Targeting Wound Biofilms: Biofilm Formation, Resistance, and Natural Antibiofilm Strategies

Millions of people worldwide suffer from chronic wounds, such as pressure sores, diabetic foot ulcers, and venous leg ulcers. Microbial biofilms, which are bacterial communities encased in extracellular matrices they produce on their own and that withstand host immune responses and antimicrobial treatments, are the main cause of these wounds' delayed healing and high recurrence rates. With a focus on cutting-edge natural treatment approaches, this review investigated biofilm formation mechanisms, resistance patterns, and persistence in chronic wounds. Bromelain, a proteolytic enzyme from pineapple (Ananas comosus), was highlighted in a thorough literature review that concentrated on recent developments in biofilm disruption. Pseudomonas aeruginosa and Staphylococcus aureus, two important biofilm-forming pathogens, have a high level of resistance to antibiotics and prolong chronic inflammation. Natural products hold significant promise in enhancing antimicrobial efficacy and disrupting biofilm structures. Bromelain enhances antibiotic penetration, promotes enzymatic debridement, and demonstrates broad-spectrum antibacterial and antibiofilm qualities. When used against mature biofilms, especially MRSA strains, the bromelain-N-acetylcysteine combination (BromAc) showed remarkable efficacy. While many natural substances exhibit antibiofilm properties, such as tea tree oil (which works against Candida albicans), tannic acid (which targets E. coli CsgD regulators), usnic acid (which inhibits P. aeruginosa adhesion), and α-amylase (which disrupts extracellular matrices), bromelain stands out due to its special combination of matrix degradation and increased antibiotic permeability, according to comparative analysis. Synergistic combinations, such as flogomicina (NAC, bromelain, and plant extracts), increase the effectiveness of antibiotics and reduce bacterial growth by more than 80%. Although more comparative research is required to completely clarify its clinical potential in the management of chronic wounds, bromelain's triple therapeutic action proteolysis, antibiofilm activity, and wound healing promotion makes it a strong contender for both standalone and combination therapies.