野外與登山醫學----預防及避免傷口感染

http://www.wemjournal.org/article/S1080-6032%2814%2900112-4/fulltext

感染預防及避免    Infection Prophylaxis And Prevention

根本原則，不管有沒有給予 預防性抗生素，傷口都需要密切觀察，併發症可能很快產生，包括局部續發性感染、深部組織穿透性感染，細菌可能經由血液造成全身性症狀（發燒、忽冷忽熱、倦 怠、虛弱），除了特殊的傷口情況，目前沒有足夠證據支持使用預防性全身性抗生素（口服、注射），開放性骨折需要使用預防性抗生素（醫院通常是靜脈注射）降 低感染率，避免日後骨髓發炎。所有開放性傷口都會有細菌，但不一定需要處理，局部有細菌不一定造成感染，人咬傷之後預防性使用抗生素，在統計上能降低感染 的機率，但貓狗咬傷則否（手部除外）。手部被哺乳動物咬傷，使用預防性抗生素能顯著降低感染率，局部塗抹抗生素可促進傷口癒合、降低感染率。

An overall principle of wound management is that whether or not prophylactic antibiotics are given, wounds should be monitored closely. Complications can develop rapidly or in an indolent manner. These include local secondary infection, undetected penetration of deeper structures, and systemic illnesses that can result from hematogenous seeding of organisms inoculated into the wound. With the exception of certain specific wound categories, there is scant evidence to support the routine use of systemic antibiotics for prophylaxis against wound infection. A notable exception is an open fracture, in which acute antibiotic administration significantly lowers the rate of infection.54, 122 This is of particular significance given the substantial morbidity associated with subsequent osteomyelitis. Virtually all open wounds are colonized with microorganisms, but this is usually without clinical consequences.123 The presence of colonizing bacteria does not constitute infection. A systematic review of mammalian bites showed a statistically significant reduction in the rate of infection with the use of prophylactic antibiotics after bites by humans but not after bites by cats or dogs, except bites of the hand.124 There was a statistically significant reduction in the rate of infection with the use of prophylactic antibiotics after mammalian bites to the hand. Although dated, there is evidence to support the use of topical antibiotics to promote wound healing and decrease infection.125, 126, 127

開放性骨折需給予全身性預防性抗生素

Recommendation～ Treatment with systemic antibiotics is indicated in the presence of open fractures.  Recommendation grade: 1A.

人咬傷需給予全身性預防性抗生素

Recommendation～ Treatment with systemic antibiotics is indicated in the presence of human bites.    Recommendation grade: 1B.

哺乳動物咬傷手部需給予全身性預防性抗生素

Recommendation～ Treatment with systemic antibiotics is indicated in the presence of mammalian bites to the hand. Recommendation grade: 1B.

局部塗抹抗生素可以促進傷口癒合，降低感染率，對於沒有過敏的人，壞處很少

Recommendation ～Use of topical antibiotics may promote wound healing and decrease the incidence of infection, with little downside risk in the nonallergic patient. Recommendation grade: 2C.

對於燙傷，預防性抗生素使用的研究比較少 一個系統性回顧研究發現，使用磺胺銀，相對於一般換藥，會增加傷口感染率。另一項系統性回顧研究指出，沒有證據支持使用含銀敷料或其他局部物質來預防感染，

There is little compelling evidence to support the prophylactic use of antibiotics for burn wounds. One systematic review concluded that the use of topical silver sulfadiazine is associated with a significant increase in the rate of burn wound infections when compared with dressings or skin substitutes.128 The same review concluded that there was not enough evidence to enable reliable conclusions to be drawn regarding the use of systemic antibiotics. Another systematic review concluded that there was insufficient evidence to support the use of silver-containing dressings or other topical agents in the prevention of infection.129

燙傷不需要使用預防性全身性抗生素

Recommendation Treatment with systemic antibiotics is not indicated for prophylactic use in burn wounds. Recommendation grade: 1C.

磺胺銀對於傷口癒合不利，可能增加感染率

Recommendation Silver sulfadiazine may negatively affect wound healing and may increase infection rate. Recommendation grade: 1A.