Biofilm-based wound care : the importance of debridement in biofilm treatment strategies

Emerging evidence from the last century on the behaviour of microorganisms in their natural environments (i.e. exploration of aquatic/marine environments) identified that microorganisms have a natural tendency to associate with surfaces, with each other, and prefer a sessile (stationary, slow growth) lifestyle (Geesey et al, 1978). A significant proportion of this work was conducted on environmental samples and has provided a platform for the contemporary medical models that we have come to understand as microbial biofilms. The concept of biofilms in human health and disease is now universally accepted in periodontal disease and dental caries (Marsh and Bradshaw, 1995), cystic fibrosis (Costerton, 2001; Bjarnsholt et al, 2009) and indwelling medical device infections (Donlan, 2001), Otitis media and other upper respiratory infections (Hall-Stoodley et al, 2006) and chronic wounds (James et al, 2008; Bjarnsholt et al, 2008; Malone et al, 2017a). Unlike planktonic counterparts, microorganisms in biofilm phenotypes demonstrate a remarkable tolerance to many forms of treatments. This presents a challenge to wound care clinicians dealing with chronic wounds complicated by biofilm. This article will focus on the treatment of wound biofilm that is supported by evidence-based practice.