Abstract
Chronic wounds are a major healthcare burden, with huge public health and economic impact. Microbial infections are the single most important cause of chronic, non-healing wounds. Chronic wound infections typically form biofilms, which are notoriously recalcitrant to conventional antibiotics. This prompts the need for alternative or adjunct ‘anti-biofilm’ approaches, notably those that account for the unique chronic wound biofilm microenvironment. In this review, we discuss the recent advances in non-conventional antimicrobial approaches for chronic wound biofilms, looking beyond standard antibiotic therapies. These non-conventional strategies are discussed under three groups. The first group focuses on treatment approaches that directly kill or inhibit microbes in chronic wound biofilms, using mechanisms or delivery strategies distinct from antibiotics. The second group discusses antimicrobial approaches that modify the biological, chemical or biophysical parameters in the chronic wound microenvironment, which in turn enables the disruption and removal of biofilms. Finally, therapeutic approaches that affect both, biofilm bacteria and microenvironment factors, are discussed. Understanding the advantages and limitations of these recent approaches, their stage of development and role in biofilm management, could lead to new treatment paradigms for chronic wound infections. Towards this end, we discuss the possibility that non-conventional antimicrobial therapeutics and targets could expose the ‘chink in the armor’ of chronic wound biofilms, thereby providing much-needed alternative or adjunct strategies for wound infection management.
Highlights
The biofilm state has been widely reported in chronic wounds, current evidence supports the view that biofilms are ubiquitous in chronic wounds [3,6,7]
Given that Negative Pressure Wound Therapy (NPWT) is widely used in the management of non-healing wounds, it presents an ideal technique to be used in combination with topical antiseptic instillation, towards combination approaches for chronic wound infections
It is clearly evident that there is a plethora of research that supports the development and potential use of non-conventional antimicrobial therapeutics for the management of chronic wound infections
Summary
Cutaneous wounds result from injury or a break in the epithelial lining of the skin, leading to disturbances in skin anatomy, physiology or function This breach likely results from an external injury (trauma or surgical incisions) but is often associated with underlying predisposing factors such as diabetes, hypertension, obesity, malignancies, peripheral vascular disease, prolonged immobilization and advanced age [1]. Following this breach in integrity, wounds heal in a well-organized, coordinated process, consisting of four distinct, overlapping phases of haemostasis, inflammation, tissue proliferation and tissue remodelling [2]. The biofilm state has been widely reported in chronic wounds (different studies report that 60–90% of chronic wounds contain biofilm-forming bacteria), current evidence supports the view that biofilms are ubiquitous in chronic wounds [3,6,7]
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