Morris Daniel, Flores Micah, Harris Llinos, Gammon John, Nigam Yamni
Faculty of Medicine, Health, and Life Science, Swansea University, Swansea SA2 8PP, UK.
BioMonde, Bridgend CF31 3BG, UK.
Microorganisms. 2023 Feb 11;11(2):457. doi: 10.3390/microorganisms11020457.
Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy's interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy-the controlled application of necrophagous blowfly larvae-acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy's effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.
慢性伤口是一项全球性的医疗挑战，其患病率正在上升，在大多数情况下，细菌生物膜是伤口愈合的主要障碍。本文对迄今为止有关幼虫疗法与慢性伤口生物膜相互作用的知识进行了系统综述。研究结果详细阐述了幼虫疗法（即有控制地应用食腐绿头苍蝇幼虫）如何通过其主要药理作用方式——向伤口床分泌和排泄生物活性物质，作用于由慢性伤口相关细菌产生的生物膜。在应用PRISMA指导的系统综述方法后，共确定了12篇符合纳入标准的出版物。对这些出版物的研究结果进行了定性分析，以总结对幼虫疗法对细菌生物膜影响的普遍认识。进一步的综述评估了现有证据的质量，以识别知识空白，并提出弥合这些空白的方法。总之，幼虫疗法在抑制和降解与伤口愈合受损相关的细菌生物膜方面似乎具有无可争议的能力。然而，需要进一步研究来澄清和规范这一研究领域的方法。在急需替代疗法之际，此类研究可能会使幼虫疗法或其衍生治疗方法应用于慢性伤口生物膜的管理，改善患者的愈合效果。
