Add Bacteria to Control Bacteria: Growing Evidence To Consider in Wound Care

A recent study in Pharmaceutics provides more cogent information to support the contention that we might consider adding bacteria in the world of wound care, rather than just removing it.¹ To (again) use a military analogy, it seems one might describe the strategy as “clear, hold, and build” rather than just “clear.”

Since diabetic foot ulcers (DFUs) often suffer from issues of perfusion and nerve dysfunction, this provides an ideal environment for opportunistic pathogens and biofilm to do their worst and delay healing.¹ One challenge that current standard and adjunctive therapies cannot always address is the ability of these pathogens to constantly evolve. The authors of this paper contend that commensal microbes (in the form of oral or topical probiotics) could provide a protective barrier against many pathogens.¹ In this review, they touch on probiotics’ role in the immune response and how they relate to proinflammatory mediators in wound healing. They also discuss innovations including probiotic encapsulation, nanoformulation with prebiotics, and extracellular vesicles.¹

We have long thought that the battle between humans and our bacterial overlords was, if you will, overly simple and likely inadequate. There is growing data to support this contention. One needs only to link here to see that.² There may now be avenues developed where this will become less and less exotic.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).

Editor’s note: This blog originally appeared here. It is adapted with permission from the author.
 
References
1.     Srivastava P, Sonda, T, Sivashanmugam, Kim K-S. A review of immunomodulatory reprogramming by probiotics in combatting chronic and acute diabetic foot ulcers (DFUs). Pharmaceutics. 2022;14(11):2436.
2.     Probiotics. DF Blog. Available at: https://diabeticfootonline.com/?s=Probiotic&orderby=relevance&order=DESC . Accessed November 21, 2022.
 
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