Bacteria and wound healing : Current Opinion in Infectious Diseases (original) (raw)

Skin and soft tissue infections

Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK

Correspondence to Miss Ruth Edwards BSc MBBCh MRCS, Clinical Research Fellow, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff Medicentre, Heath Park, Cardiff CF14 4UJ, UK Tel: +44 2920 682179; fax: +44 2920 754217; e-mail: [email protected]

Abstract

Purpose of review

Wound healing is a complex process with many potential factors that can delay healing. There is increasing interest in the effects of bacteria on the processes of wound healing. All chronic wounds are colonized by bacteria, with low levels of bacteria being beneficial to the wound healing process. Wound infection is detrimental to wound healing, but the diagnosis and management of wound infection is controversial, and varies between clinicians.

Recent findings

There is increasing recognition of the concept of critical colonization or local infection, when wound healing may be delayed in the absence of the typical clinical features of infection. The progression from wound colonization to infection depends not only on the bacterial count or the species present, but also on the host immune response, the number of different species present, the virulence of the organisms and synergistic interactions between the different species. There is increasing evidence that bacteria within chronic wounds live within biofilm communities, in which the bacteria are protected from host defences and develop resistance to antibiotic treatment.

Summary

An appreciation of the factors affecting the progression from colonization to infection can help clinicians with the interpretation of clinical findings and microbiological investigations in patients with chronic wounds. An understanding of the physiology and interactions within multi-species biofilms may aid the development of more effective methods of treating infected and poorly healing wounds. The emergence of consensus guidelines has helped to optimize clinical management.