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Ahmadieh-Yazdi A, Karimi M, Afkhami E, Hajizadeh-Tafti F, Kuchakzadeh F, Yang P, Sheykhhasan M. Unveiling therapeutic potential: Adipose tissue-derived mesenchymal stem cells and their exosomes in the management of diabetes mellitus, wound healing, and chronic ulcers. Biochem Pharmacol 2024; 226:116399. [PMID: 38944396 DOI: 10.1016/j.bcp.2024.116399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/30/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Diabetes mellitus (DM) is a pervasive global health issue with substantial morbidity and mortality, often resulting in secondary complications, including diabetic wounds (DWs). These wounds, arising from hyperglycemia, diabetic neuropathy, anemia, and ischemia, afflict approximately 15% of diabetic patients, with a considerable 25% at risk of lower limb amputations. The conventional approaches for chronic and diabetic wounds management involves utilizing various therapeutic substances and techniques, encompassing growth factors, skin substitutes and wound dressings. In parallel, emerging cell therapy approaches, notably involving adipose tissue-derived mesenchymal stem cells (ADMSCs), have demonstrated significant promise in addressing diabetes mellitus and its complications. ADMSCs play a pivotal role in wound repair, and their derived exosomes have garnered attention for their therapeutic potential. This review aimed to unravel the potential mechanisms and provide an updated overview of the role of ADMSCs and their exosomes in diabetes mellitus and its associated complications, with a specific focus on wound healing.
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Affiliation(s)
- Amirhossein Ahmadieh-Yazdi
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Karimi
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elham Afkhami
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Hajizadeh-Tafti
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Kuchakzadeh
- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Piao Yang
- Department of Molecular Genetics, College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Mohsen Sheykhhasan
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran.
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2
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Zhou M, Liu Y, Fang X, Jiang Z, Zhang W, Wang X. The Effectiveness of Polyhexanide in Treating Wound Infections Due to Methicillin-Resistant Staphylococcus Aureus: A Prospective Analysis. Infect Drug Resist 2024; 17:1927-1935. [PMID: 38766679 PMCID: PMC11102757 DOI: 10.2147/idr.s438380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/27/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Polyhexanide is a safe and effective wound care antiseptic commonly used in clinics as wound rinsing solution and gel. However, the efficacy of Polyhexanide in treatment of wound infected with MRSA (methicillin-resistant Staphylococcus aureus) is unknown. The aim of this study is to assess the effectiveness of polyhexanide with povidone iodine in treating wound infected with MRSA. Patients and Methods A prospective analysis of 62 patients with wound infections, who were admitted to our department from 2016 to 2020, was conducted in order to assess the efficacy of different treatment approaches. The patients were divided into two groups: the experimental group and the control group. In the experimental group, 30 patients underwent treatment with a combination of diluted povidone iodine and polyhexanide immersion. Conversely, in the control group, 32 patients received treatment with diluted povidone iodine along with systemic antibiotic therapy. The time required for dressing changes, bacterial clearance rates, and the Bates-Jasen wound assessment tool (BWAT) scores were utilized as indicators to evaluate the effectiveness of the treatments. Results In our study, the findings indicated that the experimental group exhibited a lesser number of days for the bacteria culture to turn negative compared to the control group, with statistical significance (p<0.05). Furthermore, the decline in the BWAT score was significantly greater in the experimental group than in the control group (p<0.05). However, no significant differences were observed in terms of dressing times and wound coverage between the two groups (p>0.05). Conclusion Polyhexanide combined with povidone iodine can effectively remove MRSA infection in wounds and reduce antibiotic dosages.
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Affiliation(s)
- Min Zhou
- Department of Orthopaedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan City, People’s Republic of China
| | - Yuping Liu
- Sichuan University West China Second University Hospital, Department of Anesthesiology, Chengdu, Sichuan, People’s Republic of China
| | - Xue Fang
- Department of Orthopaedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan City, People’s Republic of China
| | - Zhezhen Jiang
- Department of Orthopaedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan City, People’s Republic of China
| | - Wang Zhang
- Department of Orthopaedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan City, People’s Republic of China
| | - Xin Wang
- Department of Orthopaedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan City, People’s Republic of China
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Yap JW, Ismail NI, Lee CS, Oh DY. Impact of Interfering Substances on the Bactericidal Efficacy of Different Commercially Available Hypochlorous Acid-Based Wound Irrigation Solutions Commonly Found in South-East Asia. Antibiotics (Basel) 2024; 13:309. [PMID: 38666985 PMCID: PMC11047473 DOI: 10.3390/antibiotics13040309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024] Open
Abstract
The high prevalence of chronic wounds is a growing concern. Recently, hypochlorous acid (HOCl)-based solutions were introduced as an alternative antimicrobial for wound cleansing. In this study, we assessed the in vitro bactericidal activities of seven commercially available wound irrigation products commonly found in South-East Asia. The evaluation was conducted using quantitative suspension method, EN 13727 in either low or high protein conditions. Under low protein conditions, four out of the five HOCl products achieved bactericidal activity (≥5 log10 reduction factor; RF) within 2-5 min, and only one product achieved 5 log10 RF at 15 s. None of the HOCl achieved 5 log10 RF under high protein, even after 30 min of exposure time. In contrast, protein interference on the antimicrobial activities of polyhexamethylene biguanide-based product is less pronounced (low protein: 60 s vs. high protein: 2 min to attain ≥5 log10 RF). Octenidine dihydrochloride is the only active not affected by protein interference achieving ≥5 log10 RF within 15 s in both low and high protein conditions. These findings warrant the need to screen antimicrobial wound care products, especially HOCl-based products, in high protein condition to better reflect the antimicrobial activities in wound care.
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Affiliation(s)
- Jiann Wen Yap
- Wound and Stoma Care Unit, Queen Elizabeth Hospital, Karung Berkunci No. 2029, Kota Kinabalu 88586, Sabah, Malaysia;
| | - Neni Iffanida Ismail
- TECOLAB SDN BHD, J-2-6, Pusat Komersial Jalan Kuching, Kuala Lumpur 51200, Malaysia; (N.I.I.); (C.S.L.)
| | - Cheng Shoou Lee
- TECOLAB SDN BHD, J-2-6, Pusat Komersial Jalan Kuching, Kuala Lumpur 51200, Malaysia; (N.I.I.); (C.S.L.)
| | - Ding Yuan Oh
- Schülke & Mayr (Asia) Pte Ltd., 10 Jalan Kilang #04-01/02/03, Singapore 159410, Singapore
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Wiegand C, Fink S, Mogrovejo DC, Ruhlandt M, Wiencke V, Eberlein T, Brill FHH, Tittelbach J. A standardized wound infection model for antimicrobial testing of wound dressings in vitro. Int Wound J 2024; 21:e14811. [PMID: 38477866 PMCID: PMC10936570 DOI: 10.1111/iwj.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
To investigate the effectiveness of antimicrobial agents against wound infections, experiments using either 2D cultures with planktonic microorganisms or animal infection models are frequently carried out. However, the transferability of the results to human skin is limited by the lack of complexity of the 2D models or by the poor translation of the results from animal models. Hence, there is a need for wound infection models capable of assessing antimicrobial agents. In this study, an easily standardized wound infection model was established. This model consists of a mechanically wounded human skin model on a collagen matrix infected with various clinically relevant bacteria. Infection of the model led to recognition of the pathogens and induction of an inflammatory response. The untreated infection spread over time, causing significant tissue damage. By applying an antimicrobial-releasing wound dressing, the bacterial load could be reduced and the success of the treatment could be further measured by a decrease in the inflammatory reaction. In conclusion, this wound infection model can be used to evaluate new antimicrobial therapeutics as well as to study host-pathogen interactions.
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Affiliation(s)
| | - Sarah Fink
- Department of DermatologyJena University HospitalJenaGermany
| | - Diana C. Mogrovejo
- Dr. Brill + Partner GmbHInstitute for Hygiene and MicrobiologyHamburgGermany
| | - Marina Ruhlandt
- Dr. Brill + Partner GmbHInstitute for Hygiene and MicrobiologyHamburgGermany
| | - Vanessa Wiencke
- Dr. Brill + Partner GmbHInstitute for Hygiene and MicrobiologyHamburgGermany
| | | | - Florian H. H. Brill
- Dr. Brill + Partner GmbHInstitute for Hygiene and MicrobiologyHamburgGermany
| | - Jörg Tittelbach
- Department of DermatologyJena University HospitalJenaGermany
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Yadav JP, Singh AK, Grishina M, Pathak P, Verma A, Kumar V, Kumar P, Patel DK. Insights into the mechanisms of diabetic wounds: pathophysiology, molecular targets, and treatment strategies through conventional and alternative therapies. Inflammopharmacology 2024; 32:149-228. [PMID: 38212535 DOI: 10.1007/s10787-023-01407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
Diabetes mellitus is a prevalent cause of mortality worldwide and can lead to several secondary issues, including DWs, which are caused by hyperglycemia, diabetic neuropathy, anemia, and ischemia. Roughly 15% of diabetic patient's experience complications related to DWs, with 25% at risk of lower limb amputations. A conventional management protocol is currently used for treating diabetic foot syndrome, which involves therapy using various substances, such as bFGF, pDGF, VEGF, EGF, IGF-I, TGF-β, skin substitutes, cytokine stimulators, cytokine inhibitors, MMPs inhibitors, gene and stem cell therapies, ECM, and angiogenesis stimulators. The protocol also includes wound cleaning, laser therapy, antibiotics, skin substitutes, HOTC therapy, and removing dead tissue. It has been observed that treatment with numerous plants and their active constituents, including Globularia Arabica, Rhus coriaria L., Neolamarckia cadamba, Olea europaea, Salvia kronenburgii, Moringa oleifera, Syzygium aromaticum, Combretum molle, and Myrtus communis, has been found to promote wound healing, reduce inflammation, stimulate angiogenesis, and cytokines production, increase growth factors production, promote keratinocyte production, and encourage fibroblast proliferation. These therapies may also reduce the need for amputations. However, there is still limited information on how to prevent and manage DWs, and further research is needed to fully understand the role of alternative treatments in managing complications of DWs. The conventional management protocol for treating diabetic foot syndrome can be expensive and may cause adverse side effects. Alternative therapies, such as medicinal plants and green synthesis of nano-formulations, may provide efficient and affordable treatments for DWs.
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Affiliation(s)
- Jagat Pal Yadav
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
- Pharmacology Research Laboratory, Faculty of Pharmaceutical Sciences, Rama University, Kanpur, 209217, India.
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
| | - Ankit Kumar Singh
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, 151401, India
| | - Maria Grishina
- Laboratory of Computational Modeling of Drugs, Higher Medical and Biological School, South Ural State University, Chelyabinsk, 454008, Russia
| | - Prateek Pathak
- Department of Pharmaceutical Analysis, Quality Assurance, and Pharmaceutical Chemistry, School of Pharmacy, GITAM (Deemed to Be University), Hyderabad, 502329, India
| | - Amita Verma
- Bioorganic and Medicinal Chemistry Research Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India
| | - Pradeep Kumar
- Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda, 151401, India
| | - Dinesh Kumar Patel
- Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, 211007, India.
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Powell D, Comer B, Wu B, Dietz P, Bou-Akl T, Ren WP, Markel DC. Effect of Commercially Available Wound Irrigation Solutions on Uninfected Host Tissue in a Murine Model. Arthroplast Today 2024; 25:101300. [PMID: 38292145 PMCID: PMC10826152 DOI: 10.1016/j.artd.2023.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/30/2023] [Accepted: 11/05/2023] [Indexed: 02/01/2024] Open
Abstract
Background Commercially available irrigation solutions are used to reduce bacterial contamination and prevent surgical site infections. However, the effect of these solutions on the healing capacity of tissue has not been well-established. The purpose of this study was to investigate the effects of 5 commercially available irrigation solutions on host tissue in a murine model. Methods There were 5 treatment groups: bacitracin, Clorpactin, Irrisept, Prontosan, Bactisure, and normal saline control. The irrigation solutions were applied to the wound for 30 seconds or 1 minute, as per the manufacturer's instructions, and then washed with normal saline. Mice were sacrificed at 3 days and 10 days. The tissue was examined histologically for inflammation, edema, granulation tissue formation, and re-epithelialization. Granulation tissue formation and re-epithelialization were surrogates for effective wound healing. Results All of the irrigation solutions had negative effects on host tissue in the acute phase. The inflammation and edema were improved in the later phase (10 days). Recovery and healing of the open wounds were observed for all groups at 10 days. The antiseptic irrigation solutions had similar cytotoxic effects on host tissue at 3 days and did not have delayed or compromised wound healing at 10 days when compared to normal saline control. Conclusions Single short-duration use of these commercially available antiseptic irrigation solutions appears to be safe in an uninfected wound. Data from this study will provide surgeons with useful information regarding the safety of using antiseptic wound irrigation solutions intraoperatively for prevention of surgical site infections.
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Affiliation(s)
- Dexter Powell
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
| | - Brendan Comer
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
| | - Bin Wu
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
| | - Paula Dietz
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
| | - Therese Bou-Akl
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Wei-ping Ren
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - David C. Markel
- Ascension-Providence Hospital Orthopaedic Surgery Laboratory, Southfield, MI, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- The CORE Institute, Novi, MI, USA
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Chauhan S, Gulia M, Singh RP, Jhawat V. Diabetic Wound: Pathophysiology, Complications and Treatment Strategies. Curr Protein Pept Sci 2024; 25:200-205. [PMID: 37909438 DOI: 10.2174/0113892037276171231016103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
Diabetic wound healing is expected to affect 25% of all diabetics, resulting in less severe external factors, economic costs, and less trauma. Topical formulations have been continually improved to achieve a range of amazing properties and have had a significant impact on the management of diabetic wounds. Topical insulin has become one of the most attractive and convenient wound healing techniques due to its excellent biocompatibility, water retention, and therapeutic properties. Multiple versatile topical insulins have been identified and have shown promise over the past few years as they greatly facilitate the management of diabetic wounds as we understand their etiology. The physiological wound healing process repairs damaged tissue and restores skin integrity. For about a century, insulin, a powerful healing agent, and it has been utilized in several clinical and experimental researches research studies to accelerate the healing of various injuries.
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Affiliation(s)
- Sunita Chauhan
- Department of Pharmaceutical Science, School of Medical and Allied Science, GD Goenka University, Gurugram, Haryana, India
| | - Monika Gulia
- Department of Pharmaceutical Science, School of Medical and Allied Science, GD Goenka University, Gurugram, Haryana, India
| | - Rahul Pratap Singh
- Department of Pharmaceutical Science, School of Medical and Allied Science, GD Goenka University, Gurugram, Haryana, India
| | - Vikas Jhawat
- Department of Pharmaceutical Science, School of Medical and Allied Science, GD Goenka University, Gurugram, Haryana, India
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Stryja J, Teplá K, Routek M, Pavlík V, Perutková D. Octenidine with hyaluronan dressing versus a silver dressing in hard-to-heal wounds: a post-marketing study. J Wound Care 2023; 32:480-491. [PMID: 37572339 DOI: 10.12968/jowc.2023.32.8.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
OBJECTIVE This study was conducted to provide comparative data on the clinical efficacy and safety of a novel hard-to-heal wound dressing (Sorelex; Contipro a.s., Czech Republic) that combines octenidine and hyaluronan, compared with a silver-based dressing. METHOD This multicentre, open-label, randomised, post-market, clinical follow-up study provides a comparison of a octenidine and hyaluronan combination with a standard-of-care (SoC) silver-containing dressing. The investigators evaluated the management of infection in the hard-to-heal wounds based on recorded changes in the appearance of the wound bed tissue and the presence of clinical signs of infection after three weeks of treatment. Other relevant assessed parameters of wound healing were: wound size; exudation level; wound pain level; and surrounding skin appearance. RESULTS The study cohort included 48 patients in the Sorelex arm and 39 patients in the SoC arm. Both products evinced numerous parameters of wound infection management: reductions in the wound bed slough; marked decreases in wound size; the formation of re-epithelialisation and granulation tissue; and improved pain management. Sorelex significantly improved the condition of surrounding skin after three weeks of treatment, unlike SoC. Sorelex reduced wound area significantly more than SoC (p=0.04). No statistically significant differences were detected in other assessed parameters between the two study arms. All the participating investigators expressed their satisfaction with both products. No adverse reactions to Sorelex were recorded over the mean treatment period of 53 days. CONCLUSION The octenidine and hyaluronan combination provides a new alternative choice of dressing for the treatment of infected hard-to-heal wounds when compared with a silver-based product.
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Affiliation(s)
- Jan Stryja
- Centre of Vascular and Miniinvasive Surgery, Hospital Agel, Trinec Podlesi, The Czech Republic; Salvatella Ltd., Centre of Non-healing Wounds Treatment, Podiatric Outpatients' Department, Trinec, The Czech Republic
| | | | - Miroslav Routek
- Ambulance for Treatment of Chronic Wounds, Regional Hospital Nachod, Broumov, The Czech Republic
| | - Vojtech Pavlík
- Department of Dermatology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Darja Perutková
- Department of dermatology, Military hospital, Olomouc, The Czech Republic
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Wang X, Tan J, Ni S, Zhou D, Liu B, Fu Q. Antimicrobial efficacy of composite irrigation solution against dominant pathogens in seawater immersion wound and in vivo wound healing assessment. Front Microbiol 2023; 14:1188373. [PMID: 37303778 PMCID: PMC10248133 DOI: 10.3389/fmicb.2023.1188373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Seawater immersion wound is inevitably accompanied by bacterial infection. Effective irrigation is critical for bacterial infection prevention and wound healing. In this study, the antimicrobial efficacy of a designed composite irrigation solution against several dominant pathogens in seawater immersion wounds was evaluated, and in vivo wound healing assessment was conducted in a rat model. According to the time-kill result, the composite irrigation solution exhibits excellent and rapid bactericidal effect against Vibrio alginolyticus and Vibrio parahaemolyticus within 30 s of treatment while eliminating Candida albicans, Pseudomonas aeruginosa, Escherichia coli, and the mixed microbes after 1 h, 2 h, 6 h, and 12 h of treatment, respectively. Significant bacterial count reduction of Staphylococcus aureus was observed after 5 h treatment. In addition to its skin non-irritating attribute, the in vivo wound healing results further demonstrated that the irrigation solution showed high repair efficiency in the skin defect model inoculated with the mixed microbes. The wound healing rate was significantly higher than that of the control and normal saline groups. It could also effectively reduce the number of viable bacteria on the wound surface. The histological staining indicated that the irrigation solution could reduce inflammatory cells and promote collagen fibers and angiogenesis, thereby promoting wound healing. We believed that the designed composite irrigation solution has great potential for application in the treatment of seawater immersion wounds.
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Affiliation(s)
- Xin Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai, China
- Shanghai Co-Innovation Center for Energy Therapy of Tumors, Shanghai, China
| | - Jie Tan
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Shenpeng Ni
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Dengyun Zhou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Baolin Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai, China
- Shanghai Co-Innovation Center for Energy Therapy of Tumors, Shanghai, China
| | - Qiang Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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Khabadze Z, Generalova Y, Kulikova A, Podoprigora I, Abdulkerimova S, Bakaev Y, Makeeva M, Dashtieva M, Balashova M, Gadzhiev F, Mordanov O, Umarov A, Tarik H, Zoryan A, Karnaeva A, Rakhmanov Y. Irrigation in Endodontics: Polyhexanide Is a Promising Antibacterial Polymer in Root Canal Treatment. Dent J (Basel) 2023; 11:dj11030065. [PMID: 36975562 PMCID: PMC10047796 DOI: 10.3390/dj11030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Background:chronic apical periodontitis is a common pathology in dentistry, especially in endodontics. It is necessary to systematize data concerning commonly used irrigation solutions. The development of new protocols for endodontic treatment is a very promising direction. The use of a polyhexanide-based antiseptic can positively affect the results of endodontic treatment. Methods: the review was carried out involving the search for English language research and meta-analyses in the Google Scholar and PubMed databases. Results: the number of literary sources that were identified during the literature review is 180. After excluding publications that did not match the search criteria, the total number of articles included in the systematic review was determined to be 68. Conclusions: polyhexanide is a promising solution for infected root canal irrigation. The antibacterial activity of this substance is suitable for the elimination of pathogens responsible for the appearance of apical periodontitis.
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Garcia LV, Silva D, Costa MM, Armés H, Salema-Oom M, Saramago B, Serro AP. Antiseptic-Loaded Casein Hydrogels for Wound Dressings. Pharmaceutics 2023; 15:pharmaceutics15020334. [PMID: 36839656 PMCID: PMC9967843 DOI: 10.3390/pharmaceutics15020334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
Chronic wound treatment accounts for a substantial percentage of the medical expenses worldwide. Improving and developing novel wound care systems can potentially help to handle this problem. Wound dressings loaded with antiseptics may be an important tool for wound care, as they inhibit bacterial growth at the wound site. The goal of the present work was to investigate the potential of using casein hydrogel dressings loaded with two antiseptic drugs, Octiset® or polyhexanide, to treat chronic wounds. Casein-based hydrogels are inexpensive and have several properties that make them suitable for biomedical applications. Two types of casein were used: casein sodium salt and acid casein, with the formulations being labelled CS and C, respectively. The hydrogels were characterised with respect to their physical properties (swelling capacity, water content, morphology, mechanical resistance, and stability), before and after sterilisation, and they showed adequate values for the intended application. The hydrogels of both formulations were able to sustain controlled drug-release for, at least, 48 h. They were demonstrated to be non-irritant, highly haemocompatible, and non-cytotoxic, and revealed good antimicrobial properties against Staphylococcus aureus and Pseudomonas aeruginosa. Steam-heat sterilisation did not compromise the material's properties. The in vivo performance of C hydrogel loaded with Octiset® was evaluated in a case study with a dog. The efficient recovery of the wounds confirms its potential as an alternative for wound treatment. To our knowledge, this is the first time that wound dressings loaded with Octiset®, one of the most efficient drugs for wound treatment, were prepared and tested.
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Affiliation(s)
- Leonor Vasconcelos Garcia
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Diana Silva
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Correspondence: (D.S.); (B.S.)
| | - Maria Madalena Costa
- Hospital Veterinário de S. Bento, Rua de S. Bento, 358-A, 1200-822 Lisboa, Portugal
- Faculdade de Medicina Veterinária, Universidade Lusófona, Campo Grande, 376, 1749-024 Lisboa, Portugal
| | - Henrique Armés
- Hospital Veterinário de S. Bento, Rua de S. Bento, 358-A, 1200-822 Lisboa, Portugal
- Faculdade de Medicina Veterinária, Universidade Lusófona, Campo Grande, 376, 1749-024 Lisboa, Portugal
| | - Madalena Salema-Oom
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal
| | - Benilde Saramago
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Correspondence: (D.S.); (B.S.)
| | - Ana Paula Serro
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal
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12
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Rippon MG, Rogers AA, Ousey K. Polyhexamethylene biguanide and its antimicrobial role in wound healing: a narrative review. J Wound Care 2023; 32:5-20. [PMID: 36630111 DOI: 10.12968/jowc.2023.32.1.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A wound offers an ideal environment for the growth and proliferation of a variety of microorganisms which, in some cases, may lead to localised or even systemic infections that can be catastrophic for the patient; the development of biofilms exacerbates these infections. Over the past few decades, there has been a progressive development of antimicrobial resistance (AMR) in microorganisms across the board in healthcare sectors. Such resistant microorganisms have arisen primarily due to the misuse and overuse of antimicrobial treatments, and the subsequent ability of microorganisms to rapidly change and mutate as a defence mechanism against treatment (e.g., antibiotics). These resistant microorganisms are now at such a level that they are of grave concern to the World Health Organization (WHO), and are one of the leading causes of illness and mortality in the 21st century. Treatment of such infections becomes imperative but presents a significant challenge for the clinician in that treatment must be effective but not add to the development of new microbes with AMR. The strategy of antimicrobial stewardship (AMS) has stemmed from the need to counteract these resistant microorganisms and requires that current antimicrobial treatments be used wisely to prevent amplification of AMR. It also requires new, improved or alternative methods of treatment that will not worsen the situation. Thus, any antimicrobial treatment should be effective while not causing further development of resistance. Some antiseptics fall into this category and, in particular, polyhexamethylene hydrochloride biguanide (PHMB) has certain characteristics that make it an ideal solution to this problem of AMR, specifically within wound care applications. PHMB is a broad-spectrum antimicrobial that kills bacteria, fungi, parasites and certain viruses with a high therapeutic index, and is widely used in clinics, homes and industry. It has been used for many years and has not been shown to cause development of resistance; it is safe (non-cytotoxic), not causing damage to newly growing wound tissue. Importantly there is substantial evidence for its effective use in wound care applications, providing a sound basis for evidence-based practice. This review presents the evidence for the use of PHMB treatments in wound care and its alignment with AMS for the prevention and treatment of wound infection.
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Affiliation(s)
- Mark G Rippon
- Huddersfield University, Huddersfield, UK.,Dane River Consultancy Ltd, Cheshire, UK
| | | | - Karen Ousey
- University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK.,School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,RCSI, Dublin, Eire
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13
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Denysko TV, Nazarchuk OA, Gruzevskyi O, Bahniuk NÀ, Dmytriiev DV, Chornopyschuk RM, Bebyk VV. In vitro evaluation of the antimicrobial activity of antiseptics against clinical Acinetobacter baumannii strains isolated from combat wounds. Front Microbiol 2022; 13:932467. [PMID: 36267170 PMCID: PMC9577188 DOI: 10.3389/fmicb.2022.932467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare-associated infections (HCAIs) are among the most prominent medical problems worldwide. In the context of increasing antibiotic resistance globally, the use of antiseptics as the main active agent and potentiator of antibiotics for the treatment of purulent-inflammatory complications of traumatic wounds, burns, and surgical wounds can be considered to tackle opportunistic infections and their prevention during war. This study presents a comparative investigation of the antimicrobial efficacy of antiseptics used for surgical antisepsis and antiseptic treatment of skin, mucous membranes, and wounds against multidrug-resistant clinical isolates of Acinetobacter baumannii as a wound pathogen of critical priority (according to the WHO). It was found that strains of A. baumannii, which have natural and acquired resistance to antimicrobial drugs, remain susceptible to modern antiseptics. Antiseptic drugs based on decamethoxine, chlorhexidine, octenidine, polyhexanide, and povidone-iodine 10% and 2% provide effective bactericidal activity against A. baumannii within the working concentrations of these drugs. Chlorhexidine and decamethoxine can inhibit biofilm formation by A. baumannii cells. In terms of bactericidal properties and biofilm formation inhibition, chlorhexidine and decamethoxine are the most effective of all tested antiseptics.
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Affiliation(s)
- Tetyana Valeriyivna Denysko
- Department of Microbiology, Virology and Immunology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Oleksandr Adamovych Nazarchuk
- Department of Microbiology, Virology and Immunology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
- *Correspondence: Oleksandr Adamovych Nazarchuk,
| | - Oleksandr Gruzevskyi
- Department of Microbiology, Virology and Immunology Odessa National Medical University, Odessa, Ukraine
| | - Nataliia Ànatoliivna Bahniuk
- Department of Microbiology, Virology and Immunology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Dmytro Valeriiovych Dmytriiev
- Department of Anesthesiology, Intensive care, and Emergency Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | | | - Vira Volodymyrivna Bebyk
- Department of Microbiology, Virology and Immunology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
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14
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Caid M, Valk J, Danoff J. Irrigation Solutions in Total Joint Arthroplasty. Spartan Med Res J 2022; 7:37502. [PMID: 36128028 PMCID: PMC9448655 DOI: 10.51894/001c.37502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Despite advancements in the field of adult reconstruction, prosthetic joint infection (PJI) remains a common and devastating complication of total joint arthroplasty. Eradication of these infections can often prove difficult, and they remain a source of considerable morbidity and mortality. This clinical review paper will focus on some of the more commonly used irrigation solutions; povidone-iodine (PI), chlorhexidine (CHG), acetic acid (AA), hydrogen peroxide (HP), antibiotic irrigations, taurolidine, and polyhexanide-betaine (PB). SUMMARY OF THE EVIDENCE Significant research has been performed on the prevention of PJI, including use of intraoperative joint irrigation solutions. Several solutions have been theorized to aid in infection prevention, but no evidence-based practice guidelines in this area of orthopaedics have been established. There is a paucity of prospective randomized control trials to compare the efficacy of these joint irrigation solutions. CONCLUSIONS The authors present a review regarding seven major categories of commonly used intraoperative joint irrigation solutions. The current literature fails to demonstrate a clear consensus for a preferred solution and concentration for povidone-iodine, chlorhexidine, hydrogen peroxide, acetic acid, antibiotic irrigations, taurolidine, and polyhexanide-betaine. Prospective, randomized control trials directly comparing these different irrigation solutions are needed.
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15
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Aisa J, Parlier M. Local wound management: A review of modern techniques and products. Vet Dermatol 2022; 33:463-478. [PMID: 35876262 DOI: 10.1111/vde.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/01/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.
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Affiliation(s)
- Josep Aisa
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Mark Parlier
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
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16
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Weigelt MA, Lev-Tov HA, Tomic-Canic M, Lee WD, Williams R, Strasfeld D, Kirsner RS, Herman IM. Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine. Adv Wound Care (New Rochelle) 2022; 11:330-359. [PMID: 34128387 DOI: 10.1089/wound.2020.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.
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Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. David Lee
- Precision Healing, Inc., Newton, Massachusetts, USA
| | | | | | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ira M. Herman
- Precision Healing, Inc., Newton, Massachusetts, USA
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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17
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O'Donnell JA, Wu M, Cochrane NH, Belay E, Myntti MF, James GA, Ryan SP, Seyler TM. Efficacy of Common Antiseptic Solutions Against Clinically Relevant Planktonic Microorganisms. Orthopedics 2022; 45:122-127. [PMID: 34978511 DOI: 10.3928/01477447-20211227-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prosthetic joint infections (PJIs) are among the most devastating complications after joint replacement. There is limited evidence regarding the efficacy of different antiseptic solutions in reducing planktonic microorganism burden. The purpose of this study was to test the efficacy of different antiseptic solutions against clinically relevant planktonic microorganisms. We designed an experiment examining the efficacy of several antiseptic solutions against clinically relevant planktonic microorganisms in vitro. Regarding planktonic microorganisms, povidone-iodine had 99.9% or greater reduction for all microorganisms tested except for methicillin-resistant Staphylococcus aureus, which was reduced by 60.44%. Irrisept (Irrimax Corp) had 99.9% or greater reduction for all microorganisms except Staphylococcus epidermidis (98.31%) and Enterococcus faecalis (48.61%). Bactisure (Zimmer Surgical Inc) had 99.9% or greater reduction for all microorganisms tested. Various measures exist for PJI prevention, one of which is intraoperative irrigation. We tested irrigants against clinically relevant planktonic microorganisms in vitro and found significant differences in efficacy among them. Further clinical outcome data are necessary to determine whether these solutions can impact PJI in vivo. [Orthopedics. 2022;45(2):122-127.].
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18
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Davis SC, Li J, Gil J, Valdes J, Solis M, Higa A. A novel dressing with silver to treat meticillin-resistant Staphylococcus aureus biofilm infection in a pig model. J Wound Care 2022; 31:S42-S48. [PMID: 35148641 DOI: 10.12968/jowc.2022.31.sup2.s42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to use an in vivo biofilm porcine model to examine a new polyvinyl alcohol-based gelling fibre dressing with silver and compare it to other commercial dressings containing: polyvinyl alcohol-based gelling fibre without silver; carboxymethyl cellulose-based fibre with silver, benzethonium chloride and ethylenediaminetetraacetic acid; and untreated control. METHODS A total of 52 deep partial-thickness wounds (10x7x0.5mm) were created on each of three animals and inoculated with 25µl of meticillin-resistant Staphylococcus aureus (MRSA) (106 colony forming units (CFU)/ml). Wounds were covered for 24 hours to allow biofilm formation and were randomly designated to one of the four treatments. Samples were recovered for microbiological and histological analysis on days 3, 5 and 7 post-treatment. RESULTS Polyvinyl alcohol-based gelling fibre dressing with silver was able to significantly reduce biofilm more effectively than the other treatment groups. By day 7, wounds treated with the dressing had a 2.72±0.01 log CFU/g reduction in MRSA count versus untreated control wounds and a 2.59±0.01 log CFU/g reduction versus baseline counts. For histology analysis, all wounds reached 100% re-epithelialisation by day 5. CONCLUSION The results of this study indicated that polyvinyl alcohol-based gelling fibre dressing with silver was effective against biofilm of antibiotic-resistant staphylococcal strains without inhibiting the wound healing process, and may have important clinical implications when treating acute and/or hard-to-heal wounds.
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Affiliation(s)
- Stephen C Davis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jie Li
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Joel Gil
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Jose Valdes
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Michael Solis
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
| | - Alex Higa
- University of Miami Miller School of Medicine, Department of Dermatology & Cutaneous Surgery, Miami, Florida, US
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19
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Davis SC, Gil J, Solis M, Higa A, Mills A, Simms C, Pena PV, Li J, Raut V. Antimicrobial effectiveness of wound matrices containing native extracellular matrix with polyhexamethylene biguanide. Int Wound J 2022; 19:86-99. [PMID: 33955663 PMCID: PMC8684887 DOI: 10.1111/iwj.13600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of wound matrix materials that are designed to help heal both acute and chronic wounds are currently available. Because wounds often encounter opportunistic microbes that can delay healing, the effectiveness of these materials is often suboptimal, resulting in delayed or compromised wound healing. The importance of reducing and controlling wound microbes is well recognised and there are several antimicrobial options available to address this unmet clinical need. This study compares the antimicrobial and wound healing capabilities, both in vivo and in vitro against methicillin-resistant Staphylococcus aureus (MRSA) USA 300, for the following compounds: Collagen Wound Matrix-Anti Microbial (CWM-AM); Collagen Wound Matrix-Anti Microbial XT (CWM-AM XT); Antimicrobial Hydrofiber Wound Dressing (AHWD); Dermal Scaffold with Silver (DRSAg); Collagen Extracellular Matrix (CEM); Collagen Wound Matrix (CWM); Matrix Wound Dressing with Silver (MWDAg); Cadexomer Iodine Gel (CIG); Triple Antibiotic Ointment (TAO); and Antimicrobial Wound Gel (AWG). For the in vitro zone of inhibition assay, AWG and CIG had the largest diffused areas, followed by CWM-AM and CWM-AM XT. Furthermore, CWM-AM, CWM-AM XT, AWG, and CIG exhibited a persistent antimicrobial activity for up to 10 days after incubation. However, in the cytotoxicity studies performed using human fibroblasts, CWM-AM and CWM-AM XT had no detrimental effects in cell proliferation and viability, while AWG and CIG were cytotoxic and prohibitive for cell proliferation. Treatments were then assessed for microbiology and wound healing efficacy using an in vivo porcine deep reticular dermal wound model. CWM-AM XT displayed the greatest in vivo antimicrobial activity against MRSA USA300 and expedited the reepithelialisation at a faster rate than other treatment groups. This study shows that a novel collagen matrix containing an antimicrobial agent can reduce the bacterial load and support healing.
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Affiliation(s)
- Stephen C. Davis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Joel Gil
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Michael Solis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Alexander Higa
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Colin Simms
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Pilar Valencia Pena
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Jie Li
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Vivek Raut
- Organogenesis Inc.CantonMassachusettsUSA
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20
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Aswathanarayan JB, Rao P, HM S, GS S, Rai RV. Biofilm-Associated Infections in Chronic Wounds and Their Management. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022. [DOI: 10.1007/5584_2022_738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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The In Vitro Ability of Klebsiella pneumoniae to Form Biofilm and the Potential of Various Compounds to Eradicate It from Urinary Catheters. Pathogens 2021; 11:pathogens11010042. [PMID: 35055990 PMCID: PMC8780725 DOI: 10.3390/pathogens11010042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
Urinary infections related to the presence of bacterial biofilm on catheters are responsible for loss of patients’ health and, due to their high frequency of occurrence, generate a significant economic burden for hospitals. Klebsiella pneumoniae is a pathogen frequently isolated from this type of infection. In this study, using a cohesive set of techniques performed under stationary and flow conditions, we assessed the ability of 120 K. pneumoniae strains to form biofilm on various surfaces, including catheters, and evaluated the usefulness of clinically applied and experimental compounds to remove biofilm. The results of our study indicate the high impact of intraspecies variability with respect to K. pneumoniae biofilm formation and its susceptibility to antimicrobials and revealed the crucial role of mechanical flushing out of the biofilm from the catheter’s surface with use of locally active antimicrobials. Therefore, our work, although of in vitro character, may be considered an important step in the direction of efficient reduction of K. pneumoniae biofilm-related hospital infections associated with the presence of urine catheters.
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22
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Yao H, Hu Y, Wang Q, Zhang Y, Rao K, Shi S. Effects of dietary dimethylglycine supplementation on laying performance, egg quality, and tissue index of hens during late laying period. Poult Sci 2021; 101:101610. [PMID: 34936951 PMCID: PMC8704446 DOI: 10.1016/j.psj.2021.101610] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/25/2021] [Accepted: 11/13/2021] [Indexed: 12/12/2022] Open
Abstract
In this study, the effects of 5 graded dietary levels (0.025, 0.05, 0.075, 0.1, and 0.125%) of dimethylglycine (DMG) were studied in laying hens during the late laying period (71–78 wk). Graded doses of DMG from 0.025 to 0.125% in the diet produced quadratic positive (P < 0.05) responses in the laying rate, egg-feed ratio, yolk color, grade follicular weight, and the number of large white follicles and linear positive (P < 0.05) responses in average egg weight, and the number of large white follicles. With 0.1% DMG, the laying rate and egg-feed ratio improved (P < 0.05), and the abdominal fat percentage decreased. Considering the laying performance under the conditions used in this study, the best-fit model for the DMG requirements of laying hens was estimated to range from 0.049 to 0.065% DMG during the late laying period based on a regression analysis. The addition of DMG did not affect the total cholesterol (TCH) and triglyceride (TG) contents in the plasma of laying hens; however, it significantly reduced the abdominal fat rate. DMG may change the course of lipid deposition in laying hens during the late laying period. In conclusion, supplementation with DMG can improve the laying rate and follicles development of laying hens.
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Affiliation(s)
- Hong Yao
- Poultry Institute, Chinese Academy of Agriculture Science, Yangzhou, Jiangsu, 225125, China; Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Disease and Zoonose, Yangzhou University, Yangzhou, 225009, China; College of Animal Husbandry and Veterinary, Southwest Minzu University, Chengdu, 610041, China
| | - Yan Hu
- Poultry Institute, Chinese Academy of Agriculture Science, Yangzhou, Jiangsu, 225125, China; Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Disease and Zoonose, Yangzhou University, Yangzhou, 225009, China
| | - Qiang Wang
- Poultry Institute, Chinese Academy of Agriculture Science, Yangzhou, Jiangsu, 225125, China; Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Disease and Zoonose, Yangzhou University, Yangzhou, 225009, China
| | - Yijian Zhang
- Poultry Institute, Chinese Academy of Agriculture Science, Yangzhou, Jiangsu, 225125, China; Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Disease and Zoonose, Yangzhou University, Yangzhou, 225009, China
| | - Kaiqing Rao
- College of Animal Husbandry and Veterinary, Southwest Minzu University, Chengdu, 610041, China
| | - Shourong Shi
- Poultry Institute, Chinese Academy of Agriculture Science, Yangzhou, Jiangsu, 225125, China; Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Disease and Zoonose, Yangzhou University, Yangzhou, 225009, China.
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23
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Burgess JL, Wyant WA, Abdo Abujamra B, Kirsner RS, Jozic I. Diabetic Wound-Healing Science. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1072. [PMID: 34684109 PMCID: PMC8539411 DOI: 10.3390/medicina57101072] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, with subsequent high economic and psychosocial costs. The hyperglycemic environment promotes the formation of biofilms and makes diabetic wounds difficult to treat. In this review, we present updates regarding recent advances in our understanding of the pathophysiology of diabetic wounds focusing on impaired angiogenesis, neuropathy, sub-optimal chronic inflammatory response, barrier disruption, and subsequent polymicrobial infection, followed by current and future treatment strategies designed to tackle the various pathologies associated with diabetic wounds. Given the alarming increase in the prevalence of diabetes, and subsequently diabetic wounds, it is imperative that future treatment strategies target multiple causes of impaired healing in diabetic wounds.
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Affiliation(s)
| | | | | | - Robert S. Kirsner
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (J.L.B.); (W.A.W.); (B.A.A.)
| | - Ivan Jozic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (J.L.B.); (W.A.W.); (B.A.A.)
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24
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Huang J, Fan Q, Guo M, Wu M, Wu S, Shen S, Wang X, Wang H. Octenidine dihydrochloride treatment of a meticillin-resistant Staphylococcus aureus biofilm-infected mouse wound. J Wound Care 2021; 30:106-114. [PMID: 33573482 DOI: 10.12968/jowc.2021.30.2.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study sought to estimate the effect of a liquid octenidine dihydrochloride (OCT)-impregnated gauze dressing in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) biofilm-infected wounds. METHOD In this animal study, a six-millimetre punch full-thickness wound on each mouse back was inoculated with MRSA suspension, and then covered with a Tegaderm (3M Health Care, US) dressing for an established biofilm model. Animals were divided into three groups for topical application: control group (treated with phosphate-buffered saline, PBS); mupirocin group (treated with 2% mupirocin); and OCT group (treated with OCT). All applications were administrated once 24 hours post-wounding. The bioburden was determined by counting colony-forming units (cfus) and the biofilm architecture was viewed using fluorescent staining and scanning electron microscopy (SEM) on day two. The tissue repair was evaluated histologically and the related genes were detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) on day 15. RESULTS The results suggested OCT accelerated healing and reduced by >3.6 log cfu/g bacterial counts on the wounds relative to the PBS-treated control (p<0.05). Histological analysis showed OCT-treated tissue exhibited lower burden of the inflammatory cells, more mature collagen fibres and well-defined epithelialisation. LIVE/DEAD fluorescent staining and SEM confirmed OCT induced a substantial destruction to biofilm structure. RT-qPCR further demonstrated that OCT therapy could inhibit the expression of MRSA and its biofilm genes by nearly 100% (p<0.05). CONCLUSION This investigation provides a rare in vivo experimental basis for OCT improvement on MRSA-infected wound healing and the superior efficacy implies OCT topical application may represent an ideal choice to address established bacterial biofilm in hard-to-heal wounds.
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Affiliation(s)
- Jianhua Huang
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China
| | - Qing Fan
- Department of Dermatology, Shanghai Fengxian District Hospital, Shanghai (201499), PR China
| | - Mingquan Guo
- Shanghai Institute of Bacteriophage and Drug Resistance, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201514, PR China
| | - Minfeng Wu
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China
| | - Shutian Wu
- Department of Dermatology, Huadong Hospital, Fudan University, Shanghai 200040, PR China
| | - Shuzhan Shen
- Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, PR China
| | - Xiuli Wang
- Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, PR China
| | - Hongwei Wang
- Shanghai Skin Disease Hospital, Institute of Photomedicine, Tongji University School of Medicine, Shanghai, PR China
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Zheng X, Chen L, Zeng W, Liao W, Wang Z, Tian X, Fang R, Sun Y, Zhou T. Antibacterial and Anti-biofilm Efficacy of Chinese Dragon's Blood Against Staphylococcus aureus Isolated From Infected Wounds. Front Microbiol 2021; 12:672943. [PMID: 34149659 PMCID: PMC8213214 DOI: 10.3389/fmicb.2021.672943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023] Open
Abstract
Chinese dragon’s blood (CDB), a characteristic red resin, is an important traditional Chinese medicine (TCM), and empiric therapy of infected wounds with CDB is performed in clinical settings. For the first time, we herein report the antibacterial and anti-biofilm efficacy of CDB against Staphylococcus aureus (S. aureus). Antimicrobial susceptibility testing, growth curve assay, time-kill curve assay, crystal violet biofilm assay, scanning electron microscope (SEM) analysis, cell membrane tests, and quantitative real-time polymerase chain reaction (qRT-PCR) were used for this purpose. The results suggested that the minimum inhibitory concentration (MIC) values of CDB against S. aureus ranged from 32 to 128 μg/mL. Growth curves and time-kill curves confirmed that CDB could inhibit the growth of S. aureus. The biofilm formation ability and the expression levels of saeR, saeS, and hla of S. aureus in the presence and absence of CDB were statistically significant (P < 0.01). The results of SEM analysis and cell membrane tests revealed that exposure to CDB had some destructive effects on S. aureus cells. In conclusion, CDB exhibits positive antibacterial activity against S. aureus. Moreover, CDB could reduce the biofilm formation and the virulence factors of S. aureus by downregulating the expression levels of saeR, saeS, and hla genes. These findings indicated that CDB has immense potential to serve as a viable alternative for the treatment of infected wounds caused by S. aureus in clinical settings.
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Affiliation(s)
- Xiangkuo Zheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiliang Zeng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Wenli Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongyong Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuebin Tian
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Renchi Fang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Alves PJ, Barreto RT, Barrois BM, Gryson LG, Meaume S, Monstrey SJ. Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm. Int Wound J 2021; 18:342-358. [PMID: 33314723 PMCID: PMC8244012 DOI: 10.1111/iwj.13537] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 12/22/2022] Open
Abstract
Biofilms play a major role in delaying chronic wounds from healing. A wound infiltrated with biofilm, or "critically colonised" wound, may become clinically infected if the number of microbes exceeds a critical level. Chronic wound biofilms represent a significant treatment challenge by demonstrating recalcitrance towards antimicrobial agents. However, a "window of opportunity" may exist after wound debridement when biofilms are more susceptible to topical antiseptics. Here, we discuss the role of antiseptics in the management of chronic wounds and biofilm, focusing on povidone-iodine (PVP-I) in comparison with two commonly used antiseptics: polyhexanide (PHMB) and silver. This article is based on the literature reviewed during a focus group meeting on antiseptics in wound care and biofilm management, and on a PubMed search conducted in March 2020. Compared with PHMB and silver, PVP-I has a broader spectrum of antimicrobial activity, potent antibiofilm efficacy, no acquired bacterial resistance or cross-resistance, low cytotoxicity, good tolerability, and an ability to promote wound healing. PVP-I represents a viable therapeutic option in wound care and biofilm management, with the potential to treat biofilm-infiltrated, critically colonised wounds. We propose a practical algorithm to guide the management of chronic, non-healing wounds due to critical colonisation or biofilm, using PVP-I.
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Affiliation(s)
- Paulo J. Alves
- Wounds Research LaboratoryUniversidade Católica PortuguesaPortoPortugal
| | | | | | - Luc G. Gryson
- Belgian Defence Military Medical ComponentBrusselsBelgium
| | - Sylvie Meaume
- Department of Geriatrics and Wound Care UnitHospital Rothschild, APHP Assistance Publique Hôpitaux de Paris, Sorbonne UniversitéParisFrance
| | - Stan J. Monstrey
- Department of Plastic SurgeryGhent University HospitalGhentBelgium
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Stuermer EK, Plattfaut I, Dietrich M, Brill F, Kampe A, Wiencke V, Ulatowski A, Geffken M, Rembe JD, Naumova EA, Debus SE, Smeets R. In vitro Activity of Antimicrobial Wound Dressings on P. aeruginosa Wound Biofilm. Front Microbiol 2021; 12:664030. [PMID: 34054768 PMCID: PMC8160304 DOI: 10.3389/fmicb.2021.664030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022] Open
Abstract
The treatment of acute and chronic infected wounds with residing biofilm still poses a major challenge in medical care. Interactions of antimicrobial dressings with bacterial load, biofilm matrix and the overall protein-rich wound microenvironment remain insufficiently studied. This analysis aimed to extend the investigation on the efficacy of a variety of antimicrobial dressings using an in vitro biofilm model (lhBIOM) mimicking the specific biofilm-environment in human wounds. Four wound dressings containing polyhexanide (PHMB), octendine di-hydrochloride (OCT), cadexomer-iodine (C-IOD) or ionic silver (AG) were compared regarding their antimicrobial efficacy. Quantitative analysis was performed using a quantitative suspension method, separately assessing remaining microbial counts within the solid biofilm as well as the dressing eluate (representing the absorbed wound exudate). Dressing performance was tested against P. aeruginosa biofilms over the course of 6 days. Scanning electron microscopy (SEM) was used to obtain qualitative visualization on changes in biofilm structure. C-IOD demonstrated superior bacterial reduction. In comparison it was the only dressing achieving a significant reduction of more than 7 log10 steps within 3 days. Neither the OCT- nor the AG-containing dressing exerted a distinct and sustained antimicrobial effect. PHMB achieved a non-significant microbicidal effect (1.71 ± 0.31 log10 steps) at day 1. Over the remaining course (6 days) it demonstrated a significant microbistatic effect compared to OCT, AG and the control. Quantitative results in the dressing eluate correlate with those of the solid biofilm model. Overall, AG- and OCT-containing dressings did not achieve the expected anti-biofilm efficacy, while C-IOD performed best. Chemical interaction with the biofilms extrapolymeric substance (EPS), visualized in the SEM, and dressing configuration (agent concentration and release pattern) are suspected to be responsible. The unexpected low and diverse results of the tested antimicrobial dressings indicate a necessity to rethink non-debridement anti-biofilm therapy. Focussing on the combination of biofilm-disruptive (for EPS structure) and antimicrobial (for residing microorganisms) features, as with C-IOD, using dehydration and iodine, appears reasonably complementary and an optimal solution, as suggested by the here presented in vitro data.
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Affiliation(s)
- Ewa Klara Stuermer
- Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Isabell Plattfaut
- Institute of Virology and Microbiology, Faculty of Health, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Michael Dietrich
- Institute of Virology and Microbiology, Faculty of Health, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Florian Brill
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Hamburg, Germany
| | - Andreas Kampe
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Hamburg, Germany
| | - Vanessa Wiencke
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Hamburg, Germany
| | - Anna Ulatowski
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Hamburg, Germany
| | - Maria Geffken
- Institute for Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian-Dario Rembe
- Department of Vascular and Endovascular Surgery, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Ella Alexandrovna Naumova
- Department of Biological and Material Sciences in Dentistry, Faculty of Health, School of Dentistry, Witten/Herdecke University, Witten, Germany
| | - Sebastian Eike Debus
- Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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O'Donnell JA, Wu M, Cochrane NH, Belay E, Myntti MF, James GA, Ryan SP, Seyler TM. Efficacy of common antiseptic solutions against clinically relevant microorganisms in biofilm. Bone Joint J 2021; 103-B:908-915. [PMID: 33934664 DOI: 10.1302/0301-620x.103b5.bjj-2020-1245.r2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic joint infections (PJIs) are among the most devastating complications after joint arthroplasty. There is limited evidence on the efficacy of different antiseptic solutions on reducing biofilm burden. The purpose of the present study was to test the efficacy of different antiseptic solutions against clinically relevant microorganisms in biofilm. METHODS We conducted an in vitro study examining the efficacy of several antiseptic solutions against clinically relevant microorganisms. We tested antiseptic irrigants against nascent (four-hour) and mature (three-day) single-species biofilm created in vitro using a drip-flow reactor model. RESULTS With regard to irrigant efficacy against biofilms, Povidone-iodine treatment resulted in greater reductions in nascent MRSA biofilms (logarithmic reduction (LR) = 3.12; p < 0.001) compared to other solutions. Bactisure treatment had the greatest reduction of mature Pseudomonas aeruginosa biofilms (LR = 1.94; p = 0.032) and a larger reduction than Vashe or Irrisept for mature Staphylococcus epidermidis biofilms (LR = 2.12; p = 0.025). Pooled data for all biofilms tested resulted in Bactisure and Povidone-iodine with significantly greater reductions compared to Vashe, Prontosan, and Irrisept solutions (p < 0.001). CONCLUSION Treatment failure in PJI is often due to failure to clear the biofilm; antiseptics are often used as an adjunct to biofilm clearance. We tested irrigants against clinically relevant microorganisms in biofilm in vitro and showed significant differences in efficacy among the different solutions. Further clinical outcome data is necessary to determine whether these solutions can impact PJI outcome in vivo. Cite this article: Bone Joint J 2021;103-B(5):908-915.
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Affiliation(s)
- Jeffrey A O'Donnell
- Department of Orthopaedics, Duke University Hospital, Durham, North Carolina, USA
| | - Mark Wu
- Department of Orthopaedics, Duke University Hospital, Durham, North Carolina, USA
| | - Niall H Cochrane
- Department of Orthopaedics, Duke University Hospital, Durham, North Carolina, USA
| | - Elshaday Belay
- Department of Orthopaedics, Duke University Hospital, Durham, North Carolina, USA
| | | | - Garth A James
- Medical Biofilms Laboratory Center for Biofilm Engineering, Montana State University, Bozeman, Montana, USA
| | - Sean P Ryan
- Department of Orthopaedics, Duke University Hospital, Durham, North Carolina, USA
| | - Thorsten M Seyler
- Department of Orthopaedics, Duke University Hospital, Durham, North Carolina, USA
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Dydak K, Junka A, Dydak A, Brożyna M, Paleczny J, Fijalkowski K, Kubielas G, Aniołek O, Bartoszewicz M. In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds. Int J Mol Sci 2021; 22:3996. [PMID: 33924416 PMCID: PMC8069587 DOI: 10.3390/ijms22083996] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/10/2023] Open
Abstract
Local administration of antiseptics is required to prevent and fight against biofilm-based infections of chronic wounds. One of the methods used for delivering antiseptics to infected wounds is the application of dressings chemisorbed with antimicrobials. Dressings made of bacterial cellulose (BC) display several features, making them suitable for such a purpose. This work aimed to compare the activity of commonly used antiseptic molecules: octenidine, polyhexanide, povidone-iodine, chlorhexidine, ethacridine lactate, and hypochlorous solutions and to evaluate their usefulness as active substances of BC dressings against 48 bacterial strains (8 species) and 6 yeast strains (1 species). A silver dressing was applied as a control material of proven antimicrobial activity. The methodology applied included the assessment of minimal inhibitory concentrations (MIC) and minimal biofilm eradication concentration (MBEC), the modified disc-diffusion method, and the modified antibiofilm dressing activity measurement (A.D.A.M.) method. While in 96-well plate-based methods (MIC and MBEC assessment), the highest antimicrobial activity was recorded for chlorhexidine, in the modified disc-diffusion method and in the modified A.D.A.M test, povidone-iodine performed the best. In an in vitro setting simulating chronic wound conditions, BC dressings chemisorbed with polyhexanide, octenidine, or povidone-iodine displayed a similar or even higher antibiofilm activity than the control dressing containing silver molecules. If translated into clinical conditions, the obtained results suggest high applicability of BC dressings chemisorbed with antiseptics to eradicate biofilm from chronic wounds.
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Affiliation(s)
- Karolina Dydak
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (K.D.); (M.B.); (J.P.); (M.B.)
| | - Adam Junka
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (K.D.); (M.B.); (J.P.); (M.B.)
| | - Agata Dydak
- Faculty of Biological Sciences, University of Wroclaw, 51-148 Wroclaw, Poland;
| | - Malwina Brożyna
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (K.D.); (M.B.); (J.P.); (M.B.)
| | - Justyna Paleczny
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (K.D.); (M.B.); (J.P.); (M.B.)
| | - Karol Fijalkowski
- Department of Microbiology and Biotechnology, Faculty of Biotechnology and Animal Husbandry, West Pomeranian University of Technology, Szczecin, Piastow 45, 70-311 Szczecin, Poland;
| | - Grzegorz Kubielas
- Faculty of Health Sciences, Wroclaw Medical University, 50-996 Wroclaw, Poland;
| | - Olga Aniołek
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland;
| | - Marzenna Bartoszewicz
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, 50-556 Wroclaw, Poland; (K.D.); (M.B.); (J.P.); (M.B.)
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30
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Maillard JY, Kampf G, Cooper R. Antimicrobial stewardship of antiseptics that are pertinent to wounds: the need for a united approach. JAC Antimicrob Resist 2021; 3:dlab027. [PMID: 34223101 PMCID: PMC8209993 DOI: 10.1093/jacamr/dlab027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Long before the nature of infection was recognized, or the significance of biofilms in delayed healing was understood, antimicrobial agents were being used in wound care. In the last 70 years, antibiotics have provided an effective means to control wound infection, but the continued emergence of antibiotic-resistant strains and the documented antibiotic tolerance of biofilms has reduced their effectiveness. A range of wound dressings containing an antimicrobial (antibiotic or non-antibiotic compound) has been developed. Whereas standardized methods for determining the efficacy of non-antibiotic antimicrobials in bacterial suspension tests were developed in the early twentieth century, standardized ways of evaluating the efficacy of antimicrobial dressings against microbial suspensions and biofilms are not available. Resistance to non-antibiotic antimicrobials and cross-resistance with antibiotics has been reported, but consensus on breakpoints is absent and surveillance is impossible. Antimicrobial stewardship is therefore in jeopardy. This review highlights these difficulties and in particular the efficacy of current non-antibiotic antimicrobials used in dressings, their efficacy, and the challenges of translating in vitro efficacy data to the efficacy of dressings in patients. This review calls for a unified approach to developing standardized methods of evaluating antimicrobial dressings that will provide an improved basis for practitioners to make informed choices in wound care.
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Affiliation(s)
- Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Günter Kampf
- Institute of Hygiene and Environmental Medicine, University of Greifswald, Germany
| | - Rose Cooper
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
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Effect of Polyhexamethylene Biguanide in Combination with Undecylenamidopropyl Betaine or PslG on Biofilm Clearance. Int J Mol Sci 2021; 22:ijms22020768. [PMID: 33466613 PMCID: PMC7828725 DOI: 10.3390/ijms22020768] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 01/04/2023] Open
Abstract
Hospital-acquired infection is a great challenge for clinical treatment due to pathogens’ biofilm formation and their antibiotic resistance. Here, we investigate the effect of antiseptic agent polyhexamethylene biguanide (PHMB) and undecylenamidopropyl betaine (UB) against biofilms of four pathogens that are often found in hospitals, including Gram-negative bacteria Pseudomonas aeruginosa and Escherichia coli, Gram-positive bacteria Staphylococcus aureus, and pathogenic fungus, Candida albicans. We show that 0.02% PHMB, which is 10-fold lower than the concentration of commercial products, has a strong inhibitory effect on the growth, initial attachment, and biofilm formation of all tested pathogens. PHMB can also disrupt the preformed biofilms of these pathogens. In contrast, 0.1% UB exhibits a mild inhibitory effect on biofilm formation of the four pathogens. This concentration inhibits the growth of S. aureus and C. albicans yet has no growth effect on P. aeruginosa or E. coli. UB only slightly enhances the anti-biofilm efficacy of PHMB on P. aeruginosa biofilms. However, pretreatment with PslG, a glycosyl hydrolase that can efficiently inhibit and disrupt P. aeruginosa biofilm, highly enhances the clearance effect of PHMB on P. aeruginosa biofilms. Meanwhile, PslG can also disassemble the preformed biofilms of the other three pathogens within 30 min to a similar extent as UB treatment for 24 h.
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Weigelt MA, McNamara SA, Sanchez D, Hirt PA, Kirsner RS. Evidence-Based Review of Antibiofilm Agents for Wound Care. Adv Wound Care (New Rochelle) 2021; 10:13-23. [PMID: 32496980 PMCID: PMC7698998 DOI: 10.1089/wound.2020.1193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Significance: Biofilms in vivo are small densely packed aggregations of microbes that are highly resistant to host immune responses and treatment. They attach to each other and to nearby surfaces. Biofilms are difficult to study and identify in a clinical setting as their quantification necessitates the use of advanced microscopy techniques such as confocal laser scanning microscopy. Nonetheless, it is likely that biofilms contribute to the pathophysiology of chronic skin wounds. Reducing, removing, or preventing biofilms is thus a logical approach to help clinicians heal chronic wounds. Recent Advances: Wound care products have demonstrated varying degrees of efficacy in destroying biofilms in in vitro and preclinical models, as well as in some clinical studies. Critical Issues: Controlled studies exploring the beneficial role of biofilm eradication and its relationship to healing in patients with chronic wounds are limited. This review aims to discuss the mode of action and clinical significance of currently available antibiofilm products, including surfactants, dressings, and others, with a focus on levels of evidence for efficacy in disrupting biofilms and ability to improve wound healing outcomes. Future Directions: Few available products have good evidence to support antibiofilm activity and wound healing benefits. Novel therapeutic strategies are on the horizon. More high-quality clinical studies are needed. The development of noninvasive techniques to quantify biofilms will facilitate increased ease of research about biofilms in wounds and how to combat them.
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Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Stephanie A. McNamara
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Daniela Sanchez
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Penelope A. Hirt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents 2020; 56:106064. [DOI: 10.1016/j.ijantimicag.2020.106064] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/21/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
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Ohlmeier M, Filitarin S, Delgado G, Frings J, Abdelaziz H, Salber J, Frommelt L, Gehrke T, Citak M. Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection. J Med Microbiol 2020; 69:1100-1104. [PMID: 32639225 DOI: 10.1099/jmm.0.001229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction. Periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange.Aim. This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs.Methodology. Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1-9 years). Reinfection and complications rates after the one-stage exchange were analysed.Results. Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive Staphyloccocus epidermidis.Conclusion. One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.
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Affiliation(s)
- Malte Ohlmeier
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Sergei Filitarin
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Giorgio Delgado
- Department of Orthopedics, Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines
| | - Jannik Frings
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Hussein Abdelaziz
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University Bochum, Germany
| | - Lars Frommelt
- Department of Infectious Diseases, Clinical Microbiology and Infection Control, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Thorsten Gehrke
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Mustafa Citak
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
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Metcalf DG, Bowler PG. Clinical impact of an anti-biofilm Hydrofiber dressing in hard-to-heal wounds previously managed with traditional antimicrobial products and systemic antibiotics. BURNS & TRAUMA 2020; 8:tkaa004. [PMID: 32341917 PMCID: PMC7175757 DOI: 10.1093/burnst/tkaa004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/21/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022]
Abstract
Background Hard-to-heal wounds are often compromised by the presence of biofilm. This presents an infection risk, yet traditional antimicrobial wound care products and systemic antibiotics are often used despite the uncertainty of therapeutic success and wound progression. The aim of this study was to investigate the clinical impact of a next-generation anti-biofilm Hydrofiber wound dressing (AQUACEL Ag+ Extra[AQAg+ E]) in hard-to-heal wounds that had previously been treated unsuccessfully with traditional silver-, iodine- or polyhexamethylene biguanide (PHMB)-containing dressings and products and/or systemic antibiotics. Methods Clinical case study evaluations of the anti-biofilm dressing were conducted, where deteriorating or stagnant wounds were selected by clinicians and primary dressings were replaced by the anti-biofilm dressing for up to 4 weeks, or as deemed clinically appropriate, with monitoring via case report forms. The data was stratified for cases where traditional silver-, iodine- or PHMB-containing products, or systemic antibiotics, had been used prior to the introduction of the anti-biofilm dressing. Results Sixty-five cases were identified for inclusion, wounds ranging in duration from 1 week to 20 years (median: 12 months). In 47 (72%) cases the wounds were stagnant, while 15 (23%) were deteriorating; 3 wounds were not recorded. After an average of 4.2 weeks of management with the anti-biofilm dressing (range: 1-11 weeks), in 11 (17%) cases the wounds had healed (i.e. complete wound closure), 40 (62%) wounds improved, 9 (14%) wounds remained the same and 5 (8%) wounds deteriorated. Conclusions The introduction of this anti-biofilm dressing into protocols of care that had previously involved wound management with traditional antimicrobial products and/or antibiotics was shown to facilitate improvements in the healing status of most of these hard-to-heal wounds. Dressings containing proven anti-biofilm technology, in combination with antimicrobial silver and exudate management technology, appear to be an effective alternative to traditional antimicrobial products and antibiotics in the cases presented here. The use of antimicrobial wound dressings that contain anti-biofilm technology may have a key role to play in more effective wound management and antibiotic stewardship.
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Affiliation(s)
- Daniel G Metcalf
- Science & Technology, Research & Development, ConvaTec Ltd., Deeside, Flintshire, UK
| | - Philip G Bowler
- Science & Technology, Research & Development, ConvaTec Ltd., Deeside, Flintshire, UK
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Parsons D. Questioning the use of an acute porcine wound model to assess antibiofilm activity of dressings. Wound Repair Regen 2020; 28:427-428. [PMID: 31989735 DOI: 10.1111/wrr.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/03/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David Parsons
- Director of Science and Technology, ConvaTec Ltd, Deeside, UK
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Schwarzer S, James GA, Goeres D, Bjarnsholt T, Vickery K, Percival SL, Stoodley P, Schultz G, Jensen SO, Malone M. The efficacy of topical agents used in wounds for managing chronic biofilm infections: A systematic review. J Infect 2019; 80:261-270. [PMID: 31899281 DOI: 10.1016/j.jinf.2019.12.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Clinicians have increasingly adopted the widespread use of topical agents to manage chronic wound infections, despite limited data on their effectiveness in vivo. This study sought to evaluate the evidence for commonly employed topical agents used in wounds for the purpose of treating chronic infections caused by biofilm. METHOD We included in vitro, animal and human in vivo studies where topical agents were tested for their efficacy against biofilms, for use in wound care. For human studies, we only included those which utilised appropriate identification techniques for visualising and confirming the presence of biofilms. RESULT A total of 640 articles were identified, with 43 included after meeting eligibility. In vitro testing accounted for 90% (n = 39) of all included studies, five studies using animal models and three human in vivo studies. Sixteen different laboratory models were utilised, with the most frequent being the minimum biofilm eradication concentration (MBEC™) / well plate assay (38%, n = 15 of 39). A total of 44 commercially available topical agents were grouped into twelve categories with the most commonly tested agents being silver, iodine and polyhexamethylene biguanide (PHMB). In vitro results on efficacy demonstrated iodine as having the highest mean log10 reductions of all agents (4.81, ±3.14). CONCLUSION There is large disparity in the translation of laboratory studies to researchers undertaking human trials relating to the effectiveness of commercially available topical agents. There is insufficient human in vivo evidence to definitively recommend any commercially available topical agent over another for the treatment of chronic wound biofilms. The heterogeneity identified between study designs (in vitro to in vivo) further limits the generalisability of results.
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Affiliation(s)
- S Schwarzer
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, Australia.
| | - G A James
- Centre for Biofilm Engineering, Montana State University, Bozeman, MT, United States
| | - D Goeres
- Centre for Biofilm Engineering, Montana State University, Bozeman, MT, United States
| | - T Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney Australia
| | - S L Percival
- 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science (CEBS), Liverpool Bio-Innovation Hub, Liverpool UK
| | - P Stoodley
- Departments of Microbial Infection and Immunity, and Orthopaedics, Ohio State University, Columbus, OH, United States
| | - G Schultz
- Department of Obstetrics & Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, United States
| | - S O Jensen
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, Australia; Infectious Diseases and Microbiology, School of Medicine, Ingham Institute for Applied Medical Research, Western Sydney University, United States
| | - M Malone
- South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, Australia; Infectious Diseases and Microbiology, School of Medicine, Ingham Institute for Applied Medical Research, Western Sydney University, United States
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Davis SC, Li J, Gil J, Head C, Valdes J, Glinos GD, Solis M, Higa A, Pastar I. Preclinical evaluation of a novel silver gelling fiber dressing on
Pseudomonas aeruginosa
in a porcine wound infection model. Wound Repair Regen 2019; 27:360-365. [DOI: 10.1111/wrr.12718] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/07/2019] [Accepted: 03/21/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Stephen C. Davis
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Jie Li
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Joel Gil
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Cheyanne Head
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Jose Valdes
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - George D. Glinos
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Michael Solis
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Alexander Higa
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
| | - Irena Pastar
- Dr. Phillip Frost Department of Dermatology & Cutaneous SurgeryUniversity of Miami Miller School of Medicine P.O. Box 016250 (R 250) Miami Florida, 33136
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Machuca J, Lopez-Rojas R, Fernandez-Cuenca F, Pascual Á. Comparative activity of a polyhexanide-betaine solution against biofilms produced by multidrug-resistant bacteria belonging to high-risk clones. J Hosp Infect 2019; 103:e92-e96. [PMID: 30986480 DOI: 10.1016/j.jhin.2019.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/08/2019] [Indexed: 01/15/2023]
Abstract
The aim of this study was to investigate the effect of polyhexanide (polyhexamethylene biguanide)-betaine (PHMB-B) compared with 2% chlorhexidine against biofilms of high-risk and/or multidrug-resistant bacterial clones. The minimum inhibitory concentrations of both biocides were determined by microdilution. The effect of PHMB-B and chlorhexidine on biofilm was evaluated by spectrophotometry and cell viability assays. At commercial concentrations, PHMB-B reduced 24 h, 48 h and 1-week biofilms of all pathogens tested. PHMB-B was more active than 2% chlorhexidine against Gram-negative bacterial 24 h and 48 h biofilms and Gram-positive bacterial 7-day biofilms. In summary, the activity of PHMB-B was superior to that of 2% chlorhexidine in those biofilms.
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Affiliation(s)
- J Machuca
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla IBIS, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
| | - R Lopez-Rojas
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla IBIS, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - F Fernandez-Cuenca
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla IBIS, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Á Pascual
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla IBIS, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
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Pyruvate-depleting conditions induce biofilm dispersion and enhance the efficacy of antibiotics in killing biofilms in vitro and in vivo. Sci Rep 2019; 9:3763. [PMID: 30842579 PMCID: PMC6403282 DOI: 10.1038/s41598-019-40378-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/14/2019] [Indexed: 01/09/2023] Open
Abstract
The formation of biofilms is a developmental process initiated by planktonic cells transitioning to the surface, which comes full circle when cells disperse from the biofilm and transition to the planktonic mode of growth. Considering that pyruvate has been previously demonstrated to be required for the formation of P. aeruginosa biofilms, we asked whether pyruvate likewise contributes to the maintenance of the biofilm structure, with depletion of pyruvate resulting in dispersion. Here, we demonstrate that the enzymatic depletion of pyruvate coincided with the dispersion of established biofilms by S. aureus and laboratory and clinical P. aeruginosa isolates. The dispersion response was dependent on pyruvate fermentation pathway components but independent of proteins previously described to contribute to P. aeruginosa biofilm dispersion. Using porcine second-degree burn wounds infected with P. aeruginosa biofilm cells, we furthermore demonstrated that pyruvate depletion resulted in a reduction of biofilm biomass in vivo. Pyruvate-depleting conditions enhanced the efficacy of tobramycin killing of the resident wound biofilms by up to 5-logs. Our findings strongly suggest the management of pyruvate availability to be a promising strategy to combat biofilm-related infections by two principal pathogens associated with wound and cystic fibrosis lung infections.
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41
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Schultz GS, Woo K, Weir D, Yang Q. Effectiveness of a monofilament wound debridement pad at removing biofilm and slough: ex vivo and clinical performance. J Wound Care 2018; 27:80-90. [DOI: 10.12968/jowc.2018.27.2.80] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gregory S. Schultz
- Department of Obstetrics & Gynecology, University of Florida, Gainesville, Florida, US
| | - Kevin Woo
- Associate Professor, School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Dot Weir
- Catholic Health Advanced Wound Healing Centers, Buffalo, NY, US
| | - Qingping Yang
- The Institute for Wound Research at the University of Florida, Department of Obstetrics & Gynecology, University of Florida, Gainesville, FL, US
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