From the Guidelines
The best approach to manage a wound with suspected bacterial biofilm and delayed healing involves a comprehensive strategy of debridement, antimicrobial therapy, and advanced wound care. This is based on the most recent evidence from 2024, which highlights the critical role of biofilms in delaying wound healing 1. The presence of biofilms in chronic wounds can lead to a 44% delay in healing time for each log10 increase in colony-forming units (CFU)/mL of bacteria, making it essential to address biofilms effectively 1.
Key Components of Wound Management
- Debridement: Start with thorough debridement (surgical, mechanical, or enzymatic) to physically remove the biofilm, as biofilms are resistant to standard antimicrobial treatments when intact 1.
- Antimicrobial Therapy: Follow with topical antimicrobials such as cadexomer iodine, silver-containing dressings, or polyhexamethylene biguanide (PHMB) products applied directly to the wound bed 1.
- Advanced Wound Care: Maintain a moist wound environment using appropriate dressings like hydrogels or hydrocolloids, and change dressings regularly according to exudate levels, typically every 1-3 days 1.
- Address Underlying Factors: Address underlying factors such as diabetes control, vascular insufficiency, or nutritional deficiencies that may impair healing 1.
Systemic Antibiotics
Systemic antibiotics should be reserved for cases with signs of spreading infection rather than for biofilm management alone, as they may not effectively penetrate the biofilm matrix 1. The use of systemic antibiotics should be guided by the severity of the infection and the likely etiologic agent(s), with consideration of local antibiotic susceptibility data 1.
Rotation of Antimicrobial Agents
For more established biofilms, consider rotating different antimicrobial agents every 2-3 weeks to prevent resistance, as biofilms can develop resistance to antimicrobial agents over time 1. This approach can help to minimize the development of antimicrobial resistance and improve treatment outcomes.
By following this comprehensive approach, healthcare providers can effectively manage wounds with suspected bacterial biofilm and delayed healing, reducing the risk of morbidity, mortality, and healthcare resource utilization 1.
From the Research
Role of Bacteria and Biofilms in Delayed Wound Healing
- Bacteria, particularly those in biofilms, play a crucial role in delaying wound healing by impeding host fibroblast development, inflammatory responses, and the efficacy of antimicrobial therapy 2.
- Biofilms are communities of microorganisms that attach to surfaces and are embedded in a protective matrix, making them highly resistant to host immune responses and treatment 3.
- The presence of biofilm in chronic wounds is a major threat due to its substantial protection from host immunities and extreme tolerance to antimicrobial agents 4.
Management of Wounds with Suspected Bacterial Biofilm Presence
- A multi-targeted strategy, namely biofilm-based wound care, involving debridement and antimicrobial therapies, has been introduced to combat biofilm in chronic wounds 5.
- Wound hygiene, which involves multiple tools in combination (debridement, cleansing, and antimicrobial dressings), is a promising approach to maximize success in biofilm removal and encourage wound healing 5.
- Early anti-biofilm strategy is essential to combat biofilm before it takes control and prevents wound healing 5.
- The use of antibiofilm agents, such as surfactants and dressings, has shown varying degrees of efficacy in destroying biofilms in in vitro and preclinical models, as well as in some clinical studies 3.
Treatment Strategies for Biofilm Disruption
- Debridement is a possible effective method for eliminating biofilms, but it can only be applied to wounds with visible necrotic tissue 6.
- Ultrasonic debridement is available for biofilm removal and has been shown to be effective in removing biofilms in pressure ulcers 6.
- High-osmolarity surfactant solution technology is emerging as a potential multimodal treatment that has shown promise in disrupting the extracellular polymeric substance (EPS) matrix of biofilms 4.
- The use of EPS-disrupting technology in an antibiofilm treatment approach is advocated for all chronic wounds 4.