1
|
Boekema BKHL, Chrysostomou D, Ciprandi G, Elgersma A, Vlig M, Pokorná A, Peters LJF, Cremers NAJ. Comparing the antibacterial and healing properties of medical-grade honey and silver-based wound care products in burns. Burns 2024; 50:597-610. [PMID: 37940425 DOI: 10.1016/j.burns.2023.10.009] [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: 07/12/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
Burns are a major global healthcare concern, often complicated by the presence of bacteria such as Pseudomonas aeruginosa in the wounds. Silver-based dressings are commonly used in the treatment of burns but can cause skin irritation and delay healing time. Medical-grade honey (MGH) provides an interesting alternative. This study investigated the antimicrobial effects and possible cytotoxicity of L-Mesitran Soft (MGH-gel) and its individual components, Medihoney (Manuka), Flammazine (silver sulphadiazine), and silver nitrate (AgNO3) in an ex vivo human burn wound model. Bacterial survival and wound healing parameters, including re-epithelialization and keratinocyte proliferation were assessed. L-Mesitran, Flammazine, and AgNO3 reduced P. aeruginosa numbers below detection levels. L-Mesitran Soft exhibited a significantly stronger antimicrobial effect compared to Medihoney. The individual components of L-Mesitran contributed significantly to its antibacterial efficacy, thus suggesting synergistic activities. Moreover, L-Mesitran, Flammazine, and AgNO3 slightly inhibited re-epithelialization while Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation. Furthermore, clinical cases illustrated the effectiveness of MGH therapy in infected burns. Overall, L-Mesitran Soft had similar effects as silver-based products on bacterial load and epidermal regeneration, but outperformed Medihoney. Therefore, supplemented MGH could be used as an effective alternative to silver-based dressings for P. aeruginosa-infected burns.
Collapse
Affiliation(s)
- Bouke K H L Boekema
- Preclinical Research, Association of Dutch Burn Centers (ADBC), P.O. Box 1015, 1940 AE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, AUMC, Amsterdam, the Netherlands
| | - Daniela Chrysostomou
- Wound Clinic Health@45, Linksfield Road 45, Dowerglen, Johannesburg 1612, South Africa; Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Guido Ciprandi
- Bambino Gesu' Children's Hospital, Research Institute Division of Plastic and Maxillofacial Surgery, Department of Surgery, Sant' Onofrio Square 4, 00165 Rome, Italy
| | - Anouk Elgersma
- Preclinical Research, Association of Dutch Burn Centers (ADBC), P.O. Box 1015, 1940 AE Beverwijk, the Netherlands
| | - Marcel Vlig
- Preclinical Research, Association of Dutch Burn Centers (ADBC), P.O. Box 1015, 1940 AE Beverwijk, the Netherlands
| | - Andrea Pokorná
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic; College of Polytechnics Jihlava, Jihlava, Czech Republic
| | - Linsey J F Peters
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, the Netherlands
| | - Niels A J Cremers
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, the Netherlands; Department of Gynecology and Obstetrics, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands.
| |
Collapse
|
2
|
Chatzimisios K, Tsioli V, Brellou GD, Apostolopoulou EP, Angelou V, Pratsinakis ED, Cremers NAJ, Papazoglou LG. Evaluation of the Effectiveness of Medical-Grade Honey and Hypericum Perforatum Ointment on Second-Intention Healing of Full-Thickness Skin Wounds in Cats. Animals (Basel) 2023; 14:36. [PMID: 38200767 PMCID: PMC10778018 DOI: 10.3390/ani14010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to determine the effects of two topical treatments on second-intention wound healing in cats. Eight 2 × 2 cm full-thickness wounds were created, four on each side of the dorsal midline of eight laboratory cats, to receive either medical-grade honey ointment (MGH) and its control (HC), or Hypericum-based ointment (HP) and its control (HPC). MGH or HP ointment was applied to four wounds on the same side, while the remaining four were used as controls, chosen at random. Planimetry, laser Doppler flowmetry, daily physical examinations, and histologic examinations on days 0, 7, 14, and 25 were used to assess the healing of wounds. Tissue perfusion was better in the MGH-treated (2.14 ± 0.18 mm/s) and HP-treated wounds (2.02 ± 0.13 mm/s) than in the untreated controls HC (1.59 ± 0.11 mm/s) and HPC (1.60 ± 0.05 mm/s), respectively (p = 0.001). Histopathology revealed that the median edema score was lower in the MGH-treated (2; range 1-4) compared to the HC-treated wounds (3; range 2-4) on day 7 (p < 0.05). The median angiogenesis score was higher on day 7 in the MGH-treated (2; range 1-3) compared to the HP-treated wounds (2; range 1-2) (p = 0.046). The fibroblast concentration was increased in the MGH-treated wounds (3.5; range 3-4) compared to the HP-treated wounds (3; range 2-4) on day 25 (p = 0.046). MGH and HP increased tissue perfusion compared to the untreated controls. The MGH-treated wounds had histologic parameters superior to the HP-treated wounds regarding angiogenesis and fibroblast concentration in cutaneous wound healing in cats. Topical application of MGH and HP did not accelerate the healing process of feline cutaneous wounds.
Collapse
Affiliation(s)
- Kyriakos Chatzimisios
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of HealthSciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (K.C.)
| | - Vassiliki Tsioli
- Clinic of Surgery, School of Veterinary Medicine, University of Thessaly, 224 Trikalon Street, Box Office 199, 43100 Karditsa, Greece
| | - Georgia D. Brellou
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.D.B.); (E.P.A.)
| | - Emmanouela P. Apostolopoulou
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.D.B.); (E.P.A.)
| | - Vasileia Angelou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of HealthSciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (K.C.)
| | - Emmanouil D. Pratsinakis
- Laboratory of Agronomy, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Niels A. J. Cremers
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands;
- Triticum Exploitatie BV/Theomanufacturing BV, Sleperweg 44, 6222 NK Maastricht, The Netherlands
| | - Lysimachos G. Papazoglou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of HealthSciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece; (K.C.)
| |
Collapse
|
3
|
Holubová A, Chlupáčová L, Krocová J, Cetlová L, Peters LJF, Cremers NAJ, Pokorná A. The Use of Medical Grade Honey on Infected Chronic Diabetic Foot Ulcers-A Prospective Case-Control Study. Antibiotics (Basel) 2023; 12:1364. [PMID: 37760661 PMCID: PMC10525154 DOI: 10.3390/antibiotics12091364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Non-healing wounds are usually colonised and contaminated by different types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical grade honey (MGH). MGH has antioxidant, antimicrobial, anti-inflammatory, and immunomodulatory features. This study aims to evaluate the effect of MGH therapy on infected non-healing wounds, especially for diabetic foot syndrome. Prospective, observational case series (n = 5) of patients with wounds of diabetic foot syndrome are presented. There were five males with an average age of 61.6 years. All wounds were treated with MGH, and the healing trajectory was rigorously and objectively monitored. In all cases, there was a gradual disappearance of odour, pain, and exudation. Moreover, the wound areas significantly reduced within 40 days and there was a decrease in glycated haemoglobin and glycaemia values. All these outcomes resulted in improved quality of life of the patients. Despite bacterial colonisation, antibiotic treatment was not necessary. All wounds were completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in diabetic foot syndrome wounds, does not increase glycated haemoglobin or glycaemia levels, and thus constitutes an effective alternative to the use of antibiotics in the treatment of locally infected wounds.
Collapse
Affiliation(s)
- Adéla Holubová
- Faculty of Health and Social Sciences, University of South Bohemia, 370 11 České Budějovice, Czech Republic;
- DiaPodi Care, spol. s r.o., 392 01 Soběslav, Czech Republic;
| | | | - Jitka Krocová
- Department of Nursing and Midwifery, Faculty of Health Studies, University of West Bohemia, 301 00 Pilsen, Czech Republic;
| | - Lada Cetlová
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
| | | | - Niels A. J. Cremers
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, The Netherlands;
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Andrea Pokorná
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| |
Collapse
|
4
|
Papanikolaou GE, Gousios G, Cremers NAJ. Use of Medical-Grade Honey to Treat Clinically Infected Heel Pressure Ulcers in High-Risk Patients: A Prospective Case Series. Antibiotics (Basel) 2023; 12:antibiotics12030605. [PMID: 36978472 PMCID: PMC10044646 DOI: 10.3390/antibiotics12030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Management of locally infected heel-pressure ulcers (HPUs) remains challenging, and given the increasing occurrence of infections resistant to antibiotic therapy and patients’ unwillingness to surgery, innovative and effective approaches must be considered. Medical-grade honey (MGH) could be an alternative therapeutic approach due to its broad-spectrum antimicrobial activity and healing properties. This study aimed to present the high effectiveness and safety of MGH for the conservative treatment of clinically infected HPUs. In this case series, we have prospectively studied nine patients with local signs of infected HPUs. In all cases, HPUs persisted for more than 4 weeks, and previous treatments with topical antibiotics or antiseptic products were ineffective. All patients were at high-risk to develop HPU infection due to their advanced age (median age of 86 years), several comorbidities, and permanent immobility. All wounds were treated with MGH products (L-Mesitran), leading to infection resolution within 3–4 weeks and complete wound healing without complication. Considering the failure of previous treatments and the chronic nature of the wounds, MGH was an effective treatment. MGH-based products are clinically and cost-effective for treating hard-to-heal pressure ulcers such as HPUs. Thus, MGH can be recommended as an alternative or complementary therapy in wound healing.
Collapse
Affiliation(s)
- Georgios E. Papanikolaou
- GP Plastic Surgery Private Practice, P. Dagkli 1, 45444 Ioannina, Greece
- Correspondence: (G.E.P.); or (N.A.J.C.); Tel.: +30-2651-607063 (G.E.P.); +31-43-325-1773 (N.A.J.C.)
| | | | - Niels A. J. Cremers
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, The Netherlands
- Correspondence: (G.E.P.); or (N.A.J.C.); Tel.: +30-2651-607063 (G.E.P.); +31-43-325-1773 (N.A.J.C.)
| |
Collapse
|
5
|
Medical-Grade Honey Enhances the Healing of Caesarean Section Wounds and Is Similarly Effective to Antibiotics Combined with Povidone-Iodine in the Prevention of Infections-A Prospective Cohort Study. Antibiotics (Basel) 2023; 12:antibiotics12010092. [PMID: 36671293 PMCID: PMC9855001 DOI: 10.3390/antibiotics12010092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Caesarean sections (CS) are becoming increasingly popular. The antibiotic resistance crisis and relentless risk of infections, especially in developing countries, demand alternative treatment options. Medical-grade honey (MGH) exerts antimicrobial and healing properties. This study aims to evaluate the effect of MGH treatment on CS wound healing and postoperative complications when compared to conventional treatment (antibiotics in combination with povidone-iodine). In this prospective cohort study, 766 CS patients were included and evenly divided into two groups. The treatment group (n = 383) received an MGH-based formulation (L-Mesitran Soft) and the control group (n = 383) received antibiotics (Amoxicillin) combined with povidone-iodine. The wound healing time and complication rate were determined for both groups, and subsequently, predisposing factors for complications among the baseline characteristics and non-patient-related parameters were determined. The baseline characteristics were similar for both study groups, supporting a homogenous distribution. Postoperative complications were experienced by 19.3% of the patients in the control group and 18.8% in the treatment (MGH) group. The treatment group experienced significantly more superficial pus discharge than the control group, while the latter experienced significantly more deeper pus discharge. BMI, age, duration of hospitalization, anesthesia, and duration of CS could affect the complication risk. MGH significantly enhanced wound healing until day 42. On average, the healing time with MGH was 19.12 ± 7.760 days versus 24.54 ± 8.168 days in the control group. MGH is a potent alternative treatment to antibiotics and povidone-iodine because while the complication risk is similar, MGH has additional benefits. MGH promotes wound healing and does not bear the risk of resistance.
Collapse
|