Overcoming Challenges in Wound Infection: Biofilm and Antimicrobial Resistance

Significance: Chronic wounds represent a growing clinical and economic burden, affecting 1–2% of the global population, with prevalence expected to rise due to aging and increasing rates of diabetes, obesity, and vascular diseases. Wound persistence is often driven by infection and compounded by antimicrobial resistance (AMR), resulting in poor patient outcomes. High prevalence of microbial biofilms, which shield pathogens from immune clearance and promote AMR, further promotes the chronicity of infected wounds. Recent Advances: Adoption of antimicrobial stewardship in wound care is increasing, emphasizing timely diagnosis of infection and pathogen identification to guide treatment and limit unnecessary AMR-driving antibiotic use. However, current diagnostic and therapeutic approaches remain only partially effective, particularly for biofilm-containing wounds. While many antimicrobials exist, their use is constrained by negative impacts on wound healing, limited antibiofilm activity, and insufficient evidence of improved clinical outcome. To address these gaps, recent advances in diagnostics and therapeutics aim to disrupt microbial communities, reduce AMR risk, and accelerate wound healing. Critical Issues: The treatment of chronic wounds is challenged by AMR, biofilms, and the limited effectiveness of current therapies. Contemporary antimicrobials ( e.g., broad-spectrum antibiotics and silver) are linked to AMR development, compounded by biofilms that shield pathogens, limit antimicrobial efficacy, and sustain infection. While alternative treatments with lower AMR risk and greater antibiofilm activity are under investigation, the lack of robust clinical data limits their adoption. Future Directions: Broader adoption of antimicrobial stewardship and biofilm-targeting sustainable wound care practices are key for combatting AMR and improving patient outcomes.