Estrategias para el manejo de heridas crónicas complicadas con biopelícula de bacterias multirresistentes en equinos: revisión bibliográfica, diagnóstico y protocolo de tratamiento
DOI:
https://doi.org/10.15359/rcv.42-1.1Palabras clave:
Heridas crónicas, multirresistencia, biopelícula, antimicrobianos alternativos, equinosResumen
El propósito de este artículo es discutir algunos hechos relevantes hallados en varios casos clínicos de resistencia antibiótica tratados en equinos con la meta de hacer conciencia sobre el problema, revisar la literatura especializada en el tema y proponer alternativas terapéuticas diferentes al uso de los antibióticos disponibles. El tracto fistuloso ejemplifica una herida crónica y se manifiesta como un túnel subcutáneo con egreso a piel que permite la salida de secreción contaminada. Cuando el tracto está infectado con bacterias multirresistentes y presencia de biopelícula entonces el tratamiento médico es bastante más complicado, prolongado en el tiempo y caro debido al costo de procedimientos diagnósticos, manejo veterinario, medicamentos e internamiento hospitalario ocupado en muchos casos, además de que generalmente no se puede efectuar el uso zootécnico esperado para el animal hasta que el mismo sane y su precio se devalúa por la lesión. El rol de las biopelículas bacterianas en heridas con infección crónica es abordado y en vista de la dificultad para identificarlas, se aconseja buscar los signos clínicos específicos sugerentes del problema y aplicar el “Algoritmo Diagnóstico de Percival” para la detección de biopelícula. El tratamiento debería basarse en desbridamiento repetido y aplicación de terapia antimicrobiana tópica, sin recetar antibióticos sistémicos a menos que existan signos de infección generalizada. Se discuten un protocolo de tratamiento para mejorar el manejo de la lesión y la utilización de sustancias antisépticas alternativas a los antibióticos convencionales actuales, además de aplicación de conceptos de UNA SALUD para lidiar con el problema.
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