Patel M*, Polanco T, Yang KC, Goss S, Alcantara S and Lantis II JC
Department of Vascular Surgery, Icahn School of Medicine at Mount Sinai, USAFulltext PDF
Introduction: It has been speculated that bacteria colonizing chronic wounds exist as persistent biofilms and characterized microorganisms. Their presence is often thought to contribute to the poor healing that is seen in clinical practice. Treating infection and reducing microbial colonization with sharp debridement has been the standard of treatment. However, little empiric evidence exists to support these assumptions.
Methods: We combined data points from three separate studies looking at clinically critically colonized wounds; analysing the actual prevalence of biofilm and planktonic bacteria; and the effects of debridement and secondary treatment on this microbiome, over a four week period. Weekly biopsies from 50 subjects were performed to test for quantitative planktonic and biofilm bacteria.
Results: A total of 190 wound biopsies were performed, 90% had identifiable planktonic and 59% had identifiable biofilm bacteria. All biopsies had a diverse polymicrobial community. The most prominent microorganism in planktonic group was streptococcus and anaerobic (96%), and streptococcus (68%) in biofilm biopsies. We found a significant decrease in both planktonic and biofilm protected bacteria with sharp debridement (p=0.03 and p<0.05, respectively). Secondary dressing type did not impact the rate of bacterial growth significantly.
Conclusion: Serial debridement with secondary dressing is an effective way to reduce wound bioburden. While identifying bacteria has technical difficulties at times, we believe this to be one of the largest human samplings to date; it gives us an idea that not all chronic lower extremity wounds have a biofilm present. In addition we see the limited effects some therapies have on the microbes.
Patel M, Polanco T, Yang KC, Goss S, Alcantara S Lantis II JC. The Effects of Debridement and Secondary Dressing on Planktonic and Biofilm Protected Bacteria: An Analysis of 3 Studies. World J Vasc Surg. 2018; 1(2): 1015.