Burns, biofilm and a new appraisal of burn wound sepsis

Purpose: Following a burn, the wound may become colonized and septic complications may ensue. Many organisms, commonly isolated from burn wounds produce biofilms, which are defined as a collection of organisms on a surface surrounded by a matrix. Biofilms are associated with development of antibiotic resistant organisms and are refractory to the immune system. The presence of biofilm in the burn wound has not been documented. Methods: A study was undertaken using light and electron microscopy to determine the presence of biofilm in the burn wound. Specific stains were used to detect the presence of micro-organisms and associated carbohydrate, a major constituent of the biofilm matrix. A concurrent microbiological study of the burn wound was also carried out. Results: Biofilm was detected in ulcerated areas of the burn wound. Bacterial wound invasion with mixed organisms was also commonly detected. Conclusions: The finding of biofilm in the burn wound has significance in our understanding of burn wound sepsis and supports the evidence for early excision and closure of the burn wound. Due to the recalcitrant nature of biofilm associated sepsis and the difficulty in disrupting biofilm it has implications for the future development of wound care dressings. Crown Copyright (C) 2009 Published by Elsevier Ltd and ISBI. All rights reserved.