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Are chronic wounds, chronic infections?

2016; Mark Allen Group; Volume: 25; Issue: Sup10 Linguagem: Inglês

10.12968/jowc.2016.25.sup10.s3

2052-2916

Randall D. Wolcott,

Pressure Ulcer Prevention and Management

Journal of Wound CareVol. 25, No. Sup10 Supplement EditorialFree AccessAre chronic wounds, chronic infections?Randall WolcottRandall WolcottSearch for more papers by this authorRandall WolcottPublished Online:28 Sep 2016https://doi.org/10.12968/jowc.2016.25.Sup10.S3AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail We, the current providers of wound care throughout the world, are presiding over a deep foundational shift in how chronic wounds are managed. This paradigm shift reaches historical levels such as Pare's change from cauterisation to comforting salves, Winter's moist wound care and the more recent wound bed preparation model. Now, as the current wound care community fully grasps the importance of chronic wounds being chronic infections, there will be significant changes in wound care management algorithms and, more importantly, improvements in chronic wound healing outcomes.Wound care providers have always viewed the wound microbiota as important. Wound care providers routinely include antimicrobial strategies, both systemically and topically, in their management of all chronic wounds, even if the chronic wound does not appear ‘infected’. Now, science is emerging that clearly shows the wound microbiota is a primary cause of the chronic wound itself.A patient with diabetes and multiple comorbidities who is diagnosed with pneumonia must have the diabetes and comorbidities aggressively managed. However, the diabetic with pneumonia is best served by treatments that specifically address the microorganisms causing the pneumonia. So, too, is the patient with a chronic wound. Science has shown us that the wound microbiota in biofilm phenotype induces severe local hyperinflammation and induces host cell senescence which prevents healing of the chronic wound. Therefore, more than any host impairments or comorbidities the host may possess, focused, persistent management of the chronic wound microbiota addresses the most fundamental cause of all chronic wounds.By embracing this new perspective of the chronic wound bed reality, the wound care community will drive the science and the commercialisation that will make us more successful in the healing of chronic wounds. We will demand and understand new diagnostics including biomarkers, microbial identification, biofilm infection strategies and more. Just as importantly, new therapies will emerge which will address the multitude of new microorganisms being identified, the synergies used by these microorganisms, the molecules and infection strategies used at subcellular levels to produce senescence, among others that will be absolute game changers. This quantum shift in how wounds are diagnosed and managed will require wound care providers to invest more time; yet, this will give us the professional satisfaction that each of us played a significant role in this very important change which occurred on our watch. FiguresReferencesRelatedDetailsCited by‘Granulitis’: defining a common, biofilm-induced, hyperinflammatory wound pathologyChristine A Murphy, Philip G Bowler, M Fahad Chowdhury11 January 2023 | Journal of Wound Care, Vol. 32, No. 1Acute and chronic wound infections: microbiological, immunological, clinical and therapeutic distinctionsJenny Hurlow, Philip G Bowler17 May 2022 | Journal of Wound Care, Vol. 31, No. 5Implementing TIMERS: the race against hard-to-heal woundsLeanne Atkin, Zofia Bućko, Elena Conde Montero, Keith Cutting, Christine Moffatt, Astrid Probst, Marco Romanelli, Gregory S Schultz, William Tettelbach5 March 2019 | Journal of Wound Care, Vol. 28, No. Sup3aAssessment and management of chronic woundsJacky Edwards18 July 2018 | Independent Nurse, Vol. 2018, No. 7Clinical management of non-healing woundsNursing Standard, Vol. 32, No. 29 1 October 2016Volume 25Issue Sup10ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics History Published online 28 September 2016 Published in print 1 October 2016 Information© MA Healthcare LimitedPDF download