Review of the role of biofilms in chronic wounds in horses: clinical indications and treatment strategies

Abstract

Recognition of the role that biofilms play in the persistence of chronic wounds and lack of response to therapy in horses is increasing. Prevention of biofilm development in early stages of wound care involves three primary strategies: wound debridement and cleansing to reduce bacterial counts in the wound bed, appropriate use of advanced wound dressings, and implementation of topical antimicrobial agents. Once formed, eradication of biofilms requires elimination to improve the wound environment for contraction and epithelialization while not further harming the native cells integral to the healing process, which is achieved predominantly through repeated lavage and debridement combined with topical antimicrobial therapy. This review will establish why and how biofilms form, how to recognize clinical indications that biofilms have formed in equine wounds, and to review current diagnostic options and biofilm-based wound care (BBWC) strategies to eradicate biofilms. Clinical scenarios for cases in which biofilms developed and were successfully treated will be presented. This review will advance practitioners’ understanding of the presence and role of biofilms in chronic wounds and provide an updated summary of recommended treatment strategies.