Reducing Biofilm Infections in Burn Patients' Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review.

Roger E Thomas,Bennett Charles Thomas

doi:10.3390/ijerph182413195

Abstract

Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms. Key pathogens are Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Acinetobacter baumanii. Purpose: identify current and novel interventions to reduce biofilms on patients’ burns and hospital surfaces and equipment. Medline and Embase were searched without date or language limits, and 31 possible interventions were prioritised: phages, nano-silver, AgSD-NLs@Cur, Acticoat and Mepilex silver, acetic acid, graphene-metal combinations, CuCo2SO4 nanoparticles, Chlorhexidene acetate nanoemulsion, a hydrogel with moxifloxacin, carbomer, Chitosan and Boswellia, LED light therapy with nano-emodin or antimicrobial blue light + Carvacrol to release reactive oxygen species, mannosidase + trypsin, NCK-10 (a napthalene compound with a decyl chain), antimicrobial peptide PV3 (includes two snake venoms), and polypeptides P03 and PL2. Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes. Scanning electron microscopy identified important changes in bacterial surfaces. Patients with biofilms need isolating and treating before full admission to hospital. Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.

Highlights

Biofilms affect > 80% of bacterial infections in humans [1,2] and are the dominant mode of bacterial growth in which millions of bacteria cohabit in a hydrated extracellular matrix [1]
Biofilms are a key problem in burns, and 60% of the mortality from burns is attributed to biofilms [1]
Most hospital-acquired infections are due to vancomycin-resistant enterococcus (VRE), methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, multidrug-resistant Acinetobacter baumanii, Pseudomonas aeruginosa, and extended spectrum beta-lactamase-producing organisms (ESBL) [3]

Summary

Introduction

Biofilms affect > 80% of bacterial infections in humans [1,2] and are the dominant mode of bacterial growth in which millions of bacteria cohabit in a hydrated extracellular matrix [1]. Biofilms are a key problem in burns, and 60% of the mortality from burns is attributed to biofilms [1]. Biofilms are a key problem in chronic wounds such as diabetic, pressure and venous leg ulcers, lung infections in cystic fibrosis, pneumonia in patients on ventilators, and patients on medical devices and urinary catheters [1]. Most hospital-acquired infections are due to vancomycin-resistant enterococcus (VRE), methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, multidrug-resistant Acinetobacter baumanii, Pseudomonas aeruginosa, and extended spectrum beta-lactamase-producing organisms (ESBL) [3]. Biofilms have five life stages: reversible attachment to surfaces, irreversible attachment, maturation-1, maturation-2, and the planktonic form. During the final stage, ~80% of the biomass may convert back to the planktonic form and bacterial susceptibility to antibiotics

Methods

Discussion

Conclusion