Controversies and challenges of chronic wound infection diagnosis and treatment.

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]