{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:10:04Z","timestamp":1791519004576,"version":"4.3.4"},"reference-count":104,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pathogenic biofilms are a critical barrier to wound healing, driving infection persistence, delayed tissue repair, and antimicrobial resistance (AMR) and tolerance. This recognition has driven a paradigm shift from a traditional planktonic model of infection to a biofilm\u2010mediated framework, where structured microbial communities are encased within a protective extracellular polymeric substance (EPS) matrix. These communities are highly prevalent in chronic wounds, with reported detection rates of 60%\u2013100% across diabetic foot ulcers, venous leg ulcers, and pressure injuries. The establishment of biofilms fundamentally alters host\u2013microbe interactions, promotes antimicrobial tolerance, and triggers therapeutic failure, prolonged inflammation, and wound chronicity. Despite their clinical relevance, management strategies remain limited. Crucially, a lack of rapid point\u2010of\u2010care diagnostics and standardized clinical endpoints hampers timely intervention. Conventional culture based methods frequently fail to detect sessile microbial populations, necessitating advanced techniques such as next\u2010generation sequencing or confocal microscopy, which are largely unavailable in routine practice. A detailed understanding of the molecular and cellular mechanisms underpinning biofilm persistence is essential to translate knowledge into targeted clinical interventions. Effective management requires a biofilm centric, multimodal strategy that prioritizes regular mechanical debridement to disrupt the EPS matrix, supported by proactive exudate control and appropriate topical therapies. Looking forward, advances in diagnostic technologies, artificial intelligence (AI)\u2010assisted analysis, and matrix disrupting or permeating agents offer significant potential. Furthermore, emerging biological therapies, including bacteriophages, promise to help transform wound management, reduce the burden of AMR, and potentially improve patient outcomes globally.<\/jats:p>","DOI":"10.1111\/joim.70138","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:01:11Z","timestamp":1786114871000},"page":"420-439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An update on biofilms in acute and chronic wounds: Incidence, clinical evidence, diagnosis, prevention, and treatment"],"prefix":"10.1111","volume":"300","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7752-5935","authenticated-orcid":false,"given":"Steven L.","family":"Percival","sequence":"first","affiliation":[{"name":"5D Health Protection Group Ltd  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6288-7135","authenticated-orcid":false,"given":"Marcus J.","family":"Swann","sequence":"additional","affiliation":[{"name":"5D Health Protection Group Ltd  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1075-1831","authenticated-orcid":false,"given":"Kristian","family":"Daly","sequence":"additional","affiliation":[{"name":"5D Health Protection Group Ltd  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5933-7749","authenticated-orcid":false,"given":"Dieter O.","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Dermatology University Hospital of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8882-6723","authenticated-orcid":false,"given":"Prashini","family":"Moodley","sequence":"additional","affiliation":[{"name":"Nelson R. Mandela School of Medicine University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8384-4353","authenticated-orcid":false,"given":"Rui","family":"Chen","sequence":"additional","affiliation":[{"name":"5D Health Protection Group Ltd  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_5_2_1","volume-title":"Wound care essentials: practice principles","author":"Baranoski S","year":"2020"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742\u2010481X.2012.00947.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/322972"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro821"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u2010475X.2012.00836.x"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1462\u20135822.2009.01323.x"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.MB\u20100010\u20132014"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0003326"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u2010475X.2007.00321.x"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms11081994"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/scientificamerican0178\u201086"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.284.5418.1318"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2017.26.1.20"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2008.17.4.28835"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.2174\/1874285801004010008"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2012.0381"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2008.17.8.30796"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12777"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2015.0635"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12505"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2023.32.5.273"},{"key":"e_1_2_5_23_1","volume-title":"Wound infection in clinical practice: an international consensus document","author":"International Wound Infection Institute (IWII)","year":"2016"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2011.0333"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2014.0557"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12590"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70145"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a041172"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2021.0016"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12910\u2010018\u20130253\u2010x"},{"key":"e_1_2_5_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/19386400231225708"},{"key":"e_1_2_5_32_1","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01042\u201025"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2014.10.024"},{"key":"e_1_2_5_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70181"},{"key":"e_1_2_5_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2021.05.010"},{"key":"e_1_2_5_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751\u20137915.70218"},{"key":"e_1_2_5_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14228121"},{"key":"e_1_2_5_38_1","doi-asserted-by":"publisher","DOI":"10.25270\/wnds\/24124"},{"key":"e_1_2_5_39_1","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00013\u201014"},{"key":"e_1_2_5_40_1","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.001340"},{"key":"e_1_2_5_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u2010475X.2009.00561.x"},{"key":"e_1_2_5_42_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0003326"},{"key":"e_1_2_5_43_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms8101580"},{"key":"e_1_2_5_44_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22158278"},{"key":"e_1_2_5_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201098073\u2010x"},{"key":"e_1_2_5_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2013319\u201009782\u20104_3"},{"key":"e_1_2_5_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/apm.12099"},{"key":"e_1_2_5_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20100691.2012.04001.x"},{"key":"e_1_2_5_49_1","doi-asserted-by":"publisher","DOI":"10.4161\/viru.2.5.17724"},{"key":"e_1_2_5_50_1","doi-asserted-by":"publisher","DOI":"10.1201\/9781420079944-c8"},{"key":"e_1_2_5_51_1","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.GPP3\u20100023\u20132018"},{"key":"e_1_2_5_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/femspd\/ftv111"},{"key":"e_1_2_5_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mib.2020.01.013"},{"key":"e_1_2_5_54_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid0103.950301"},{"key":"e_1_2_5_55_1","volume-title":"Streptococcus pyogenes: basic biology to clinical manifestations","author":"Young C","year":"2022"},{"key":"e_1_2_5_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12866\u2010024\u201003422\u20101"},{"key":"e_1_2_5_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bioflm.2021.100063"},{"key":"e_1_2_5_58_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.21011"},{"key":"e_1_2_5_59_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/1207536"},{"key":"e_1_2_5_60_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.877995"},{"key":"e_1_2_5_61_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.44.7.1818\u20131824.2000"},{"key":"e_1_2_5_62_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.00414"},{"key":"e_1_2_5_63_1","doi-asserted-by":"publisher","DOI":"10.4161\/viru.2.5.17783"},{"key":"e_1_2_5_64_1","doi-asserted-by":"publisher","DOI":"10.5772\/intechopen.85020"},{"key":"e_1_2_5_65_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0904124"},{"key":"e_1_2_5_66_1","doi-asserted-by":"publisher","DOI":"10.21315\/mjms2020.27.4.2"},{"key":"e_1_2_5_67_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8111935"},{"key":"e_1_2_5_68_1","doi-asserted-by":"publisher","DOI":"10.1099\/00222615\u201011\u20134\u2013513"},{"key":"e_1_2_5_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20132672.2012.05264.x"},{"key":"e_1_2_5_70_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.2.167\u2013193.2002"},{"key":"e_1_2_5_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.micinf.2016.01.002"},{"key":"e_1_2_5_72_1","doi-asserted-by":"publisher","DOI":"10.3390\/antiox14060682"},{"key":"e_1_2_5_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tim.2004.11.007"},{"key":"e_1_2_5_74_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens6040051"},{"key":"e_1_2_5_75_1","doi-asserted-by":"publisher","DOI":"10.33073\/pjm-2014-019"},{"key":"e_1_2_5_76_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13121120"},{"key":"e_1_2_5_77_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40001\u2010023\u201001121\u20107"},{"key":"e_1_2_5_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.13170"},{"key":"e_1_2_5_79_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2015.24.11.498"},{"key":"e_1_2_5_80_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12112223"},{"key":"e_1_2_5_81_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd1008"},{"key":"e_1_2_5_82_1","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00016\u201010"},{"key":"e_1_2_5_83_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1472\u2010765X.2012.03243.x"},{"key":"e_1_2_5_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mib.2017.11.008"},{"key":"e_1_2_5_85_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010024\u201063729\u2010x"},{"key":"e_1_2_5_86_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2019.28.12.824"},{"key":"e_1_2_5_87_1","doi-asserted-by":"publisher","DOI":"10.1093\/jbcr\/irz167"},{"key":"e_1_2_5_88_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20101\u20134939\u20139179\u20102_11"},{"key":"e_1_2_5_89_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2010.19.8.77709"},{"key":"e_1_2_5_90_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12091434"},{"key":"e_1_2_5_91_1","doi-asserted-by":"publisher","DOI":"10.1002\/mbo3.187"},{"key":"e_1_2_5_92_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12091434"},{"key":"e_1_2_5_93_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02012-20"},{"key":"e_1_2_5_94_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12943\u2010025\u201002348\u20100"},{"key":"e_1_2_5_95_1","first-page":"94","article-title":"Critical colonisation: clinical reality or myth?","volume":"1","author":"White R","year":"2005","journal-title":"Wound UK."},{"key":"e_1_2_5_96_1","doi-asserted-by":"publisher","DOI":"10.34133\/bmef.0104"},{"issue":"1","key":"e_1_2_5_97_1","first-page":"54","article-title":"Microbial biofilms and chronic wounds: facts and speculation","volume":"26","author":"Jakobsen TH","year":"2025","journal-title":"J Wound Manage."},{"issue":"7","key":"e_1_2_5_98_1","first-page":"234","article-title":"Biofilms and their potential role in wound healing","volume":"16","author":"Percival SL","year":"2004","journal-title":"Wounds."},{"key":"e_1_2_5_99_1","volume-title":"Understanding the effects of bacterial communities and biofilms on wound healing","author":"Percival SL","year":"2004"},{"key":"e_1_2_5_100_1","first-page":"171","volume-title":"Biofilms, persistence and ubiquity","author":"Percival SL","year":"2005"},{"key":"e_1_2_5_101_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10433"},{"key":"e_1_2_5_102_1","doi-asserted-by":"publisher","DOI":"10.1039\/d5tb02157j"},{"key":"e_1_2_5_103_1","doi-asserted-by":"publisher","DOI":"10.52198\/23.STI.42.WH1692"},{"key":"e_1_2_5_104_1","doi-asserted-by":"publisher","DOI":"10.1080\/1040841X.2019.1573803"},{"key":"e_1_2_5_105_1","first-page":"59","article-title":"Tolerance of biofilms to antimicrobials and significance to antibiotic resistance in wounds","volume":"33","author":"Salisbury AM","year":"2018","journal-title":"Surg Technol Int."}],"container-title":["Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/joim.70138","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/joim.70138","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/joim.70138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:53:09Z","timestamp":1789167189000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/joim.70138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":104,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/joim.70138"],"URL":"https:\/\/doi.org\/10.1111\/joim.70138","archive":["Portico"],"relation":{},"ISSN":["0954-6820","1365-2796"],"issn-type":[{"value":"0954-6820","type":"print"},{"value":"1365-2796","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"2026-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}