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Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden. Vascular impairment represents the main cause of chronic ulceration, while the infection is the most frequent complication. Chronic infections persist and progress despite an adequate antimicrobial regimen and are typically caused by mono- or polymicrobial biofilms. The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains, with the risk of life-threatening septic complications, especially in immunocompromised individuals. In this article, we perform a thorough literature review, in order to answer the main controversies regarding the involvement of planktonic and/or biofilm bacteria in the healing process of chronic wounds. Furthermore, we aim to analyse the utility of antimicrobial treatment in non-healing wounds, and to establish its main end-points, for the optimal benefit of the patients. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic inflammatory skin disease, with a poor therapeutic response and a significant impact on the patient's quality of life. The aim of this review-type article is to assess the role of bacterial infections in both the pathogenesis and evolution of the hidradenitis suppurativa, but also to evaluate the convenience of antibiotherapy in the management of the disease. Antibiotherapy plays an important role in its longterm management, mainly due to the anti-inflammatory action of the frequently recommended agents from the schemes of treatment. The therapy's initiation ought to be consistent with the antibiotic sensitivity profile of microorganisms isolated in the laboratory, personalized depending on the disease’s severity, history of antibiotic use, the risk of drug interactions and the patient's comorbidities. Moreover, the association of antibiotics with anti-TNF-α (tumour necrosis factor) biologic therapy represents a valid therapeutic alternative that can significantly enhance the quality of life, of great utility especially in severe disease stages. In order to elucidate the pathogenesis, we propose two main research directions. Firstly, the profile analysis of virulence of microorganisms and its correlation with the host response to bacterial insult. Secondly, the description of the bacterial biofilm communities, both architecturally and physiologically in-depth analyzes of inter-cellular communication mechanisms. These steps are necessary for the discovery of new therapeutic agents. [ABSTRACT FROM AUTHOR]

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden. Vascular impairment represents the main cause of chronic ulceration, while the infection is the most frequent complication. Chronic infections persist and progress despite an adequate antimicrobial regimen and are typically caused by mono- or polymicrobial biofilms. The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains, with the risk of life-threatening septic complications, especially in immunocompromised individuals. In this article, we perform a thorough literature review, in order to answer the main controversies regarding the involvement of planktonic and/or biofilm bacteria in the healing process of chronic wounds. Furthermore, we aim to analyse the utility of antimicrobial treatment in non-healing wounds, and to establish its main end-points, for the optimal benefit of the patients. [ABSTRACT FROM AUTHOR]

Chronic venous leg ulcers (CVLU) account for the final outcome of a far wider disease spectrum referred to as chronic venous disease. Physiological wound healing involves a three-stage process, with the coagulation/ inflammatory, granulation and epithelialization phases occurring successively. In the case of chronic wounds, such as CVLUs, the tissue damage and repair are misbalanced, resulting in the ulcer's lodging in a particular wound stage - the inflammation or granulation stage -, consequently impairing progression towards wound healing. Failure to rebuild the skin integrity may be due to a large number of factors, either endogenous - host factors determining or maintaining breaches in the protective barrier of the skin -, or exogenous, such as microbial biofilm infections. The future research should focus upon the study of wound microenvironment. The detection of specific biomarkers of chronic wound healing, as well as the discovery of therapeutic agents that target molecules involved in the pathogenic cascade would change the course of the disease. [ABSTRACT FROM AUTHOR]