Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, Stoodley P, Swanson T, Tachi M, Wolcott RD, Global Wound Biofilm Expert Panel., et al.
Wound repair and regeneration : official publication of the Wound Healing Society [and] the Eur.... Date of publication 2017 Sep 1;volume 25(5):744-757.
1. Wound Repair Regen. 2017 Sep;25(5):744-757. doi: 10.1111/wrr.12590. Epub 2017 Dec
12.
Consensus guidelines for the identification and treatment of biofilms in chronic
nonhealing wounds.
Schultz G(1), Bjarnsholt T(2)(3), James GA(4), Leaper DJ(5), McBain AJ(6), Malone
M(7)(8), Stoodley P(9), Swanson T(10), Tachi M(11), Wolcott RD(12); Global Wound
Biofilm Expert Panel.
Author information:
(1)Department of Obstetrics & Gynecology, Institute for Wound Research,
University of Florida, Gainesville, Florida.
(2)Department of Immunology and Microbiology, Costerton Biofilm Center,
University of Copenhagen, Copenhagen, Denmark.
(3)Department of Clinical Microbiology, Copenhagen University Hospital,
Copenhagen, Denmark.
(4)Center for Biofilm Engineering, Montana State University, Bozeman, Montana.
(5)Clinical Sciences, University of Huddersfield, Huddersfield, United Kingdom.
(6)Division of Pharmacy and Optometry, School of Health Sciences, Faculty of
Biology, Medicine and Health, University of Manchester, Manchester, United
Kingdom.
(7)Liverpool Hospital, South West Sydney LHD, Sydney, New South Wales, Australia.
(8)LIVEDIAB, Ingham Institute of Applied Medical Research, Sydney, New South
Wales, Australia.
(9)Departments of Microbial Infection and Immunity, and Orthopaedics, Ohio State
University, Columbus, Ohio.
(10)Warrnambool Base Hospital, Warrnambool, Victoria, Australia.
(11)Department of Plastic and Reconstructive Surgery, Graduate School of
Medicine, Tohoku University, Sendai, Japan.
(12)Southwest Regional Wound Center, Lubbock, Texas.
BACKGROUND: Despite a growing consensus that biofilms contribute to a delay in
the healing of chronic wounds, conflicting evidence pertaining to their
identification and management can lead to uncertainty regarding treatment. This,
in part, has been driven by reliance on in vitro data or animal models, which may
not directly correlate to clinical evidence on the importance of biofilms.
Limited data presented in human studies have further contributed to the
uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are
needed to help aid the identification and management of biofilms, providing a
clinical focus to support clinicians in improving patient care through
evidence-based medicine.
METHODS: A Global Wound Biofilm Expert Panel, comprising 10 clinicians and
researchers with expertise in laboratory and clinical aspects of biofilms, was
identified and convened. A modified Delphi process, based on published scientific
data and expert opinion, was used to develop consensus statements that could help
identify and treat biofilms as part of the management of chronic nonhealing
wounds. Using an electronic survey, panel members rated their agreement with
statements about biofilm identification and treatment, and the management of
chronic nonhealing wounds. Final consensus statements were agreed on in a
face-to-face meeting.
RESULTS: Participants reached consensus on 61 statements in the following topic
areas: understanding biofilms and the problems they cause clinicians; current
diagnostic options; clinical indicators of biofilms; future options for
diagnostic tests; treatment strategies; mechanical debridement; topical
antiseptics; screening antibiofilm agents; and levels of evidence when choosing
antibiofilm treatments.
CONCLUSION: This consensus document attempts to clarify misunderstandings about
the role of biofilms in clinical practice, and provides a basis for clinicians to
recognize biofilms in chronic nonhealing wounds and manage patients optimally. A
new paradigm for wound care, based on a stepped-down treatment approach, was
derived from the consensus statements.
© 2017 by the Wound Healing Society.
DOI: 10.1111/wrr.12590
PMID: 28960634 [Indexed for MEDLINE]
