infections this could very well be one of the explanations for a relapse of infection
even after an initial successful treatment.
However the surgical procedure induces a change of milieu and this will force the microorganisms
to re-arrange and re-adapt. This might create a window of opportunity as described by Wolcott
et al. In the few hours following the surgical procedure antibiotics and the immune defense
system could prove to be effective. This could also explain why a chronic wound,
that have been present for months or even years, when treated with appropriate measures,
will start the healing process. We change the environment and the bacteria have to adapt
to that. When compression therapy is applied to a venous leg ulcer or proper off-loading
is provided to a diabetic foot ulcer, an ulcer, despite evidence of bacterial biofilm, can
heal.
I will postulate that challenging the bacteria with environmental changes is a very potent
treatment option that still needs exploring and development.
Antibiotic treatment is usually given systemically but the increased tolerance to antibiotics
in bacterial biofilm rise the problem that adequate tissue concentration of the antibiotic
is not possible. In order to overcome this problem local antibiotic treatment have been
developed. Different delivery systems are used, as simple flushing with antibiotics
seems to be inadequate. The antibiotic needs to be in a high concentration for some time,
even in antibiotics with concentration dependent kill-ratio. This is due to dilution by diffusion
and the fact that most antibiotics only kill bacteria in growth.
The ideal delivery system has not yet been identified but will have to deliver high concentrations
of antibiotics for a given time and the delivery should be complete. This is to ensure that
the period with sub-inhibitory concentrations is as short as possible to prevent resistance
due to a high selection pressure. Another option to give local treatment is