Challenges in the management of chronic wound infections

Polyaminoglycoside nanosystem expressing antimicrobial peptides for multistage chronic wound management

Chronic wounds are difficult to heal due to pathogenic microbial colonization and dysregulation of healing cascades, necessitating novel therapeutic strategies. This study developed a multifunctional nanosystem by integrating the antimicrobial peptide LL37 with cationic polyaminoglycoside (SS-HPT), constructing a self-sustaining "AMP factory" to achieve multi-stage modulation of the wound healing. Validation through cell-level experiments and in vivo dual models (mechanical injury and bacterial infection) in immunocompromised rats demonstrated the system's unique dual intracellular-extracellular pathogen-killing capability, significantly accelerating the wound healing process. Transcriptomic analysis revealed that its mechanism involves the dual effects of suppressing pro-inflammatory factor expression and activating tissue repair pathways. Histological evidence confirmed that the system promotes angiogenesis, enhances re-epithelialization rates, and guides orderly collagen fiber deposition. This nanosystem, combining efficient AMP delivery and integrated therapeutic strategies, achieves three-dimensional synergy in microbial clearance, immune microenvironment regulation, and tissue matrix remodeling, providing theoretical and technical foundations for a paradigm shift in chronic wound treatment.

A review of advancements in antiseptics for wound care in diabetic and non-diabetic patients

Wounds affect many people and require a considerable annual cost to manage. Wound infections significantly delay the healing process, particularly in individuals with diabetes mellitus, due to impaired immunity and microvascular complications. The use of antiseptics is considered a way to reduce this problem. The study aims to assess the different antiseptic categories frequently employed in wound management, focusing on identifying and understanding their unique features. A comprehensive review of PubMed, Scopus, and EMBASE databases identified key antiseptics, including isopropyl alcohol, chlorhexidine, polyhexanide, octenidine, povidone-iodine, hypochlorous acid, silver-based products, hydrogen peroxide, triclosan, and benzalkonium chloride. These antiseptics exhibit varying efficacies and cytotoxicity profiles, necessitating tailored usage to optimize healing while preventing antimicrobial resistance. The primary indication for antiseptics is the prevention of Surgical Site Infections (SSIs), as recommended by guidelines. For diabetic foot ulcers, the strongest evidence supports the use of hypochlorous acid. There are no universal recommendations for antiseptic use; their application depends on specific circumstances. This review highlights the need for evidence-based, condition-specific antiseptic strategies to address unique patient needs effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01607-7.

3D Printed Human Amnion-Based Bioactive Hybrid Dressings for Effective Management of Complex Infected Wounds

Chronic wounds are often afflicted with persistent infection, excessive exudate accumulation, and delayed healing, leading to prolonged hospitalization. Excess moisture overhydrates the wound, promotes infection, and causes edema. Peri-wound skin may develop rashes, immersion injuries, and epidermal detachment. Nutrient-rich exudates foster microbial growth, increasing the infection risk. High bacterial loads lead to crust formation, continuous leakage, and foul odor, further complicating healing. To address this challenge, we developed a 3D printed amnion-based hybrid dressing comprising a regenerative layer integrated with a laminated silver-embedded polyurethane foam layer for partial and full thickness (thickness 0.12 mm-4 mm) infected wounds and burns. This dressing can suffice the varied clinical requirements of wound management by augmenting tissue regeneration, reducing bacterial load, and managing wound exudate. Human amnion was processed through decellularization and lyopreservation. Key angiogenic growth factors VEGF-A (54.12 ± 2.31 pg/mg) and PDGF-BB (3.760 ± 0.14 pg/mg) were quantified. Long-term in vitro cell viability was assessed for 20 days (as per ISO 10993-5 standards). Bioink was formulated using cryo-milled amnion particles and excipients optimized through rheology. Hybrid dressing was developed using an extrusion-based 3D printer, layering the amnion bioink onto the physical substrate, followed by lyophilization and gamma sterilization. Preclinical efficacy was assessed using a rodent Staphylococcus aureus-infected wound model, comparing the hybrid dressing to an in-house-developed amnion-mupirocin (AM) powder formulation with standard of care dressing. Both treatments demonstrated comparable wound closure rates and a significant bacterial load reduction. However, hybrid dressing offered superior healed tissue quality, increased CD31 expression, and improved neovascularization compared to AM powder treatment with a temporally regulated CD31 expression pattern mirroring the natural healing progression. This can be attributed to the hybrid construct of the dressing that provides effective exudate management, preventing its accumulation that could otherwise hinder angiogenesis, along with replenishment of wound bed with regenerative factors, aiding in mimicking the natural healing cascades.

SEMTWIST Quantification of Biofilm Infection in Human Chronic Wound Using Scanning Electron Microscopy and Machine Learning

Objective: To develop scanning electron microscopy-based Trainable Weka (Waikato Environment for Knowledge Analysis) Intelligent Segmentation Technology (SEMTWIST), an open-source software tool, for structural detection and rigorous quantification of wound biofilm aggregates in complex human wound tissue matrix. Approach: SEMTWIST model was standardized to quantify biofilm infection (BFI) abundance in 240 distinct SEM images from 60 human chronic wound-edge biospecimens (four technical replicates of each specimen). Results from SEMTWIST were compared against human expert assessments and the gold standard for molecular BFI detection, that is, peptide nucleic acid fluorescence in situ hybridization (PNA-FISH). Results: Correlation and Bland-Altman plot demonstrated a robust correlation (r = 0.82, p < 0.01), with a mean bias of 1.25, and 95% limit of agreement ranging from -43.40 to 47.11, between SEMTWIST result and the average scores assigned by trained human experts. While interexpert variability highlighted potential bias in manual assessments, SEMTWIST provided consistent results. Bacterial culture detected infection but not biofilm aggregates. Whereas the wheat germ agglutinin staining exhibited nonspecific staining of host tissue components and failed to provide a specific identification of BFI. The molecular identification of biofilm aggregates using PNA-FISH was comparable with SEMTWIST, highlighting the robustness of the developed approach. Innovation: This study introduces a novel approach "SEMTWIST" for in-depth analysis and precise differentiation of biofilm aggregates from host tissue elements, enabling accurate quantification of BFI in chronic wound SEM images. Conclusion: Open-source SEMTWIST offers a reliable and robust framework for standardized quantification of BFI burden in human chronic wound-edge tissues, supporting clinical diagnosis and guiding treatment.

Efficacy of xenogeneic fresh and lyophilized amniotic membranes on the healing of experimentally induced full-thickness skin wounds in dogs

Wound healing is a complex process involving multiple phases aimed at repairing damaged tissues. Disruptions in this process can lead to chronic wounds and infections. Effective treatments that maintain cellular bioactivity while being cost-effective and easy to manufacture and store are needed. The amniotic membrane (AM) is highly biocompatible and rich in bioactive factors, making it valuable for regenerative medicine. Bovine AM is noteworthy for its large size, which facilitates its use in medical settings. However, preserving its bioactivity during storage is a challenge. Therefore, this study aimed to evaluate the effect of bovine lyophilized AM on full-thickness skin wound healing in dogs, compared to that of fresh AM. Bovine AM was collected, lyophilized, and characterized by quantifying growth factors, including vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), as well as collagen, glycosaminoglycans (GAGs), elastin, and DNA. Additionally, the surface morphology was imaged using scanning electron microscopy (SEM). The effects of conditioned media from fresh and lyophilized AM on fibroblast and endothelial cell proliferation were compared. In vivo, three full-thickness skin wounds were created on the back in twelve dogs and treated with saline (control), fresh AM, or lyophilized AM, and monitored for healing over 1, 3, and 5 weeks. The fresh AM contained 57.3 ± 6.21 µg/mg collagen, 5.62 ± 1.1 µg/mg GAGs, 11.6 ± 4.52 µg/mg elastin, and 46.3 ± 12.8 ng/mg DNA, with VEGF and bFGF levels of 5.43 ± 2.485 and 1.97 ± 0.482 ng/mg, respectively. The lyophilized AM contained 217.74 ± 8.78 µg/mg collagen, 14.4 ± 1.56 µg/mg GAGs, 43.2 ± 6.8 µg/mg elastin, and 234.6 ± 21.5 ng/mg DNA, with VEGF and bFGF levels of 28.12 ± 7.6 and 13.3 ± 6.89 ng/mg, respectively. SEM revealed a monolayer with poorly defined borders in fresh AM, whereas lyophilized AM displayed a well-defined apical border with few microvilli. Lyophilized AM-conditioned media promoted greater endothelial cell and fibroblast proliferation. Compared with those in the fresh AM and control groups, wounds treated with lyophilized AM healed faster, with narrower edges and more pronounced re-epithelization and collagen remodeling at 1-, 3-, and 5-weeks post-wounding. Histopathology revealed quicker granulation and inflammatory cell infiltration in the first week for lyophilized AM, and better re-epithelization and collagen remodeling in subsequent stages. In conclusion, the amniotic membrane, particularly in its lyophilized form, offers significant benefits for skin wound healing due to its bioactivity, availability, and cost-effectiveness.

Dual-Network Hydrogel Loaded With ROS-activated Hydrogen Sulfide Donor to Accelerate Wound Healing and Inhibit Scar Production

The wound healing process consists of four continuous and overlapping stages-hemostasis, inflammation, proliferation, and remodeling-involving a variety of cells, growth factors, and the extracellular matrix. In recent years, growing evidence has shown that enhancing endogenous hydrogen sulfide (H2S) synthesis or providing exogenous H2S can promote angiogenesis, inhibit inflammation, reduce excessive oxidative stress, and support collagen deposition. However, the administration of exogenous H2S often presents challenges related to controlling its release duration and achieving targeted delivery. To achieve controlled and site-specific delivery of H2S to the wound area, a dual-network cross-linked injectable hydrogel formed by grafted ε-poly-L-lysine (designed as EG) and oxidized dextran (OD) (EGODF) loaded with a hydrogen sulfide donor (HSDF-NH2) to study its potential in wound healing is developed. The hydrogel exhibits excellent injectability, self-healing capability, and mechanical strength. Upon reactive oxygen species (ROS) stimulation, HSDF-NH2 releases both self-reporter fluorescence (HSDG-NH2) and H2S. Changes in the self-reporter fluorescence signal reflect H2S production and its entry into the body to exert therapeutic effects. Finally, using a wound model and a hypertrophic scar repair model, it is demonstrated that EGODF hydrogel is effective in promoting wound healing and inhibiting scar production.

Development and characterization of alginate and chitosan hybrid films for dual administration of neomycin and lidocaine

Wound care is frequently hindered by infections, which prevent recovery and adversely affect patients' quality of life. A prevalent example is the presence of bacteria such as Staphylococcus aureus, which can lead to severe inflammation. This study developed and characterized hybrid films composed of alginate and chitosan, incorporating the antimicrobial agent neomycin and the local anesthetic lidocaine, to be applied as a dressing for wound treatment. The research employed an experimental design to identify the optimal formulation, evaluating aspects such as uniformity, cracking, and consistency of the films. After determining the ideal formulation, the films were evaluated: roughness, moisture absorption, swelling, and thickness. Additionally, advanced analytical techniques such as electron microscopy and spectroscopy were employed to provide a comprehensive characterization of the films. The results indicated that the films maintained good chemical stability after incorporating the drugs, effectively absorbed liquids, and exhibited suitable thickness. Biocompatibility was confirmed through hemolysis and antimicrobial activity tests. The films containing both neomycin and lidocaine exhibited good efficacy against S. aureus, highlighting the enhanced bacterial inhibition when both drugs were present. These hybrid films show promise as dressings, possessing antimicrobial, anesthetic, and biocompatible properties, along with the ability to absorb liquids.

Advances in Designer Materials for Chronic Wound Healing

Significance: Nonhealing or chronic wounds represent a significant and growing global health concern, imposing substantial burdens on individuals, health care systems, and economies worldwide. Although the standard-of-care treatment involves the application of wound dressings, most dressing materials are not specifically designed to address the pathological processes underlying chronic wounds. This review highlights recent advances in biomaterial design tailored to chronic wound healing. Recent Advances: Chronic wounds are characterized by persistent inflammation, impaired granulation tissue formation, and delayed re-epithelialization. Newly developed designer materials aim to manage reactive oxygen species and extracellular matrix degradation to suppress inflammation while promoting vascularization, cell proliferation, and epithelial migration to accelerate tissue repair. Critical Issues: Designing optimal materials for chronic wounds remains challenging due to the diverse etiology and a multitude of pathological mechanisms underlying chronic wound healing. While designer materials can target specific aberrations, designing a materials approach that restores all aberrant wound-healing processes remains the Holy Grail. Addressing these issues requires a deep understanding of how cells interact with the materials and the complex etiology of chronic wounds. Future Directions: New material approaches that target wound mechanics and senescence to improve chronic wound closure are under development. Layered materials combining the best properties of the approaches discussed in this review will pave the way for designer materials optimized for chronic wound healing.

Multifunctional PdH-hydride MOFs for synergistic hydrogen and photothermal antibacterial therapy in accelerated wound healing

Introduction

The growing threat of bacterial infections poses a critical challenge to public health, underscoring the urgent need for innovative antibacterial agents and therapeutic strategies. In response, we have developed a multifunctional nanoplatform based on palladium-hydride metal-organic frameworks (P(H)ZPAg) for synergistic hydrogen and photothermal antibacterial therapy.

Methods

This nanoplatform integrates palladium hydride (PdH) encapsulated within a zeolitic imidazolate framework (ZIF-8), surface modification with polydopamine (PDA), and in situ generation of silver nanoparticles (Ag NPs) to achieve enhanced antibacterial efficacy. Comprehensive characterization was performed to assess hydrogen release kinetics, photothermal performance, and silver-mediated bactericidal activity. The therapeutic potential of P(H)ZPAg was further evaluated in vivo using a Staphylococcus aureus-infected rat wound model.

Results

The P(H)ZPAg nanoplatform demonstrated a successful combination of hydrogen release, photothermal conversion, and silver ion-based antibacterial mechanisms. In vitro assays revealed potent synergistic antibacterial effects against both Escherichia coli and Staphylococcus aureus. In vivo studies showed that treatment with P(H)ZPAg nanoparticles significantly enhanced wound healing and bacterial clearance compared to control groups.

Discussion

These findings highlight the potential of combining hydrogen therapy, photothermal therapy, and silver ion release within a single nanoplatform to markedly improve antibacterial outcomes. This study presents a promising strategy for the development of multifunctional nanotherapeutics, offering a novel and effective approach for managing topical bacterial infections and promoting wound healing.

Early post-trauma wound microbiota and its association with pain outcomes and mental health in combat-related extremity injuries: a prospective analysis

Introduction

Given that many armed conflicts are currently ongoing worldwide, a thorough study of issues related to providing medical care for the wounded is essential.

Material and methods

We included 45 participants aged 20-60 years with limb injuries in our study. The participants were surveyed using a visual analog pain scale, the PHQ-9, and the PTSD-5. We formed three groups: the first group included patients with limb amputations, the second group consisted of patients with limb trauma, and the third group involved patients with limb burns.

Results

We found that the average pain level in Group 1 was higher, though statistical significance was not achieved (p > 0,05). According to the PHQ-9, all participants exhibited depressive symptoms of varying severity. In the trauma group, patients reported fewer PTSD symptoms. Among the amputees, a significant predominance of Gram-negative microorganisms was noted. The correlation between the slightly higher pain levels and the significant predominance of Gram-negative flora in amputee patients was negative (P > 0.05).

Conclusions

In the amputee group, there was a trend toward higher mean pain scores compared to the other groups (p > 0,05). The same presence and distribution of depressive and PTSD symptoms were observed across all groups. Correlation analysis between pain intensity and contamination with Gram-negative bacteria did not reveal a relationship between these two variables. The study requires a larger patient sample. Gram-negative pathogens such as Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella oxytoca, and Proteus mirabilis were found more frequently among all patients.

State-of-the-art in natural hydrogel-based wound dressings: Design, functionalization, and fabrication approaches

Natural hydrogel-based wound dressings, synthesized from biopolymers such as chitosan, sodium alginate, and cellulose, are gaining recognition in wound care due to their ability to promote healing through biocompatibility, moisture retention, and biodegradability. These materials foster an ideal healing environment by supporting cell proliferation and tissue regeneration while providing a protective barrier against infection. For chronic or infected wounds, enhancing the therapeutic performance of these hydrogels is essential. This review critically evaluates advanced functionalization strategies, including chemical modifications to optimize hydrogel properties, the incorporation of bioactive agents like growth factors and antimicrobial compounds, and the development of stimuli-responsive hydrogels that adjust to environmental cues such as pH, temperature, and enzymatic activity. Furthermore, fabrication techniques-such as solution casting, freeze-drying, electrospinning, and 3D printing-are discussed for their potential to generate tailored dressings with specific mechanical properties and bioactive capabilities. By highlighting key innovations and challenges, this review provides a comprehensive roadmap for the design, functionalization, and fabrication of natural hydrogel-based wound dressings, identifying critical areas for future research and development.

Potent antimicrobial activity of hydrogel loaded with the antimicrobial peptide, D-Bac8c2,5 Leu, against monospecies and polymicrobial biofilms of Staphylococcus aureus and Pseudomonas aeruginosa

Introduction

Acute and chronic wound infections involving biofilms and caused by antimicrobial resistant (AMR) pathogens present significant challenges in healthcare, leading to substantial patient morbidity, increased hospital stays, and rising healthcare costs. Novel antimicrobial therapies are urgently needed to address these infections.

Methods

A screening of multiple antimicrobial peptides (AMPs) was performed and the most potent candidate, D-Bac8c2,5 Leu, was tested against monospecies and polymicrobial biofilms of Staphylococcus aureus and Pseudomonas aeruginosa using static and dynamic in vitro models. Cytotoxicity was evaluated on human cell lines, and the peptide was incorporated into a methylcellulose hydrogel to assess sustained release and antimicrobial efficacy as a hydrogel dressing.

Results

D-Bac8c2,5 Leu significantly reduced biofilm viability in both monospecies and polymicrobial biofilms. In static biofilm assays, treatment led to a 2-3 log reduction in bacterial load compared to untreated controls. In Duckworth biofilm flow device, a similar reduction was observed, demonstrating efficacy in conditions mimicking wound environments. Furthermore, D-Bac8c2,5 Leu exhibited low cytotoxicity against human cell lines, and its incorporation into a methylcellulose hydrogel facilitated sustained release and enhanced antimicrobial activity. Furthermore, the peptide-loaded hydrogel showed considerable efficacy in disrupting pre-formed biofilms, underscoring its potential as a novel treatment for acute and chronic wound infections.

Discussion

These findings highlight the potential of D-Bac8c2,5 Leu to help address the urgent need for effective therapies against AMR pathogens and biofilm-associated wound infections. Further studies should focus on in vivo efficacy to optimize its therapeutic application in wound care.

Healing beyond the surface: Empathy's role in chronic wound care a qualitative study

AIM

This study aimed to investigate health professionals' perceptions of the impact of empathy on healing outcomes, patient satisfaction and delivery of wound care.

MATERIALS AND METHODS

A descriptive qualitative approach was used, employing semi-structured face-to-face interviews with 10 healthcare professionals specializing in wound care in Australia. Participants were purposively sampled, and interviews lasted between 22 and 47 min. Data collection concluded upon achieving saturation. Interviews were transcribed verbatim using CORV, a secured transcription tool, and analyzed using Braun and Clarke's six-phase thematic framework. Rigor was ensured by employing COREQ guidelines, triangulating data analysis, and including direct quotes for confirmability.

RESULTS

Three key themes emerged: (1) Empathy as a Foundation for Trust, Engagement, and Collaboration where participants emphasized that empathy promotes trust, improves patient adherence, and aligns treatment goals. (2) The Dual Role of Empathy in Addressing Emotional and Physical Barriers to Healing where empathetic care alleviated psychological distress, built resilience, and improved adherence to care regimens. (3) Barriers and Facilitators to Empathy in Wound Care where time constraints, emotional fatigue, and cultural differences were identified as barriers, while mentorship, training, and supportive environments facilitated empathetic care.

CONCLUSION

Health professionals considered empathy to be a critical factor in enhancing patient satisfaction and supporting healing outcomes in wound care. By providing trust, addressing emotional barriers, and aligning care with patient needs, empathy plays a meaningful role in the care process. Additionally, addressing systemic barriers and thoughtfully integrating empathy training into clinical practice can contribute to improved outcomes in chronic wound management.

Clinical, Operational, and Economic Benefits of a Digitally Enabled Wound Care Program in Home Health: Quasi-Experimental, Pre-Post Comparative Study

BACKGROUND

The demand for home health care and nursing visits has steadily increased, requiring significant allocation of resources for wound care. Many home health agencies operate below capacity due to clinician shortages, meeting only 61% to 70% of demand and frequently declining wound care referrals. Implementing artificial intelligence-powered digital wound care solutions (DWCSs) offers an opportunity to enhance wound care programs by improving scalability and effectiveness through better monitoring and risk identification.

OBJECTIVE

This study assessed clinical and operational outcomes across 14 home health branches that adopted a DWCS, comparing pre- and postadoption data and outcomes with 27 control branches without the technology.

METHODS

This pre-post comparative study analyzed clinical outcomes, including average days to wound healing, and operational outcomes, such as skilled nursing (SN) visits per episode (VPE) and in-home visit durations, during two 7-month intervals (from November to May in 2020-2021 and 2021-2022). Data were extracted from 14,278 patients who received wound care across adoption and control branches. Projected cost savings were also calculated based on reductions in SN visits.

RESULTS

The adoption branches showed a 4.3% reduction in SN VPE and a 2.5% reduction in visit duration, saving approximately 309 staff days. In contrast, control branches experienced a 4.5% increase in SN VPE and a 2.2% rise in visit duration, adding 42 days. Healing times improved significantly in the adoption branches, with a reduction of 4.3 days on average per wound compared to 1.6 days in control branches (P<.001); pressure injuries, venous ulcers, and surgical wounds showed the most substantial improvements.

CONCLUSIONS

Integrating digital wound management technology enhances clinical outcomes, operational efficiencies, and cost savings in home health settings. A reduction of 0.3 SN VPE could generate annual savings of up to US $958,201 across the organization. The adoption branches avoided 1187 additional visits during the study period. If control branches had implemented the DWCS and achieved similar outcomes, they would have saved 18,546 healing days. These findings emphasize the importance of incorporating DWCSs into wound care programs to address increasing demands, clinician shortages, and rising health care costs while maintaining positive clinical outcomes.

Debridement - how efficient can a wound dressing be? The answer from a large prospective observational study

OBJECTIVE

To evaluate the performance and tolerance of two polyabsorbent fibre dressings (a pad impregnated with a technology lipido-colloid healing matrix and a rope) in an unselected cohort of patients with wounds of various aetiologies in daily practice.

METHOD

A prospective, observational, multicentre study was conducted in 152 centres across Germany. Wounds were treated with the evaluated dressings (UrgoClean pad and UrgoClean rope, Laboratoires Urgo, France) for six weeks. Main outcomes included changes in: overall wound healing progression; wound bed tissues; exudate; infection status; malodour; and pain, as well as acceptability and tolerance of the dressings.

RESULTS

A total of 1558 patients (aged 3-100 years) were included: 944 patients with chronic (mostly venous leg ulcers, diabetic foot ulcers and pressure ulcers) wounds; and 614 with other wounds (mostly surgical wounds, skin abrasions and burns). By the final visit, 42.0% of wounds had healed within 33±15 days, and a wound healing improvement was reported in 52.5%. Continuous reduction in sloughy tissue was observed (from 60% initially to 10% at final visit), regardless of dressing or wound type. This improvement was associated with a reduction in: infection rates, by 87.3%; malodour, by 86.7%; maceration by 65.6%; and spontaneous pain by 60.4%. Both dressings were rated as 'very well' tolerated and 'accepted' by most patients (85.3 and 76.1%, respectively), and judged as 'extremely useful' by the majority of physicians (72.0%), notably in cases of infected wounds without antibiotic therapy.

CONCLUSION

The two dressings assessed in this study were shown to be efficient in removing sloughy tissue and promoting wound healing, regardless of wound type or infection status. These results are consistent with previous clinical evidence and support their intended use.

Treating diabetic foot ulcers with antimicrobial wound dressing impregnated with dialkylcarbamoyl chloride

OBJECTIVE

Diabetic foot ulcers (DFUs) are at significant risk of becoming infected, with an associated elevated risk of amputation. Choosing an appropriate treatment would help prevent infection, improve healing and patients' quality of life, as well as reduce healthcare costs. The aim of this study was to assess the efficacy of a dialkylcarbamoyl chloride (DACC)-coated wound dressing to reduce bacterial load in the treatment of infected diabetic foot ulcers with signs of biofilm.

METHOD

In this prospective, descriptive observational study, patients with infected DFUs were treated with a DACC-coated wound dressing, and were followed until complete healing was achieved. Levels of bacterial load and the presence of biofilm were also assessed.

RESULTS

The patients consisted of 42 males and 19 females, with a mean age of 54.4 years. All wounds exhibited complete wound closure upon treatment with the DACC-coated wound dressing, with an average time to heal of 71.8 days. A total of 53 patients had received systemic antibiotic treatment prior to study enrolment, and the number of patients requiring antibiotic treatment reduced to 20 during the study. The level of bacterial load (including biofilm) was reduced, leading to wound progression in a proportion of wounds.

CONCLUSION

The findings of this study revealed that treatment with a non-medicated antimicrobial wound dressing was an appropriate dressing choice to reduce microbial load and aid promotion of healing in infected DFUs with the presence of biofilm.

The future approach for the management of acute bacterial skin and skin structure infections

PURPOSE OF REVIEW

To discuss the new available options for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) and how to implement in the clinical practice innovative approaches for their management.

RECENT FINDINGS

The availability of long-acting antibiotics, including dalbavancin and oritavancin, changed the approach to patients with ABSSSI. Direct discharge from the emergency department and early discharge from the hospital should be considered in patients with ABSSSI. Despite limited data about different bactericidal properties, the choice between dalbavancin and oritavacin is usually based on patients' characteristics and comorbidities. Delafloxacin and omadacycline are other options and have the advantage to be available for both intravenous and oral formulations, allowing a sequential therapy and switch from intravenous to oral treatment in clinically stable patients. Further studies should elucidate the profile of patients who may beneficiate from these drugs.

SUMMARY

Early discharge from the hospital should be considered in patients with ABSSSI at a high risk of methicillin-resistant Staphylococcus aureus and in vulnerable patients for which hospitalization may have detrimental consequences. In elderly individuals, patients with diabetes mellitus, oncological people who need for continuing their healthcare pathway, this approach may reduce complications and costs related to hospitalization.

Naturally derived hydrogels for wound healing

Natural hydrogels have garnered increasing attention due to their natural origins and beneficial roles in wound healing. Hydrogel water-retaining capacity and excellent biocompatibility create an ideal moist environment for wound healing, thereby enhancing cell proliferation and tissue regeneration. For this reason, naturally derived hydrogels formulated from biomaterials such as chitosan, alginate, gelatin, and fibroin are highly promising due to their biodegradability and low immunogenic responses. Recent integrated approaches to utilizing new technologies with bioactive agents have significantly improved the mechanical properties of hydrogels and the controlled release and delivery of active compounds, thereby increasing the efficiency of the treatment processes. Herein, this review highlights the advantages and the challenges of natural hydrogels in wound healing, focusing on their mechanical strength, controlled degradation rates, safety and efficiency validation, and the potential for incorporating advanced technologies such as tissue engineering and gene therapy for utilization in personalized medicine.

Functional hydrogels promote chronic infectious wound healing by re-rousing macrophage M1 and inducing bacterial copper-like death

Traditional antibiotics are often ineffective against biofilm-associated infections, and biofilm-induced macrophage immune evasion directly halts the wound healing process. Disrupting biofilms and regulating macrophage immune functions are critical to improving wound healing. In this study, we synthesized g-C3N4 with peroxidase (POD) enzyme activity via thermal polymerization and copper alginate microspheres (CAM) via gas cutting. These were co-encapsulated into GelMA hydrogels to form a functionalized wound repair system (GelMA/CAM@g-C3N4) with both anti-biofilm and local immune microenvironment remodeling capabilities. In vitro, this system exhibited excellent biocompatibility and promoted endothelial cell migration, vascular formation, and CD31 expression. It also polarized macrophages toward the M1 phenotype, restoring their pro-inflammatory functions, upregulating inflammatory cytokines (IL-1, IL-6, TNF-α), and inhibiting Staphylococcus aureus and Escherichia coli. In vivo, the system suppressed S. aureus growth, promoted angiogenesis and collagen deposition, and reshaped the pathological microenvironment to achieve wound repair and regeneration. Conclusions: This system offers a new therapeutic strategy for chronic infectious wounds.

Activated carbon-chitosan hydrogel dressing loaded with LL37 microspheres for the treatment of infected wounds: In vivo antimicrobial and antitoxin assessment

Wound healing is a complex process which is crucial for recovery. Delayed wound healing which is caused by the presence of pathogens has posed significant clinical implications affecting millions of patients globally. Wounds infection caused by Pseudomonas aeruginosa present significant challenges due to their resistance to multiple antimicrobial drugs. The Gram-negative bacteria secretes endotoxin lipopolysaccharide (LPS), which impede wound healing and may lead to severe complications, including life-threatening sepsis. Previously, our laboratory has successfully developed a new hydrogel containing a synthetic antimicrobial peptide as an alternative therapy to conventional antibiotics. This hydrogel contains LL37 microspheres embedded into activated carbon-chitosan hydrogel (LL37-AC-CS). LL37-AC-CS has shown desirable physicochemical properties as well as promising antimicrobial and antitoxin activities in vitro. This current study has two main objectives. The first is to evaluate the in vivo antimicrobial efficacy of LL37-AC-CS hydrogel in full-thickness rat wounds infected with P. aeruginosa. The second objective is to investigate the antitoxin efficacy on the rat wound models treated with E. coli endotoxins LPS. The wound healing efficacy was assessed in terms of the macroscopic appearance, wound contraction rate, histology, and wound tissue biochemical markers. As a result, the LL37-AC-CS hydrogel exhibited remarkable antimicrobial and antitoxin efficacy as compared to the controls. The wound healing efficacy was evident in increased wound closure rate and decrease in bacterial bioburden, and favourable changes in wound healing biomarkers namely the myeloperoxidase, interleukin-6 and tumour necrosis factor α. The elevation of hydroxyproline levels in the LPS-treated wound model indicates there was collagen synthesis. In conclusion, the results presented in this study have significantly enhanced our comprehension of the LL37-AC-CS hydrogel's potential in wound healing. Specifically, the research highlights its effectiveness in eliminating endotoxins and preventing bacterial growth.

Broad-spectrum antimicrobial properties of linalool: supporting its pharmacological use in chronic wound infections by pathogens within the ESKAPE group and polymicrobial biofilms

Chronic wound infections are caused by biofilm forming opportunistic pathogenic bacteria. The persistence of infection, co-infecting pathogens and prolonged use of antibiotics promote antibiotic resistance hampering healing process due to increased inflammation. Hence, we tested the broad range antibacterial activity of linalool, a bioactive monoterpene commonly present in many essential oils having anti-inflammatory and antimicrobial activities to target different opportunistic pathogens commonly found in the chronic wound. We included some of the common pathogens such as Acinetobacter baumannii, Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus, to study the broad range antimicrobial efficacy of linalool. The in vitro effect of linalool on biofilm was quantified in pre-treatment, post-treatment, repetitive treatment, and polymicrobial biofilm scenarios. Time-kill and XTT (2,3-bis [2-methyloxy-4-nitro-5-sulfophenyl]-2 H-tetrazolium-5-carboxanilide) assays were performed to confirm the efficacy of linalool against wound infections, and these results were further validated using simulated wound exudates medium (WEM) which mimics the wound environment. The mechanism of bactericidal action was determined using assays for membrane integrity and oxidative stress. The results indicated the broad range antimicrobial activity of linalool with minimum inhibitory concentration (MIC) ranging from 2.5 to 5 µL/mL against E. coli, A. baumannii, E. faecalis, S. aureus, and K. pneumoniae, while for P. aeruginosa the MIC was 20 µL/mL. Linalool was most effective against E. coli, E. faecalis, K. pneumoniae, A. baumannii, and S. aureus, and could inhibit the growth and biofilm by more than 90% and 80%, respectively, at 5 µL/mL. The XTT assay confirmed the MIC results, showing a significant reduction in the metabolic activity of the pathogens (p < 0.001). In the simulated WEM similar response of the bacteria to linalool treatment was observed. At 5 to 20 µL/mL concentrations, linalool significantly inhibited the polymicrobial biofilm consisting of P. aeruginosa, A. baumannii, and S. aureus in two species combinations. The mechanism of bactericidal action was associated with the increased reactive oxygen species production and disruption in the membrane integrity leading to release of cellular content. The anti-inflammatory activity of linalool, assessed using the albumin denaturation method showed significant activity at the tested concentrations. In conclusion, the findings suggest the therapeutic potential of linalool in treating biofilm associated chronic wound infections due to its versatile broad spectrum activity.

Photoinitiated Nitric Oxide Release as an Antibacterial Treatment for Chronic Wounds

Taking advantage of their innate roles as antibacterial strategies, the dual activity of photobiomodulation (PBM) and nitric oxide (NO) was combined to provide a tunable, on-demand chronic wound therapeutic. S-nitrosothiol-modified mesoporous silica nanoparticles (RSNO-MSNs) were doped into polyurethane (PU) to demonstrate preliminary utility as an antibacterial wound dressing treatment for chronic wounds. Photoinitiated and resultant NO-release kinetics and payloads were evaluated at 405, 430, and 530 nm for multiple irradiances. The use of photons and the NO-releasing MSNs against common chronic wound pathogens, such as Pseudomonas aeruginosa and Staphylococcus aureus, proved to be highly bactericidal. Cytocompatibility of the treatment was confirmed using human epidermal keratinocytes, a representative skin cell line.

Biofilm Dispersal and Wound Infection Clearance With Preclinical Debridement Agents

Biofilms complicate wound care by causing recurrent infections that are often resistant to debridement and are highly antibiotic-tolerant. We investigated whether the addition of a biofilm dispersal agent could improve the efficacy of debridement. The previous studies have indicated that a glycoside hydrolase cocktail of alpha-amylase and cellulase can act as a potent biofilm dispersal agent. With in vitro and ex vivo Pseudomonas aeruginosa biofilm models, we compared glycoside hydrolases against other, clinically relevant, enzymatic debridement agents (papain, bromelain, and collagenase). Glycoside hydrolase biofilm dispersal was dose-dependent. However, at doses of 1% or above, glycoside hydrolases outperformed, or were comparable, to other enzymatic debridement agents. With our in vivo surgical wound infection model, we evaluated biofilm dispersal using infection dissemination as a proxy. We found that sharp debridement followed by multiple glycoside hydrolase treatments enhanced biofilm dispersal. Furthermore, a single dose of glycoside hydrolase in combination with debridement decreased infection load in acute wounds. Similarly, when we treated established 5-day-old infections, we saw a decrease in infection load and no infection dissemination. Overall, our data suggest that debridement enhances the efficacy of a topical antibiotic ointment, allowing for greater infection clearance.

Dual phage-incorporated electrospun polyvinyl alcohol-eudragit nanofiber matrix for rapid healing of diabetic wound infected by Pseudomonas aeruginosa and Staphylococcus aureus

Diabetic wound healing remains a healthcare challenge due to co-occurring multidrug-resistant (MDR) bacterial infections and the constraints associated with sustained drug delivery. Here, we integrate two new species of phages designated as PseuPha1 and RuSa1 respectively lysing multiple clinical MDR strains of P. aeruginosa and S. aureus into a novel polyvinyl alcohol-eudragit (PVA-EU†) nanofiber matrix through electrospinning for rapid diabetic wound healing. PVA-EU† evaluated for characteristic changes that occurred due to electrospinning and subjected to elution, stability and antibacterial assays. The biocompatibility and wound healing ability of PVA-EU† were assessed through mouse fibroblast cell line NIH3T3, followed by validation through diabetic mice excision wound co-infected with P. aeruginosa and S. aureus. The electrospinning resulted in the incorporation of ~ 75% active phages at PVA-EU†, which were stable at 25 °C for 30 days and at 4 °C for 90 days. PVA-EU† showed sustained release of phages for 18 h and confirmed to be detrimental to both mono- and mixed-cultures of target pathogens. The antibacterial activity of PVA-EU† remained unaltered in the presence of high amounts of glucose, whereas alkaline pH promoted the activity. The matrix exerted no cytotoxicity on NIH3T3, but showed significant (p < 0.0001) wound healing in vitro and the process was rapid as validated through a diabetic mice model. The sustained release, quick wound closure, declined abundance of target MDR bacteria in situ and histopathological signs of recovery corroborated the therapeutic efficacy of PVA-EU†. Taken together, our data signify the potential application of PVA-EU† in the rapid treatment of diabetic wounds without the aid of antibiotics.

Injectable Light-Responsive Hydrogel Dressing Promotes Diabetic Wound Healing by Enhancing Wound Angiogenesis and Inhibiting Inflammation

Diabetic wounds are therapeutically challenging because of the complex and adverse microenvironment that impedes healing. Unlike conventional wound dressings, hydrogels provide antibacterial, anti-inflammatory, and repair-promoting functions. In this study, we developed a light-responsive and injectable chitosan methacryloyl (CSMA) hydrogel, incorporating soy isoflavones (SIs) and gold nanoparticles (AuNPs). Transmission electron microscopy (TEM), Fourier transform infrared (FTIR) spectroscopy, and proton nuclear magnetic resonance (1H NMR) spectroscopy analyses confirmed the successful synthesis of the CSMA/SI/AuNP hydrogels. In vitro experiments demonstrated that this hydrogel exhibited exceptional biocompatibility and enhanced the migration of human umbilical vein endothelial cells (p < 0.05), thereby underscoring its potential for promoting angiogenesis. In vivo studies have indicated that hydrogels significantly enhance the rate of wound healing (p < 0.001). Moreover, they facilitate angiogenesis (p < 0.01) and diminish the inflammatory response at the wound site (p < 0.05). Additionally, hydrogels promote collagen deposition and the regeneration of skin appendages. These findings substantiate the hydrogel's therapeutic potential for diabetic wound care, highlighting its promise for regenerative medicine. CSMA/SI/AuNP represents a significant advancement in diabetic wound treatment, addressing key challenges in wound healing by offering a multifaceted therapeutic approach with broad clinical implications for enhancing patient outcomes in chronic wound management.

In Vitro Assessment of Gallium Nanoalloy Hydrogels for Antimicrobial and Wound Healing Applications

Chronic and recurring wounds pose a significant challenge in modern healthcare, leading to substantial morbidity. These wounds allow pathogens to colonize, potentially resulting in local and systemic infections. Current interventions need to be revised and become increasingly less reliable due to the emergence of antibiotic resistance. In the present study, we aim to address these issues by fabricating hydrogels impregnated with gallium-based nanoalloys for their antimicrobial activity. Gallium liquid metal nanoparticles (approximately 100 nm in diameter) were alloyed in different combinations with bismuth and silver ions through a galvanic replacement reaction. These multimetallic hydrogels showed favorable antibacterial activity against the Gram-positive Staphylococcus aureus and the Gram-negative Pseudomonas aeruginosa, as observed with fluorescence microscopy and inhibition assays. The multimetallic hydrogels showed no toxicity against murine macrophages or human dermal fibroblasts and enhanced in vitro wound healing. The development of these innovative gallium-based hydrogels represents a promising strategy to combat chronic wounds and their associated complications, offering an effective alternative to current antimicrobial treatments amidst rising antibiotic resistance.

New Perspectives of Hydrogels in Chronic Wound Management

Chronic wounds pose a substantial healthcare concern due to their prevalence and cost burden. This paper presents a detailed overview of chronic wounds and emphasizes the critical need for novel therapeutic solutions. The pathophysiology of wound healing is discussed, including the healing stages and the factors contributing to chronicity. The focus is on diverse types of chronic wounds, such as diabetic foot necrosis, pressure ulcers, and venous leg ulcers, highlighting their etiology, consequences, and the therapeutic issues they provide. Further, modern wound care solutions, particularly hydrogels, are highlighted for tackling the challenges of chronic wound management. Hydrogels are characterized as multipurpose materials that possess vital characteristics like the capacity to retain moisture, biocompatibility, and the incorporation of active drugs. Hydrogels' effectiveness in therapeutic applications is demonstrated by how they support healing, including preserving ideal moisture levels, promoting cellular migration, and possessing antibacterial properties. Thus, this paper presents hydrogel technology's latest developments, emphasizing drug-loaded and stimuli-responsive types and underscoring how these advanced formulations greatly improve therapy outcomes by enabling dynamic and focused reactions to the wound environment. Future directions for hydrogel research promote the development of customized hydrogel treatments and the incorporation of digital health tools to improve the treatment of chronic wounds.

Vibration therapy for patients with hard-to-heal wounds: A systematic review and meta-analysis of experimental studies

INTRODUCTION

Hard-to-heal wounds lead to functional loss, decreased quality of life, and prolonged hospitalization due to delayed healing. The healthcare costs of managing such wounds are substantial. Vibration therapy has been proposed as an alternative treatment for hard-to-heal wounds but no comprehensive reviews have quantitatively analyzed its efficacy.

MATERIALS AND METHODS

Six databases were systematically searched for relevant articles on August 1, 2024. The methodologies of the studies included in the analysis were assessed using Version 2 of the Cochrane Risk of Bias tool for randomized trials and ROBINS-I tool for non-randomized studies. A random-effects model was applied to aggregate the pooled effect size. Heterogeneity was assessed using I2. A forest plot was generated for meta-analysis.

RESULTS

Ten studies were included in the meta-analysis. Vibration therapy significantly reduced neuropathy (pooled standardized mean difference [SMD] = -0.79; 95 % CI = -1.51 to -0.07; p = 0.03; I2 = 61.40 %) and enhanced the ulcer healing area (pooled SMD = 0.92; 95 % CI = 0.60 to 1.23; p < 0.001; I2 = 0.00 %) of patients with hard-to-heal wounds. However, the intervention did not significantly alleviate pain (pooled SMD = -0.51; 95 % CI = -1.38 to 0.36; p = 0.25; I2 = 74.15 %). Significant heterogeneity was identified in the pooled result for pain and neuropathy.

CONCLUSIONS

Vibration therapy appears to enhance ulcer healing and reduce neuropathy. These results may help researchers and healthcare providers to further develop vibration therapy to address the underlying requirements for bridging the evidence-practice gap in wound care. Future studies should consider the safety and potential adverse outcomes of vibration therapy to ensure its appropriate application for treating hard-to-heal wounds.

Revealing the promising era of silk-based nanotherapeutics: a ray of hope for chronic wound healing treatment

Chronic wounds significantly contribute to disability and affect the mortality rate in diabetic patients. In addition, pressure ulcers, diabetic foot ulcers, arterial ulcers, and venous ulcers pose a significant health burden due to their associated morbidity and death. The complex healing process, environmental factors, and genetic factors have been identified as the rate-limiting stages of chronic wound healing. Changes in temperature, moisture content, mechanical strain, and genetics can result in slow wound healing, increased susceptibility to bacterial infections, and poor matrix remodelling. These obstacles can be addressed with natural biomaterials exhibiting antimicrobial, collagen synthesis, and granulation tissue formation properties. Recently, silk proteins have gained significant attention as a natural biomaterial owing to good biocompatibility, biodegradability, reduced immunogenicity, ease of sterilization, and promote the wound healing process. The silk components such as sericin and fibroin in combination with nano(platforms) effectively promote wound repair. This review emphasises the potential of sericin and fibroin when combined with nano(platforms) like nanoparticles, nanofibers, and nanoparticles-embedded films, membranes, gels, and nanofibers.

Understanding the pathophysiology of Pseudomonas aeruginosa colonization as a guide for future treatment for chronic leg ulcers

Chronic leg wounds represent a major burden of disease worldwide, costing health care systems billions of dollars each year. Aside from the financial implications, they also impose a significant physical and psychosocial burden on the patient, their relatives and/or carers, and the community. Whilst measures such as maintenance of wound hygiene, debridement, dressings and compression are the current standard of care, complete healing is not always achievable and ulcer recurrence is common. Thus, there is still a gap to breach in terms of understanding the intricate pathophysiology of chronic wounds and the role this plays on treatment and management. Pseudomonas aeruginosa has been linked to poor wound healing, with the pathogen being frequently isolated from chronic leg ulcers. Characterized by its multi-drug resistance, targeting P. aeruginosa requires the development of novel therapeutic options. Thus, the aim of this literature review is to describe the pathophysiology of P. aeruginosa in chronic leg ulcers and discuss novel treatment strategies. Here, we describe the key molecular mechanisms driving the observed clinical effect of P. aeruginosa on wounds and discuss novel strategies of molecular targeting of this common bacteria, establishing new approaches that could benefit patients with chronic hard to heal wounds.

In silico Profiling and Pharmacokinetic Modelling of Olivetol: Evaluating its Potential as a Therapeutic Agent for Diabetic Wound Healing

BACKGROUND

Diabetic wound healing poses a significant challenge due to the intricate disruptions in cellular and molecular processes induced by hyperglycaemia, leading to delayed or impaired tissue repair. Computational techniques offer a promising avenue for unravelling the complexities of diabetic wound healing by elucidating the molecular mechanisms involved.

METHODOLOGY

This study utilized in silico molecular docking and dynamics simulations to explore the potential therapeutic effectiveness of olivetol, a phenolic compound, in the context of diabetic wound healing. Furthermore, computational methodologies, encompassing pkCSM, Swiss ADME, OSIRIS® property explorer, PASS online web resource, and MOLINSPIRATION® software, were employed to forecast the pharmacokinetic properties, biological actions, and in vitro analyses, such as MTT and scratch assays, to evaluate the therapeutic effectiveness of olivetol in wound healing.

RESULTS AND DISCUSSION

Our findings have revealed olivetol to be a promising candidate for targeting multiple pathways implicated in diabetic wound healing. Its ability to modulate inflammation, oxidative stress, extracellular matrix remodeling, angiogenesis, and cell signaling suggests a multifaceted approach to promoting effective wound repair. Moreover, olivetol has been found to demonstrate strong binding affinity with key MRSA target proteins, indicating its potential as an antimicrobial agent against MRSA infections in diabetic wounds. The in vitro MTT assay demonstrated cell viability with an IC50 value of 40.80 μM, highlighting its cytotoxicity potential. Additionally, the scratch assay confirmed promising wound healing activity, showcasing its effectiveness in promoting cell migration and closure.

CONCLUSION

Olivetol emerges as a promising candidate for targeted interventions in non-healing diabetic wounds, particularly due to its ability to address prolonged inflammation, a common obstacle in diabetic wound healing.

Photobiomodulation studies on diabetic wound healing: An insight into the inflammatory pathway in diabetic wound healing

Diabetes mellitus remains a global challenge to public health as it results in non-healing chronic ulcers of the lower limb. These wounds are challenging to heal, and despite the different treatments available to improve healing, there is still a high rate of failure and relapse, often necessitating amputation. Chronic diabetic ulcers do not follow an orderly progression through the wound healing process and are associated with a persistent inflammatory state characterised by the accumulation of pro-inflammatory macrophages, cytokines and proteases. Photobiomodulation has been successfully utilised in diabetic wound healing and involves illuminating wounds at specific wavelengths using predominantly light-emitting diodes or lasers. Photobiomodulation induces wound healing through diminishing inflammation and oxidative stress, among others. Research into the application of photobiomodulation for wound healing is current and ongoing and has drawn the attention of many researchers in the healthcare sector. This review focuses on the inflammatory pathway in diabetic wound healing and the influence photobiomodulation has on this pathway using different wavelengths.

Local Treatment of Wound Infections: A Review of Clinical Trials from 2013 to 2024

Significance: Management of infection is a critical aspect of wound care. It involves the application of various interventions to treat the wound and prevent the infection from spreading to other parts of the body, which may lead to serious complications, including sepsis. Local treatment of skin wound infections is the favored route of administration, reducing the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. The purpose of this article was to review clinical trials from 2013 and onward, focusing on local treatment of acute wounds and burns as well as chronic wounds as their primary outcome measurement. Recent Advances: Based on our literature search, 49 clinical trials were focusing on treating infected chronic wounds, and 6 trials studied infection as their primary outcome in acute wounds during the last 10 years. Critical Issues: Currently commercially available local treatments do not prevent the onset of invasive infection. Therefore, there is a need for more effective local therapies. Future Directions: Despite multiple preclinical studies introducing novel and promising strategies in terms of novel antimicrobial agents and delivery methods to prevent and treat skin wound infections locally, many have yet to be tested in a clinical setting. These preclinically tested approaches could still be valuable additions to today's care of infected skin wounds.

Analysis of Outcomes and Factors Influencing Community-Acquired Pressure Injury: A Retrospective Review of 413 Patients

PURPOSE

The purpose of this study was to analyze the outcomes and influencing factors of patients with community-acquired pressure injuries (CAPIs) and provide insights for clinical practice.

DESIGN

Retrospective cohort study.

SUBJECTS AND SETTING

We reviewed medical records of 413 patients with a total of 522 CAPIs. Patients with CAPIs who were hospitalized at Mianyang Central Hospital, Sichuan Province, China, between December 2021 and December 2022.

METHODS

Depending on CAPI outcome at the time of discharge, the patients were split into "improvement" and "no improvement" groups. Factors influencing CAPI outcomes were examined using univariate analysis followed by multivariate analysis (logistic regression).

RESULTS

A majority of patients (n = 324, 78.5%) showed improvement, and 89 (21.5%) showed no improvement. Logistic regression analysis showed statistically significant associations between CAPI outcomes and Braden Scale for Pressure Sore Risk scores, Barthel Index for Activities of Daily living scores, along with serum albumin, hemoglobin, interleukin-6, and C-reactive protein levels.

CONCLUSIONS

The outcomes of patients with CAPIs were influenced by the Braden score, the Barthel score, serum albumin and hemoglobin levels, as well as inflammatory markers, including interleukin-6 and C-reactive protein. To effectively treat and care for patients with CAPIs, nurses should develop customized nursing interventions based on the unique characteristics of patients.

Effect of ceramic dressings and silver-impregnated dressings on bacterial load and wound closure: a comparative study

Wound healing is a series of complex and dynamic processes which occur in several stages. Optimal wound healing is essential for restoring the integrity and function of the affected area. Although medicated wound dressings have been extensively employed to control wound infection, the risks associated with antimicrobials make the use of non-medicated alternatives necessary. Nevertheless, the relationship between the concentrations of medicated wound dressings and their antimicrobial activities, along with their wound healing efficacies, still remains unclear. Non-medicated wound dressings are an alternative to dressings that contain active ingredients acting as antimicrobials or antiseptics. In the present study, the researchers examined the reduction of bacterial load as the primary endpoint and the healing rate as the secondary endpoint, comparing microporous ceramic dressings to silver-impregnated dressings in participants from two outpatient wound management clinics. The study included 25 participants in the silver-impregnated dressing (control) group and 28 participants in the ceramic dressing (study) group. The participants' wounds were assessed through MolecuLight i:X (MolecuLight Inc., Canada) wound tracing and MolecuLight i:X fluorescence imaging to measure the wound size, as well as presence of a bacterial load of >104 colony forming units/g at weeks 1, 2, 3 and 4. The results indicated that there was a significant difference in the distribution over the categories of bacterial load cleared after weeks 1, 2, 3 or 4 in the two groups. Moreover, the bacterial load cleared significantly faster in the study group (p=0.001). Mean wound size was 10.93cm2 (range: 0.10-37.95cm2) in the control group and 11.48cm2 (range: 0.80-60cm2) in the study group. In the maximum likelihood regression analysis, the mean reduction in wound area for the study group was greater than that for the control group. The study concluded that the ceramic dressings could be an effective alternative to silver-impregnated dressings when treating infected wounds.

Managing drug therapy-related problems and assessment of chronic diabetic wounds

Type 2 diabetes mellitus (T2DM), responsible for most diabetes cases recorded worldwide, increases the risk of chronic wounds and amputation. Patients with T2DM appear to be more susceptible to delayed wound healing due to their treatment adherence. This review explores the specifics of polypharmacy, side effects, possible drug interactions and the importance of medication adherence for therapeutic efficacy. We discuss the effects of anti-diabetes medications on wound healing as well as the role that biofilms and microbial infections play in diabetic wounds. Inconsistent use of medications can lead to poor glycaemic control, which negatively affects the healing process of diabetic foot ulcers. Managing chronic wounds represents a substantial portion of healthcare expenditures. Biofilm-associated infections are difficult for the immune system to treat and respond inconsistently to antibiotics as these infections are slow growing and persistent. Additionally, we emphasize the critical role pharmacists play in enhancing patient adherence and optimizing diabetes treatment by offering comprehensive coverage of drugs associated with problems related to pharmacological therapy in type 2 diabetes.

Multifunctional poloxamer-based thermo-responsive hydrogel loaded with human lactoferricin niosomes: In vitro study on anti-bacterial activity, accelerate wound healing, and anti-inflammation

Chronic wound infections are attributed to delayed tissue repair, which remains a major clinical challenge in long-term health care. Particularly, infections with antibiotic resistance have more serious effects on health, often resulting in unsuccessful treatments. Thus, antimicrobial peptide (AMP)-based therapy holds promise as a potential therapeutic approach to overcoming drug resistance. Conventional wound dressing is a passive strategy for wound care that is not capable of eradicating pathogens and promoting tissue repair. In this study, we aim to construct an advanced wound dressing; a thermo-responsive hydrogel incorporated with lactoferricin (Lfcin) niosome (Lfcin-Nio/hydrogel) for bacterial pathogen treatment. The Lfcin-loaded niosome (Lfcin-Nio) has a particle size of 396.91 ± 20.96 nm, 0.38 ± 0.01 of PdI, -10.5 ± 0.3 mV of ζ potential, and 72.30 ± 7.05 % Lfcin entrapment efficiency. Lfcin-Nio exhibited broad antibacterial activity on both drug-susceptible and drug-resistant strains, and also on bacteria residing in the biofilm matrix. The Lfcin-Nio/hydrogel was fabricated from 0.5 % w/v poloxamer 188-20 % w/v poloxamer 407, and supplemented with Lfcin-Nio and epidermal growth factor (EGF). The physical properties of Lfcin-Nio/hydrogels showed elasticity, swelling ability, and strong injectability with responsiveness to 33-37 °C temperatures. The biological properties of Lfcin-Nio/hydrogels exhibited a bactericidal effect against drug-resistant strains of S. aureus and P. aeruginosa, and showed less toxicity to the human skin fibroblast. It also promoted the healing of scratches by 55 % within 6 h, compared to the wound closure rate of 20 % in the cell control. The inflammatory response of the Lfcin-Nio/hydrogel-treated cells was reduced via suppression of IL-1β and COX-2 mRNA expressions. From this study, Lfcin-Nio/hydrogels can be suggested as a modern wound dressing that possesses multifunctional and beneficial properties for the management of chronic wound infections.

Antimicrobial hydrogel foam dressing with controlled release of gallium maltolate for infection control in chronic wounds

Effective treatment of infection in chronic wounds is critical to improve patient outcomes and prevent severe complications, including systemic infections, increased morbidity, and amputations. Current treatments, including antibiotic administration and antimicrobial dressings, are challenged by the increasing prevalence of antibiotic resistance and patients' sensitivity to the delivered agents. Previous studies have demonstrated the potential of a new antimicrobial agent, Gallium maltolate (GaM); however, the high burst release from the GaM-loaded hydrogel gauze required frequent dressing changes. To address this need, we developed a hydrogel foam-based wound dressing with GaM-loaded microspheres for sustained infection control. First, the minimal inhibitory and bactericidal concentrations (MIC and MBC) of GaM against two Staphylococcus aureus strains isolated from chronic wounds were identified. No significant adverse effects of GaM on dermal fibroblasts were shown at the MIC, indicating an acceptable selectivity index. For the sustained release of GaM, electrospraying was employed to fabricate microspheres with different release kinetics. Systematic investigation of loading and microsphere size on release kinetics indicated that the larger microsphere size and lower GaM loading resulted in a sustained GaM release profile over the target 5 days. Evaluation of the GaM-loaded hydrogel dressing demonstrated cytocompatibility and antibacterial activities with a zone of inhibition test. An equine distal limb wound model was developed and utilized to demonstrate the efficacy of GaM-loaded hydrogel foam in vivo. This antimicrobial hydrogel foam dressing displayed the potential to combat methicillin-resistant S. aureus (MRSA) infection with controlled GaM release to improve chronic wound healing.

The Acid-Buffered Engineered Gel Promotes In Vitro Cutaneous Healing and Fights Resistant Bacteria in Wounds

Background: Treatment of cutaneous wound infections is becoming a major clinical challenge due to the growing problem of antimicrobial resistance associated with existing wound treatments. Two prevalent pathogens in wound infections, Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa), continue to present a serious challenge, underscoring the critical need for new therapeutic alternatives. Methods: Novel alginate acid-buffered gels (ABF-1, ABF-2, and ABF-3) were developed using a combination of organic acids in various concentrations and buffered at a pH of 4.5. The acid-buffering capacity of the gels was evaluated against sodium hydroxide solution and simulated wound fluid (SWF) at different wound pHs, mimicking infected and non-infected wound environments. The in vitro antibacterial activity was assessed against resistant bacterial strains (Gram-positive and Gram-negative) using a microdilution method and wound biofilm assay. The rheological properties and cell viability of the gels were evaluated and the gel showing positive cell viability was further investigated for healing ability using an in vitro wound scratch assay. Results: The gels showed promising in vitro antibacterial activity against Staphylococcus epidermidis, S. aureus, and P. aeruginosa. Gels with higher acid concentrations (ABF-1 and ABF-2) were highly effective in reducing the bacterial load in chronic biofilms of S. aureus and P. aeruginosa, while the gel with a lower acid concentration (ABF-3) showed positive effects on the viability of skin cells (over 80% cells viable) and for promoting wound closure. All three gels demonstrated excellent acid-buffering capabilities. Conclusions: The acid-buffered gels demonstrate promising in vitro antibacterial effects, indicating their potential for enhancing wound healing.

Advances in DNA nanotechnology for chronic wound management: Innovative functional nucleic acid nanostructures for overcoming key challenges

Chronic wound management is affected by three primary challenges: bacterial infection, oxidative stress and inflammation, and impaired regenerative capacity. Conventional treatment methods typically fail to deliver optimal outcomes, thus highlighting the urgency to develop innovative materials that can address these issues and improve efficacy. Recent advances in DNA nanotechnology have garnered significant interest, particularly in the field of functional nucleic acid (FNA) nanomaterials, owing to their exceptional biocompatibility, programmability, and therapeutic potential. Among them, FNAs with unique nanostructures have garnered considerable attention. First, they inherit the biological properties of FNAs, including biocompatibility, reactive oxygen species (ROS)-scavenging capabilities, and modulation of cellular functions. Second, based on a precise design, these nanostructures exhibit superior physical properties, stability, and cellular uptake. Third, by leveraging the programmability of DNA strands, FNA nanostructures can be customized to accommodate therapeutic nucleic acids, peptides, and small-molecule drugs, thereby enabling a stable and controlled drug delivery system. These unique characteristics enable the use of FNA nanostructures to effectively address the major challenges in chronic wound management. This review focuses on various FNA nanostructures, including tetrahedral framework nucleic acids (tFNAs), DNA hydrogels, DNA origami, and rolling-circle amplification (RCA) DNA assembly. Additionally, a summary of recent advancements in their design and application for chronic wound management as well as insights for future research in this field are provided.

The chronic wound characterisation study and biobank: a study protocol for a prospective observational cohort investigation of bacterial community composition, inflammatory responses and wound-healing trajectories in non-healing wounds

INTRODUCTION

Chronic wounds affect 1%-2% of the global population, with rising incidence due to ageing and lifestyle-related diseases. Bacterial biofilms, found in 80% of chronic wounds, and scattered single-cell bacteria may hinder healing. Microbes are believed to negatively impact healing by exacerbating inflammation and host immune response.

METHODS AND ANALYSIS

The primary objective of the chronic wound characterisation (CWC) study is to investigate chronic wounds through a prospective observational cohort study exploring bacterial community composition, inflammatory responses and the influence of bacteria on wound-healing trajectories. The CWC study will be investigated through two cohorts: the predictive and in-depth.The predictive cohort includes patients with a chronic wound scheduled for mechanical debridement. The debrided material will be collected for dual RNA sequencing and 16s ribosomal RNA gene sequencing, as well as samples for microbial culturing and a photo to assess the wound. Clinical data is recorded, and healing and/or other clinical endpoints are established through medical records.The in-depth cohort includes and follows patients undergoing split-thickness skin grafting. Extensive sampling (ESwabs, biopsies, tape strips, debrided material and a sample of the skin graft) will be performed on surgery and patients will be seen at two follow-up visits. Samples will be analysed through culturing and next-generation sequencing methods. A biobank will be established comprising longitudinal clinical samples and clinical data.

ETHICS AND DISSEMINATION

The study has been approved by the board of health ethics, Capital Region of Denmark, under protocol number H-20032214. The study findings will be disseminated through peer-reviewed publications and showcased at both national and international conferences and meetings within the domains of microbiology, wound healing and infection.

Synergistic effect of zinc oxide-cinnamic acid nanoparticles for wound healing management: in vitro and zebrafish model studies

Wound infections resulting from pathogen infiltration pose a significant challenge in healthcare settings and everyday life. When the skin barrier is compromised due to injuries, surgeries, or chronic conditions, pathogens such as bacteria, fungi, and viruses can enter the body, leading to infections. These infections can range from mild to severe, causing discomfort, delayed healing, and, in some cases, life-threatening complications. Zinc oxide (ZnO) nanoparticles (NPs) have been widely recognized for their antimicrobial and wound healing properties, while cinnamic acid is known for its antioxidant and anti-inflammatory activities. Based on these properties, the combination of ZnO NPs with cinnamic acid (CA) was hypothesized to have enhanced efficacy in addressing wound infections and promoting healing. This study aimed to synthesize and evaluate the potential of ZnO-CN NPs as a multifunctional agent for wound treatment. ZnO-CN NPs were synthesized and characterized using key techniques to confirm their structure and composition. The antioxidant and anti-inflammatory potential of ZnO-CN NPs was evaluated through standard in vitro assays, demonstrating strong free radical scavenging and inhibition of protein denaturation. The antimicrobial activity of the nanoparticles was tested against common wound pathogens, revealing effective inhibition at a minimal concentration. A zebrafish wound healing model was employed to assess both the safety and therapeutic efficacy of the nanoparticles, showing no toxicity at tested concentrations and facilitating faster wound closure. Additionally, pro-inflammatory cytokine gene expression was analyzed to understand the role of ZnO-CN NPs in wound healing mechanisms. In conclusion, ZnO-CN NPs demonstrate potent antioxidant, anti-inflammatory, and antimicrobial properties, making them promising candidates for wound treatment. Given their multifunctional properties and non-toxicity at tested concentrations, ZnO-CN NPs hold significant potential as a therapeutic agent for clinical wound management, warranting further investigation in human models.

Chitosan/agarose hydrogel dressing: pH response real-time monitoring and chemo-/photodynamic therapy synergistic treatment of infected wounds

The early diagnosis and real-time monitoring of bacterial infections are of great significance for the establishment of integrated diagnosis and treatment systems. In this study, a pH-responsive smart hydrogel patch system, named CABP, was developed to monitor and treat wound infections. CABP has a sandwich structure, with non-woven fabric/chitosan (NF/CS) as the intermediate skeleton layer, Agarose/chitosan/Bromothymol Blue (AG/CS/BTB) hydrogel as the detection layer, and Agarose/chitosan/phthalocyanine (AG/CS/Pc) hydrogel as the treatment layer. When Staphylococcus aureus (S. aureus) infection occurs, the pH of the environment decreases, which triggers the CABP to change from its original blue color to yellow, achieving an intuitive visual transformation. Moreover, the hydrogel patch showed a significant inhibition rate of up to 99.99971 % against S. aureus under 660 nm light radiation, showing a good photodynamic therapy (PDT)/ chemotherapy (CT) synergistic effect. In addition, CABP showed excellent antibacterial and wound healing effects on S. aureus infection in a full-layer skin defect experiment. In short, the patch system is simple to prepare and easy to use, and can provide important research value for the integrated diagnosis and treatment system in biomedical applications.

Antimicrobial effects of a multimodal wound matrix against methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in an in vitro and an in vivo porcine wound model

Chronic non-healing wounds pose significant challenges due to an elevated inflammatory response caused in part by bacterial contamination (Physiol Rev. 2019;99:665). These wounds lead to billions being spent in the health care system worldwide (N Engl J Med. 2017;376:2367, Int J Pharm. 2014;463:119). We studied the in-vitro and in-vivo antimicrobial effects of a multimodal wound matrix (MWM) against two common wound pathogens, Methicillin-Resistant Staphylococcus aureus (MRSA USA300) and Pseudomonas aeruginosa ATCC 27312 (PA27312) (Int Wound J. 2019;16:634). The in-vitro study conducted was a zone of inhibition test with the two microbes at 104 Log CFU/mL inoculated on Tryptic soy agar with 5% sheep blood (TSAII) plates. Treatments used were MWM, Mupirocin (Positive control for MRSA), Silver Sulfadiazine (Positive Control for PA), Petrolatum and Sterile Saline (both serving as Negative Controls). Treatments were allowed to diffuse into the agar for 3 h and then were incubated for 24 h at 37°C. The in-vivo study utilized a deep dermal porcine wound model (22 × 22 × 3 mm) created on six animals. Three animals were inoculated with MRSA USA300 and the other three with PA27312 with each allowing a 72-h biofilm formation. After 72 h, baseline wounds were assessed for bacterial concentration and all remaining wounds were treated with either MWM alone, Silver Treatment or Untreated Control. Wounds were assessed on days 4, 8 and 12 after treatment application for microbiological analysis. In-vitro, MWM exhibited significant inhibition of MRSA USA300 and PA27312 growth when compared to negative controls (p ≤ 0.05). Likewise, in-vivo, the MWM-treated wounds exhibited a significant (p ≤ 0.05) bacterial reduction compared to all other treatment groups, especially on days 8 and 12 for both pathogens. MWM demonstrated promise in addressing colonized wounds with biofilms. Additional studies on MWM's benefits and comparisons with existing treatments are warranted to optimize wound care strategies (Adv Wound Care. 2021;10:281).

Combinatorial Effects of Ursodeoxycholic Acid and Antibiotic in Combating Staphylococcus aureus Biofilm: The Roles of ROS and Virulence Factors

Staphylococcus aureus is a biofilm-forming bacterium responsible for various human infections, one particularly challenging to treat due to its antibiotic resistance. Biofilms can form on both soft tissues and medical devices, leading to persistent and hard-to-treat infections. Combining multiple antimicrobials is a potential approach to overcoming this resistance. This study explored the effects of ursodeoxycholic acid (UDCA) combined with the antibiotic ciprofloxacin against S. aureus biofilms, aiming to evaluate any synergistic effects. Results showed that UDCA and ciprofloxacin co-treatment significantly reduced biofilm formation and disrupted pre-formed biofilms more effectively than either agent alone (p < 0.01). The combination also displayed a slight synergistic effect, with a fractional inhibitory concentration of 0.65. Additionally, the treatment reduced the production of extracellular polymeric substances, increased reactive oxygen species production, decreased metabolic activity, altered cell membrane permeability, and lowered cell surface hydrophobicity in S. aureus. Furthermore, it diminished biofilm-associated pathogenic factors, including proteolytic activity and staphyloxanthin production. Overall, the UDCA-ciprofloxacin combination shows considerable promise as a strategy to combat infections related to staphylococcal biofilms, offering a potential solution to the healthcare challenges posed by antibiotic-resistant S. aureus.

Efficacy of melanin-loaded lipoic acid-modified chitosan hydrogel in diabetic wound healing

The healing of diabetic wounds is significantly impeded due to severe oxidative stress and hindered angiogenesis, presenting a major challenge to clinical treatment. In this context, we introduces a novel hydrogel dressing strategy that uniquely combines α-lipoic acid-modified chitosan (LAMC) and melanin nanoparticles (MNPs). This innovative hydrogel, LAMC@MNPs, is formulated to gel under ultraviolet (UV) light without the need for a photoinitiator, simplifying the preparation process and potentially enhancing safety. Our experimental results demonstrate that the LAMC@MNPs hydrogel not only exhibits superior skin adhesion, with an average strength of 56.59 ± 3.16 KPa, but also effectively alleviates oxidative stress and accelerates vascular regeneration and wound healing. This is achieved by promoting cell migration and scavenging free radicals, addressing the critical barriers in diabetic wound care. The combination of these materials and their functional benefits presents a promising new approach to diabetic wound treatment.

Bacterial-responsive biodegradable silver nanoclusters composite hydrogel for infected wound therapy

Skin wounds are susceptible to bacterial infections, which hinder healing and extend recovery. Herein, we designed a silver nanoclusters (Ag NCs) composite hydrogel for infected wound treatment via bacterial enzymatic degradation and Ag release. Using biocompatible gelatine and polyethylene glycol as the main components, DNA-templated Ag NCs were covalently linked to a polymer network to obtain the final nanocomposite hydrogel. This hydrogel exhibited good compressive and tensile stiffness, bioadhesion and water absorption. The overexpressed bacterial enzymes protease and DNase in the infected wound were hydrolysed by the gel matrix, subsequently releasing antibacterial Ag ions. In vitro experimental results proved that the hydrogel demonstrated excellent bactericidal effect on Staphylococcus aureus and Escherichia coli, which are commonly implicated in clinical wound infections. Animal experiments revealed that the hydrogel considerably promoted cell proliferation and wound healing with less inflammatory responses. Thus, these results demonstrate strategies for bacterial enzyme-responsive Ag release for infected wound healing, facilitating further development of intelligent bandages.

Antibacterial, Antibiofilm, and Wound Healing Activities of Rutin and Quercetin and Their Interaction with Gentamicin on Excision Wounds in Diabetic Mice

Phytochemicals are effective and are gaining attention in fighting against drug-resistant bacterial strains. In the present study, rutin and quercetin were tested for antibacterial, antibiofilm, and wound healing activities on excision wounds infected with MDR-P. aeruginosa in diabetic mice. Antibacterial and antibiofilm activities were studied in vitro using broth dilution assay and crystal violet assay, respectively. These phytochemicals were tested alone for wound-healing activities at different concentrations (0.5% and 1% in ointment base) and in combination with gentamicin to evaluate any additive effects. Rutin and quercetin demonstrated effectiveness against MDR-P. aeruginosa at higher concentrations. Both phytochemicals inhibited biofilm formation in vitro and contributed to the healing of diabetic wounds by eradicating biofilm in the wounded tissue. Rutin at a low concentration (0.5%) had a lesser effect on reducing the epithelization period and regeneration of the epithelial layer compared to quercetin. When combined with gentamicin, quercetin (1%) displayed the maximum effect on epithelium regeneration, followed by rutin (1%) in combination with gentamicin. Both phytochemicals were found to be more effective in controlling biofilm and wound-healing activities when used as an additive with gentamicin. The study supports the traditional use of phytochemicals with antibacterial, antibiofilm, and wound-healing activities in managing diabetic infections.

Cannabinoids in Integumentary Wound Care: A Systematic Review of Emerging Preclinical and Clinical Evidence

This systematic review critically evaluates preclinical and clinical data on the antibacterial and wound healing properties of cannabinoids in integument wounds. Comprehensive searches were conducted across multiple databases, including CINAHL, Cochrane library, Medline, Embase, PubMed, Web of Science, and LILACS, encompassing records up to May 22, 2024. Eighteen studies met the inclusion criteria. Eleven were animal studies, predominantly utilizing murine models (n = 10) and one equine model, involving 437 animals. The seven human studies ranged from case reports to randomized controlled trials, encompassing 92 participants aged six months to ninety years, with sample sizes varying from 1 to 69 patients. The studies examined the effects of various cannabinoid formulations, including combinations with other plant extracts, crude extracts, and purified and synthetic cannabis-based medications administered topically, intraperitoneally, orally, or sublingually. Four animal and three human studies reported complete wound closure. Hemp fruit oil extract, cannabidiol (CBD), and GP1a resulted in complete wound closure in twenty-three (range: 5-84) days with a healing rate of 66-86% within ten days in animal studies. One human study documented a wound healing rate of 3.3 cm2 over 30 days, while three studies on chronic, non-healing wounds reported an average healing time of 54 (21-150) days for 17 patients by oral oils with tetrahydrocannabinol (THC) and CBD and topical gels with THC, CBD, and terpenes. CBD and tetrahydrocannabidiol demonstrated significant potential in reducing bacterial loads in murine models. However, further high-quality research is imperative to fully elucidate the therapeutic potential of cannabinoids in the treatment of bacterial skin infections and wounds. Additionally, it is crucial to delineate the impact of medicinal cannabis on the various phases of wound healing. This study was registered in PROSPERO (CRD42021255413).