Abstract
Following confirmation of the presence of biofilms in chronic wounds, the term biofilm became a buzzword within the wound healing community. For more than a century pathogens have been successfully isolated and identified from wound specimens using techniques that were devised in the nineteenth century by Louis Pasteur and Robert Koch. Although this approach still provides valuable information with which to help diagnose acute infections and to select appropriate antibiotic therapies, it is evident that those organisms isolated from clinical specimens with the conditions normally used in diagnostic laboratories are mainly in a planktonic form that is unrepresentative of the way in which most microbial species exist naturally. Usually microbial species adhere to each other, as well as to living and non-living surfaces, where they form complex communities surrounded by collectively secreted extracellular polymeric substances (EPS). Cells within such aggregations (or biofilms) display varying physiological and metabolic properties that are distinct from those of planktonic cells, and which contribute to their persistence. There are many factors that influence healing in wounds and the discovery of biofilms in chronic wounds has provided new insight into the reasons why. Increased tolerance of biofilms to antimicrobial agents explains the limited efficacy of antimicrobial agents in chronic wounds and illustrates the need to develop new management strategies. This review aims to explain the nature of biofilms, with a view to explaining their impact on wounds.
Highlights
Increased tolerance of biofilms to antimicrobial agents explains the limited efficacy of antimicrobial agents in chronic wounds and illustrates the need to develop new management strategies
Based on the evidence above, the concept of bacterial biofilms in chronic wounds is supported, but whether these biofilms play a role in the lack of healing is another question
Wounds created on the pig were inoculated with S. aureus and treated with either one or two antibiotic preparations within 15 minutes or after 48 hours, respectively
Summary
Based on the evidence above, the concept of bacterial biofilms in chronic wounds is supported, but whether these biofilms play a role in the lack of healing is another question. The biofilm phenotype enables protection of the bacteria from both antibiotics and other antimicrobial agents such as silver and the host defence. This implies that if the bacteria succeed in forming a biofilm in the wound bed, the bacteria will be extremely difficult to eradicate. The role of biofilms in wound colonisation and infection was explored with an animal model and S. aureus.[71] Wounds created on the pig were inoculated with S. aureus and treated with either one or two antibiotic preparations within 15 minutes (to simulate an acute infection caused by planktonic bacteria) or after 48 hours (when a biofilm had established), respectively. The term ‘persister’ was derived by Bigger.[44]
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