Micro‐management: curbing chronic wound infection

Abstract

Chronic wounds, including pressure ulcers, foot ulcers and venous leg ulcers have a detrimental impact on the health and well-being of an estimated 2% of people in the UK.Chronic wounds are normally colonised by bacteria and in some instances bacterial load increases sufficiently for infection to ensue. Once a chronic wound becomes infected it is difficult to resolve and a combination of continuous inflammation and bacterial proliferation makes these wounds difficult to manage. A state of prolonged inflammation can occur as a result of impaired homeostatic pathways which are exacerbated by bacterial growth.Chronic, infected wounds can persist for many months or even years, sometimes requiring surgical intervention in the form of regular debridement or amputation when other strategies such as antimicrobial treatments fail. The complex relationships between both oral microbiota and the host have been extensively characterised, including the shift from health to disease, and has allowed for the development of numerous control strategies. This knowledge combined with contemporary studies of chronic infected wounds can be used to develop an understanding of the relationship between the host and microorganism in the chronic wound environment. Such information has the potential to inform wound management including strategies to control infection and promote wound healing.

Therapeutic strategies for chronic wound infection

“… 2 Since bacterial colonization is a typical characteristic of chronic wounds, infection might occur when there are over 1×10 5 colony forming units per gram tissue. 3 Infection can inhibit normal wound healing procedures in multiple ways.…”

Mesenchymal stem cells in the treatment of Cesarean section skin scars: study protocol for a randomized, controlled trial

“…Abnormal wound healing processes can also cause bacterial proliferation. In some instances, the bacterial load increases sufficiently for infection to ensue [ 15 ]. Therefore, an abnormal wound healing process could increase the risk of hypertrophic scarring and wound infection.…”

Alginate films augmented with chlorhexidine hexametaphosphate particles provide sustained antimicrobial properties for application in wound care

“…The CHX-HMP alginate films showed a dose-dependent antimicrobial efficacy against laboratory strains of five common wound infecting pathogens. S. aureus, P. aeruginosa and E. coli were selected on the basis that they are some of the most common pathogens isolated from chronic wounds [25][26][27]; a methicillin-resistant strain of S. aureus was utilised in this study on the basis of its importance in the hospital and community settings where chronic wounds are most commonly managed, and with respect to the observation that some MRSA strains exhibit reduced susceptibility to CHX [28], thus providing a more robust challenge to the novel CHX technology in this study. K. pneumoniae and A. baumannii have historically been less associated with chronic wounds, but these frequently multi-drug-resistant species are increasingly believed to play an important role in wound infections, particularly in wounds sustained by military personnel in conflict zones [29,30] and in burn wound infections [31,32].…”