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Rippon MG, Daly K, Rogers AA, Westgate S. Safety and effectiveness of an antiseptic wound cleansing and irrigation solution containing polyhexamethylene biguanide. J Wound Care 2024; 33:324-334. [PMID: 38683774 DOI: 10.12968/jowc.2024.33.5.324] [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: 05/02/2024]
Abstract
OBJECTIVE There is currently a wide range of cleansing and irrigation solutions available for wounds, many of which contain antimicrobial agents. The aim of this study was to assess the safety of HydroClean Solution (HARTMANN, Germany), a polyhexamethylene biguanide (PHMB)-containing irrigation solution, in a standard cytotoxicity assay, and to assess its effect in a three-dimensional (3D) full-thickness model of human skin. METHOD A number of commercially available wound cleansing and irrigation solutions, including the PHMB-containing irrigation solution, were tested in a cytotoxicity assay using L929 mouse fibroblasts (ISO 10993-5:2009). The PHMB-containing irrigation solution was then assessed in an in vitro human keratinocyte-fibroblast 3D full-thickness wounded skin model to determine its effect on wound healing over six days. The effect of the PHMB-containing irrigation solution on tissue viability was measured using a lactate dehydrogenase (LDH) assay, and proinflammatory effects were measured using an interleukin-6 (IL-6) production assay. RESULTS The PHMB-containing irrigation solution was shown to be equivalent to other commercially available cleansing and irrigation solutions when tested in the L929 fibroblast cytotoxicity assay. When assessed in the in vitro 3D human full-thickness wound healing model, the PHMB-containing irrigation solution treatment resulted in no difference in levels of LDH or IL-6 when compared with levels produced in control Dulbecco's phosphate-buffered saline cultures. There was, however, a pronounced tissue thickening of the skin model in the periwound region. CONCLUSION The experimental data presented in this study support the conclusion that the PHMB-containing irrigation solution has a safety profile similar to other commercially available cleansing and irrigation solutions. Evidence also suggests that the PHMB-containing irrigation solution does not affect tissue viability or proinflammatory cytokine production, as evidenced by LDH levels or the production of IL-6 in a 3D human full-thickness wound healing model. The PHMB-containing irrigation solution stimulated new tissue growth in the periwound region of the skin model.
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Affiliation(s)
- Mark G Rippon
- Huddersfield University, Huddersfield, UK
- Daneriver Consultancy Ltd, Holmes Chapel, Cheshire, UK
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2
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Dietrich M, Besser M, Stuermer EK. Characterization of the Human Plasma Biofilm Model (hpBIOM) to Identify Potential Therapeutic Targets for Wound Management of Chronic Infections. Microorganisms 2024; 12:269. [PMID: 38399673 PMCID: PMC10892339 DOI: 10.3390/microorganisms12020269] [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: 12/10/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
The treatment of chronic wounds still represents a major challenge in wound management. Recent estimates suggest that 60-80% of chronic wounds are colonized by pathogenic microorganisms, which are strongly considered to have a major inhibiting influence on the healing process. By means of an innovative biofilm model based on human plasma, the time-dependent behavior of various bacterial strains under wound-milieu-like conditions were investigated, and the growth habits of different cocci species were compared. Undescribed fusion events between colonies of MRSA as well as of Staphylococcus epidermidis were detected, which were associated with the remodeling and reorganization of the glycocalyx of the wound tissue. After reaching a maximum colony size, the spreading of individual bacteria was observed. Interestingly, the combination of different cocci species with Pseudomonas aeruginosa in the human plasma biofilm revealed partial synergistic effects in these multispecies organizations. RT-qPCR analyses gave a first impression of the relevant proteins involved in the formation and maturation of biofilms, especially the role of fibrinogen-binding proteins. Knowledge of the maturation and growth behavior of persistent biofilms investigated in a translational human biofilm model reflects a starting point for the development of novel tools for the treatment of chronic wounds.
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Affiliation(s)
- Michael Dietrich
- Institute of Virology and Microbiology, Centre for Biomedical Education and Research (ZBAF), Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Manuela Besser
- Institute of Virology and Microbiology, Centre for Biomedical Education and Research (ZBAF), Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Ewa Klara Stuermer
- Department of Vascular Medicine, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
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3
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Paleczny J, Brożyna M, Dudek B, Woytoń A, Chodaczek G, Szajnik M, Junka A. Culture Shock: An Investigation into the Tolerance of Pathogenic Biofilms to Antiseptics in Environments Resembling the Chronic Wound Milieu. Int J Mol Sci 2023; 24:17242. [PMID: 38139071 PMCID: PMC10744066 DOI: 10.3390/ijms242417242] [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: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Credible assessment methods must be applied to evaluate antiseptics' in vitro activity reliably. Studies indicate that the medium for biofilm culturing should resemble the conditions present at the site of infection. We cultured S. aureus, S. epidermidis, P. aeruginosa, C. albicans, and E. coli biofilms in IVWM (In Vitro Wound Milieu)-the medium reflecting wound milieu-and were compared to the ones cultured in the laboratory microbiological Mueller-Hinton (MH) medium. We analyzed and compared crucial biofilm characteristics and treated microbes with polyhexamethylene biguanide hydrochloride (PHMB), povidone-iodine (PVP-I), and super-oxidized solution with hypochlorites (SOHs). Biofilm biomass of S. aureus and S. epidermidis was higher in IVWM than in MH medium. Microbes cultured in IVWM exhibited greater metabolic activity and thickness than in MH medium. Biofilm of the majority of microbial species was more resistant to PHMB and PVP-I in the IVWM than in the MH medium. P. aeruginosa displayed a two-fold lower MBEC value of PHMB in the IVWM than in the MH medium. PHMB was more effective in the IVWM than in the MH medium against S. aureus biofilm cultured on a biocellulose carrier (instead of polystyrene). The applied improvement of the standard in vitro methodology allows us to predict the effects of treatment of non-healing wounds with specific antiseptics.
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Affiliation(s)
- Justyna Paleczny
- Platform for Unique Models Application, Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (B.D.); (A.W.)
| | - Malwina Brożyna
- Platform for Unique Models Application, Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (B.D.); (A.W.)
| | - Bartłomiej Dudek
- Platform for Unique Models Application, Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (B.D.); (A.W.)
| | - Aleksandra Woytoń
- Platform for Unique Models Application, Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (B.D.); (A.W.)
| | - Grzegorz Chodaczek
- Bioimaging Laboratory, Lukasiewicz Research Network—PORT Polish Center for Technology Development, 54-066 Wroclaw, Poland;
| | - Marta Szajnik
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland;
| | - Adam Junka
- Platform for Unique Models Application, Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.P.); (M.B.); (B.D.); (A.W.)
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4
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Strickland AD, Ozturk M, Conti T, Tabatabaei F. Copper-based dressing: Efficacy in a wound infection of ex vivo human skin. Tissue Cell 2023; 84:102196. [PMID: 37611328 DOI: 10.1016/j.tice.2023.102196] [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: 04/06/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
This study aimed to evaluate the wound healing and antibacterial effects of two experimental copper dressings compared to a commercial silver dressing. Burn wounds were created in the ex vivo human skin biopsies, then were infected by Staphylococcus aureus. Tissues were treated with copper dressings, silver dressing, or a dressing without any antibacterial component. An infected wound tissue without treatment was considered as the control group. Three days after treatments, tissues were analyzed by bacterial count and histology staining, while their media was used to assess the expression of cytokines and chemokines. Histology staining confirmed the presence of second-degree burn wounds and colonization of bacteria in the surface and superficial layer of tissues. The results demonstrated a higher antibacterial effect, improved epithelium formation, and decreased wound area in one of the copper dressings compared to other dressings. Markers associated with infection control increased in both the copper and silver-treated groups. The cytokine profiling analysis revealed increased expression of markers related to angiogenesis and anti-inflammatory responses and decreased pro-inflammatory cytokine responses in the infected wound treated with one of the copper dressings. Our results confirmed the efficacy of the experimental copper dressing in reducing bacteria and promoting wound healing.
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5
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Dittmer M, Brill FHH, Kampe A, Geffken M, Rembe JD, Moll R, Alio I, Streit WR, Debus ES, Smeets R, Stuermer EK. Quantitative Insights and Visualization of Antimicrobial Tolerance in Mixed-Species Biofilms. Biomedicines 2023; 11:2640. [PMID: 37893014 PMCID: PMC10604264 DOI: 10.3390/biomedicines11102640] [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: 08/30/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Biofilms are a major problem in hard-to-heal wounds. Moreover, they are composed of different species and are often tolerant to antimicrobial agents. At the same time, interspecific synergy and/or competition occurs when some bacterial species clash. For this reason, the tolerance of two dual-species wound biofilm models of Pseudomonas aeruginosa and Staphylococcus aureus or Enterococcus faecium against antimicrobials and antimicrobial dressings were analyzed quantitatively and by confocal laser scanning microscopy (CLSM). The results were compared to findings with planktonic bacteria. Octenidine-dihydrochloride/phenoxyethanol and polyhexamethylene biguanide (PHMB) irrigation solutions showed a significant, albeit delayed reduction in biofilm bacteria, while the PHMB dressing was not able to induce this effect. However, the cadexomer-iodine dressing caused a sustained reduction in and killed almost all bacteria down to 102 cfu/mL within 6 days compared to the control (1010 cfu/mL). By means of CLSM in untreated human biofilm models, it became evident that P. aeruginosa dominates over E. faecium and S. aureus. Additionally, P. aeruginosa appeared as a vast layer at the bottom of the samples, while S. aureus formed grape-like clusters. In the second model, the distribution was even clearer. Only a few E. faecium were visible, in contrast to the vast layer of P. aeruginosa. It seems that the different species avoid each other and seek their respective niches. These mixed-species biofilm models showed that efficacy and tolerance to antimicrobial substances are nearly species-independent. Their frequent application appears to be important. The bacterial wound biofilm remains a challenge in treatment and requires new, combined therapy options.
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Affiliation(s)
- Mandy Dittmer
- Department of Vascular Medicine, Translational Research, University Heart Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Florian H H Brill
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, 22339 Hamburg, Germany
| | - Andreas Kampe
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, 22339 Hamburg, Germany
| | - Maria Geffken
- Institute for Transfusion Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Julian-Dario Rembe
- Department of Vascular and Endovascular Surgery, Heinrich-Heine-University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Raphael Moll
- Department of Microbiology and Biotechnology, University Hamburg, 20148 Hamburg, Germany
| | - Ifey Alio
- Department of Microbiology and Biotechnology, University Hamburg, 20148 Hamburg, Germany
| | - Wolfgang R Streit
- Department of Microbiology and Biotechnology, University Hamburg, 20148 Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, Translational Research, University Heart Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ewa Klara Stuermer
- Department of Vascular Medicine, Translational Research, University Heart Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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6
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Dietrich M, Besser M, Debus ES, Smeets R, Stuermer EK. Human skin biofilm model: translational impact on swabbing and debridement. J Wound Care 2023; 32:446-455. [PMID: 37405939 DOI: 10.12968/jowc.2023.32.7.446] [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: 07/07/2023]
Abstract
OBJECTIVE Wound biofilms are one of the greatest challenges in the therapy of hard-to-heal (chronic) wounds, as potent antimicrobial substances fail to eradicate bacteria within short incubation periods. Preclinical investigations using novel model systems that closely mimic the human wound environment and wound biofilm are required to identify new and effective therapeutic options. This study aims to identify bacterial colonisation patterns that are relevant for diagnosis and therapy. METHOD In this study, a recently established human plasma biofilm model (hpBIOM) was incorporated into a wound within human dermal resectates after abdominoplasty. The interaction of the biofilm-forming bacteria meticillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa with the skin cells was investigated. Possible effects on wound healing processes in correlation with the persistence of the biofilm in the wound environment were analysed in patients with leg ulcers of different aetiologies and biofilm burden. RESULTS Using haematoxylin and eosin staining, species-dependent infiltration modes of the bacteria into the wound tissue were determined for the pathogens MRSA and Pseudomonas aeruginosa. The spreading behaviour correlated with clinical observations of the spatial distributions of the bacteria. In particular, the clinically prominent Pseudomonas aeruginosa-specific distension of the wound margin was identified as epidermolysis due to persistent infiltration. CONCLUSION The hpBIOM applied in this study represents a potential tool for preclinical analyses dealing with approval processes for new antimicrobial applications. In terms of clinical practice, a microbiological swabbing technique including the wound margin should be routinely applied to prevent wound exacerbation.
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Affiliation(s)
- Michael Dietrich
- Institute of Virology and Microbiology, Faculty of Health, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Germany
| | - Manuela Besser
- Clinic for General, Visceral and Transplant Surgery, University Hospital Muenster, Germany
| | - Eike S Debus
- Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Ewa K Stuermer
- Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Germany
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7
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Paleczny J, Junka AF, Krzyżek P, Czajkowska J, Kramer A, Benkhai H, Żyfka-Zagrodzińska E, Bartoszewicz M. Comparison of antibiofilm activity of low-concentrated hypochlorites vs polyhexanide-containing antiseptic. Front Cell Infect Microbiol 2023; 13:1119188. [PMID: 37009512 PMCID: PMC10050698 DOI: 10.3389/fcimb.2023.1119188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Chronic wound infection is highly associated with morbidity and endangers the patient's life. Therefore, wound care products must have a potent antimicrobial and biofilm-eradicating effect. In this work, the antimicrobial/antibiofilm activity of two low-concentrated chlorine-based and releasing solutions was investigated on a total of 78 strains of methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans, using the cohesive spectrum of in vitro settings, including microtiter plate models, biofilm-oriented antiseptic test, cellulose-based biofilm model, biofilm bioreactors and Bioflux model. The antiseptic containing polyhexamethylene biguanide was used in the character of usability control of performed tests. The results obtained by static biofilm models indicate that low-concentrated chlorine-based and releasing solutions display none to moderate antibiofilm activity, while data obtained by means of the Bioflux model, providing flow conditions, indicate the moderate antibiofilm activity of substances compared with the polyhexanide antiseptic. Considering in vitro data presented in this manuscript, the earlier reported favorable clinical results of low-concentrated hypochlorites should be considered rather an effect of their rinsing activity combined with low cytotoxicity but not the antimicrobial effect per se. For the treatment of heavily biofilm-infected wounds, polyhexanide should be considered the agent of choice because of its higher efficacy against pathogenic biofilms.
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Affiliation(s)
- Justyna Paleczny
- Department of Pharmaceutical Microbiology and Parasitology, Unique Application Models Laboratory, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Adam Junka, ; Justyna Paleczny,
| | - Adam Felix Junka
- Department of Pharmaceutical Microbiology and Parasitology, Unique Application Models Laboratory, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Adam Junka, ; Justyna Paleczny,
| | - Paweł Krzyżek
- Department of Microbiology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Czajkowska
- Department of Biochemistry and Molecular Biology, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Hicham Benkhai
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Marzenna Bartoszewicz
- Department of Pharmaceutical Microbiology and Parasitology, Unique Application Models Laboratory, Wroclaw Medical University, Wroclaw, Poland
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8
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Lorenz K, Preem L, Sagor K, Putrinš M, Tenson T, Kogermann K. Development of In Vitro and Ex Vivo Biofilm Models for the Assessment of Antibacterial Fibrous Electrospun Wound Dressings. Mol Pharm 2023; 20:1230-1246. [PMID: 36669095 PMCID: PMC9907351 DOI: 10.1021/acs.molpharmaceut.2c00902] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/21/2023]
Abstract
Increasing evidence suggests that the chronicity of wounds is associated with the presence of bacterial biofilms. Therefore, novel wound care products are being developed, which can inhibit biofilm formation and/or treat already formed biofilms. A lack of standardized assays for the analysis of such novel antibacterial drug delivery systems enhances the need for appropriate tools and models for their characterization. Herein, we demonstrate that optimized and biorelevant in vitro and ex vivo wound infection and biofilm models offer a convenient approach for the testing of novel antibacterial wound dressings for their antibacterial and antibiofilm properties, allowing one to obtain qualitative and quantitative results. The in vitro model was developed using an electrospun (ES) thermally crosslinked gelatin-glucose (GEL-Glu) matrix and an ex vivo wound infection model using pig ear skin. Wound pathogens were used for colonization and biofilm development on the GEL-Glu matrix or pig skin with superficial burn wounds. The in vitro model allowed us to obtain more reproducible results compared with the ex vivo model, whereas the ex vivo model had the advantage that several pathogens preferred to form a biofilm on pig skin compared with the GEL-Glu matrix. The in vitro model functioned poorly for Staphylococcus epidermidis biofilm formation, but it worked well for Escherichia coli and Staphylococcus aureus, which were able to use the GEL-Glu matrix as a nutrient source and not only as a surface for biofilm growth. On the other hand, all tested pathogens were equally able to produce a biofilm on the surface of pig skin. The developed biofilm models enabled us to compare different ES dressings [pristine and chloramphenicol-loaded polycaprolactone (PCL) and PCL-poly(ethylene oxide) (PEO) (PCL/PEO) dressings] and understand their biofilm inhibition and treatment properties on various pathogens. Furthermore, we show that biofilms were formed on the wound surface as well as on a wound dressing, indicating that the demonstrated methods mimic well the in vivo situation. Colony forming unit (CFU) counting and live biofilm matrix as well as bacterial DNA staining together with microscopic imaging were performed for biofilm quantification and visualization, respectively. The results showed that both wound biofilm models (in vitro and ex vivo) enabled the evaluation of the desired antibiofilm properties, thus facilitating the design and development of more effective wound care products and screening of various formulations and active substances.
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Affiliation(s)
- Kairi Lorenz
- Institute
of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Liis Preem
- Institute
of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Kadi Sagor
- Institute
of Technology, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Marta Putrinš
- Institute
of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
- Institute
of Technology, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Tanel Tenson
- Institute
of Technology, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
| | - Karin Kogermann
- Institute
of Pharmacy, University of Tartu, Nooruse 1, 50411 Tartu, Estonia
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Benkocká M, Herma R, Lupínková S, Slepička P, Švorčík V, Kolská Z. Antibacterial nanocomposite supporting cell growth and spheroid formation by chemical surface treatment of polymer foil. SURF INTERFACE ANAL 2022. [DOI: 10.1002/sia.7082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M. Benkocká
- Faculty of Science, J. E. Purkinje University in Usti nad Labem Usti nad Labem Czech Republic
| | - R. Herma
- Faculty of Science, J. E. Purkinje University in Usti nad Labem Usti nad Labem Czech Republic
| | - S. Lupínková
- Faculty of Science, J. E. Purkinje University in Usti nad Labem Usti nad Labem Czech Republic
| | - P. Slepička
- Institute of Solid State Engineering, University of Chemistry and Technology Prague Prague 6 Czech Republic
| | - V. Švorčík
- Institute of Solid State Engineering, University of Chemistry and Technology Prague Prague 6 Czech Republic
| | - Z. Kolská
- Faculty of Science, J. E. Purkinje University in Usti nad Labem Usti nad Labem Czech Republic
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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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