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The Dual Hypothesis of Pathogenesis: Exploring Biofilm Dynamics in Chronic Wounds

This study from West Virginia University's Biofilm Research Laboratory examines the Dual Hypothesis of pathogenesis, focusing on the interplay between biofilm structures and planktonic organisms in chronic wound environments. It discusses critical colonization timelines, the influence of endogenous skin flora and exogenous pathogens, and the biotic and abiotic factors affecting wound healing. Proposing a tri-phasic wound model, this research advocates for targeted debridement and antibiotic use to manage biofilm prevalence and improve clinical outcomes in chronic wounds.

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The Dual Hypothesis of Pathogenesis: Exploring Biofilm Dynamics in Chronic Wounds

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  1. West Virginia University Biofilm Research Laboratory Percival/Thomas: Dual Hypothesis Pathogenesis INTER-RELATIONSHIP CRITICAL COLONIZATION (Anti-Koch) HYPOTHESIS HYPOTHESIS I II BIOFILM RATIO EARLY TISSUE LATE ENDOGENOUS SKIN FLORA EXOGENOUS PATHOGENS Procaryote DEPTH ENVIRONMENT pH/Eh/STRESS 5 – 7 Day Critical Colonization Eucaryote 8 SELECTIVE PRESSURES 1. 2. BI-PHASIC CHRONIC WOUND ENVIRONMENT ORGANISM SELECTION / BF STRUCTURE

  2. West Virginia University Biofilm Research Laboratory Percival/Thomas: Dual Hypothesis Interface of 2 Hypotheses with Wound Development & Treatment Options Reversible Wound Environment pH, Eh Debridement Depth Critical Colonization Hypothesis I (Planktonic) Microbiology Hypothesis II Colonization (Biofilm) Structure (Stage I-II) Breaking the Cycle: Wound Management & Therapeutic Microbiology Debridement Therapeutics Antibiotics (Anti-Tumor) Probiotics

  3. West Virginia University Biofilm Research Laboratory Integrating Biofilm (BF) Stage and Planktonic (P) Transmission“Ping-Pong” Pathogenesis ABIOTIC Eh pH Dressing BF Nutrient Supply & Stress Planktonic Planktonic BF Wound Bed BIOTIC

  4. Biofilm Reactors: Chronic Wounds /Gauze The Covered Wound Bed is a Static Biofilm Reactor Influenced by Eh and pH via Perfusion, Enhancing Up Regulation to Recalcitrant Biofilm Phenotype (PBF) And changing Ratio from Planktonic Phenotype (PP) in Chronic Wounds _ PBF_ PP Planktonic Predominate ≤1 (Susceptible) ≥1 Biofilm Predominate (Recalcitrant)

  5. Tri-Phasic Model West Virginia University Biofilm Research Laboratory

  6. TRI PHASIC (PLUS) WOUND/Perio MODEL pH pH Oxygen tension Procaryote CLSM.SEM RATIO Organisms BF/P Phenotype Zone C Zone B Interface Zone A Target cells Eucaryote Histtoche Live/dead

  7. (CFU’s / ml / cm2) BAD >1 Clinical Outcomes PHENOTYPE Biofilm Planktonic Congo Red+ / Planktonic GOOD <1 Congo Red- / Planktonic (CFU’s / ml / cm2)

  8. West Virginia University Biofilm Research Laboratory COLONIZATION RESISTANCE 1000 µg/ml ANTI-INFECTIVE >5 BAD Clinical Outcomes RATIO MBEC MIC >1 and <5 ANTI-INFECTIVE <1 GOOD MBEC > MIC 0.1 0.01 256 µg/ml

  9. West Virginia University Biofilm Research Laboratory Results

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