biofilm based wound care
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Biofilm Based Wound Care. Planktonic vs Biofilm. Overview. Medical Biofilms. Wound Biofilm. Bioburden. Biochemical Impairment of Chronic Wounds. Elevated proinflammatory cytokines Elevated proteinase activity – MMPs Diminished activity of growth factors Degraded receptor sites. - PowerPoint PPT PresentationTRANSCRIPT
Biofilm Based Wound Care
Planktonic vs BiofilmPlanktonic vs Biofilm
OverviewOverview
Medical BiofilmsMedical Biofilms
Wound BiofilmWound Biofilm
BioburdenBioburden
Biochemical Impairment of Biochemical Impairment of Chronic WoundsChronic Wounds
Elevated proinflammatory cytokinesElevated proinflammatory cytokines
Elevated proteinase activity – MMPsElevated proteinase activity – MMPs
Diminished activity of growth factorsDiminished activity of growth factors
Degraded receptor sitesDegraded receptor sites
Excessive NeutrophilsExcessive Neutrophils
Diegelmann RF Wound Repair Regen Vol 11 2003
Biofilm and InflammationBiofilm and Inflammation
Costerton and Stewart Science Vol 284, 1999
Biofilm DefensesBiofilm Defenses
Host DefensesHost Defenses
Lam, JS Infect Immun Vol 42, 1983
Host DefensesHost Defenses
Leid, JG Infect Immun Vol 70, 2002
Antibiotic ResistanceAntibiotic Resistance MRSA, MDRPA, VREMRSA, MDRPA, VRE
BiofilmBiofilmVanc vs Staph biofilm Vanc vs Staph biofilm >1000x>1000x
Tobra vs Tobra vs Pseudomonas biofilmPseudomonas biofilm
Biocides vs. BiofilmBiocides vs. Biofilm
DakinsDakins
PeroxidePeroxide
Acetic AcidAcetic Acid
Costerton Sci Am Vol 285, 2001
Acute vs. Chronic Acute vs. Chronic WoundWound
For every mistake for not knowing ten are made for not For every mistake for not knowing ten are made for not lookinglooking
Chronic WoundChronic Wound
Acute WoundAcute Wound
Common Pathogens in SSSIs: Common Pathogens in SSSIs: SENTRY United States and Canada, 2000SENTRY United States and Canada, 2000
N=1404Staphylococcus aureus
Rennie RP et al. Diagn Microbiol Infect Dis. 2003;45:287-293.
Pull off chart
MRSA, 14%
MSSA, 32%
Other, 30%β-Hemolytic
streptococci, 2%
Coagulase-negative
Staphylococcus, 3%
Pseudomonas aeruginosa, 11%
Enterococcus spp, 8%
MRSA=methicillin-resistant S aureus.MSSA=methicillin-susceptible S aureus.
Molecular StudiesMolecular Studies
Gel LaneDistinct Bands
Bacteria cultured
Wound type
A 2 2Non-healing
surgical wound
B 1 0Venous leg
ulcerC 2 2 Calciphylaxis
D 5 2Venous leg
ulcer
E 6 3Diabetic foot
ulcer
F 1 2Venous leg
ulcer
G 11 3 Chronic wound
H 3 1Venous leg
ulcer
I 8 1Diabetic foot
ulcer
J 9 2Diabetic foot
ulcer
K 7 1 Decubitus ulcer
L 6 1Diabetic foot
ulcer
M 5 2Non-healing
surgical wound
Cystic FibrosisCystic Fibrosis
PseudomonasPseudomonas BurkholderiaBurkholderia StaphylococcusStaphylococcus
121 unique organisms121 unique organisms 25% ~ 1/3 dominant25% ~ 1/3 dominant 50% ~ 2/3 dominant 50% ~ 2/3 dominant
Harris PNAS Vol 104 2007
454 Data454 DataShana XXXX 14730 Hsp_evalue
Buttiauxella noackiae NSW11T 51607T); AJ293689 16.02 1.65E-139
Streptococcus dysgalactiae subsp. dysgalactiae ATCC 43078; AB002485 7.82 1.34E-134
Staphylococcus aureus CCM 7213; AY727530 7.03 7.00E-129
Enterococcus spp. 5.90 4.71E-136
Kluyvera georgiana ATCC 51603; AF047186 5.90 8.83E-139
Streptococcus pneumoniae 5.32 7.78E-136
Corynebacterium spp. 5.14 1.09E-128
Raoultella planticola ATCC 33531T; AF129443 5.11 1.99E-138
Peptoniphilus harei DSM 10020; SBH432; Y07839 4.60 2.24E-140
Cedecea davisae DSM 4568; AF493976 4.53 1.28E-137
Finegoldia magna ATCC15794; GIFU 7881; D14149 4.49 1.38E-128
Actinomyces europaeus CCUG 32789A; Y08828 3.26 2.36E-142
Streptococcus agalactiae ATCC 13813, NCTC 8181; AB002479 3.22 5.21E-137
Burkholderia spp. 2.81 2.25E-128
Delftia spp. 1.92 2.89E-134
Escherichia spp. 1.85 2.38E-140
Pseudomonas spp. 1.78 8.34E-132
Stenotrophomonas maltophilia ATCC 13637T; AB008509 1.23 6.43E-118
Yersinia intermedia ATCC 29909; AF366380 1.23 1.18E-133
Streptococcus anginosus NCTC 10713 X58309 1.17 1.98E-133
Achromobacter denitrificans DSM 30026, type strain; Y14907 1.06 6.39E-127
Peptoniphilus ivorii DSM 10022; SBH093; Y07840 1.03 3.11E-117
Peptostreptococcus spp. 1.03 2.05E-133
Ecology of WoundsEcology of Wounds
Acidovorax* Acidovorax* Enterococcus Enterococcus Peptoniphilus*Peptoniphilus*
Acinetobacter Acinetobacter Escherichia*Escherichia* Prevotella* Prevotella*
Actinomyces* Actinomyces* Eubacterium*Eubacterium* ProteusProteus
Alcaligenes* Alcaligenes* Ferrimonas* Ferrimonas* Pseudomonas Pseudomonas
Anaerococcus* Anaerococcus* Finegoldia* Finegoldia* Rhodopseudomonas* Rhodopseudomonas*
Bacillus* Bacillus* Fusobacterium* Fusobacterium* Riemerella* Riemerella*
Bacteroides* Bacteroides* Gemella* Gemella* Salmonella* Salmonella*
Bradyrhizobium* Bradyrhizobium* Gordonia* Gordonia* Selenomonadaceae* Selenomonadaceae*
Brevibacterium* Brevibacterium* Haemophilus* Haemophilus* Serratia Serratia
Brevundimonas* Brevundimonas* Hydrogenophaga* Hydrogenophaga* Sphingomonas* Sphingomonas*
Clostridium* Clostridium* KlebsiellaKlebsiella Staphylococcus Staphylococcus
CorynebacteriumCorynebacterium Morganella* Morganella* Stenotrophomonas* Stenotrophomonas*
Delftia* Delftia* Paenibacillus*Paenibacillus* Streptococcus Streptococcus
Dendrosporobacter*Dendrosporobacter* Pantoea* Pantoea* Varibaculum* Varibaculum*
Dialister* Dialister* Pectobacterium* Pectobacterium* Veillonella* Veillonella*
Eikenella* Eikenella* Peptococcus*Peptococcus* Xanthomonas* Xanthomonas*
Enterobacter Enterobacter
* Not cultured
Proof of Principle resultsProof of Principle results
Sanger Sanger
shotgunshotgunQt PCR Qt PCR
assayassay
all bacteriaall bacteria 100100 100.0100.0
Pseudomonas Pseudomonas 13.513.5 21.721.7
Klebsiella sp.Klebsiella sp. 2.12.1 0.00.0
Serratia Serratia marcescensmarcescens 1.61.6 1.91.9
Clostridium Clostridium perfringensperfringens 1.11.1 1.01.0
Enterococcus Enterococcus faecalisfaecalis 1.11.1 1.01.0
Escherichia coliEscherichia coli 0.50.5 1.21.2
AnaerobesAnaerobes
0%
20%
40%
60%
80%
100%
Ba
cte
ira
l Po
pu
lati
on
Venous Ulcer Diabetic Ulcer Pressure Ulcer
Distribution of Bacterial Populations in Chronic Wounds in Relation to Aerotolerance
Aerobes
FacultativeAnaerobesStrictAnaerobes
SloughSlough
Treating BiofilmTreating Biofilm
Sharp DebridementSharp Debridement
Frequently Frequently New Wound BedNew Wound BedBiofilmsBiofilms
Wet to Dry DressingsWet to Dry Dressings
78% of Physicians78% of Physicians
Cost moreCost more
PainfulPainful
No margin of safetyNo margin of safety
Detrimental…Detrimental…
Do No HarmDo No Harm
Think Outside the BoxThink Outside the Box
Antibiofilm AgentsAntibiofilm Agents
Short TermShort TermLactoferrinLactoferrin
XylitolXylitol
GalliumGallium
FarnasolFarnasol
DeferoxamineDeferoxamine
EDTAEDTA
Dispersin BDispersin B
Fatty Acid GelFatty Acid Gel
Nitric OxideNitric Oxide
Long TermLong Term
Quorum Sensing Quorum Sensing InhibitorInhibitor
RNA III Inhibitory PeptideRNA III Inhibitory Peptide
FuranonesFuranones
AutoinducerAutoinducer
D Davies et al. Science. 1998 Apr 10; 280(5361): 295-8.
Biofilm Based Wound CareBiofilm Based Wound Care
Debridement- Frequent and aggressive
Selective biocides Silver, Iodosorb, Hydrofera Blue
Antibiofilm Agents
Lactoferrin, Xylitol, Farnasol Plant Products, Fatty Acid Gel
Antibiotics Adjunct Strong and long
Multiple Concurrent Strategies
Biofilm Based Wound CareBiofilm Based Wound Care
www.woundcarecenter.netwww.woundcarecenter.net
Critical Limb IschemiaCritical Limb Ischemia
Lubbock 0%
Kalani 15%
Fife 65%
www.woundcarehospital.com
All CLI
CLI w /oOsteo orDiabetes
CLI +Diabetes CLI + Osteo
CLI + Osteo +Diabetes
77%91%
75%
67%67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Healing Rates in Wounds with Critical Ischemia
Orthopedic Management
Biofilm Management
The Biofilm SurpriseThe Biofilm Surprise