Recommendations for the management of biofilm: a consensus document.
The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of laboratory-based research has been carried out on this topic, however, in 2013 the European Wound Management Association (EWMA) pointed out the lack of guidance for managing biofilms in clinical practice and solicited the need for guidelines and further clinical research. In response to this challenge, the Italian Nursing Wound Healing Society (AISLeC) initiated a project which aimed to achieve consensus among a multidisciplinary and multiprofessional international panel of experts to identify what could be considered part of 'good clinical practice' with respect to the recognition and management of biofilms in acute and chronic wounds. The group followed a systematic approach, developed by the GRADE working group, to define relevant questions and clinical recommendations raised in clinical practice. An independent librarian retrieved and screened approximately 2000 pertinent published papers to produce tables of levels of evidence. After a smaller focus group had a multistep structured discussion, and a formal voting process had been completed, ten therapeutic interventions were identified as being strongly recommendable for clinical practice, while another four recommendations were graded as being 'weak'. The panel subsequently formulated a preliminary statement (although with a weak grade of agreement): 'provided that other causes that prevent optimal wound healing have been ruled out, chronic wounds are chronically infected'. All members of the panel agreed that there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence. In the meantime it was agreed that expert-based guidelines were needed to be developed for the recognition and management of biofilms in wounds and for the best design of future clinical trials. This is a fundamental and urgent task for both laboratory-based scientists and clinicians.
UO Dermatologia AUSL Bologna - Istituto delle scienze neurologiche Bellaria, Bologna, Italy.
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Bianchi
Southwest Regional Wound Care Center, Lubbock, Texas, USA.
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Wolcott
Casa Di Cura Solatrix Rovereto, AISLeC Membership, Italy.
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Peghetti
University of Newcastle upon Tyne, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.
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Leaper
Wound Care 4 Heroes and Perfectus Biomed, UK.
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Cutting
IOT Hospital Cardiovascular Rehabilitation, Florence, Italy.
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Polignano
Ambulatorio Infermieristico ASS 1 Trieste, AISLeC Membership, Italy.
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Rosa Rita
Lesioni Cutanee e Ambulatori Infermieristici Lesioni Cutanee SITRA, A.O. Legnano e Abbiategrasso, AISLeC Membership, Italy.
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Moscatelli
Outpatient Wound Care Centre, Local Health Care System Frosinone, Italy.
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Greco
Division of Dermatology, Dept. of Clinical and Experimental Medicine, University of Pisa, Pisa Italy.
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Romanelli
Burns Unit, Department of Neonatal and Emergency Surgery, "Meyer" Children's Hospital, Florence (Italy).
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Pancani
Ambulatory vascular and wound care centre, Policlinic San Matteo, Pavia, Italy.
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Bellingeri
Wound Care Centre - AOU Careggi, Firenze, AISLeC Membership, Italy.
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Ruggeri
Università Politecnica delle Marche, Istituto di Clinica Medica, AOU Ospedali Riuniti di Ancona, Italy.
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Postacchini
UO Dermatologia AUSL Bologna - Istituto delle scienze neurologiche Bellaria, Bologna, Italy.
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Tedesco
Università Politecnica delle Marche, Istituto di Clinica Medica, AOU Ospedali Riuniti di Ancona, Italy.
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Manfredi
Regione Emilia-Romagna, Library - Bologna, Italy.
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Camerlingo
University of Modena, C3S - Lecturer - Clinical Scientific Support Services, Italy.
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Rowan
Università Politecnica delle Marche, Istituto di Clinica Medica, AOU Ospedali Riuniti di Ancona, Italy.
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Gabrielli
Istituto di Clinica Medica, AOU Ospedali Riuniti di Ancona, Italy.
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Pomponio
D000890:Anti-Infective Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001458:Bandages; D018441:Biofilms; D002056:Burns / Q000175:diagnosis / Q000628:therapy*; D003646:Debridement / Q000379:methods*; D017719:Diabetic Foot / Q000175:diagnosis / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D003668:Pressure Ulcer / Q000175:diagnosis / Q000628:therapy*; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000628:therapy*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000628:therapy; D014647:Varicose Ulcer / Q000175:diagnosis / Q000628:therapy*; D014946:Wound Infection / Q000175:diagnosis / Q000628:therapy*; D014947:Wounds and Injuries / Q000628:therapy
D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local
biofilm; consensus; ulcer; wound healing; wound infection