Kadam Snehal, Shai Saptarsi, Shahane Aditi, Kaushik Karishma S
Ramalingaswami Re-entry Fellowship, Department of Biotechnology, Pune 411045, India.
Poona College of Pharmacy, Bharati Vidyapeeth Deemed (to be) University, Erandwane, Pune 411038, India.
Biomedicines. 2019 Apr 30;7(2):35. doi: 10.3390/biomedicines7020035.
Chronic wounds are a major healthcare burden, with huge public health and economic impact. Microbial infections are the single most important cause of chronic, non-healing wounds. Chronic wound infections typically form biofilms, which are notoriously recalcitrant to conventional antibiotics. This prompts the need for alternative or adjunct 'anti-biofilm' approaches, notably those that account for the unique chronic wound biofilm microenvironment. In this review, we discuss the recent advances in non-conventional antimicrobial approaches for chronic wound biofilms, looking beyond standard antibiotic therapies. These non-conventional strategies are discussed under three groups. The first group focuses on treatment approaches that directly kill or inhibit microbes in chronic wound biofilms, using mechanisms or delivery strategies distinct from antibiotics. The second group discusses antimicrobial approaches that modify the biological, chemical or biophysical parameters in the chronic wound microenvironment, which in turn enables the disruption and removal of biofilms. Finally, therapeutic approaches that affect both, biofilm bacteria and microenvironment factors, are discussed. Understanding the advantages and limitations of these recent approaches, their stage of development and role in biofilm management, could lead to new treatment paradigms for chronic wound infections. Towards this end, we discuss the possibility that non-conventional antimicrobial therapeutics and targets could expose the 'chink in the armor' of chronic wound biofilms, thereby providing much-needed alternative or adjunct strategies for wound infection management.
慢性伤口是一项重大的医疗负担，对公共卫生和经济有着巨大影响。微生物感染是慢性难愈合伤口的最重要单一原因。慢性伤口感染通常会形成生物膜，而传统抗生素对生物膜的治疗效果 notoriously recalcitrant 。这促使人们需要替代或辅助的“抗生物膜”方法，尤其是那些考虑到慢性伤口生物膜独特微环境的方法。在本综述中，我们讨论了针对慢性伤口生物膜的非常规抗菌方法的最新进展，超越了标准抗生素疗法。这些非常规策略分为三类进行讨论。第一类重点关注直接杀死或抑制慢性伤口生物膜中微生物的治疗方法，其使用的机制或递送策略不同于抗生素。第二类讨论了改变慢性伤口微环境中的生物学、化学或生物物理参数的抗菌方法，这反过来又能破坏和清除生物膜。最后，讨论了同时影响生物膜细菌和微环境因素的治疗方法。了解这些最新方法的优点和局限性、它们的发展阶段以及在生物膜管理中的作用，可能会带来慢性伤口感染的新治疗模式。为此，我们讨论了非常规抗菌疗法和靶点可能揭示慢性伤口生物膜“弱点”的可能性，从而为伤口感染管理提供急需的替代或辅助策略。
