Recent Advances in Non-Conventional Antimicrobial Approaches for Chronic Wound Biofilms: Have We Found the ‘Chink in the Armor’?
Abstract
:1. Introduction
1.1. Chronic Wounds and Biofilms
1.2. The Chronic Wound Biofilm Microenvironment
1.3. Status Quorum in the Treatment of Chronic Wound Biofilms
2. Recent Advances in Non-Conventional Antimicrobial Approaches for Chronic Wound Biofilms
2.1. Antimicrobial Therapies that Directly Target Microbial Processes
2.1.1. Phage Therapy
2.1.2. Nano-Based Technologies
2.1.3. Blue Light Therapy
2.1.4. Quorum Sensing Inhibitors
2.2. Antimicrobial Therapies that Target the Chronic Wound Biofilm Microenvironment, Indirectly Affecting Microbial Growth and Survival
2.2.1. pH Modulation
2.2.2. Negative Pressure Wound Therapy
2.2.3. Hyperbaric Oxygen Therapy
2.2.4. Surfactants
2.2.5. Electrical and Electrochemical Approaches
2.3. Antimicrobial Therapies that Target Bacteria and the Chronic Wound Biofilm Microenvironment, Both Directly and Indirectly Impacting Microbial Growth and Survival
2.3.1. Probiotics
2.3.2. Mesenchymal Stem Cells
3. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Therapy | Advantages | Limitations | Current Status of the Therapeutic in Wound Infection Management | References |
---|---|---|---|---|
Antimicrobial therapies that directly target microbial processes | ||||
Phage therapy | -Highly-specificity for bacterial strains -High-density biofilms could enable -Efficient propagation of phage -Less likelihood of resistance development -Able to infect dormant cells and persister variants | -Maintaining phage viability in the delivery vehicle is a concern -Phage therapy to gain a foothold in infection management | -Several clinical trials conducted for usage and safety in burns and post-surgical infections | [34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54] |
Nano-based technologies | -A wide-range of formulations and combinations available -Physical parameters enable penetration into dense biofilm matrix -Can be coated onto dressings, bandages, sutures, drains -Reduced likelihood of resistance development | -Often effective only in combination with conventional antibiotics but not as stand-alone therapy | -Several commercial products based on nanomaterials available and in commercial use | [55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78] |
Blue light therapy | -Effective against a wide range of pathogens -Reduced likelihood of resistance development -Ease of administration -Observable adverse effects to host cells minimal -In use for skin ailments such as acne | -Less effective against Gram positive pathogens; important given the polymicrobial nature of wound biofilms | -In vivo preclinical evidence supporting its use -No reports of clinical trials for use in chronic wound biofilms | [79,80,81,82,83,84,85,86,87,88,89,90,91,92,93] |
Quorum sensing inhibitors | -Potential to prevent early stage biofilm formation -A wide-range of potential therapeutic molecules available | -Highly strain/species-specific -Toxicity to host cells -Efficacy in complex, in vivo models is reduced -Yet to gain a foothold in infection management | -In vivo preclinical evidence with mixed results -No reports of clinical trials for use in chronic wound biofilms | [94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114] |
Antimicrobial therapies that target the chronic wound biofilm microenvironment, indirectly affecting microbial growth and survival | ||||
Modulation of pH | -In principle, pH modifying agents are easy to administer onto the wound surface -Less likelihood of resistance development | -Fine-tuning pH in the wound bed is a difficult approach -pH variations have multiple effects on several factors -Effects of pH depend on wound-specific conditions; no universal strategy possible | -Largely in vitro evidence with varied results | [115,116,117,118,119,120,121,122,123] |
Negative Pressure Wound Therapy (NPWT) | -Standard of care in wound management -Almost no likelihood of resistance development -Well-suited for use in combination with antiseptic instillation | -Likely to be effective only in combination with conventional antiseptics but not as stand-alone therapy | -Already in use for wound care, can be leveraged to manage wound infections with more clinical studies and evidence-based practice | [124,125,126,127,128,129] |
Hyperbaric Oxygen Therapy (HBOT) | -Standard of care in wound management -Almost no likelihood of resistance development -Can have minimal adverse effects if delivered locally | -Cumbersome delivery mechanism; local delivery devices need to be evaluated -Likely to be effective only in combination with other therapies but not as stand-alone therapy | -Already in use for wound care, can be leveraged to manage wound infections with more clinical studies and evidence-based practice | [130,131,132,133,134,135,136,137,138] |
Surfactants | -Can be used to coat dressings, sutures, bandages -Less likelihood of resistance development | -Likely to be effective only in conjunction with antibiotics | -FDA approved surfactant polymer dressing available and in use | [139,140,141] |
Electrical and Electrochemical approaches | -Almost no likelihood of resistance development -Can be combined with other agents in wound dressings | -Likely to be effective only in combination with other therapeutics but not as stand-alone therapy -Mode of delivery may not convenient | -Few commercial products available | [142,143,144,145,146,147] |
Antimicrobial therapies that target bacteria and the chronic wound biofilm microenvironment, both directly and indirectly impacting microbial growth and survival | ||||
Probiotics | -An established mode of therapy for other medical conditions -Less toxicity and adverse effects likely -Less likelihood of resistance development | -Could be counterintuitive to administer bacteria to treat an infection, this notion has to be overcome -Mode of delivery needs to be developed | -Reasonable body of in vitro and in vivo evidence; no specific wound infection product available | [148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166] |
Mesenchymal stem cells | -Harness the ability of the innate immune system -Less likelihood of resistance development -Can be administered via bioengineered skin grafts or dressings | -Likely to be effective when combined with antibiotics -Ethical considerations (particularly for parenteral administration) | -In vivo preclinical evidence promising -Needs robust clinical evaluation to take it forward, approvals for which are likely to be rigorous | [167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182] |
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Kadam, S.; Shai, S.; Shahane, A.; Kaushik, K.S. Recent Advances in Non-Conventional Antimicrobial Approaches for Chronic Wound Biofilms: Have We Found the ‘Chink in the Armor’? Biomedicines 2019, 7, 35. https://doi.org/10.3390/biomedicines7020035
Kadam S, Shai S, Shahane A, Kaushik KS. Recent Advances in Non-Conventional Antimicrobial Approaches for Chronic Wound Biofilms: Have We Found the ‘Chink in the Armor’? Biomedicines. 2019; 7(2):35. https://doi.org/10.3390/biomedicines7020035
Chicago/Turabian StyleKadam, Snehal, Saptarsi Shai, Aditi Shahane, and Karishma S Kaushik. 2019. "Recent Advances in Non-Conventional Antimicrobial Approaches for Chronic Wound Biofilms: Have We Found the ‘Chink in the Armor’?" Biomedicines 7, no. 2: 35. https://doi.org/10.3390/biomedicines7020035