title: From germ theory to germ therapy: skin microbiota, chronic wounds, and probiotics.
abstract: BACKGROUND
  Microorganisms living throughout the body comprise the human "microbiota" and play an important role in health and disease. Recent research suggests that alterations in the skin microbiota may underlie chronic wound pathology. Probiotics are bacteria or yeast that confer a health benefit on the host and may have a role in preventing and treating nonhealing wounds by modulating host-microbe interactions.
  
  
  METHODS
  The English literature on skin microbiota, chronic wounds, biofilms, and probiotics is reviewed.
  
  
  RESULTS
  Recent evidence indicates that disruption of microbial communities and bacteria-host interactions may contribute to impaired wound healing. Preclinical and human studies highlight the potential of probiotics to prevent or treat various infectious, immune-mediated, and inflammatory diseases.
  
  
  CONCLUSIONS
  Advances in molecular sequencing and microbiology have shed light on the importance of the human microbiota in development, health, and disease. Probiotics represent a novel approach to altering the microbial environment with beneficial bacteria. Ongoing challenges include the need for better understanding of therapeutic mechanisms, improved regulation of manufacturing practices, and validation in controlled human trials. Current evidence suggests that probiotic-based therapies have considerable potential to exploit host-microbe relationships and improve clinical outcomes.
authors.affiliation: Portland, Ore.; and Stanford, Calif. From the Department of Surgery, Oregon Health & Science University; and Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Wong
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.forename: Michael T
authors.initials: MT
authors.lastname: Longaker
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Gurtner
mesh_terms: D000818:Animals; D018441:Biofilms; D002908:Chronic Disease; D060755:Germ Theory of Disease; D006801:Humans; D064307:Microbiota / Q000502:physiology*; D019936:Probiotics / Q000627:therapeutic use*; D012867:Skin / Q000382:microbiology / Q000503:physiopathology; D014945:Wound Healing; D014947:Wounds and Injuries / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy*