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Leg ulcers
Hard-to-heal wounds
Diabetic foot ulcers
Biofilms

The prevalence of biofilms in chronic wounds: a systematic review and meta-analysis of published data

02 January 2018
Review
02 January 2018
Volume 2 · Issue 1

Abstract

The presence of biofilms in chronic non-healing wounds, has been identified through in vitro model and in vivo animal data. However, human chronic wound studies are under-represented and generally report low sample sizes. For this reason we sought to ascertain the prevalence of biofilms in human chronic wounds by undertaking a systematic review and meta-analysis. Our initial search identified 554 studies from the literature databases (Cochrane Library, Embase, Medline). After removal of duplicates, and those not meeting the requirements of inclusion, nine studies involving 185 chronic wounds met the inclusion criteria. Prevalence of biofilms in chronic wounds was 78.2 % (confidence interval [CI 61.6–89, p<0.002]). The results of our meta-analysis support our clinical assumptions that biofilms are ubiquitous in human chronic non-healing wounds.

Unlike planktonic microorganisms, biofilm phenotypes have been defined as structured consortiums of aggregated microbial cells, surrounded by a polymer matrix, that adhere to natural surfaces, to artificial surfaces or to themselves.1 The concept of biofilms in human health and disease is now universally accepted in tuberculosis,2 periodontal disease and dental caries,3 cystic fibrosis,4,5,6 in-dwelling medical device infections,7 otitis media and other upper respiratory infections,8,9 and chronic wounds.10,11 So highly attuned are researchers to the wide involvement of biofilm-associated infections across the spectrum of human health and disease, that the US Department of Defense has recognised the significance of biofilm as being problematic in wound healing, and has prioritised research in this area.12

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biofilm
systematic review
wound healing
infection
non-healing