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Bedeutung von Wundspüllösungen und Flüssigkeiten mit antiseptischer Wirkung in Therapie und Prophylaxe

Update 2017

Importance of wound irrigation solutions and fluids with antiseptic effects in therapy and prophylaxis

Update 2017

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Zusammenfassung

Einleitung

Trotz moderner Antibiotika sowie aufwendiger prä-, peri-, intra- und postoperativer Maßnahmen zur Prophylaxe postoperativer Infektionen („surgical site infections“, SSI) konnte deren Rate nicht entscheidend reduziert werden. Die Einführung biokompatibler antiseptischer Wirkstoffe mit hohem mikrobioziden Effekt bietet in einer Zeit des zunehmenden Auftretens multiresistenter Erreger (MRE) die Option erfolgreicher Infektionsprävention und -therapie. Daher sollen Fragen zur Nutzen-Risiko-Abwägung antiseptischer Wundspüllösungen, zum prophylaktischen Einsatz zur Reduktion von SSI und zum Effekt der Instillationsanwendung bei der Vakuumversiegelungsmethode („negative pressure wound therapy combined with instillation“, NPWTi) beantwortet werden.

Methode

Vor dem Hintergrund der eigenen Erfahrung mit dem Einsatz antiseptischer Wundspüllösungen wurde eine Literaturanalyse (computergestützte MEDLINE-, EMBASE- und Cochrane-Recherche, Stand April 2017) durchgeführt.

Ergebnisse

Den für die Orthopädie und Unfallchirurgie geeigneten antiseptischen Lösungen PVP-Iod, Octenidin, Polihexanid (PHMB), Natriumhypochlorit/hypochlorige Säure sowie Essigsäure ist gemeinsam, dass bisher keine Resistenzentwicklung nachgewiesen wurde und sich bei Beachtung der Kontraindikationen die antiseptische Wirkung ohne klinisch bedeutende lokale und systemische Nebenwirkungen entwickeln kann. Für die vorgestellten Substanzen gilt in der Regel, dass ein Biokompatibilitätsindex >1 vorliegt. Sie sind gegen Biofilme und multiresistente Erreger wirksam. Die aufgeführten antiseptischen Substanzen können, mit Vorbehalt für Octenidin, auch für die Vakuuminstillationstherapie (NPWTi) eingesetzt werden.

Schlussfolgerung

Für die Unfallchirurgie ist als Grundausstattung eine Auswahl von 3 verschiedenen antiseptischen Wundspüllösungen zur Reduktion der Rate posttraumatischer und -operativer Wundinfektionen zu empfehlen. Die Anwendung der Antiseptika sollte im klinischen Alltag fortlaufend überprüft und insbesondere das Augenmerk auf unerwünschte Auffälligkeiten im Heilungsverlauf gerichtet werden. Nach 7‑ bis 14-tägiger Anwendung muss die Indikation zum Einsatz der Antiseptika erneut kritisch überprüft werden.

Abstract

Introduction

Despite the use of modern antibiotics as well as complex perioperative, intraoperative and postoperative prophylactic measures, the rate of surgical site infections (SSI) could not be significantly reduced. The introduction of biocompatible antiseptic drugs with a high microbiocidal effect provided a successful alternative for infection prevention and therapy, particularly in a time of increasing occurrence of multi-drug resistant pathogens. Hence, questions about the risk-benefit ratio of antiseptic wound irrigation solutions, the prophylactic use of wound irrigation solutions for the reduction of SSI and the effect of negative pressure wound therapy combined with instillation (NPWTi) need to be answered.

Method

Against the background of our own experiences with the use of antiseptic wound irrigation solutions, a literature analysis (e.g. computer-supported MEDLINE, EMBASE and Cochrane database research as of April 2017) was performed.

Results

Antiseptic fluids can be used both prophylactically and therapeutically, in acute and chronic, clean, contaminated and infected wounds to reduce the posttraumatic and postoperative wound infection rates. The antiseptic solutions that are commonly used in orthopedic and trauma surgery (e.g. PVP-iodine, octenidine, polyhexanide, sodium hypochlorite/hypochlorous acid and acetic acid), have in common that no development of resistance has so far been shown and that when the contraindications are taken into account, the antiseptic effect can develop without any clinically significant local and systemic side effects. As a rule the biocompatibility index is higher than 1 for the substances mentioned. In addition, they show an antiseptic effect against biofilms and multi-drug resistant pathogens. These antiseptic solutions can also be used for NPWTi with some limitations for octenidine.

Conclusion

As the basic equipment in trauma surgery, a selection of three different antiseptic wound irrigation solutions for the reduction of the rates of posttraumatic and SSI can be recommended. The use of antiseptics should be reviewed on an ongoing basis in the daily clinical routine and particular attention should be paid to unwanted effects in the course of the healing process. After application of 7–14 days, the indications for continuing the use of the antiseptic solutions must be carefully re-evaluated.

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Literatur

  1. Abhyankar SV, Venkatesh V, Karnad S, Kulkarni KP, Juneja M, Nanda BS, Saifulla T (2009) Efficacy and safety of oxum in treatment of chronic wounds. J Indian Med Assoc 107(12):904–906

    PubMed  Google Scholar 

  2. Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjo M, Piaggesi A, Probst A, Vowden P (2017) EWMA document: negative pressure wound therapy. J Wound Care 26(Sup3):S1–S154

    Article  PubMed  Google Scholar 

  3. Back DA, Scheuermann-Poley C, Willy C (2013) Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions – when, where and how to use: what does the evidence show? Int Wound J 10(Suppl 1):32–42

    Article  PubMed  Google Scholar 

  4. Becerro de Bengoa Vallejo R, Losa Iglesias ME, Cervera LA, Fernandez DS, Prieto JP (2011) Efficacy of intraoperative surgical irrigation with polihexanide and nitrofurazone in reducing bacterial load after nail removal surgery. J Am Acad Dermatol 64(2):328–335

    Article  CAS  PubMed  Google Scholar 

  5. Bellingeri A, Falciani F, Traspedini P, Moscatelli A, Russo A, Tino G, Chiari P, Peghetti A (2016) Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. J Wound Care 25(3):2–6

    Article  Google Scholar 

  6. Brinkert D, Ali M, Naud M, Maire N, Trial C, Teot L (2013) Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J 10(Suppl 1):56–60

    Article  PubMed  Google Scholar 

  7. Cheng MT, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH (2005) Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 30(15):1689–1693

    Article  PubMed  Google Scholar 

  8. Chindera K, Mahato M, Sharma AK, Horsley H, Kloc-Muniak K, Kamaruzzaman NF, Kumar S, McFarlane A, Stach J, Bentin T, Good L (2016) The antimicrobial polymer PHMB enters cells and selectively condenses bacterial chromosomes. Sci Rep 6:23121

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Eason E, Wells G, Garber G, Hemmings R, Luskey G, Gillett P, Martin M, Vaginal Antisepsis For Abdominal Hysterectomy Study Group (2004) Antisepsis for abdominal hysterectomy: a randomised controlled trial of povidone-iodine gel. BJOG 111(7):695–699

    Article  CAS  PubMed  Google Scholar 

  10. Eisenbeiß W, Siemers F, Amtsberg G, Hinz P, Hartmann B, Kohlmann T, Ekkernkamp A, Albrecht U, Assadian O, Kramer A (2012) Prospective, double-blinded, randomised controlled trial assessing the effect of an Octenidine-based hydrogel on bacterial colonisation and epithelialization of skin graft wounds in burn patients. Int J Burns Trauma 2(2):71–79

  11. Fabry W, Trampenau C, Bettag C, Handschin AE, Lettgen B, Huber FX, Hillmeier J, Kock HJ (2006) Bacterial decontamination of surgical wounds treated with Lavasept. Int J Hyg Environ Health 209(6):567–573

    Article  CAS  PubMed  Google Scholar 

  12. Fournel I, Tiv M, Soulias M, Hua C, Astruc K, Aho Glele LS (2010) Meta-analysis of intraoperative povidone-iodine application to prevent surgical-site infection. Br J Surg 97(11):1603–1613

    Article  CAS  PubMed  Google Scholar 

  13. Ganzer D, Völker L, Follak N, Wolf E, Granzow H (2000) Reaktion des hyalinen Gelenkknorpels und der Synovialis auf eine intraartikuläre Instillation von verschiedenen Antiinfektiva. Arthroskopie 14(1):31–44

    Article  Google Scholar 

  14. Gathen M, Petri M, Krettek C, Omar M (2016) Negative pressure wound therapy with instillation in the treatment of critical wounds. Z Orthop Unfall 154(2):122–127

    Article  CAS  PubMed  Google Scholar 

  15. Gill RS, Al-Adra DP, Campbell S, Olson DW, Rowe BH (2011) Povidone-iodine irrigation of subcutaneous tissues May decrease surgical site infections in elective colorectal operations: a systematic review. Gastroenterology Res 4(3):97–106

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Hadi SF, Khaliq T, Bilal N, Sikandar I, Saaiq M, Zubair M, Aurangzeb S (2007) Treating infected diabetic wounds with superoxidized water as anti-septic agent: a preliminary experience. J Coll Physicians Surg Pak 17(12):740–743

    PubMed  Google Scholar 

  17. Hayashi H, Murakami H, Demura S, Kato S, Yoshioka K, Shinmura K, Yokogawa N, Ishii T, Fang X, Shirai T, Tsuchiya H (2015) Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology. Spine J 15(1):132–137

    Article  PubMed  Google Scholar 

  18. Hospenthal DR, Murray CK, Andersen RC, Blice JP, Calhoun JH, Cancio LC, Chung KK, Conger NG, Crouch HK, D’Avignon LC, Dunne JR, Ficke JR, Hale RG, Hayes DK, Hirsch EF, Hsu JR, Jenkins DH, Keeling JJ, Martin RR, Moores LE, Petersen K, Saffle JR, Solomkin JS, Tasker SA, Valadka AB, Wiesen AR, Wortmann GW, Holcomb JB (2008) Guidelines for the prevention of infection after combat-related injuries. J Trauma 64(3 Suppl):S211–S220

    Article  PubMed  Google Scholar 

  19. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, Cho JM, Chung KK, Clasper JC, Colyer MH, Conger NG, Costanzo GP, Crouch HK, Curry TK, D’Avignon LC, Dorlac WC, Dunne JR, Eastridge BJ, Ficke JR, Fleming ME, Forgione MA, Green AD, Hale RG, Hayes DK, Holcomb JB, Hsu JR, Kester KE, Martin GJ, Moores LE, Obremskey WT, Petersen K, Renz EM, Saffle JR, Solomkin JS, Sutter DE, Tribble DR, Wenke JC, Whitman TJ, Wiesen AR, Wortmann GW, Infectious Diseases Society of A, Surgical Infection S (2011) Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma 71(2 Suppl 2):S210–S234

    Article  CAS  PubMed  Google Scholar 

  20. http://www.kci-medical.de/cs/Satellite?blobcol=urldata&blobheadername1=Content-type&blobheadername2=Content-disposition&blobheadername3=MDT-Type&blobheadervalue1=application%2Fpdf&blobheadervalue2=inline%3B+filename%3D985%2F226%2F20537%2BKCI%2BULTA_SolutionsBroch_GER_2012-04-23.pdf&blobheadervalue3=abinary%3B+charset%3DUTF-8&blobkey=id&blobtable=MungoBlobs&blobwhere=1226664135816&ssbinary=true. Zugegriffen: 29. Mai 2017

  21. Kapur V, Marwaha AK (2011) Evaluation of effect and comparison of superoxidised solution (oxum) v/s povidone iodine (betadine). Indian J Surg 73(1):48–53

    Article  PubMed  Google Scholar 

  22. Keeman JN (2004) Treatment of open fractures before Lister and the management of the fatal leg fracture of Admiral Michiel Adriaensz de Ruyter, 1676. Ned Tijdschr Geneeskd 148(52):2607–2615

    CAS  PubMed  Google Scholar 

  23. Kirketerp-Moller K (2013) The antimicrobial effect of acetic acid – An alternative to common local antiseptics. In: Willy C (Hrsg) Antiseptics in surgery – update 2013. Lindqvist Book Publishing, Berlin, S 113–118

    Google Scholar 

  24. Kokavec M, Fristakova M (2008) Efficacy of antiseptics in the prevention of post-operative infections of the proximal femur, hip and pelvis regions in orthopedic pediatric patients. Analysis of the first results. Acta Chir Orthop Traumatol Cech 75(2):106–109

    CAS  PubMed  Google Scholar 

  25. Kramer A, Kremer J, Assadian O, Schneider I, Dahne H, Schwemmer J, Muller G, Siegmund W, Jakel C (2006) The classification of antiseptic products to be administered to wounds – another borderline case between medicinal products and medical devices? Int J Clin Pharmacol Ther 44(12):677–692

    Article  CAS  PubMed  Google Scholar 

  26. Kramer A, Jäkel C, Kremer J, Dähne H, Schwemmer J, Assadian O (2008) Abgrenzung von Arzneimitteln und Medizinprodukten sowie Konsequenzen für den Verbraucherschutz. In: Kramer A, Assadian O (Hrsg) Wallhäußers Praxis der Sterilisation, Desinfektion, Antiseptik und Konservierung. Thieme, Stuttgart, S 592–600

    Google Scholar 

  27. Kramer A, Assadian O, Below H, Willy C (2013) Wound antiseptics today – An overview. In: Willy C (Hrsg) Antiseptics in surgery – update 2013, scientific basis, indications for use, evidence based recommendations, vacuum instillation therapy. Lindqvist Book Publishing, Berlin, S 83–105

    Google Scholar 

  28. Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, Tuchmann F, Assadian O (2017) Konsensusempfehlung zu Indikationen und Auswahlkriterien von Wundantiseptika – Update 2017. Skin Pharmacol Physiol (eingereicht)

  29. Lehner B, Fleischmann W, Becker R, Jukema GN (2011) First experiences with negative pressure wound therapy and instillation in the treatment of infected orthopaedic implants: a clinical observational study. Int Orthop 35(9):1415–1420

    Article  PubMed  PubMed Central  Google Scholar 

  30. Matiasek J, Djedovic G, Mattesich M, Morandi E, Pauzenberger R, Pikula R, Verstappen R, Pierer G, Koller R, Rieger UM (2014) The combined use of NPWT and instillation using an octenidine based wound rinsing solution: a case study. J Wound Care 23(11):590–596

    Article  CAS  PubMed  Google Scholar 

  31. Mohd AR, Ghani MK, Awang RR, Su Min JO, Dimon MZ (2010) Dermacyn irrigation in reducing infection of a median sternotomy wound. Heart Surg Forum 13(4):E228–32

    Article  PubMed  Google Scholar 

  32. Muller G, Benkhai H, Matthes R, Finke B, Friedrichs W, Geist N, Langel W, Kramer A (2014) Poly (hexamethylene biguanide) adsorption on hydrogen peroxide treated Ti-Al-V alloys and effects on wettability, antimicrobial efficacy, and cytotoxicity. Biomaterials 35(20):5261–5277

    Article  PubMed  Google Scholar 

  33. Nagoba BS, Selkar SP, Wadher BJ, Gandhi RC (2013) Acetic acid treatment of pseudomonal wound infections – a review. J Infect Public Health 6(6):410–415

    Article  CAS  PubMed  Google Scholar 

  34. Ossanna PJ, Test ST, Matheson NR, Regiani S, Weiss SJ (1986) Oxidative regulation of neutrophil elastase-alpha-1-proteinase inhibitor interactions. J Clin Invest 77(6):1939–1951

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Roth B, Neuenschwander R, Brill F, Wurmitzer F, Wegner C, Assadian O, Kramer A (2017) Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study. J Wound Care 26(3):79–87

    Article  CAS  PubMed  Google Scholar 

  36. Seifert J, Gümbel D, Frank M, Kramer A, Ekkernkamp A (2017) Wundinfektionen – Infektionsprävention in Unfallchirurgie und Orthopädie. Krankenhhyg Up2date 12(2):1–14

    Google Scholar 

  37. Singh DP, Gowda AU, Chopra K, Tholen M, Chang S, Mavrophilipos V, Semsarzadeh N, Rasko Y, Holton Iii L (2017) The effect of negative pressure wound therapy with antiseptic instillation on Biofilm formation in a porcine model of infected spinal instrumentation. Wounds. 2017 Mar 24. pii: WNDS20170324-3. [Epub ahead of print]

  38. Steller D, Willy C (2013) Literature analysis on the topic „antiseptics for the treatment of acute soft tissue and bone wounds“ following the guidelines of „evidence-based medicine“. In: Willy C (Hrsg) Antiseptics in surgery – update 2013, scientific basis, indications for use, evidence based recommendations, vacuum instillation therapy. Lindqvist Book Publishing, Berlin, S 33–82

    Google Scholar 

  39. Takesue Y, Takahashi Y, Ichiki K, Nakajima K, Tsuchida T, Uchino M, Ikeuchi H (2011) Application of an electrolyzed strongly acidic aqueous solution before wound closure in colorectal surgery. Dis Colon Rectum 54(7):826–832

    Article  PubMed  Google Scholar 

  40. Taylor K (1916) Treatment of bacillus pyocyaneus infection. J Am Med Assoc 67(22):1598–1599

    Article  Google Scholar 

  41. Wang L, Bassiri M, Najafi R (2007) Hypochlorous acid as a potential wound care agent. Part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds 6:65–79

    Google Scholar 

  42. Willy C (2004) Richard von Volkmann – Künstler und Chirurg – Seine Märchen „Träumereien an französischen Kaminen“, sein Leben und ärztliches Wirken. Lindqvist Book Publishing, Berlin, S 198

    Google Scholar 

  43. World Health Organization (2016) Global Guidelines for the prevention of Surgical Site Infection. WHO, Geneva

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland

    Christian Willy MD, Catharina Scheuermann-Poley & Marcus Stichling

  2. Abteilung für Septische und Rekonstruktive Chirurgie, BG Unfallklinik Murnau, Prof.-Küntscher-Straße 8, 82418, Murnau, Deutschland

    Thomas von Stein

  3. Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Walter-Rathenau-Straße 49A, 17475, Greifswald, Deutschland

    Axel Kramer

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  1. Christian Willy MD
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Correspondence to Christian Willy MD.

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Interessenkonflikt

C. Willy, C. Scheuermann-Poley, M. Stichling, T. von Stein und A. Kramer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Willy, C., Scheuermann-Poley, C., Stichling, M. et al. Bedeutung von Wundspüllösungen und Flüssigkeiten mit antiseptischer Wirkung in Therapie und Prophylaxe. Unfallchirurg 120, 549–560 (2017). https://doi.org/10.1007/s00113-017-0375-5

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