Electroceutical Management of Bacterial Biofilm and Surgical Infection.

Sen, Chandan K; Mathew-Steiner, Shomita S; Das, Amitava; Sundaresan, Vishnu Baba; Roy, Sashwati

SIGNIFICANCE In the host-microbe microenvironment, bioelectrical factors influence microbial, host as well as host-microbe interactions. This article discusses relevant mechanistic underpinnings of this novel paradigm. It also addresses how such knowledge may be leveraged to develop novel electroceutical solutions to manage biofilms in the context of surgical infection. Recent Advances: Systematic review and meta-analysis of several hundred wound studies reported a 78.2% prevalence of biofilms in chronic wounds. Biofilm infection is a major cause of delayed wound healing. In the host-microbe microenvironment, bioelectrical factors influence microbial, host as well as host-microbe interactions. CRITICAL ISSUES Rapid biological responses are driven by electrical signals generated by minute currents of ions moving across cell membranes. Bacterial life, growth and function relies on a bioelectrical milieu which when perturbed impairs their ability to form biofilm, a major threat to healthcare. Viral stability depends on electrostatic forces. Weak electrical field strength, otherwise safe for humans, can achieve such benefit. In the host, electric field enhanced keratinocyte migration, bolstered immune defenses, improved mitochondrial function and demonstrated multiple other effects consistent with supporting wound healing. Deeper mechanistic understanding of electrical principles will inform the design of next generation electroceuticals. FUTURE DIRECTIONS This is an opportune moment in time as there is a surge of interest in electroceuticals in medicine. Projected to reach $35.5 billion by 2025, electroceuticals are becoming a cynosure in the global market. WHO reports that more than 50% of surgical site infections can be antibiotic resistant. Electroceuticals offer a serious alternative.