Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm

Abstract

Biofilms play a major role in delaying chronic wounds from healing. A wound infiltrated with biofilm, or “critically colonised” wound, may become clinically infected if the number of microbes exceeds a critical level. Chronic wound biofilms represent a significant treatment challenge by demonstrating recalcitrance towards antimicrobial agents. However, a “window of opportunity” may exist after wound debridement when biofilms are more susceptible to topical antiseptics. Here, we discuss the role of antiseptics in the management of chronic wounds and biofilm, focusing on povidone‐iodine (PVP‐I) in comparison with two commonly used antiseptics: polyhexanide (PHMB) and silver. This article is based on the literature reviewed during a focus group meeting on antiseptics in wound care and biofilm management, and on a PubMed search conducted in March 2020. Compared with PHMB and silver, PVP‐I has a broader spectrum of antimicrobial activity, potent antibiofilm efficacy, no acquired bacterial resistance or cross‐resistance, low cytotoxicity, good tolerability, and an ability to promote wound healing. PVP‐I represents a viable therapeutic option in wound care and biofilm management, with the potential to treat biofilm‐infiltrated, critically colonised wounds. We propose a practical algorithm to guide the management of chronic, non‐healing wounds due to critical colonisation or biofilm, using PVP‐I.

Bacteriophages and antibiotic interactions in clinical practice: what we have learned so far

“…It can also be the cause of many illnesses and infections in humans, such as oral diseases, native valve endocarditis, and a number of nosocomial infections [ 56 ]. Biofilms also play a role in the treatment delay of chronic wounds [ 57 ]. Biofilm formation is the first step to catheter-associated urinary tract infection (CAUTI) pathogenesis [ 58 ].…”

Nanoceutical Adjuvants as Wound Healing Material: Precepts and Prospects

“…Similarly, silver compounds in the form of solutions, creams, and ointments or nanocrystalline silver have long been used as antimicrobial agents. Their mechanical action is either through cell membrane lysis, the disruption of cellular protein and electron transport chains, or DNA levels by blocking transcription initiation [ 92 ]. The expediency of antiseptics on the skin surface, though they are fairly well-established and used, and their utilization as a prophylactic anti-infective agent for open wounds, remains a debatable and unexplored area in the present time.…”

Disclosure of a Promising Lead to Tackle Complicated Skin and Skin Structure Infections: Antimicrobial and Antibiofilm Actions of Peptide PP4-3.1

“…However, debridement often does not suffice to ensure complete eradication of the biofilms, and a complementary antibiotic treatment is needed. As such, after debridement, there is a "window of opportunity" where topically applied antiseptics could have crucial action in avoiding recurrence of the infection [8][9][10]. In parallel, timely application of adequate topical formulations could further contribute to prepare the wound bed for fast and correct healing.…”