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Biofilm can be defined as micro­bial cells adherent to a living or non-living surface, which are embed­ded within a self-produ­ced matrix of extra-cellu­lar polyme­ric substan­ces (EPS). Biofilm provi­des tolerance to antimi­cro­bial agents and can result in persis­tent inflamma­tion and infec­tion. [1,2]

Biofilm is a huge problem:

  • It’s present in at least 78 % of chronic wounds [3].
  • It’s diffi­cult to eradicate.
  • It delays wound healing [4,5].

Biofilm opera­tes in a wound in three diffe­rent modes:

1. DEFENCE MODE

EPS shields micro-organisms from antibio­tics, antisep­tics and the host’s immune response.[2] This biofilm-speci­fic defence and the inabi­lity to breach the EPS matrix contri­bu­tes to a chronic inflamma­tory state in the wound environ­ment. 1

2. RECOVERY MODE

Biofilm is diffi­cult to remove comple­tely as it is attached to the wound bed. Biofilm can reform in as little as 24h, even following aggres­sive debri­de­ment [6]. To prevent biofilm refor­ma­tion, effec­tive long-lasting antimi­cro­bial protec­tion is needed [6].

3. ATTACK MODE

Biofilm can spread and form new colonies by constantly releasing micro-organisms from the mature biofilm struc­ture [7]. This can incre­ase the risk of cross-infec­tion both within the wound and in the surroun­ding environment.

[1] Gurjala AN et al. Develo­p­ment of a novel, highly quanti­ta­tive in-vivo model for the study of biofilm-impai­red cutane­ous wound healing. Wound Rep Reg (2011) 19 400–410.
[2] Hall-Stood­ley LI et al. Towards diagnostic guide­li­nes for biofilm-associa­ted infec­tions. FEMS Immunol Med Micro­biol. 2012; 65:127–145.
[3] Malone M et al. 2017. The preva­lence of biofilm in chronic wounds: a syste­ma­tic review and meta-analy­sis of publis­hed data. JWC; 20–25.
[4] Hurlow, J., Couch, K., Laforet, K., Bolton, L., Metcalf, D. et al. (2015). Clini­cal Biofilms: A Challen­ging Frontier in Wound Care. Advan­ces in Wound Care, 4(5). 295–301.
[5] Metcalf, Bowler. Biofilm delays would healing: a review of the evidence. Burns Trauma 2013; 1: 5–12.
[6] Wolcott RD et al. Biofilm maturity studies indicate sharp debri­de­ment opens a time depen­dent thera­peu­tic window. J Wound Care. 2010; 19: 320–328.
[7] Coster­ton JW, Stewart PS, Green­berg EP. Bacte­rial Biofilms: A Common Cause of Persis­tent Infec­tions. 1999: 284 Science.