title: A review of the scientific evidence for biofilms in wounds.
abstract: Both chronic and acute dermal wounds are susceptible to infection due to sterile loss of the innate barrier function of the skin and dermal appendages, facilitating the development of microbial communities, referred to as biofilms, within the wound environment. Microbial biofilms are implicated in both the infection of wounds and failure of those wounds to heal. The aim of this review is to provide a summary of published papers detailing biofilms in wounds, the effect they have on infection and wound healing, and detailing methods employed for their detection. The studies highlighted within this paper provide evidence that biofilms reside within the chronic wound and represent an important mechanism underlying the observed, delayed healing and infection. The reasons for this include both protease activity and immunological suppression. Furthermore, a lack of responsiveness to an array of antimicrobial agents has been due to the biofilms' ability to inherently resist antimicrobial agents. It is imperative that effective strategies are developed, tested prospectively, and employed in chronic wounds to support the healing process and to reduce infection rates. It is increasingly apparent that adoption of a biofilm-based management approach to wound care, utilizing the "antibiofilm tool box" of therapies, to kill and prevent reattachment of microorganisms in the biofilm is producing the most positive clinical outcomes and prevention of infection.
authors.affiliation: Scapa Healthcare Plc, Manchester, UK. Steven.Percival@scapa.com
authors.forename: Steven L
authors.initials: SL
authors.lastname: Percival
authors.forename: Katja E
authors.initials: KE
authors.lastname: Hill
authors.forename: David W
authors.initials: DW
authors.lastname: Williams
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Hooper
authors.forename: Dave W
authors.initials: DW
authors.lastname: Thomas
authors.forename: John W
authors.initials: JW
authors.lastname: Costerton
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development*; D002908:Chronic Disease; D017719:Diabetic Foot / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007455:Iodine / Q000008:administration & dosage; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development*; D012837:Silver Sulfadiazine / Q000008:administration & dosage; D014647:Varicose Ulcer / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D014945:Wound Healing; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology
chemical_list: D000890:Anti-Infective Agents; D007455:Iodine; D012837:Silver Sulfadiazine