January 18, 2011 at 6:13 pm #2873
Dr. Randy Wolcott has been practicing medicine for almost thirty years and focusing on treating unhealable wounds the last twelve. His personal research at the Wound Care Centers Research and Testing Laboratories and his collaboration with biofilm experts in the wound care field have earned him international recognition. His work has been published in textbooks as well as prominent journals like the Journal of the American Medical Association and Journal of Wound Care.
His clinic treats not only surface wounds, but the underlying causes that include poor circulation and insidious bacterial biofilms that prevent healing. By using two stage molecular diagnostics, they assess what bacteria are present in the wound bed. More importantly, their diagnostic data reveals the presence of biofilm and a list of both bacterial and non-bacterial microbes which create highly polymicrobial biofilm communities that form the foundation of chronic infections.
Knowing the components of the complex biofilm-based infection helps the medical staff customize the solution for the patient: highly personalized topicals, antibiotics and dressings that treat the wound. All of these services work together to facilitate healing, saving the patients limbs, reducing healing time and saving Medicare large sums of money.
I met Randy and his staff in October of 2010 and interviewed him, staff members and patients to get a sense of how advanced their diagnostic & treatment methods really were. I do believe that their treatment approach has set a new (and badly needed) standard of care for treating chronic wounds and this observation is surely validated by witnessing his patients’ recoveries.
So, here are three chunks of information for you on this interesting healer, Dr. Randy Wolcott:
1. Watch an eight-minute clip from two of my interviews here: YouTube – Randy Wolcott, M.D.
2. Read the article posted elsewhere on this site: http://www.biofilmcommunity.org/f4/we-can-heal-dr-randy-wolcotts-wound-biofilm-treatments-41/
3. See the interview excerpt below.
January 18, 2011 at 7:06 pm #3442
The following interview excerpt was edited for brevity and clarity.
Richard Longland: So what is the problem you are working on here?
Dr. Wolcott: its the most desperate thing youve ever seen. Because it happened slowly, people really dont get a full picture of what we are dealing with. But wounds are probably the window into all other biofilm diseases. Wounds are just insidious and they lull you to sleep.
But heres what happens: it affects many different people for lots of different reasons. Over 4 million new wounds every year, probably in the neighborhood of 8 to 10 million Americans have a chronic wound at any one time. So thats the prevalence. Its a big deal. And the biggest deal on that is about 50,000 people die from those wounds and thats like Christopher Reeves. So this is a real important thing. In fact, there is an article out by Armstrong that suggests that a patient is more at risk of dying; a diabetic is more risk of dying from a diabetic foot ulcer when he presents to the clinic that if that same person had had a heart attack. So think of ER: people go running around and everybody is so excited and its so urgent to fix that heart. Yet, somebody gets a diabetic foot ulcer and people just cover it up for three months or a year and yet that puts that person at as much risk of dying as that heart did.
What we see in wound care is somebody will get a wound, it will grow a little bit, it will wax and wane a little bit, then they lose a toe, then they lose a foot, then they lose their other leg, and then they lose their life. And I see that pattern over and over and over again. And you know, its just not something you can watch too many times and then you say, Hey, this is a big deal. You know, so the problem is chronic infections make people suffer, but chronic infections also make people die. And so its something that has to be addressed and it has to be addressed with urgency
Richard Longland: So maybe there are people in the public wondering, what is the importance of bacterial biofilm infections from a public policy perspective or healthcare policy?
Dr. Wolcott: When we looked at over 2,000 articles on medical biofilms and said, what does it infect? What kind of problems does it cause for that tissue system? If its a sinus or heart valve, a colon or a prostate. You dont think of a chronic sinus infection as a big deal. Yet over 100,000 sinus surgeries and almost 2,000 people die every year of that sinus surgery and you go “.” What kind of public policy do you need for that? Wounds, 50,000 die. People with chronic obstructive pulmonary disease, somewhere around 50,000 die a year. Ventilator acquired pneumonia, 67,000 die. And you add all those up and you have 500,000 people dying. But they dont just die; they suffer from their chronic infection. They lose body parts. And then they die.
Richard Longland: You have some impressive analytics and diagnostic capabilities that we saw earlier today. Can you talk a little bit, either specifically or generally, about the kinds of pathogens that are causing chronic infections, particularly in your patients with foot wounds?
Dr. Wolcott: The diagnostics change the playing field. Cultures gave me a microbial reality of one bacteria, a couple bacteria and it was mainly certain kinds — Staph, itd be Strep, itd be Pseudomonas. Those are things I knew I had antibiotics for them. I was very comfortable with those, but it wasnt changing the outcomes of these wounds! You know it wasnt working.
And so, we wanted to go and start doing biofilm diagnostics. And I assumed we would pick up some other bacteria. The very first culture I got back is the slide I show in our presentation. And it shows 63 different bacteria were in the wound that I looked at. That same wound was diagnosed with a culture, a growing culture and it showed that that person had MRSA. Well our molecular showed that he had MRSA but it was only 7% of all the bugs. And there were 62 other bacteria in there. I cant even say the names of 30 of them. And theres anaerobes and gram negative bacteria. And all the sudden it dawned on me. That was my epiphany: chronic infections, biofilm phenotype infections: that is the pathogen. The biofilm is a single entity
So now its a single entity and it is the pathogen. Now its made up of different species and thats going to determine how we try to manage that biofilm. But it is truly the pathogen. Its not the Staph. Its not the Pseudomonas thats there. Its not the Enterococcus. Its how they combine together to cause that infection. That chronic infection in that host. Thats what I have to attack. Now I need to know those species. I also need to know some other information on the colony defenses so that we can degrade those. So the pathogen is the biofilm whereas in the individual, the acute infection, the pathogen is the species. So you say its MRSA. You say its Pseudomonas. And you are talking about a pathogen. A single thing. Acute infections tend to be one organism. Biofilms tend to be polymicrobial or multiple organisms. What kind of species are we seeing? We are seeing Raoultella planticola, we are seeing things that are just so rare, there are three cases in the literature or something like that. And we see it very frequently. The problem was the cultures werent revealing that to us. So now theres a whole new reality.
Richard Longland: Perhaps there are economic gains associated with these newer technologies as well. Have you gone to any measures to try to quantify the actual monetary savings for the patient, the patients family, or you know the American public at large? Are there economic gains we can realize by moving to these newer treatment options?
Dr. Wolcott: Well the answer to that is yes. And the reason I know that is that Medicare has really hammered us. Medicare wants innovation and they want less cost and everything, the problem is there system is set up that if youre different, youre the bad guy. Youre guilty until proven innocent. We are now proven innocent. Because we did it different. Because the old way wasnt working. So what we did was we abandoned the culture, we went to molecular studies. Those molecular studies cost twice as much as a regular growing culture, but now it gave us more than twice as much information. It told us about the bacteria, but it told us about the fungus, it told us about the yeast, and it also gave us quantitative information and all of the sudden it was accurate!
Now did that make a difference in outcomes? Well, we looked at groups of patients that were treated with molecular diagnostics and without molecular diagnostics and there was a 23% decrease in time to healing if we used the molecular. So, does that translate into cost savings?
At the end of the day we said, thats the money we saved. Well just say thats what we saved Medicare. Just the money of those prevented amputations. Well, the average cost of molecular and doing the, getting the patient healed was somewhere around $2,500 per year and some people took up to 2 years. The most expensive person outlier was $7,600 to get their wound healed. Do you understand the difference in that? I mean, I think it ended up being about, we saved Medicare somewhere in the neighborhood of 35 to 50 times, if you just count the amputations. Not anything else. 50 times savings. Just with that.
And thats the reality. If you can heal the wound in situ and not take off body parts, it is so much more cost effective than starting to cut things off or replacing things. Its just orders of magnitude more when you get into that. So healing the chronic infection in place, whether its a wound or a sinus, whatever the chronic infection, its far more cost effective than any other strategy…”
January 21, 2011 at 12:13 am #2874
Plast Reconstr Surg. 2011 Jan;127 Suppl 1:28S-35S.
The role of biofilms: are we hitting the right target?
Wolcott R, Dowd S.
Southwest Regional Wound Care Center and the Research and Testing Laboratory, Lubbock, Texas 79410, USA.
Plast Reconstr Surg. 2011 Jan;127 Suppl 1:36S-37S.
BACKGROUND: Chronic infections affect 17 million people yearly, and approximately 550,000 people die each year from, or with, their chronic infections. Acute and chornic infection differences are well known to clinicians, but the role of bacteria in producing these clinical differences remains poorly understood.
METHODS: This review relies on basic science, clinical studies, and a general review of the medical biofilm literature. The basic science studies are level A and B quality of evidence. The clinical studies are mainly retrospective cohort (level B) and case studies (level C). The biofilm literature includes reviews with varying levels of evidence. All articles have been peer reviewed and meet the standard of evidence-based medicine.
RESULTS: Acute infections are associated with planktonic bacteria and must be diagnosed rapidly and accurately to prevent tissue damage and/or death. In contrast, biofilm behavior pursues a more parasitic course by producing sustained host hyperinflammation, with the biofilm feeding on plasma exudate. Chronic infections vacillate over long periods of time, responding only partially to antibiotics and reemerging once the antibiotics are withdrawn. Chronic wounds exhibit similar clinical behavior seen in other chronic infections and are associated with biofilm phenotype bacteria on their surface. Biofilm infections, such as chronic wounds, cannot be adequately diagnosed with current clinical cultures; therefore, molecular methods are necessary.
CONCLUSIONS: Biofilm phenotype bacteria require multiple concurrent strategies, including débridement and targeted antibiofilm agents. Biofilm phenotype bacteria predominate on the surface of wounds, and biofilm-based management improves wound healing outcomes, indicating that biofilm is the right target for managing the bioburden barrier of chronic wounds.
PMID: 21200270 [PubMed – in process]
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