Clinically Addressing Biofilm in Chronic Wounds

Abstract

Background: A chronic wound is a wound that is arrested in the inflammatory phase of wound healing and cannot progress further. Over 90% of chronic wounds contain bacteria and fungi living within a biofilm construct.

The problem: Each aggregation of microbes creates a distinct biofilm with differing characteristics so that a clinical approach has to be tailored to the specifics of a given biofilm. Defining the characteristics of that biofilm and then designing a therapeutic option particular to that biofilm is currently being defined.

Basic/clinical science advances: Biofilm becomes resistant to therapeutic maneuvers at 48-96 h after formation. By repeatedly attacking it on a regular schedule, one forces biofilm to reattach and reform during which time it is susceptible to antibiotics and host defenses. Identifying the multiple bacteria and fungi that make up a specific biofilm using polymerase chain reaction (PCR) allows directed therapeutic maneuvers such as application of specific topical antibiotics and biocides to increase the effectiveness of the debridement.

Clinical care relevance: Most chronic wounds contain biofilm that perpetuate the inflammatory phase of wound healing. Combining debridement with using PCR to identify the bacteria and fungi within the biofilm allows for more targeted therapeutic maneuvers to eliminate a given biofilm.

Conclusion: Therapeutic options in addition to debridement are currently being evaluated to address biofilm. Using PCR to direct adjunctive therapeutic maneuvers may increase the effectiveness of addressing biofilm in a chronic wound.

Christopher Attinger

Figure 1.

Graphical illustration of the effects of biofilm-based wound care. The goal of biofilm-based wound care is to ensure the therapy maintains its balance within the healing window, as described in the text. It can be assumed from this figure that, without concurrent strategy, the frequency of debridement could be increased to keep the wound from falling below the healing stall point. Debridement remains the primary tool for ensuring the wound stays above the stall point.