Probiotics in the Treatment of Infected Wounds: Current State and Delivery Technologies

Wound infections remain a challenging problem in modern medicine amid the growing antimicrobial resistance of pathogens. Topical probiotics, primarily representatives of the genera Lactobacillus and Bifidobacterium, are considered as a promising alternative to traditional antibiotics due to their ability to suppress pathogen growth, disrupt biofilms, modulate immune response, stimulate tissue regeneration, and restore the wound microbiome. Despite encouraging preclinical data, the clinical application of live probiotics is constrained by technological barriers related to bacterial instability, the need to maintain their viability, and the risk of systemic dissemination. This review systematizes the current understanding of the mechanisms of action of probiotics in wound infection, particularly for topical application, and analyzes their delivery technologies, including hydrogels, microparticles, nanofibers, and hybrid systems. Preclinical and clinical studies, challenges in clinical translation, and promising directions for future research are also discussed. In conclusion, the combination of topical live probiotics with hybrid delivery systems has demonstrated encouraging efficacy in preclinical settings; however, its translation into clinical trials will require standardization of dosages and delivery protocols, as well as further improvement of safety profiles.