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OBJECTIVE: To assess the efficacy of five silver-containing gelling fibre wound dressings against single-species and multispecies biofilms using internally validated, UKAS-accredited in vitro test models. METHOD: Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans single- and multispecies biofilms were cultured using Centres for Disease Control (CDC) biofilm reactors and colony drip flow reactors (CDFR). Following a 72 hour incubation period, the substrates on which biofilms were grown were rinsed to remove planktonic microorganisms and then challenged with fully hydrated silver-containing gelling fibre wound dressings. Following dressing application for 24 or 72 hours, remaining viable organisms from the treated biofilms were quantified. RESULTS: In single-species in vitro models, all five antimicrobial dressings were effective in eradicating Staphylococcus aureus and Pseudomonas aeruginosa biofilm bacteria. However, only one of the five dressings (Hydrofiber technology with combination antibiofilm/antimicrobial technology) was able to eradicate the more tolerant single-species Candida albicans biofilm. In a more complex and stringent CDFR biofilm model, the hydrofiber dressing with combined antibiofilm/antimicrobial technology was the only dressing that was able to eradicate multispecies biofilms such that no viable organisms were recovered. CONCLUSION: Given the detrimental effects of biofilm on wound healing, stringent in vitro biofilm models are increasingly required to investigate the efficacy of antimicrobial dressings. Using accredited in vitro biofilm models of increasing complexity, differentiation in the performance of dressings with combined antibiofilm/antimicrobial technology against those with antimicrobial properties alone, was demonstrated.

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Significance: Bacterial biofilms are considered to be responsible for over 80% of persistent infections, including chronic lung infections, osteomyelitis, periodontitis, endocarditis, and chronic wounds. Over 60% of chronic wounds are colonized with bacteria that reside within a biofilm. The exaggerated proteolytic environment of chronic wounds, more specifically elevated matrix metalloproteinases, is thought to be one of the possible reasons as to why chronic wounds fail to heal. However, the role of bacterial proteases within chronic wounds is not fully understood. Recent Advances: Recent research has shown that bacterial proteases can enable colonization and facilitate bacterial immune evasion. The inhibition of bacterial proteases such as Pseudomonas aeruginosa elastase B (LasB) has resulted in the disruption of the bacterial biofilm in vitro. P. aeruginosa is thought to be a key pathogen in chronic wound infection, and therefore, the disruption of these biofilms, potentially through the targeting of P. aeruginosa bacterial proteases, is an attractive therapeutic endeavor. Critical Issues: Disrupting biofilm formation through the inhibition of bacterial proteases may lead to the dissemination of bacteria from the biofilm, allowing planktonic cells to colonize new sites within the wound. Future Directions: Despite a plethora of evidence supporting the role of bacterial proteases as virulence factors in infection, there remains a distinct lack of research into the effect of bacterial proteases in chronic wounds. To assess the viability of targeting bacterial proteases, future research should aim to understand the role of these proteases in a variety of chronic wound subtypes.

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Biofilms are of great importance in infection control and healthcare-associated infections owing to their inherent tolerance and 'resistance' to antimicrobial therapies. Biofilms have been shown to develop on medical device surfaces, and dispersal of single and clustered cells implies a significant risk of microbial dissemination within the host and increased risk of infection. Although routine microbiological testing assists with the diagnosis of a clinical infection, there is no 'gold standard' available to reveal the presence of microbial biofilm from samples collected within clinical settings. Furthermore, such limiting factors as viable but non-culturable micro-organisms and small-colony variants often prevent successful detection. In order to increase the chances of detection and provide a more accurate diagnosis, a combination of microbiological culture techniques and molecular methods should be employed. Measures such as antimicrobial coating and surface alterations of medical devices provide promising opportunities in the prevention of biofilm formation on medical devices.

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Photodynamic therapy (PDT) is the application of a photoactive dye followed by irradiation that leads to the death of microbial cells in the presence of oxygen. Its use for controlling biofilms has been documented in many areas, particularly oral care. However, the potential use of PDT in the treatment of chronic wound-associated microbial biofilms has sparked much interest in the field of wound care. The aim of this article is to provide an overview on the effectiveness of PDT on in vitro and in vivo biofilms, their potential application in both the prevention and management of wound biofilm infections and their prospective role in the enhancement of wound healing.

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The presence of viable Helicobacter pylori (H. pylori) in the environment is considered to contribute to the levels of H. pylori found in the human population, which also aids to increase its genetic variability and its environmental adaptability and persistence. H. pylori form biofilms both within the in vitro and in vivo environment. This represents an important attribute that assists the survival of this bacterium within environments that are both hostile and adverse to proliferation. It is the aim of this paper to review the ability of H. pylori to form biofilms in vivo and in vitro and to address the inherent mechanisms considered to significantly enhance its persistence within the host and in external environments. Furthermore, the dissemination of H. pylori in the external environment and within the human body and its impact upon infection control will be discussed.