title: The prevalence of biofilms in chronic wounds: a systematic review and meta-analysis of published data.
abstract: The presence of biofilms in chronic non-healing wounds, has been identified through in vitro model and in vivo animal data. However, human chronic wound studies are under-represented and generally report low sample sizes. For this reason we sought to ascertain the prevalence of biofilms in human chronic wounds by undertaking a systematic review and meta-analysis. Our initial search identified 554 studies from the literature databases (Cochrane Library, Embase, Medline). After removal of duplicates, and those not meeting the requirements of inclusion, nine studies involving 185 chronic wounds met the inclusion criteria. Prevalence of biofilms in chronic wounds was 78.2 % (confidence interval [CI 61.6-89, p<0.002]). The results of our meta-analysis support our clinical assumptions that biofilms are ubiquitous in human chronic non-healing wounds.
authors.affiliation: Head of Department, Podiatric Medicine, Global Wound Biofilm Expert Panel; Liverpool Hospital, South West Sydney LHD, Australia; and Ingham Institute of Applied Medical Research, Sydney, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Malone
authors.affiliation: University of Copenhagen, Costerton Biofilm Center, Denmark; and Department of Clinical Microbiology, Rigshospitalet, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Bjarnsholt
authors.affiliation: Faculty of Biology, Medicine and Health, University of Manchester.
authors.forename: A J
authors.initials: AJ
authors.lastname: McBain
authors.affiliation: Center for Biofilm Engineering, Montana State University, US.
authors.forename: G A
authors.initials: GA
authors.lastname: James
authors.affiliation: Center for Microbial Interface Biology and Department of Microbial infection, Immunity and Orthopaedics, Ohio State University, US.
authors.forename: P
authors.initials: P
authors.lastname: Stoodley
authors.affiliation: Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK; and Imperial College, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Leaper
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tachi
authors.affiliation: Institute of Wound Research, Department of Obstetrics and Gynecology, College of Medicine, University of Florida.
authors.forename: G
authors.initials: G
authors.lastname: Schultz
authors.affiliation: South West Healthcare, Warrnambool, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Swanson
authors.affiliation: Southwest Regional Wound Care Centre, Lubbock Texas, US.
authors.forename: R D
authors.initials: RD
authors.lastname: Wolcott
mesh_terms: D018441:Biofilms; D002908:Chronic Disease / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D014945:Wound Healing
keywords: biofilm; infection; non-healing; systematic review; wound healing