Infections

Dear Sir,

Healy B, Freedman A. ABC OF WOUND HEALING. Infections. BMJ Vol 332 8
Apr. 2006 p.838-841

I have read with great interest this summary article on wound
infection, but I
am deeply concerned to see that there is no mention of ‘biofilm’. A
‘Google’
search today for ‘Biofilm in Chronic Wounds’ reveals over 33,000 sites, a
number of which reveal the importance that the study of chronic wound
biofilm production, and its management, now holds in chronic wound care.

Biofilm formation in nature is ubiquitous, and is fine tuned to
resist adverse
environments. If it is true that even a small proportion of biofilm in
chronic
wounds is resistant to invasion by the host defensive cells, antibodies
and
antibiotics (whether topical or systemic), then laboratory research and
clinical
focussing must be directed to the better understanding of the biology of
these biofilms, and their eradication (1 – 3)

Maggot Débridement Therapy (MDT) has a number of beneficial effects
in
open wounds and ulcers, including the apparent digestion of established
biofilm, and suppression of its formation (4).

If active agents, such as the spectrum of enzymes exhibited in some
maggot
exo-secretions, could be identified, purified and used clinically as
topical
agents, this would be a major breakthrough in wound care. Further, if
such
agents could also be selectively used systemically, then this would give
us the
prospect that biofilm could be destroyed in situ, wherever it might form,
notably on the surface of surgically implanted devices, such as joint
replacements, heart valves, and pacemakers. This would then considerably
reduce the necessity for ‘salvage’ surgery, which currently demands the
exploration of the infected implant, its removal and excision of all
infected
material, and, where possible, the later replacement of the device.

Yours faithfully,

John C T Church MD FRCSE

Refs.

(1) Mertz PM. Feature: Cutaneous Biofilms: Friend or Foe. Wounds –
ISSN.
2003 May;15(5):129-132

(2) Edwards R, Harding KG. Bacteria and Wound Healing. Current Opin
Infect
Dis. 2004 Apr;17(2):91-6

(3) Percival SL, Bowler PG. Feature: Biofilms and Their Potential
Role in Wound
Healing. Wounds – ISSN. 2004 July; 16(7):234-240

(4) Chambers I, Woodrow S, Brown AP, Harris PD, Phillips D, Hall M,
Church
JCT, Pritchard DI. Degradation of extracellular matrix components by
defined
proteinases from the greenbottle larva Lucilia sericata used for the
clinical
debridement of non-healing wounds. British Journal of Dermatology
2003;148:14-23

Competing interests:
None declared