Micro-management: curbing chronic wound infection

Abstract

Chronic wounds, including pressure ulcers, foot ulcers and venous leg ulcers have a detrimental impact on the health and well-being of an estimated 2% of people in the UK. Chronic wounds are normally colonised by bacteria and in some instances bacterial load increases sufficiently for infection to ensue. Once a chronic wound becomes infected it is difficult to resolve and a combination of continuous inflammation and bacterial proliferation makes these wounds difficult to manage. A state of prolonged inflammation can occur as a result of impaired homeostatic pathways which are exacerbated by bacterial growth. Chronic, infected wounds can persist for many months or even years, sometimes requiring surgical intervention in the form of regular debridement or amputation when other strategies such as antimicrobial treatments fail. The complex relationships between both oral microbiota and the host have been extensively characterised, including the shift from health to disease, and has allowed for the development of numerous control strategies. This knowledge combined with contemporary studies of chronic infected wounds can be used to develop an understanding of the relationship between the host and microorganism in the chronic wound environment. Such information has the potential to inform wound management including strategies to control infection and promote wound healing.