Biofilm

The biofilm barrier

Biofilm is a cluster of attached bacteria embedded in a matrix of proteins and sugars which offers protection from host defences and antimicrobials.¹

Biofilm is difficult to identify as it is invisible to the naked eye, non-uniformly distributed across the wound12 and often present in deeper tissues.13,14

Biofilm is thought to be present in up to 78% of all chronic wounds¹⁵ and is thought to be  directly linked to delayed healing^16-18

Learn more about biofilm

References

1. Burmølle, M. et al., FEMS Immunol. Med. Microbiol. 59,(2010);
2. Stoodley, P et al. Annu. Rev. Microbiol. (2002); 56: 187–209;
3. Flemming HC et al. Nature Rev Microb. (2010); 8,623-633;
4. Phillips P, et al. Int Wound J. 2013:1-15;
5. Wolcott, R. D. et al. J. Wound Care. 2010 .19, 320–8;
6. Stewart PS & Costerton JW. 2001. Lancet (London, England) 358, 135–8;
7. Jesaitis AJ, et al. 2003. J. Immunol. 171, 4329–4339;
8. Bjarnsholt, T. et al. Microbiology 2005. 151, 373–383;
9. Cochrane, DM, et al. 1998. J. Med. Microbiol. 27, 255–61;
10. Bjarnsholt T et al. Wound Repair Regen (2008); 16: 2–10;
11. Costerton, J. W. et al. Science 284, 1318–22 (1999);
12. Thomsen T. R. et al.l Wound Rep Reg 18 38–49,(2010);
13. Kirketerp-Møller, K. et al. J. Clin. Microbiol. 46, 2717–22 (2008);
14. Fazli, M. et al. J. Clin. Microbiol. (2009). 47, 4084–9.
15. Malone, M. et al. J. Wound Care 25,12, 20–25 (2016);
16. Roche ED, et al. Wound Repair Regen 2012; 20: 537–43.
17. Schierle CF, et al. Wound Repair Regen. 2009;17: 354–9.
18. Zhao G. et al. Wound Repair 2012; 20: 342–352

Despite the best care some wounds struggle to heal

Biofilm is thought to be present in up to 78% of all chronic wounds¹ and is thought to be  directly linked to delayed healing^2-4

• Biofilms are difficult to treat as they provide tolerance to antimicrobial treatments^5-7 and the host immune response^8-10
• Periodic release of motile bacteria from colonies can result in recurrent infections¹¹

Detection is difficult since classic signs of infection may not be present, but indirect signs and symptoms may include:

• Antimicrobial therapy failure^5-7
• Delayed wound healing^2-4
• Recurrent infections¹¹
• Chronic, low-level inflammation⁴

	24%* of patients with chronic wounds lived with their wound for at least 6 months, 16% have remained unhealed for a year or more12
	The patient care cost of a non-healing** wound was a mean 135% more than that of a healed wound13
	Biofilm is present in 78% of chronic wounds1 and believed to play a significant role in non-healing2-4
	Wounds that contain biofilm may not be identified, resulting in ineffective treatment and delayed healing2,3, 14
	Most topical antimicrobials fail to disrupt biofilm5,15
	*European data **non-healing wound defined as non-progression after 12 weeks

Why silver is not effective against biofilm Charged ions, such as silver or chlorides are more easily neutralised by the EPS matrix.16 Moreover the concentration of silver required to eradicate biofilm is estimated to be 10 to 100 times higher than that used to eradicate planktonic bacteria.15 Such concentrations are currently unavailable in any silver dressing.

References

1. Malone, M. et al. J. Wound Care 25,12, 20–25 (2016);
2. Roche ED, et al. Wound Repair Regen 2012; 20: 537–43.
3. Schierle CF, et al. Wound Repair Regen. 2009;17: 354–9.
4. Bjarnsholt T, et al. Wound Rep Reg. 2008;16:2-10 ;
5. Phillips P, et al. Int Wound J. 2013:1-15.
6. Wolcott, R. D. et al. J. Wound Care. 2010 .19, 320–8.
7. Stewart PS & Costerton JW. 2001. Lancet (London, England) 358, 135–8.
8. Jesaitis AJ, et al.. 2003. J. Immunol. 171, 4329–4339.
9. Bjarnsholt, T. et al. Microbiology 2005. 151, 373–383;
10. Cochrane, DM, et al. 1998. J. Med. Microbiol. 27, 255–61.
11. Costerton JW. Science. 1999;284:1318-1322.
12. Lindholm C, Searle R. Int Wound J. (2016) Jul;13 Suppl 2:5-15;
13. Guest JF et al; Int. Wound J. 14, 2 322-330. (2016);
14. Zhao G. et al. Wound Repair (2012); 20: 342–352;
15. Bjarnsholt et al. APMIS (2007).115: 921–8;
16. Stewart, P. S. et al. J. Appl. Microbiol. (2001). 91, 525–32

Biofilms are linked to delayed wound healing^1-3

Around 78% of chronic wounds contain a biofilm⁴. Biofilms are difficult to treat as they provide tolerance to antimicrobial treatments^5-7 and the host immune response^8-10

Superior efficacy against biofilm proven across different lab models^5,11-13

IODOSORB™ has a long history of effectiveness against biofilm with superior results compared to other topical antimicrobials such as PHMB, silver and povidone iodine.⁵

In line with the biofilm experts’ recommendations¹⁴ on selecting an effective anti-biofilm dressing, IODOSORB has been tested and shown to be more effective than AquacelTM Ag+ across five challenging and clinically relevant biofilm models.^11-13

Evidence: IODOSORB against biofilm

References

1.Roche ED, et al. Wound Repair Regen 2012; 20: 537–43;
2. Schierle CF, et al. Wound Repair Regen. 2009;17: 354–9;
3. Bjarnsholt T, et al. Wound Rep Reg. 2008;16:2-10;
4. Malone, M. et al. J. Wound Care 25,12, 20–25 (2016);
5. Phillips P, et al. Int Wound J. 2013:1-15;
6. Wolcott, R. D. et al. J. Wound Care. 2010 .19, 320–8;
7. Stewart PS & Costerton JW. 2001. Lancet (London, England) 358, 135–8;
8. Jesaitis AJ, et al. 2003. J. Immunol. 171, 4329–4339;
9. Bjarnsholt, T. et al. Microbiology 2005. 151, 373–383;
10. Cochrane, DM, et al. 1998. J. Med. Microbiol. 27, 255–61;
11.Fitzgerald, D. J. et al. Wound Repair Regen. 25: 13-24 (2016) ;
12. Schultz, G. & Yang. Poster presented at WUWHS Florence (2016);
13. Oates J.L. et al. Poster presented at SAWC, Atlanta.(2016);
14.Schultz et al. Wound Repair Regen (2017); approved article;
15. Malone, M. et al. J Antimicrob Chemother 2017; 00: 1–9;