Our next topic for discussion within these bulletins will be the subject of biofilms. Although the term ‘biofilm’ was only coined in the 1970s, the phenomenon of microbes existing together in colonies that adhere to a surface has been recognized for decades. In 1940, Heukelekian and Heller wrote in the Journal of Bacteriology, ‘Surfaces enable bacteria to develop in substances otherwise too dilute for growth. Development takes place either as bacterial slime or colonial growth attached to surfaces’.1
What a Biofilim Is
We now understand a biofilm to be a community of microorganisms that attach to the wound surface encasing themselves in an extracellular polysaccharide matrix. This matrix allows microbes to survive in conditions that would otherwise be unfavorable, and help protect the microbes from antiseptics, antimicrobials and other hostile environments.2 Biofilms may form on living or non-living surfaces and can be prevalent in natural, industrial and hospital settings.
In terms of wound care, biofilms can often be found on devitalized tissue and implanted devices such as catheters.2 Because biofilms are formed from multiple types of microbe, they can actually function synergistically, with the presence of oxygen-consuming bacteria encouraging the growth of anaerobic organisms, and vice versa. Furthermore, biofilms are thought to be 50 to 100 times more resistant to antimicrobials than free living bacteria. Interestingly, if an individual microbe breaks away from the biofilm, it appears to retain its enhanced resistance to antimicrobials.2
While the absolute quantity of microbes within a biofilm may not be technically sufficient to constitute an infection, the presence of a biofilm should, in fact, be viewed as a specific type of bacterial infection which has an extreme and adverse effect on wound healing.
Next week we will look at the molecular processes underlying the formation of biofilms, while the following week will be devoted to strategies to mitigate the effects of biofilms in wound healing.
Biofilms are a complex phenomena, all aspects of which are not yet fully understood. One way to learn more about this interesting and problematic issue in wound management is to pursue additional vocational and professional training.
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- Heukelekian H and Heller A. Relation between food concentration and surface for bacterial growth. J Bacteriol 1940; 40(4): 547-558.
- Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
- Chen Li and Wen Y-m. The role of bacterial biofilm in persistent infections and control strategies. Int J Oral Sci. 2011; 3:66-73.