Combined antibacterial effects of tissue‐tolerable plasma and a modern conventional liquid antiseptic on chronic wound treatment

Klebes, Martin; Ulrich, Ch.; Kluschke, Franziska; Patzelt, Alexa; Vandersee, Staffan; Richter, Heike; Боб, А. О.; Hutten, Johanna von; Krediet, Jorien Tannette; Krämer, Axel; Lademann, Jürgen; Lange-Asschenfeld, Bernhard

doi:10.1002/jbio.201400007

Cited by 69 publications

(36 citation statements)

References 23 publications

(37 reference statements)

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“…This three‐arm RCT reported that the application of AP or OCT result in similar “microbial reduction classes,” with no further reduction if both treatments were applied sequentially on wounds. At first glance, the finding of Klebes et al appears to be in direct contrast to the results reported by Ulrich et al However, both RCTs used absolutely not comparable microbiological measurements. Because of this and other limitations, we therefore could not include this latter RCT into our meta‐analysis as, in most of the 34 included patients, the three treatment procedures were performed on each wound, and only the immediate antibacterial effect of the applied interventions were investigated and reported semi‐quantitatively as “4—abundant,” “3—moderate growth,” “2—little growth,” “1—marginal growth,” and “0—no growth.” Finally, changes of wound size and occurrence of SAEs were not included as outcome measures in this study …”

Section: Discussioncontrasting

confidence: 56%

“…To our knowledge, there is only one more RCT that compared AP against OCT or the sequential application of AP followed by OCT treatment on chronic, open wounds . This three‐arm RCT reported that the application of AP or OCT result in similar “microbial reduction classes,” with no further reduction if both treatments were applied sequentially on wounds.…”

Section: Discussionmentioning

confidence: 99%

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Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

Assadian

Ousey

Daeschlein

et al. 2018

International Wound Journal

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The use of atmospheric low‐temperature plasma (AP) on chronic wounds and its effect on microbial bioburden in open wounds has not been explored with a systematic review and meta‐analysis. PRISMA guidelines were followed and PubMed, Embase, CENTRAL, and CINAHL databases searched for randomised controlled trials (RCTs), which compared AP with no AP for the management of open, chronic wounds. The primary outcomes of reduction of bioburden or wound size were included. Meta‐analyses were performed; odds ratio (OR) and 95% confidence intervals (CIs) were extracted and pooled in a random effects model. Four RCTs investigated the effect of AP on chronic wound healing. Chronic wounds treated with AP did not show a significant improvement in healing (AP vs control: OR = 1.46; 95% CI = 0.89‐2.38; P = 0.13). Five further RCTs investigated the reduction of bioburden in wounds, but AP demonstrated no significant reduction of bioburden (AP vs control: OR = 0.85; 95% CI = 0.45‐1.62; P = 0.63). All nine RCTs recorded the presence of any severe adverse events (SAEs) in the 268 patients studied, with only one unrelated SAE identified in each group (AP vs control: OR = 1.00; 95% CI = 0.05‐19.96; P = 1.00). Use of AP in wound care is safe, but the retrieved evidence and meta‐analysis show that there is no clinical benefit of AP in chronic open wounds using currently available AP device settings.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

Assadian

Ousey

Daeschlein

et al. 2018

International Wound Journal

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“…In this field called plasma medicine, encouraging results have been achieved for disinfection purposes [2], in vitro [3,4,5] and in patients [6,7,8]. Notably, a key feature determining healing is the state of wound oxygenation [9], and evidence suggests that the scavenging of active oxygen species impairs wound healing [10].…”

Section: Introductionmentioning

confidence: 99%

One Year Follow-Up Risk Assessment in SKH-1 Mice and Wounds Treated with an Argon Plasma Jet

Schmidt

Woedtke

Stenzel³

et al. 2017

IJMS

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Multiple evidence in animal models and in humans suggest a beneficial role of cold physical plasma in wound treatment. Yet, risk assessment studies are important to further foster therapeutic advancement and acceptance of cold plasma in clinics. Accordingly, we investigated the long-term side effects of repetitive plasma treatment over 14 consecutive days in a rodent full-thickness ear wound model. Subsequently, animals were housed for 350 days and sacrificed thereafter. In blood, systemic changes of the pro-inflammatory cytokines interleukin 1β and tumor necrosis factor α were absent. Similarly, tumor marker levels of α-fetoprotein and calcitonin remained unchanged. Using quantitative PCR, the expression levels of several cytokines and tumor markers in liver, lung, and skin were found to be similar in the control and treatment group as well. Likewise, histological and immunohistochemical analysis failed to detect abnormal morphological changes and the presence of tumor markers such as carcinoembryonic antigen, α-fetoprotein, or the neighbor of Punc 11. Absence of neoplastic lesions was confirmed by non-invasive imaging methods such as anatomical magnetic resonance imaging and positron emission tomography-computed tomography. Our results suggest that the beneficial effects of cold plasma in wound healing come without apparent side effects including tumor formation or chronic inflammation.

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“…It was reported that CAP treatment influences gene expression of key regulators that are important for inflammation and wound healing, as well as activation of antimicrobial peptides [16]. CAP has been clearly shown to enhance the wound healing effect when used in combination with certain antiseptic liquids [17]. Therefore, CAP is currently in use as a decontaminant in hospital environments [18] and for functionalization of wound dressings [19].…”

mentioning

confidence: 99%

Combination of Cold Atmospheric Plasma and Vitamin C Effectively Disrupts Bacterial Biofilms

Pandit¹,

Mokkapati²,

Helgadottir³

et al. 2017

Clin Microbiol

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Cold atmospheric plasma (CAP) is increasingly used in medical applications for eradication of bacterial and tumor cells. CAP treatment devices, known as plasma jet pens, produce reactive oxygen and nitrogen species at atmospheric pressure and room temperature. The produced reactive species are concentrated in a small and precisely defined area, allowing for high precision medical treatments. CAP has been demonstrated as very effective against planktonic bacterial cells. Unfortunately, bacterial cells in biofilms are typically aggregated and protected by dense exopolymeric matrix, synthesized and secreted by the bacterial community. The main limitation in using CAP against bacterial biofilms is the thick protective matrix of extracellular polymers that shields bacterial cells within this complex architecture. CAP has also been shown to effectively eradicate tumor cells, but the main current limitation is the susceptibility of the surrounding healthy tissues to higher doses. We have recently demonstrated that vitamin C, a natural food supplement, can be used to destabilize bacterial biofilms and render them more susceptible to the CAP killing treatment. Here we discuss the possible impact that a pre-treatment with vitamin C could have on CAP applications in medicine. Specifically, we argue that vitamin C could enhance the effectiveness of CAP treatments against both the bacterial biofilms and some selected tumors.

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Combined antibacterial effects of tissue‐tolerable plasma and a modern conventional liquid antiseptic on chronic wound treatment

Cited by 69 publications

References 23 publications

Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

One Year Follow-Up Risk Assessment in SKH-1 Mice and Wounds Treated with an Argon Plasma Jet

Combination of Cold Atmospheric Plasma and Vitamin C Effectively Disrupts Bacterial Biofilms

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