandırılarak incelenmiştir. Povidon iyodin geniş spektrumuyla öne çıkarken, klorheksidin FDA onaylı yara temizleme ajanıdır ancak çapraz direnç riskleri taşır. Hidrojen peroksit kimyasal debridman sağlasa da yeni kılcallara ve fibroblastlara toksik etki gösterebilir. Asetik asit özellikle dirençli Pseudomonas spp. enfeksiyonlarında etkilidir. Triklosan ise güvenlik gerekçeleriyle FDA tarafından yasaklanmıştır. Alkoller açık yarada kullanılmazken, gümüş bileşikleri protein denatürasyonuyla etki gösterir. Güçlü bir oksitleyici olan hipokloröz asit ise biyofilm ve bakteri yükünü azaltmada oldukça etkindir. Sonuç olarak antiseptikler, yara iyileşme sürecini bozmamak adına doğru doz ve sürelerde kullanıldığında kronik yara yönetiminde direnci tetiklemeyen güçlü silahlardır.
Chronic wound infections represent a significant health issue that arises from the disruption of the skin barrier and the subsequent colonization of microorganisms through biofilm formation. Since antibiotic resistance poses a critical risk in treatment, topical antiseptics with a broad antimicrobial spectrum serve as vital alternatives for superficial infections. These antiseptics facilitate wound cleansing and irrigation, thereby reducing the bacterial load and preventing biofilm formation. Within the text, agents such as povidone-iodine, chlorhexidine, hydrogen peroxide, acetic acid, triclosan, alcohol, silver compounds, and hypochlorous acid are categorized and analyzed based on their chemical structures and mechanisms of action. While povidone-iodine stands out with its broad spectrum, chlorhexidine is an FDA-approved wound cleansing agent, though it carries risks of cross-resistance. Hydrogen peroxide provides chemical debridement but can exert toxic effects on newly developing capillaries and fibroblasts. Acetic acid is particularly effective against resistant Pseudomonas spp. infections, whereas triclosan has been banned by the FDA due to safety concerns. Alcohols are not utilized on open wounds, while silver compounds function through protein denaturation. Hypochlorous acid, a powerful oxidizer, is highly effective in reducing both biofilm and bacterial load. Ultimately, when utilized in appropriate doses and durations to avoid disrupting the wound healing process, antiseptics constitute powerful weapons in chronic wound management that do not trigger antibiotic resistance.
Referanslar
Moffarah, A. S., Al Mohajer, M., Hurwitz, B. L., & Armstrong, D. G. (2016). Skin and soft tissue infections. Microbiology spectrum, 4(4), 4.4. 14.
Malheiro, J., & Simões, M. (2017). Antimicrobial resistance of biofilms in medical devices. In Biofilms and implantable medical devices (pp. 97-113). Elsevier.
Hoang, T. P. N., Ghori, M. U. U., & Conway, B. R. (2021). Topical Antiseptic Formulations for Skin and Soft Tissue Infections. Pharmaceutics, 13(4), 558.
Poulakou, G., Lagou, S., & Tsiodras, S. (2019). What's new in the epidemiology of skin and soft tissue infections in 2018? Current opinion in infectious diseases, 32(2), 77-86.
Tognetti, L., Martinelli, C., Berti, S., Hercogova, J., Lotti, T., Leoncini, F., & Moretti, S. (2012). Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment: a collaboration between dermatologists and infectivologists. Journal of the European Academy of Dermatology and Venereology, 26(8), 931-941.
Drosou, A., Falabella, A., & Kirsner, R. S. (2003). Antiseptics on wounds: an area of controversy. Wounds, 15(5), 149-166.
Antiseptics., T. U. S. F. a. D. A. F. Q. A. f. C. H. C. (2019). https://www.fda.gov/drug-class /qa-consumers-health-care-antiseptics.
Leaper, D., Assadian, O., & Edmiston, C. E. (2015). Approach to chronic wound infections. British Journal of Dermatology, 173(2), 351-358.
Chang, R.-K., Raw, A., Lionberger, R., & Yu, L. (2013). Generic development of topical dermatologic products: formulation development, process development, and testing of topical dermatologic products. The AAPS journal, 15(1), 41-52.
(McDonnell, 2007).
Nagoba, B., Selkar, S., Wadher, B., & Gandhi, R. (2013). Acetic acid treatment of pseudomonal wound infections–a review. Journal of infection and public health, 6(6), 410-415.
Landis, S. J. (2008). Chronic wound infection and antimicrobial use. Advances in skin & wound care, 21(11), 531-540.
Esen, Ş. (2019). Antiseptikler In D. Y. M. Duygu Perçin Renders (Ed.), Sterilizasyon Dezenfeksiyon Rehberi (pp. 64).
Zinn, J., Jenkins, J. B., Swofford, V., Harrelson, B., & McCarter, S. (2010). Intraoperative patient skin prep agents: is there a difference? AORN journal, 92(6), 662-674.
Eggers, M. (2019). Infectious disease management and control with povidone iodine. Infectious diseases and therapy, 8(4), 581-593.
Deshmukh, N., Kramer, J. W., & Kjellberg, S. I. (1998). A comparison of 5-minute povidone-iodine scrub and 1-minute povidone-iodine scrub followed by alcohol foam. Military Medicine, 163(3), 145-147.
Anderson, D. E., Sivalingam, V., Kang, A. E. Z., Ananthanarayanan, A., Arumugam, H., Jenkins, T. M., Hadjiat, Y., & Eggers, M. (2020). Povidone-iodine demonstrates rapid in vitro virucidal activity against SARS-CoV-2, the virus causing COVID-19 disease. Infectious diseases and therapy, 9(3), 669-675.
Cooper, M. L., Laxer, J. A., & Hansbrough, J. F. (1991). The cytotoxic effects of commonly used topical antimicrobial agents on human fibroblasts and keratinocytes. The Journal of trauma, 31(6), 775-782; discussion 782.
Tanzer, J., Slee, A., & Kamay, B. (1977). Structural requirements of guanide, biguanide, and bisbiguanide agents for antiplaque activity. Antimicrobial agents and chemotherapy, 12(6), 721-729.
Williamson, D. A., Carter, G. P., & Howden, B. P. (2017). Current and emerging topical antibacterials and antiseptics: agents, action, and resistance patterns. Clinical microbiology reviews, 30(3), 827-860.
Climo, M. W., Sepkowitz, K. A., Zuccotti, G., Fraser, V. J., Warren, D. K., Perl, T. M., Speck, K., Jernigan, J. A., Robles, J. R., & Wong, E. S. (2009). The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Critical care medicine, 37(6), 1858-1865.
Auda, S. H., Mahrous, G. M., Ibrahim, M. A., Shazly, G. A., & Salem-Bekhit, M. M. (2017). Novel chlorhexidine dermal patches, preparation characterization and antimicrobial evaluation. Polymer Bulletin, 74(10), 3995-4007.
Schlett, C. D., Millar, E. V., Crawford, K. B., Cui, T., Lanier, J. B., Tribble, D. R., & Ellis, M. W. (2014). Prevalence of chlorhexidine-resistant methicillin-resistant Staphylococcus aureus following prolonged exposure. Antimicrobial agents and chemotherapy, 58(8), 4404-4410.
Linley, E., Denyer, S. P., McDonnell, G., Simons, C., & Maillard, J.-Y. (2012). Use of hydrogen peroxide as a biocide: new consideration of its mechanisms of biocidal action. Journal of antimicrobial Chemotherapy, 67(7), 1589-1596.
Juma, I. M., & Al-Jaber, F. H. (2007). Comparison between the effect of acetic acid and salicylic acid in different concentrations on Pseudomonas aeruginosa isolated from burn wound infection. Al-Taqani, 20(1).
Sloss, J., Cumberland, N., & Milner, S. (1993). Acetic acid used for the elimination of Pseudomonas aeruginosa from burn and soft tissue wounds. JOURNAL-ROYAL ARMY MEDICAL CORPS, 139, 49-49.
Al-Ibran, E., Khan, M., Lateef, T., Bibi, F., Azmi, M. B., & Qureshi, S. A. (2010). Efficacy of topical application of 1% acetic acid in eradicating pseudomonal infections in burn wounds. Journal of the Dow University of Health Sciences (JDUHS), 4(3), 90-93.
Jung, W. K., Koo, H. C., Kim, K. W., Shin, S., Kim, S. H., & Park, Y. H. (2008). Antibacterial activity and mechanism of action of the silver ion in Staphylococcus aureus and Escherichia coli. Applied and environmental microbiology, 74(7), 2171-2178.
Gray, M. J., Wholey, W.-Y., & Jakob, U. (2013). Bacterial responses to reactive chlorine species. Annual review of microbiology, 67, 141-160.
Sakarya, S., Gunay, N., Karakulak, M., Ozturk, B., & Ertugrul, B. (2014). Hypochlorous acid: an ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency. Wounds, 26(12), 342-350.
