Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
Boston University School of Medicine, Boston, Massachusetts, USA.
Adv Wound Care (New Rochelle). 2021 Jan;10(1):13-23. doi: 10.1089/wound.2020.1193. Epub 2020 Jun 22.
Biofilms are small densely packed aggregations of microbes that are highly resistant to host immune responses and treatment. They attach to each other and to nearby surfaces. Biofilms are difficult to study and identify in a clinical setting as their quantification necessitates the use of advanced microscopy techniques such as confocal laser scanning microscopy. Nonetheless, it is likely that biofilms contribute to the pathophysiology of chronic skin wounds. Reducing, removing, or preventing biofilms is thus a logical approach to help clinicians heal chronic wounds. Wound care products have demonstrated varying degrees of efficacy in destroying biofilms in and preclinical models, as well as in some clinical studies. Controlled studies exploring the beneficial role of biofilm eradication and its relationship to healing in patients with chronic wounds are limited. This review aims to discuss the mode of action and clinical significance of currently available antibiofilm products, including surfactants, dressings, and others, with a focus on levels of evidence for efficacy in disrupting biofilms and ability to improve wound healing outcomes. Few available products have good evidence to support antibiofilm activity and wound healing benefits. Novel therapeutic strategies are on the horizon. More high-quality clinical studies are needed. The development of noninvasive techniques to quantify biofilms will facilitate increased ease of research about biofilms in wounds and how to combat them.
生物膜是微生物高度密集聚集的小区域，对宿主免疫反应和治疗具有很强的抵抗力。它们彼此附着，并附着在附近的表面上。生物膜在临床环境中难以研究和识别，因为它们的定量需要使用先进的显微镜技术，如共聚焦激光扫描显微镜。尽管如此，生物膜很可能是慢性皮肤伤口病理生理学的原因之一。因此，减少、去除或预防生物膜是帮助临床医生治愈慢性伤口的一种合理方法。在体内和临床前模型中，以及在一些临床研究中，伤口护理产品已经证明了在破坏生物膜方面具有不同程度的疗效。然而，探索生物膜清除的有益作用及其与慢性伤口患者愈合的关系的对照研究非常有限。本综述旨在讨论目前可用的抗生物膜产品（包括表面活性剂、敷料和其他产品）的作用模式和临床意义，重点是在破坏生物膜方面的疗效证据水平和改善伤口愈合结果的能力。目前很少有产品有充分的证据支持抗生物膜活性和伤口愈合益处。新的治疗策略即将出现。需要更多高质量的临床研究。开发非侵入性技术来定量生物膜将有助于更轻松地研究伤口中的生物膜以及如何对抗它们。
