Emerging dressings used in wound care will have to address biofilm in order to achieve effective wound healing.
"It's very hard to treat the biofilm component of a wound," says Randall Wolcott M.D., founder and medical director, Regional Wound Care Center in Lubbock, Texas. "There is no quick way to identify biofilm. Cultures are limited in how they help us in wound care. There are no hard and fast rules, but you can look for signs like exudate and odor. Acute infections usually don't give off volatile gases," he adds.
Biofilm behaves differently than planktonic bacteria, which is associated with acute infection, Dr. Wolcott explains.
"They are different phenotypes," Dr. Wolcott says. "When you treat, you should treat both (planktonic bacteria and biofilm). Biofilm attaches and inflames the tissue in the host environment, and it uses plasma to nourish itself."
Indeed, biofilm is a significant factor in the failure of a sore to heal as biofilm is highly organized and its protects bacteria from antibiotic therapy and a patient's immune response.
Addressing biofilm improves health and reduces health-care costs in medical practice, Dr. Wolcott says. In the United States, chronic wounds affect 6.5 million patients. More than US$25 billion is estimated to be dedicated to the treatment of chronic wounds, and that cost is growing with increasing health care costs, an aging population, and a steep climb in the incidence of diabetes and obesity worldwide. Wound Repair and Regeneration. 2009;17(6):763-771.
A dressing needs to contain components to allow the physical disruption of biofilm, Dr. Wolcott explains.
"There needs to be a synergy between the components in the dressing," Dr. Wolcott says. "If you use too many components, they may neutralize each other. The synergy between the components dissolves the matrix and opens up the bacteria to other components."
The formulation of wound care dressings that tackle biofilm are based on principles of allowing the antimicrobial agent to more effectively penetrate through the biofilm to kill cells, Dr. Wolcott explains, noting in some designs that includes a chelating agent.
The efficacy of a dressing can make the difference between a patient losing or salvaging a limb, according to Dr. Wolcott. "If we save a limb, we can save a life," Dr. Wolcott says.