A Formidable Foe Is Sabotaging Your Results: What You Should Know about Biofilms and Wound Healing

Abstract

Learning Objectives After reading this article, the participant should be able to: 1. Describe biofilm pathogenesis as it relates to problem wounds, 2. Understand the pre-clinical and clinical evidence implicating biofilm in problem wounds, 3. Explain the diagnostic and treatment challenges that biofilms create for problem wounds, 4. Demonstrate a basic understanding of emerging strategies aimed at counteracting these processes. Summary Biofilm represents a protected mode of growth for bacteria, allowing them to evade standard diagnostic techniques and avoid eradication by standard therapies. Though only recently discovered, biofilm has existed for millennia and complicates nearly every aspect of medicine. Biofilm impacts wound healing by allowing bacteria to evade immune responses, prolonging inflammation and disabling skin barrier function. It is important to understand why problem wounds persist despite state-of-the-art treatment, why they are difficult to accurately diagnose, and why they recur. The aim of this article is to focus on current gaps in knowledge related to problem wounds, specifically, biofilm infection.

BD-2 and BD-3 increase skin flap survival in a model of ischemia and Pseudomonas aeruginosa infection

“…This suggests that, in this rodent model, the ongoing P . aeruginosa infection associated with the foreign body led to continuous breakdown of the overlying integument 72 . This had already been amply observed in clinical practice 72,78 .…”

“…This lends support to the notion that in bacteria capable of producing biofilms, such as P . aeruginosa , the protracted release of bacterial cells from the biofilm medium is one of the main determinants of continuous tissue damage to the overlying tissues 45,60,72–74 . In fact, a recent meta-analysis demonstrated that biofilms are present in more than three quarters of chronic wounds, increasing their extension or preventing their closure 73 .…”

Biofilm and Equine Limb Wounds

“…Infection with biofilm is not necessarily accompanied by the cardinal signs of inflammation such as pain, redness, heat, and swelling, and many studies have tried to identify specific clinical signs related to biofilm-infected chronic wounds. However, signs vary, and no specific clinical signs have been found to correlate with biofilm infection [10,18,26,[91][92][93], which makes it extremely difficult for clinicians to evaluate whether wounds are infected with biofilm.…”

Antibacterial-Integrated Collagen Wound Dressing for Diabetes-Related Foot Ulcers: An Evidence-Based Review of Clinical Studies

“…The prevalence of biofilms in chronic wounds according to recent meta-analysis has been reported to be 78.2%, with some cases recording a higher rate of infection [ 15 , 16 ]. Bacterial infection triggers inflammation at the injury site following the recognition of bacterial antigen or secreted products, such as proteolytic enzymes [ 17 , 18 ]. The abnormal level of infection rate contributes to the delay in wound healing by prolonging the inflammatory phase as the immune cells attempt to clear the infection [ 19 ].…”