Nanocoatings for Chronic Wound Repair—Modulation of Microbial Colonization and Biofilm Formation

Abstract

Wound healing involves a complex interaction between immunity and other natural host processes, and to succeed it requires a well-defined cascade of events. Chronic wound infections can be mono- or polymicrobial but their major characteristic is their ability to develop a biofilm. A biofilm reduces the effectiveness of treatment and increases resistance. A biofilm is an ecosystem on its own, enabling the bacteria and the host to establish different social interactions, such as competition or cooperation. With an increasing incidence of chronic wounds and, implicitly, of chronic biofilm infections, there is a need for alternative therapeutic agents. Nanotechnology shows promising openings, either by the intrinsic antimicrobial properties of nanoparticles or their function as drug carriers. Nanoparticles and nanostructured coatings can be active at low concentrations toward a large variety of infectious agents; thus, they are unlikely to elicit emergence of resistance. Nanoparticles might contribute to the modulation of microbial colonization and biofilm formation in wounds. This comprehensive review comprises the pathogenesis of chronic wounds, the role of chronic wound colonization and infection in the healing process, the conventional and alternative topical therapeutic approaches designed to combat infection and stimulate healing, as well as revolutionizing therapies such as nanotechnology-based wound healing approaches.

Efficacy of Using Probiotics with Antagonistic Activity against Pathogens of Wound Infections: An Integrative Review of Literature

“…e skin is an important organ that represents the first line of defence against the external environment. Its main functions are to provide mechanical strength, regulate water and salt loss and protect the body from environmental damage, including that caused by microorganisms [13,14]. Despite its tough physical characteristics, particularly in desiccated, nutrient-poor, acidic conditions, the skin is colonized by beneficial microorganisms that serve as an additional biophysical barrier to prevent the invasion of pathogens.…”

“…Skin damage can be caused by a variety of different reasons such as trauma (including cuts, abrasions, chemical burns, fire burns, cold, heat, radiation, surgery), or as a consequence of underlying illnesses such as diabetes. e most effective wound management strategy is to prevent infections, promote healing, and prevent excess scarring [14]. e wound classification system categorizes all surgeries into four groups: clean, clean/contaminated, contaminated, and dirty [20].…”

“…Surgical site infections are currently one of the frequent types of nosocomial infections [21]. Chronically infected wounds, such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds delay wound healing, have a significant impact on the patients' quality of life, represent a significant cause of morbidity and mortality, and result in enormous healthcare expenditures [14,[22][23][24]. Wound infections are most often caused by biofilm-forming bacteria such as Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Peptostreptococcus spp., etc., [25][26][27][28][29][30][31][32].…”

“…Biofilms are adherent communities of microorganisms that secrete a biochemical and physical matrix for protection, support, and survival; this matrix is a semipermeable barrier that limits diffusion of molecules that might otherwise gain access to planktonic microbes, such as quorum-sensing molecules and antibiotics. Biofilms impact chronic wound healing by delaying the inflammatory and maturation phases [14]. Different microbes are present during the beginning of a wound infection at neutral pH and after the wound becomes chronic when the pH becomes more alkaline and anaerobes are more likely to be present; causative agents of infections also differ according to wound type [26,33].…”

“…Some experts claim that topical use of antibiotics or other medication is very important for the treatment of infected wounds (especially burns and chronic wounds) because the active substances of systemic antibiotics often do not reach the site of infection in sufficient quantities, namely, intravenous dosing of antibiotics is not as effective due to the reduction of microcirculation in the burned skin and the failure to eradicate biofilm infections. However, there are publications that state that topical use of antibiotics could more likely lead to the development of resistance than use of systemic antibiotics [14,35]. Since it seems that antimicrobial resistance is transmitted even more frequently by topical application of antibiotics, the use of alternatives is imperative.…”