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Biofilm Based Wound Care

Biofilm Based Wound Care. Planktonic vs Biofilm. Overview. Medical Biofilms. Wound Biofilm. Bioburden. Biochemical Impairment of Chronic Wounds. Elevated proinflammatory cytokines Elevated proteinase activity – MMPs Diminished activity of growth factors Degraded receptor sites.

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Biofilm Based Wound Care

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  1. Biofilm Based Wound Care

  2. Planktonic vs Biofilm

  3. Overview

  4. Medical Biofilms

  5. Wound Biofilm

  6. Bioburden

  7. Biochemical Impairment of Chronic Wounds • Elevated proinflammatory cytokines • Elevated proteinase activity – MMPs • Diminished activity of growth factors • Degraded receptor sites

  8. Excessive Neutrophils Diegelmann RF Wound Repair Regen Vol 11 2003

  9. Biofilm and Inflammation Costerton and Stewart Science Vol 284, 1999

  10. Biofilm Defenses

  11. Host Defenses Lam, JS Infect Immun Vol 42, 1983

  12. Host Defenses Leid, JG Infect Immun Vol 70, 2002

  13. Antibiotic Resistance • MRSA, MDRPA, VRE • Biofilm • Vanc vs Staph biofilm >1000x • Tobra vs Pseudomonas biofilm

  14. Biocides vs. Biofilm • Dakins • Peroxide • Acetic Acid Costerton Sci Am Vol 285, 2001

  15. Acute vs. Chronic Wound

  16. For every mistake for not knowing ten are made for not looking

  17. Chronic Wound

  18. Acute Wound

  19. Common Pathogens in SSSIs: SENTRY United States and Canada, 2000 N=1404 Staphylococcusaureus MSSA, 32% Coagulase- negative Staphylococcus, 3% MRSA, 14% Pseudomonas aeruginosa, 11% Pull off chart Enterococcus spp, 8% Other, 30% β-Hemolytic MRSA=methicillin-resistant S aureus. MSSA=methicillin-susceptible S aureus. streptococci, 2% Rennie RP et al. Diagn Microbiol Infect Dis. 2003;45:287-293.

  20. Molecular Studies

  21. Cystic Fibrosis • Pseudomonas • Burkholderia • Staphylococcus • 121 unique organisms • 25% ~ 1/3 dominant • 50% ~ 2/3 dominant Harris PNAS Vol 104 2007

  22. 454 Data

  23. Ecology of Wounds * Not cultured

  24. Proof of Principle results

  25. Anaerobes

  26. Slough

  27. Treating Biofilm

  28. Sharp Debridement • Frequently • New Wound Bed • Biofilms

  29. Wet to Dry Dressings • 78% of Physicians • Cost more • Painful • No margin of safety • Detrimental…

  30. Do No Harm

  31. Think Outside the Box

  32. Antibiofilm Agents • Short Term • Lactoferrin • Xylitol • Gallium • Farnasol • Deferoxamine • EDTA • Dispersin B • Fatty Acid Gel • Nitric Oxide • Long Term • Quorum Sensing Inhibitor • RNA III Inhibitory Peptide • Furanones • Autoinducer D Davies et al. Science. 1998 Apr 10; 280(5361): 295-8.

  33. Biofilm Based Wound Care • Debridement- Frequent and aggressive • Selective biocides • Silver, Iodosorb, Hydrofera Blue • Antibiofilm Agents • Lactoferrin, Xylitol, Farnasol • Plant Products, Fatty Acid Gel • Antibiotics • Adjunct • Strong and long Multiple Concurrent Strategies

  34. Biofilm Based Wound Care www.woundcarecenter.net

  35. Critical Limb Ischemia Lubbock 0% Kalani 15% Fife 65% www.woundcarehospital.com

  36. The Biofilm Surprise

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