Estrategias para el manejo de heridas crónicas complicadas con biopelícula de bacterias multirresistentes en equinos: revisión bibliográfica, diagnóstico y protocolo de tratamiento

The purpose of this article is to discuss some relevant facts found in several clinical cases of antibiotic resistance in equines to raise awareness about the problematic, make a literature review on the topic and propose therapeutical alternatives different to the use antibiotics currently available. The fistulous tract exemplifies a chronic wound that presents itself as a subcutaneous tunnel exiting through the skin with presence of contaminated secretion. When the tract is infected with multi-resistant bacteria and there is biofilm presence, the medical treatment is, therefore, a lot more complicated, prolonged in time and expensive due to the cost of diagnostic procedures, veterinary management, medicines, and hospital boarding, which is often required. In addition, normally, the expected zootechnical use of the animal cannot be carried out until it heals, and its price is devalued due to the injury. The role of bacterial biofilms in chronic infected wounds is addressed and due to the difficulty in identifying them, it is advisable to look for specific clinical signs suggestive of the problem and apply the “Percival´s Diagnostic Algorithm” for the detection of biofilm. Treatment should be based on repeated debridement and the application of topical antimicrobial therapy without prescribing systemic antibiotics unless there are signs of generalized infection. A treatment protocol to improve the management of the injury and the use of alternative antiseptic substances to current conventional antibiotics are discussed, as well as the application of “ONE HEALTH” concepts to deal with such problem. 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