title: Biofilm detection by wound blotting can predict slough development in pressure ulcers: A prospective observational study.
abstract: Bacteria have been found to form multicellular aggregates which have collectively been termed "biofilms." It is hypothesized that biofilm formation is a means to protect bacterial cells including protection form the immune response of humans. This protective mechanism is believed to explain persistent chronic wound infections. At times, the biofilms are abundant enough to see, and remove by simple wiping. However, recent evidence has shown that the removal of these visible portions are not sufficient, and that biofilms can continue to form even with daily wiping. In this work, we tested an approach to detect the biofilms which are present after clinically wiping or sharp wound debridement. Our method is based on a variation of impression cytology in which a nitrocellulose membrane was used to collect surface biofilm components, which were then differentially stained. In this prospective study, members of an interdisciplinary pressure ulcer team at a university hospital tested our method's ability to predict the generation of wound slough in the week that followed each blotting. A total of 70 blots collected from 23 pressure ulcers produced 27 wounds negative for staining and 43 positive. In the negative blots 55.6% were found to have decreased wound slough, while 81.4% with positive staining had either increase or unchanged wound slough generation. These results lead to an odds ratio of positive blotting cases of 9.37 (95% confidence intervals: 2.47-35.5, p = 0.001) for slough formation; suggesting that the changes in wound slough formation can be predicted clinically using a non-invasive wound blotting method.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Gojiro
authors.initials: G
authors.lastname: Nakagami
authors.affiliation: Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, Florida.
authors.forename: Gregory
authors.initials: G
authors.lastname: Schultz
authors.affiliation: Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, Florida.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gibson
authors.affiliation: Kirksville College of Osteopathic Medicine, AT Still University of Health Sciences, Kirksville, Missouri.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Phillips
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Minematsu
authors.affiliation: Department of Dermatology, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Miyagaki
authors.affiliation: Department of Plastic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Akitatsu
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Sanae
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core Institute for Frontier Science Initiative, Kanazawa University, Ishikawa, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D018441:Biofilms; D003101:Collodion; D003584:Cytological Techniques / Q000379:methods; D003646:Debridement; D006801:Humans; D008567:Membranes, Artificial; D003668:Pressure Ulcer / Q000382:microbiology* / Q000503:physiopathology*; D011446:Prospective Studies; D014014:Tissue Adhesives
chemical_list: D008567:Membranes, Artificial; D014014:Tissue Adhesives; D003101:Collodion