Consensus guidelines for the identification and treatment of biofilms in chronic non-healing wounds
Consensus guidelines for the identification and treatment of biofilms in chronic non-healing wounds
Background: Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine.
Methods: A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic non-healing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic non-healing wounds. Final consensus statements were agreed on in a face-to-face meeting.
Results: Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening anti-biofilm agents; and levels of evidence when choosing anti-biofilm treatments.
Conclusion: This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic non-healing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements.
Biofilm, infection, chronic wounds, therapeutic strategies, consensus guidelines, clinical indicators, antiseptics, antibiotics
Schultz, Gregory
22354860-85ad-4184-8224-51674784b311
Bjarnsholt, Thomas
b9b074bb-4cd1-4523-bf46-effdf5786b84
James, Garth A.
0768f272-b064-47cc-b69b-d760f83e73fa
Leaper, David J.
de467550-ab56-4a7b-ba85-387b5cd5b9fd
McBain, Andrew J.
11651ba2-2296-441e-80e7-b00ca486d765
Malone, Matthew
4743c7e3-de3c-4735-9409-c92846b5b0ee
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f
Swanson, Terry
27d7606e-b475-44b6-b725-f366f1735438
Tachi, Masahiro
3d62e0f0-31d5-4f40-b467-2bade2318436
Wollcott, Randall D.
389b3ff1-7c3b-42d9-b03d-3012ac35aa6d
Schultz, Gregory
22354860-85ad-4184-8224-51674784b311
Bjarnsholt, Thomas
b9b074bb-4cd1-4523-bf46-effdf5786b84
James, Garth A.
0768f272-b064-47cc-b69b-d760f83e73fa
Leaper, David J.
de467550-ab56-4a7b-ba85-387b5cd5b9fd
McBain, Andrew J.
11651ba2-2296-441e-80e7-b00ca486d765
Malone, Matthew
4743c7e3-de3c-4735-9409-c92846b5b0ee
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f
Swanson, Terry
27d7606e-b475-44b6-b725-f366f1735438
Tachi, Masahiro
3d62e0f0-31d5-4f40-b467-2bade2318436
Wollcott, Randall D.
389b3ff1-7c3b-42d9-b03d-3012ac35aa6d
Schultz, Gregory, Bjarnsholt, Thomas, James, Garth A., Leaper, David J., McBain, Andrew J., Malone, Matthew, Stoodley, Paul, Swanson, Terry, Tachi, Masahiro and Wollcott, Randall D.
(2017)
Consensus guidelines for the identification and treatment of biofilms in chronic non-healing wounds.
Wound Repair and Regeneration, 25 (5).
(doi:10.1111/wrr.12590).
Abstract
Background: Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine.
Methods: A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic non-healing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic non-healing wounds. Final consensus statements were agreed on in a face-to-face meeting.
Results: Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening anti-biofilm agents; and levels of evidence when choosing anti-biofilm treatments.
Conclusion: This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic non-healing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements.
Text
Biofilms ms_30Aug17_Final
- Accepted Manuscript
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Accepted/In Press date: 11 September 2017
e-pub ahead of print date: 29 September 2017
Keywords:
Biofilm, infection, chronic wounds, therapeutic strategies, consensus guidelines, clinical indicators, antiseptics, antibiotics
Identifiers
Local EPrints ID: 414239
URI: http://eprints.soton.ac.uk/id/eprint/414239
ISSN: 1067-1927
PURE UUID: c338cc3a-2c49-46aa-b248-bdf2d7170b82
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Date deposited: 20 Sep 2017 16:31
Last modified: 16 Mar 2024 04:01
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Contributors
Author:
Gregory Schultz
Author:
Thomas Bjarnsholt
Author:
Garth A. James
Author:
David J. Leaper
Author:
Andrew J. McBain
Author:
Matthew Malone
Author:
Terry Swanson
Author:
Masahiro Tachi
Author:
Randall D. Wollcott
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