Biofilms and bacterial imbalances in chronic wounds: anti-Koch.

Microbial imbalances and synergistic relationships between bacteria in medically important biofilms are poorly researched. Consequently, little is known about how synergy between bacteria may increase the net pathogenic effect of a biofilm in many diseases and infections, including chronic wounds. Microbial synergy in chronic wounds may increase virulence and pathogenicity, leading to enhanced tissue degradation, malodour and in some cases, an impairment of the host immune response. Microbial synergy and growth within a biofilm provide a competitive advantage to the microorganisms cohabiting in a wound, thereby promoting their survival and tolerance and resistance to antimicrobial agents. The aim of this article was to provide greater insight into microbial imbalances found within wound biofilms and the significance they may have on non healing and infected wounds. We also present two possible hypotheses which could explain the role microorganisms play in non healing chronic wounds and offer possible strategies for combating harmful and detrimental biofilms.