Larval Therapy and Larval Excretions/Secretions: A Potential Treatment for Biofilm in Chronic Wounds? A Systematic Review

Abstract

Chronic wounds present a global healthcare challenge and are increasing in prevalence, with bacterial biofilms being the primary roadblock to healing in most cases. A systematic review of the to-date knowledge on larval therapy’s interaction with chronic-wound biofilm is presented here. The findings detail how larval therapy—the controlled application of necrophagous blowfly larvae—acts on biofilms produced by chronic-wound-relevant bacteria through their principle pharmacological mode of action: the secretion and excretion of biologically active substances into the wound bed. A total of 12 inclusion-criteria-meeting publications were identified following the application of a PRISMA-guided methodology for a systematic review. The findings of these publications were qualitatively analyzed to provide a summary of the prevailing understanding of larval therapy’s effects on bacterial biofilm. A further review assessed the quality of the existing evidence to identify knowledge gaps and suggest ways these may be bridged. In summary, larval therapy has a seemingly unarguable ability to inhibit and degrade bacterial biofilms associated with impaired wound healing. However, further research is needed to clarify and standardize the methodological approach in this area of investigation. Such research may lead to the clinical application of larval therapy or derivative treatments for the management of chronic-wound biofilms and improve patient healing outcomes at a time when alternative therapies are desperately needed.

Variables Associated with Attitudes toward Biodebridement Using Lucilia sericata Larvae in a Group of Nurses

“…Even if new drugs are developed without changing behavior, antibiotic resistance will still remain one of the main threats in medicine [25]. The implementation of MDT into clinical practice (2004) provides opportunities not only for wound debridement but also for the elimination of many microorganisms, including those that are multidrug-resistant [12,15,26]. However, despite scientific reports documenting the efficacy and safety of MDT, the adoption of this therapy into common clinical practice has been slow [8,10].…”

“…Despite many studies demonstrating its efficacy and safety as well as recommendations from wound care experts and organizations [12,14,15], MDT remains scarce in clinical practice. There are several factors that may contribute to the reluctance of staff (doctors, nurses) and patients to accept maggot debridement therapy.…”

Pushing the Frontiers in the Fight Against Antimicrobial Resistance: The Potential of Fecal and Maggot Therapies

“…Biofilms are complex assemblies of microbial communities shielded within a self-generated matrix, rendering them resilient to traditional antimicrobial interventions [ 39 ]. In addition to their inherent phenotypic recalcitrance to traditional antibiotics, biofilms provide environments that foster and fuel AMR [ 40 ]. Biofilms enable exposure to subinhibitory concentrations of antibiotics coupled with high cell densities, increased genetic competence and the accumulation of genetic elements or uptake of resistance genes.…”

“…Horizontal transfer of resistance genes via conjugation is the sole mechanism identified for biofilm-mediated resistance-gene acquisition, with several studies showing it to be more efficient in bacterial biofilms as compared with planktonic cells [ 39 ]. MDT addresses this resistance through the active degradation of the biofilm structure, facilitated by enzymes such as proteases and lipases secreted by the larvae [ 40 ]. Coupled with the mechanical disruption caused by the larvae, the underlying bacteria are exposed and rendered more vulnerable to antimicrobial treatments [ 40 ].…”

“…MDT addresses this resistance through the active degradation of the biofilm structure, facilitated by enzymes such as proteases and lipases secreted by the larvae [ 40 ]. Coupled with the mechanical disruption caused by the larvae, the underlying bacteria are exposed and rendered more vulnerable to antimicrobial treatments [ 40 ]. This distinctive, dual-action approach enhances the efficacy of existing therapies and illuminates new pathways to subvert the intricate mechanisms of resistance, positioning MDT as a vital component in the multifaceted battle against AMR.…”