Investigating the potential of clinical signs and symptoms for indicating the presence of biofilm in chronic wounds: Development of a methodological pathway

Introduction Chronic wounds are injuries to the skin that fail to proceed to closure through the healing processes of haemostasis, inflammation, proliferation and maturation/modelling. Failure of the healing pathway usually occurs because of comorbidities such as diabetes, venous insufficiency, or circumstances of adverse pressure on areas of the skin. Biofilms are an aggregate or community phenotype exhibited by bacterial cells that are ubiquitous in the environment. Aggregates are three dimensional, affixed to/associated with biotic/abiotic surfaces and surrounded by a self-produced extra cellular polymeric substance. Furthermore, the aggregates exhibit internal physiological gradients and are extremely resistant to adverse environmental circumstances including host immune responses and antimicrobial therapy. It is generally accepted that biofilms contribute to delayed healing of chronic wounds and there are interventions available to mitigate their adverse effects. However, evidence supporting these interventions is limited. Furthermore, identification of biofilm is challenging; techniques are not routine, are of limited ability or are still in early stages of development. These limits in terms of evidence to support interventions for treating and techniques for identifying biofilm give rise to concerns: if biofilm cannot be readily confirmed in a wound, how can it be known that it is there in the first place, if interventions have been effective and have removed/destroyed it, and if its removal/destruction truly benefits the wound. A means to address these concerns could be to create a predictive tool that is readily capable of indicating presence of biofilm in chronic wounds in a clinical setting. A Clinical Prediction Rule is a process by which the probability of a clinical condition or outcome is estimated based on the presence or absence of valid predictive factors or indicators which could comprise clinical signs, patient characteristics or investigative results. Clinical signs and symptoms are commonly used to confirm biofilm presence in chronic wounds and algorithms that incorporate them have been developed. However, there is little evidence to support their use in this fashion.

Funder

Irish Research Council
Health Research Board

Publisher

University of Galway

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CC BY-NC-ND

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University of Galway Theses (PhD Theses)