Position document: Management of biofilm

Antimicrobial and multi-drug resistance loom large on the global healthcare landscape, in particular in the treatment of chronic, hard-to-heal wounds where current figures put the presence of biofilm in 60%–100% of non-healing wounds. While the role that biofilm play in the chronicity of wounds is still in infancy, it is becoming widely accepted that hard-to-heal wounds contain biofilm — and that somehow their presence delays or prevents healing.

Management of biofilm in chronic wounds is rapidly becoming a primary objective of wound care. However management of biofilm is an undeniably complex task. Beyond the basic steps of initial prevention (use of anti-biofilm agents), removal (debridement, desloughing) and prevention of reformation (use of antimicrobial agents), there are myriad patient, environmental and clinical parameters that must be considered when identifying a tailored solution.

Detection and localisation of biofilms in chronic wounds provide useful clinical information that helps assess and direct the effectiveness of debridement. Yet gaps in the knowledge base remain in detecting and localising biofilm. While existing guidelines (e.g. ESCMID 2015) do offer direction in diagnosis and treatment of biofilm infection, questions remain unanswered, including whether there are visual signs that might be useful in deciding whether or not to take a biopsy.

As the debate around whether or not biofilm can be seen with the naked eye gathers pace and new techniques (e.g. Nagakami and colleagues’ ‘biofilm wound map’) come to light, there still reminas a critical need for a ‘point-of-care’ biofilm detector that can detect the presence of biofilm in minutes, not hours or days.

While significant progress has been made in prevention, detection and management of biofilm, more research is needed to reduce the impact on patients and on healthcare systems alike.

In this Position Document, leading clinicians look at the role biofilm plays in delayed wound healing; the management of biofilm in practice, and how research — existing and yet to come — will further understanding of these bacterial communities.

Supported by an educational grant from B Braun

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