Hurlow J, Blanz E, Gaddy JA, et al.
Journal of wound care. Date of publication 2016 Sep 1;volume 25 Suppl 9():S11-22.
1. J Wound Care. 2016 Sep;25 Suppl 9:S11-22. doi: 10.12968/jowc.2016.25.Sup9.S11.
Clinical investigation of biofilm in non-healing wounds by high resolution
microscopy techniques.
Hurlow J(1), Blanz E(2), Gaddy JA(2)(3).
Author information:
(1)Association for the Advancement of Wound Care (AAWC) Board of Directors, Wound
Care LLC, Memphis, Tennessee, US.
(2)Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville,
Tennessee, US.
(3)Vanderbilt University Medical Center, Department of Medicine, Nashville,
Tennessee, US.
OBJECTIVE: The aim of this study was to analyse wound biofilm from a clinical
perspective. Research has shown that biofilm is the preferred microbial phenotype
in health and disease and is present in a majority of chronic wounds. Biofilm has
been linked to chronic wound inflammation, impairment in granulation tissue and
epithelial migration, yet there lacks the ability to confirm the clinical
presence of biofilm. This study links the clinical setting with microscopic
laboratory confirmation of the presence of biofilm in carefully selected wound
debridement samples.
METHOD: Human wound debridement samples were collected from adult patients with
chronic non-healing wounds who presented at the wound care centre. Sample choice
was guided by an algorithm that was developed based on what is known about the
characteristics of wound biofilm. The samples were then evaluated by light
microscopy and scanning electron microscopy for the presence of biofilm. Details
about subject history and treatment were recorded. Adherence to biofilm-based
wound care (BBWC) strategies was inconsistent. Other standard antimicrobial
dressings were used and no modern antiseptic wound dressings with the addition of
proven antibiofilm agents were available for use.
RESULTS: Of the patients recruited, 75% of the macroscopic samples contained
biofilm despite the prior use of modern antiseptic wound dressings and in some
cases, systemic antibiotics. Wounds found to contain biofilm were not all acutely
infected but biofilm was present when infection was noted. The clinical histories
associated with positive samples were consistent with ideas presented in the
algorithm used to guide sample selection.
CONCLUSION: Visual cues can be used by the clinician to guide suspicion of the
presence of wound biofilm. This suspicion can be further enhanced with the use of
a clinical algorithm. Standard antiseptic wound dressings used in this study
demonstrated limited antibiofilm efficacy. This study also highlighted a need for
the clinical team to focus on expiration of dressing action and consistent
practice of BBWC strategies which includes the use of proven antibiofilm agents.
DOI: 10.12968/jowc.2016.25.Sup9.S11
PMCID: PMC5058422
PMID: 27608736 [Indexed for MEDLINE]
