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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:


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


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].


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.