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.

Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models

OBJECTIVE

Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions.

METHOD

Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified.

RESULTS

The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered.

CONCLUSION

This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.

Antiseptic-Loaded Casein Hydrogels for Wound Dressings

Chronic wound treatment accounts for a substantial percentage of the medical expenses worldwide. Improving and developing novel wound care systems can potentially help to handle this problem. Wound dressings loaded with antiseptics may be an important tool for wound care, as they inhibit bacterial growth at the wound site. The goal of the present work was to investigate the potential of using casein hydrogel dressings loaded with two antiseptic drugs, Octiset^® or polyhexanide, to treat chronic wounds. Casein-based hydrogels are inexpensive and have several properties that make them suitable for biomedical applications. Two types of casein were used: casein sodium salt and acid casein, with the formulations being labelled CS and C, respectively. The hydrogels were characterised with respect to their physical properties (swelling capacity, water content, morphology, mechanical resistance, and stability), before and after sterilisation, and they showed adequate values for the intended application. The hydrogels of both formulations were able to sustain controlled drug-release for, at least, 48 h. They were demonstrated to be non-irritant, highly haemocompatible, and non-cytotoxic, and revealed good antimicrobial properties against Staphylococcus aureus and Pseudomonas aeruginosa. Steam-heat sterilisation did not compromise the material's properties. The in vivo performance of C hydrogel loaded with Octiset^® was evaluated in a case study with a dog. The efficient recovery of the wounds confirms its potential as an alternative for wound treatment. To our knowledge, this is the first time that wound dressings loaded with Octiset^®, one of the most efficient drugs for wound treatment, were prepared and tested.

Octenidine dihydrochloride treatment of a meticillin-resistant Staphylococcus aureus biofilm-infected mouse wound

OBJECTIVE

This study sought to estimate the effect of a liquid octenidine dihydrochloride (OCT)-impregnated gauze dressing in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) biofilm-infected wounds.

METHOD

In this animal study, a six-millimetre punch full-thickness wound on each mouse back was inoculated with MRSA suspension, and then covered with a Tegaderm (3M Health Care, US) dressing for an established biofilm model. Animals were divided into three groups for topical application: control group (treated with phosphate-buffered saline, PBS); mupirocin group (treated with 2% mupirocin); and OCT group (treated with OCT). All applications were administrated once 24 hours post-wounding. The bioburden was determined by counting colony-forming units (cfus) and the biofilm architecture was viewed using fluorescent staining and scanning electron microscopy (SEM) on day two. The tissue repair was evaluated histologically and the related genes were detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) on day 15.

RESULTS

The results suggested OCT accelerated healing and reduced by >3.6 log cfu/g bacterial counts on the wounds relative to the PBS-treated control (p<0.05). Histological analysis showed OCT-treated tissue exhibited lower burden of the inflammatory cells, more mature collagen fibres and well-defined epithelialisation. LIVE/DEAD fluorescent staining and SEM confirmed OCT induced a substantial destruction to biofilm structure. RT-qPCR further demonstrated that OCT therapy could inhibit the expression of MRSA and its biofilm genes by nearly 100% (p<0.05).

CONCLUSION

This investigation provides a rare in vivo experimental basis for OCT improvement on MRSA-infected wound healing and the superior efficacy implies OCT topical application may represent an ideal choice to address established bacterial biofilm in hard-to-heal wounds.

The Antibacterial Activity of Lavender Essential Oil Alone and In Combination with Octenidine Dihydrochloride against MRSA Strains

In the post-antibiotic era the issue of bacterial resistance refers not only to antibiotics themselves but also to common antiseptics like octenidine dihydrochloride (OCT). This appears as an emerging challenge in terms of preventing staphylococcal infections, which are both potentially severe and easy to transfer horizontally. Essential oils have shown synergisms both with antibiotics and antiseptics. Therefore the aim of this study was to investigate the impact of lavender essential oil (LEO) on OCT efficiency towards methicillin-resistant S. aureus strains (MRSA). The LEO analyzed in this study increased the OCT’s susceptibility against MRSA strains. Subsequent FTIR analysis revealed cellular wall modifications in MRSA strain cultured in media supplemented with OCT or LEO/OCT. In conclusion, LEO appears to be a promising candidate for an efficient enhancer of conventional antiseptics.

[Persistent reddening and induration after wound cleansing with octenidine]

With its long-lasting effectiveness, octenidine is an agent of first choice for antiseptic wound treatment. However, the manufacturer advises against instillation of the agent under pressure. A 50-year-old patient presented with erythema and extensive soft tissue induration after wound cleansing with octenidine under pressure. Due to the lack of resorption of the agent, this caused long-lasting interstitial soft tissue edema. This case demonstrates the importance of following the manufacturer's instructions for use. Advantages of the agent such as lack of systemic toxicity or broad spectrum efficacy can only be achieved if the agent is applied correctly.