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Biofilms and Chronic Wounds: Pathogenesis and Treatment Options

Summary

Chronic wounds, such as diabetic foot ulcers and burn injuries, are often complicated by bacterial and fungal biofilms—protective communities of microorganisms that resist antibiotics and delay healing. This review summarizes how biofilms form, why they are difficult to treat with standard approaches, and discusses new therapeutic strategies. While debridement and antiseptics remain important, combining them with novel treatments like bacteriophages, enzyme therapies, and nanotechnology offers better chances for healing these stubborn wounds.

Background

Chronic wounds affect 2% of the US population and are a significant healthcare challenge. Biofilms are structured microbial communities encased in extracellular polymeric substances that are present in up to 60% of chronic wounds. These biofilms confer antimicrobial resistance, promote inflammation, and protect pathogens from host defenses, making eradication difficult with standard therapies.

Objective

This review examined the role of biofilms in chronic wounds, diabetic foot ulcers (DFUs), and burn injuries, as well as conventional and emerging treatment strategies. The goal was to synthesize current understanding of biofilm formation and discuss established and emerging strategies aimed at disrupting biofilm-associated infections.

Results

Biofilms are implicated in up to 60% of chronic wounds and more than 50% of burn wounds. In DFUs, both bacterial and fungal biofilms contribute to chronicity, with P. aeruginosa and E. coli being common. Conventional treatments like debridement and antiseptics reduce surface biofilm burden but rarely achieve full eradication. Emerging approaches including quorum sensing inhibitors, bacteriophage therapy, matrix-degrading enzymes, electroceutical dressings, and nanotechnology show promise when integrated with standard wound care.

Conclusion

Biofilms are central to the pathogenesis of chronic wounds, DFUs, and burn injuries. While conventional therapies remain essential, integrating mechanism-based antibiofilm therapies with standard care represents a key research priority. Future progress depends on standardized biofilm models, deeper understanding of fungal-bacterial interactions, and translational studies evaluating multimodal antibiofilm approaches.
  • Published in:Journal of Clinical Medicine,
  • Study Type:Literature Review,
  • Source: PMID: 41227178, DOI: 10.3390/jcm14217784
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