Background: Chronic wounds are commonly associated with polymicrobial biofilm
infections. In the last years, the extensive use of antibiotics has generated several antibiotic-resistant
variants. To overcome this issue, alternative natural treatments have been proposed, including the
use of microorganisms like probiotics. The aim of this manuscript was to review current literature
concerning the application of probiotics for the treatment of infected chronic wounds.
Methods: Relevant articles were searched in the Medline database using PubMed and Scholar,
using the keywords “probiotics” and “wound” and “injuries”, “probiotics” and “wound” and
“ulcer”, “biofilm” and “probiotics” and “wound”, “biofilm” and “ulcer” and “probiotics”, “biofilm”
and “ulcer” and “probiotics”, “probiotics” and “wound”.
Results: The research initially included 253 articles. After removal of duplicate studies, and
selection according to specific inclusion and exclusion criteria, 19 research articles were included
and reviewed, accounting for 12 in vitro, 8 in vivo studies and 2 human studies (three articles
dealing with animal experiments included also in vitro testing). Most of the published studies about
the effects of probiotics for the treatment of infected chronic wounds reported a partial inhibition of
microbial growth, biofilm formation and quorum sensing.
Discussion: The application of probiotics represents an intriguing option in the treatment of
infected chronic wounds with multidrug-resistant bacteria; however, current results are difficult to
compare due to the heterogeneity in methodology, laboratory techniques, and applied clinical
protocols. Lactobacillus plantarum currently represents the most studied strain, showing a positive
application in burns compared to guideline treatments, and an additional mean in chronic wound
Conclusions: Although preliminary evidence supports the use of specific strains of probiotics in
certain clinical settings such as infected chronic wounds, large, long-term clinical trials are still
lacking, and further research is needed.