Effect on total microbial load and community composition with two vs six‐week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers

Malone, Matthew; Schwarzer, Saskia; Radzieta, Michael; Jeffries, Thomas; Walsh, Annie; Dickson, Hugh G; Micali, Grace; Jensen, Slade O.

doi:10.1111/iwj.13219

Cited by 16 publications

(23 citation statements)

References 36 publications

(65 reference statements)

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“…2.4 | Specimen collection, processing, and analysis workflow for DNA sequencing, qPCR, SEM, and PNA-FISH Sample collection and storage, DNA extraction, nextgeneration DNA sequencing, sequence analysis and quality control, qPCR, and the characterisation and visualisation of biofilms in DFUs using SEM and PNA-FISH have been previously described 14,15,21 and are available in full in S1 to S8. All tissue samples were stored until the end of the study recruitment period and processed in bulk.…”

Section: Discussionmentioning

confidence: 99%

“…Microbial biofilms that form on human tissue have been implicated as causes of chronic infection. Previous studies in the areas of DFUs 3,6,[13][14][15] and diabetic foot osteomyelitis 21,23 have identified that biofilms are often (but not always) polymicrobial in nature. Several alterations to growth, behaviour, and function render them highly tolerant to many antimicrobial treatments and host defences.…”

Section: Discussionmentioning

confidence: 99%

“…12 A limited number of research groups have performed human in vivo proof-of-concept studies, utilising molecular DNA sequencing and microscopy approaches to explore the effects of topical antimicrobial wound agents on microbial (planktonic and biofilm) communities. [13][14][15] These studies have illustrated that topical antimicrobial therapy can lead to alterations in microbial community composition, diversity and load, and biofilm architecture. Recently, a non-antimicrobial, concentrated surfactant gel (SG) demonstrated an ability to eliminate bacterial biofilms in a porcine skin explant model with daily application and wiping over 3-day treatment period.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of a topical concentrated surfactant gel on microbial communities in non‐healing diabetic foot ulcers with chronic biofilm infections: A proof‐of‐concept study

Malone

Radzieta

Schwarzer

et al. 2021

International Wound Journal

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This proof-of-concept study sought to determine the effects of standard of care (SOC) and a topically applied concentrated surfactant gel (SG) on the total microbial load, community composition, and community diversity in nonhealing diabetic foot ulcers (DFUs) with chronic biofilm infections. SOC was provided in addition to a topical concentrated SG, applied every 2 days for 6 weeks. Wound swabs were obtained from the base of ulcers at baseline (week 0), week 1, mid-point (week 3), and end of treatment (week 6). DNA sequencing and real-time quantitative polymerase chain reaction (qPCR) were employed to determine the total microbial load, community composition, and diversity of patient samples. Tissue specimens were obtained at baseline and scanning electron microscopy and peptide nucleic acid fluorescent in situ hybridisation with confocal laser scanning microscopy were used to confirm the presence of biofilm in all 10 DFUs with suspected chronic biofilm infections. The application of SG resulted in 7 of 10 samples achieving a reduction in mean log10 total microbial load from baseline to end of treatment (0.8 Log10 16S copies, ±0.6), and 3 of 10 samples demonstrated an increase in mean Log10 total microbial load (0.6 log10 16S copies, ±0.8) from baseline to end of treatment. Composition changes in microbial communities were driven by changes to the most dominant bacteria. Corynebacterium sp. and Streptococcus sp. frequently reduced in relative abundance in patient samples from week 0 to week 6 but did not disappear. In contrast, Staphylococcus sp., Finegoldia sp., and Fusobacterium sp., relative abundances frequently increased in patient samples from week 0 to week 6. The application of a concentrated SG resulted in varying shifts to diversity (increase or decrease) between week 0 and week 6 samples at the individual patient level. Any shifts in community diversity were independent to changes in the total microbial loads. SOC and a topical concentrated SG directly affect the microbial loads and community composition of DFUs with chronic biofilm infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of a topical concentrated surfactant gel on microbial communities in non‐healing diabetic foot ulcers with chronic biofilm infections: A proof‐of‐concept study

Malone

Radzieta

Schwarzer

et al. 2021

International Wound Journal

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“…Treatments such as iodine paste, 33 silver dressings, 34 and maggot therapy 35 have been reported to reduce bioburden in wounds. However, we did not identify any changes in quantitative bacterial cultures during the course of therapy with topical oxygen therapy or in healers and nonhealers in this study.…”

Section: Discussionmentioning

confidence: 99%

The effect of continuous diffusion of oxygen treatment on cytokines, perfusion, bacterial load, and healing in patients with diabetic foot ulcers

Lavery

Killeen

Farrar

et al. 2020

International Wound Journal

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To evaluate continuous diffusion of oxygen therapy (CDO) on cytokines, perfusion, and bacterial load in diabetic foot ulcers we evaluated 23 patients for 3 weeks. Tissues biopsies were obtained at each visit to evaluate cytokines and quantitative bacterial cultures. Perfusion was measured with hyperspectral imaging and transcutaneous oxygen. We used paired T tests to compare continuous variables and independent T tests to compare healers and nonhealers. There was an increase from baseline to week 1 in TGF‐β (P = .008), TNF‐α (P = .014), VEGF (P = .008), PDGF (P = .087), and IGF‐1 (P = .058); baseline to week 2 in TGF‐β (P = .010), VEGF (P = .051), and IL‐6 (P = .031); and baseline to week 3 with TGF‐β (P = .055) and IL‐6 (P = .054). There was a significant increase in transcutaneous oxygen after 1 week of treatment on both medial and lateral foot (P = .086 and .025). Fifty‐three percent of the patients had at least a 50% wound area reduction (healers). At baseline, there were no differences in cytokines between healers and nonhealers. However, there was an increase in CXCL8 after 1 week of treatment (P = .080) and IL‐6 after 3 weeks of treatment in nonhealers (P = .099). There were no differences in quantitative cultures in healers and nonhealers.

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“…A modification of the wound microbiota was observed in samples following an angioplasty procedure (37), debridement (31,37), and in the use of cadexomer iodine (i.e. antiseptics) (38) and traditional Chinese medicine (24).…”

Section: Selection Of the Sources Of Evidencementioning

confidence: 99%

Factors related to the composition and diversity of wound microbiota investigated using culture-independent molecular methods: a scoping review

Kunimitsu

Kataoka

Nakagami

et al. 2021

DD&T

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All open wounds are often colonized by commensal microbes as a loss of skin can provide a ready portal of entry for microorganisms. Although the wound microbiota is known to be associated with wound infection and with delayed healing, the factors related to the formations of wound microbiota contributing to such poor clinical outcomes are not clear and have not led to effective infection prevention interventions. This review aimed to scope the factors related to the composition and diversity of wound microbiota that have been investigated using culture-independent molecular methods. Original articles on wound microbiota published from January 1986 to February 2020 were included in this review. Thirty-one articles met the inclusion criteria and were grouped according to wound types: chronic, acute, and animal model wounds. The factors identified were categorized according to patient characteristics, wound characteristics, treatment, and sampling. Although some studies reported the effect size of the factors, the values were small. No studies elucidated the mechanism of wound microbiota formation. The results of this scoping review highlight that the factors associated with the diversity of wound microbiota are poorly understood and that further studies are needed.

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Effect on total microbial load and community composition with two vs six‐week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers

Cited by 16 publications

References 36 publications

Efficacy of a topical concentrated surfactant gel on microbial communities in non‐healing diabetic foot ulcers with chronic biofilm infections: A proof‐of‐concept study

Efficacy of a topical concentrated surfactant gel on microbial communities in non‐healing diabetic foot ulcers with chronic biofilm infections: A proof‐of‐concept study

The effect of continuous diffusion of oxygen treatment on cytokines, perfusion, bacterial load, and healing in patients with diabetic foot ulcers

Factors related to the composition and diversity of wound microbiota investigated using culture-independent molecular methods: a scoping review

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