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. 2025 May;22(5):e70181.
doi: 10.1111/iwj.70181.

A Scoping Review to Identify Clinical Signs, Symptoms and Biomarkers Reported in the Literature to Be Indicative of Biofilm in Chronic Wounds

John D Ivory  1   2 , Laure Perrier  3 , Akke Vellinga  2   4 , Duygu Sezgin  1   2 , Chloe M Hobbs  2   5 , Cathal Ffrench  1   2 , Patricia M Coutts  6 , James P O'Gara  2   5 , Georgina Gethin  1   2   7
Affiliations

A Scoping Review to Identify Clinical Signs, Symptoms and Biomarkers Reported in the Literature to Be Indicative of Biofilm in Chronic Wounds

John D Ivory et al. Int Wound J. 2025 May.

Abstract

The objective of this review was to identify clinical signs/symptoms reported in the literature to be indicative of biofilm in chronic wounds. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews, and the Joanna Briggs Institute Evidence Synthesis manual guided review conduct. Any article/study type reporting signs/symptoms of biofilm in adults with venous, diabetic, pressure and/or mixed arterial/venous ulcers was eligible. Medline, Embase, CINAHL, Cochrane CENTRAL and the Bielefeld Academic Search Engine were searched. Titles/abstracts and full-text articles were screened against eligibility criteria. One-hundred and eleven reports of 109 articles were included. They provided 830 accounts of clinical signs/ symptoms being indicative of biofilm. These were categorised into 26 statements. Visual indicators such as a shiny, slimy layer on a non-healing wound surface quickly reforming in the absence of frequent cleansing or debridement represented 24% of accounts, followed by failed response to antimicrobial therapies (15%), and failure of wound to close or progress to healing despite optimal management strategies (13%). Wound duration > 6 weeks and extreme tolerance to host defences represented 1% of accounts. Clinical signs/symptoms are recommended and used as indicators of biofilm presence in chronic wounds but with little supporting validation data.

Keywords: biofilms; chronic wounds; scoping review; signs and symptoms; wound healing.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of search results (inception to July 6th 2023) [47].
FIGURE 2
FIGURE 2
Included reports n (%) by year of publication.
FIGURE 3
FIGURE 3
Included reports n (%) by study design/article type.
FIGURE 4
FIGURE 4
Included reports n (%) by wound aetiology.
FIGURE 5
FIGURE 5
Signs and symptoms reported to be indicative of biofilm in chronic wounds n (%) by study design/article type.
See this image and copyright information in PMC

References

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