Excessive moisture associated with wound |
Bacteria in biofilms secrete
extracellular matrix and biofilm presence promotes inflammation,
resulting in increased exudate. |
Autograft or allograft fails on wounds |
Applying tissue grafts over
biofilms provides a second growth surface and food source, leading to
devitalization of graft tissue and increased exudate and
inflammation. |
Poor quality granulation tissue (e.g. hypergranular, friable) |
Biofilm
presence contributes to delayed epithelialization and is frequently
associated with poor quality granulation tissue. |
Indications of local infection (swelling, sensitivity, redness, heat) |
Biofilms promote inflammation and may be a precursor to other clinical
indications of infection. |
History of persistent or recurrent infection despite antimicrobial
therapy |
Biofilm bacterial phenotypes adapt rapidly and may only
demonstrate 1 to 2 log reduction with antibiotic therapy at 50 to 1000x
MIC. Biofilms contain persister cells that remain once antibiotic
therapy is discontinued, seeding, and contributing to subsequent biofilm
reformation. |
Negative culture results despite clinical suspicion of infection or
signs of bacterial colonization |
Biofilm bacteria metabolize more
slowly and are phenotypically different than planktonic bacteria.
Standard microbiological culture techniques are not capable of
identifying all species present, making bacteria in biofilms difficult
or impossible to identify by culture. |
Wound remains in chronic inflammatory state and recalcitrant to therapy
despite addressing comorbities |
Biofilms are resistant to host
inflammatory responses and actually feed off exudate produced by
inflammation, further promoting inflammation. |