Biofilm maturity studies indicate sharp debridement opens a time- dependent therapeutic window.
OBJECTIVE
To investigate the hypothesis that newly formed wound biofilms (or bioburdens) are more susceptible to antimicrobial treatment.


METHODS
Four separate and distinct models were performed by four separate biofilm research laboratories to evaluate the resistance of biofilms to antimicrobial treatments over time. These included a drip-flow biofilm model along with a hydrodebridement study, a porcine skin punch biopsy ex vivo model, a mouse chronic wound model and clinical longitudinal debridement study.


RESULTS
All four models showed that, within the first 24 hours, the biofilm community was more susceptible to the selected antibiotics, and after maturing for up to 48 hours became increasingly tolerant. In each model, there was at least a 24-hour period in which the biofilms were more resistant to antibiotics. Each of the models utilised showed a significant decrease in the resistance of the biofilm/ burden to gentamicin for up to 24 hours with a confidence interval of at least 95%. The resistance increased in each of the models by 48 hours and reached original resistance levels by 72 hours.


CONCLUSIONS
These data suggest the principles of biofilm-based wound care, along with the use of serial debridement to continually remove mature biofilm, followed by biofilm wound management strategies, including topical antibiotics while the bioburden is still immature and more susceptible, are valid.
Wolcott
R D
RD
Southwest Regional Wound Care Center, Lubbock, TX, USA.
Rumbaugh
K P
KP
James
G
G
Schultz
G
G
Phillips
P
P
Yang
Q
Q
Watters
C
C
Stewart
P S
PS
Dowd
S E
SE
D000279:Administration, Cutaneous; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development*; D001706:Biopsy; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D004195:Disease Models, Animal; D024881:Drug Resistance, Bacterial; D051379:Mice; D011552:Pseudomonas Infections / Q000382:microbiology / Q000628:therapy; D017592:Skin Care; D013203:Staphylococcal Infections / Q000382:microbiology / Q000628:therapy; D013552:Swine; D007507:Therapeutic Irrigation; D013997:Time Factors; D014945:Wound Healing; D014946:Wound Infection / Q000382:microbiology / Q000628:therapy
D000900:Anti-Bacterial Agents