Biofilm Based Wound Care Randall Wolcott MD

Transcription

1 Biofilm Based Wound Care 1 Objectives Learn the two methods by which bacteria cause infection Understand different technologies to diagnose biofilm infection Learn management strategies for biofilm infection COI: equity ownership in PathoGenius Laboratory 2 Biofilm in nature 3 1

2 Overview 4 Peg Dirckx Host biofilm development 5 Masako,K Journal of Dermatologic Science, June 2005 Bacterial biofilm is a major barrier to wound healing 6 MSU-CBE, Peg Dirckx 2

3 Microorganisms Acute wound Positive: Commensals Neutral: Contaminates 7 Negative: Infection Chronic wound Biofilm infection Antibiotic Antibody Planktonic cell Biofilm cell Phagocyte enzymes 8 Costerton and Stewart, Science, 284, 1999 Senescence Host cell membrane Tip Needle Outer membrane rings Connector Inner membrane ring Outer membrane Peptidoglycan Periplasm Inner membrane 9 Cytoplasm Putting Enterohemorrhagic E. coli on a pedestal, Cell Host & Microbe 5, Mar

4 Molecular mechanisms of senescence new paradigm of bacterial pathogenesis Bacterial measures that counterbalance epithelial cell death and cell survival 10 Kim, Cell Host and Microbe, 8 (1), July 2010 Planktonic vs. Biofilm 11 MSU-CBE, Peg Dirckx Medical biofilms 12 Del Pozoand Patel, ClinPharm Ther,82, 2007; Medical biofilm paradigm, Journal of Wound Care, 19 (2), Biofilm and Chronic Infections, JAMA, 299 (22),

5 Biofilm defenses 13 Center for biofilm engineering at MSU-Bozeman Antibiotic resistance Biofilm Vanc. vs. Staph. biofilm >1000x Tobra. vs. Pseudomonas biofilm Tobramycin vs. P. aeruginosa biofilm biofilm planktonic Center for biofilm engineering at MSU-Bozeman 14 Reconstitution of slough 15 Debridement 24 hrs post-debridement Robert Galiano MD 5

6 Results: epithelial gap Control Biofilm 16 Robert Galiano MD Slough 17 Full biofilm debridement No matter how good the debridement, fragments will always remain embedded in the wound Those fragments will reattach quickly, and become metabolically active They will start propagating and coalescing, quorum sensing will then take place Within 24 hours, early biofilm will have formed Within 2-3 days formal, mature biofilm will be present 18 6

7 Don t over analyze 19 Acute vs. Chronic wound 20 Debridement biopsy phenomena

8 Pyoderma to granulation 22 Surface management Sharp Scrub Ultrasound Enzymes Maggots Autolytic 23 Sharp debridement Alter the anatomy - Devitalized tissue - Soft, degraded, friable - Tunneling - Undermining - Irregularities - Polyps - Foreign bodies 24 Falanga, Ostomy and Wound Management, Supp, 2008 Steed, J of the American College of Surgeons, 183,

9 Osteomyelitis Biofilm Based Wound Care 25 Diagnose then treat For every mistake for not knowing ten are made for not looking Avoid bad habits 26 Common pathogens in SSSIs: SENTRY United States and Canada, 2000 Staphylococcus aureus MSSA, 32% Coagulase-negative Staphylococcus, 3% N=1404 MRSA, 14% Pseudomonas aeruginosa, 11% Pull off chart Enterococcus spp, 8% Other, 30% MRSA = methicillin-resistant S. aureus MSSA = methicillin-susceptible S. aureus 27 β-hemolytic streptococci, 2% Rennie RP. et al., Diagn Microbiol Infect Dis. 2003; 45:

10 Clinical identification of bacteria Biofilm Based Wound Care Aerobic bacteria detected by molecular methods and also detected by culture 600 When considering Culture the Gold Standard Sensitivity: 82% (75/92) 500 When considering Sequencing 400 the Gold Standard Culture sensitivity: 17% (92/552) 300 Bacteria detected by culture and also detected by molecular methods Culture Molecular 28 Minor Major Dominant Cultures 0 Culture Molecular Rhoads BMC Micro 2012 Microbial identification 29 Hope and change 30 10

11 Biofilm based wound care 31 Wolcott, Journal of Wound Care, 17, 2008 Allen 32 Biofilm based wound care Debridement -frequent and aggressive Selective biocides - Silver, Iodine, methyline blue Antibiofilm agents - Lactoferrin, Xylitol, Farnasol - Plant Products, Free Fatty Acids Antibiotics - Personalize - Strong and long 33 Multiple concurrent dynamic strategies 11

12 Personalized wound care days 60 days 90 days 120 days 150 days 206 days Dowd, Molecular Diagnostics and Personalised Medicine in Wound Care, Journal of Wound Care,20, 2011 BBWC and NPWT 35 BBWC and CBT About 40% more 3 mos About 50% less failures About 30% more 6 mos About 70% less failures 36 Wolcott More effective cell-based therapy through biofilm suppression, JWC, 22,

13 The biofilm surprise Always be ready for any surprises in life