Beauty and Biofilm: The Intersection of Science, Art, and Wound Care

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by Jeffrey M. Levine MD, AGSF, CWS-P

You are looking at an amazing image of a dime-sized biofilm of Pseudomonas aeruginosa, grown and photographed by Scott Chimileski – a biologist, photographer, and writer at the Kolter Lab at Harvard Medical School.

Pseudomonas aeruginosa

Pseudomonas aeruginosa. Photo reproduced with permission from Scott Chimileski, microbephotography.com

He captured the eerie, otherworldly look of this dangerous organism. The bacterial colony appears red because of the stain that Scott used to demonstrate its chemical structure. This photo is one of the winners of the Federation of American Societies for Experimental Biology (FASEB) 2016 BioArt contest. Part of Scott’s research is on the fundamental processes of biofilm formation, one of the major frontiers in wound healing science today.

The Impact of Pseudomonas Aeruginosa Biofilms on Wound Healing

Pseudomonas is a common gram-negative pathogen that causes pneumonia, urinary tract infections, bacteremia, sepsis, endocarditis, and soft tissue infections. This organism may account for 10% of all hospital acquired infections, and multi-drug resistant strains are on the rise. Those of us who have encountered Pseudomonas in wounds often remember its characteristic sweet odor. Pseudomonas commonly attacks skin rendered vulnerable from edema, vascular disease, and diabetes, and is often hard to eradicate particularly in immunocompromised patients. Here is one of my clinical photos of Pseudomonas infection of leg ulcers:

Patient with P. aeruginosa

Pseudomonas can occur in burns, post-surgical wounds, pressure injuries, and diabetic foot wounds. The microorganism secretes a variety of materials to form an extracellular matrix that holds the biofilm together, and protects the bacteria from antibiotics and the immune system - making it challenging to eradicate.

I’ve always been interested in the intersection of art and science, and Scott Chimileski is right on point. You can see more amazing photographs of microorganisms on his website, http://www.scottchimileskiphotography.com/.

Click here to see the results of the 2016 FASEB BioArt Winners.

About the Author
Dr. Jeffrey Levine is a board certified internist and geriatrician with over thirty years of experience in wound care in hospitals, nursing homes, and home care environments. He is Associate Professor of Geriatrics and Palliative Care at the Icahn School of Medicine at Mount Sinai, and has a hospital based wound care practice at the Center for Advanced Wound Care at Mount Sinai Beth Israel Medical Center in Manhattan. He received his fellowship training in geriatrics at the Mount Sinai Medical Center where he began his interest in chronic wounds. He is an elected board member of the National Pressure Ulcer Advisory Panel (NPUAP).

Dr. Levine’s interest in pressure ulcers began in the 1980s during his geriatric training when he noticed that many of his nursing home patients had pressure ulcers but there was little reliable information on treatment methods. This motivated him to study not just prevention and treatment of chronic wounds, but to delve into the rich history of wound care over the centuries. He has since published a number of articles on historical topics ranging from wound care in ancient Egypt through the 20th Century.

The views expressed in this post are solely those of the author, and do not represent the views of any medical school or national organization, WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

Thank you for sharing that incredible image of a biofilm Dr. Levine and for the important information about biofilms and wound care. Biofilms are amazing, incredibly complex and difficult to eliminate. There are many natural ingredients (including polyphenols) found in our small molecule nutrient-rich skin and wound care that help in the fight against wound biofilms and we are grateful that you have highlighted this very important problem in wound care.

Local Manuka honey as antimicrobial is fair enough for biofilm ,if the patient not manifesting any fever or signs of systemic inflammatory response syndrome

great photo but where is the biofilm?
Is it the central dark area?
photo caption is not clear

It is important to recognize that revolutionary photos in the past two years have shown us that biofilms in vivo (on humans) look nothing like biofilms in vitro (in petri dishes). Dr. Chandon Sen's team of researchers discussed this at the annual meeting of the Wound Healing Society in 2015 (and displayed posters). The morphology is likely so dramatically different because the organisms making up the biofilm are responding to the body's powerful immune system. Although pseudomonas is an integral part of most biofilms, it is also a commensal bacteria at times, preventing the proliferation of candida when the skin becomes overly alkaline. The skin's acid mantle usually prevents overgrowth of pseudomonas, and applying an acid (such as dilute household vinegar) is how one usually kills it.

This is very timely! The focus of chronic wound management at the bedside/clinician level has been on "what dressing do I use?". We are now seeing the impact of biofilm on keeping bacteria well hidden/protected-- and in helping bacteria spread. It's fascinating... but also raises the need to focus on how to get rid of biofilm (a big challenge!). Surgical debridement, aggressive removal appears to be essential. So, irrigation and scrubbing of the wound bed (which sounds contrary to what we have practiced) where there is a liklihood of biofilm, should be done. As well, traditional dressings with silver, honey, iodine, methylene blue/gentian violet have some potential-- but other treatments such as Lactoferrin, Xylitol and Farnasol have shown to help break up the biofilm/bacterial connectors.
We do need to recognize that biofilm must be dealt with if wounds are to heal.

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