In vivo observations of biofilm adhering to a dialkylcarbamoyl chloride‐coated mesh dressing when applied to diabetes‐related foot ulcers: A proof of concept study

Abstract

In this proof-of-concept study of twenty participants, we sought to determine if a DACC (Dialkylcarbamoyl chloride)-coated mesh dressing demonstrates an ability to adhere biofilm when placed on Diabetes Related Foot Ulcers (DRFUs) with chronic infection. The study also sought to determine if removal of the DACC-coated mesh dressings contributes to reducing the total number of bacteria in DRFUs, by exploring the total microbial loads, microbial community composition, and diversity. Standard of care was provided in addition

In vitro and in vivo evaluation of the antimicrobial effectiveness of non‐medicated hydrophobic wound dressings

“…Previous research in this area has shown that microbiota community instability was associated with faster healing and improved outcomes 34 and these observations have been seen in other in vivo studies testing the effectiveness of topical antimicrobial and non-antimicrobial agents. 33,[35][36][37][38] In the study by Malone et al, 33 the authors also commented on fouling observations seen under SEM from soiled dressings obtained after 72 h. It was these observations which formed the premise behind performing a time assay in this study, to understand more about how host fouling affects dressing materials over time. To provide in vivo evidence of fouling, we obtained soiled wound dressings from three patients at set times over a 72-h period.…”

“…In the study by Malone et al, 33 the authors also commented on fouling observations seen under SEM from soiled dressings obtained after 72 h. It was these observations which formed the premise behind performing a time assay in this study, to understand more about how host fouling affects dressing materials over time. To provide in vivo evidence of fouling, we obtained soiled wound dressings from three patients at set times over a 72‐h period.…”

“…To support our in vitro observation that bacterial attachment has minor effects on the bacterial load in challenge suspensions, we refer to two clinical studies that have demonstrated that DACC‐coated mesh dressings do not reduce the bacterial load in human wounds using a molecular microbiology approach 32,33 . Additionally, Malone et al 33 performed an ecological analysis of diabetes‐related foot ulcers to demonstrate that the use of DACC‐coated mesh dressings did not alter the microbiota or community composition of ulcers post‐treatment.…”

“…Additionally, Malone et al 33 performed an ecological analysis of diabetes‐related foot ulcers to demonstrate that the use of DACC‐coated mesh dressings did not alter the microbiota or community composition of ulcers post‐treatment. Previous research in this area has shown that microbiota community instability was associated with faster healing and improved outcomes 34 and these observations have been seen in other in vivo studies testing the effectiveness of topical antimicrobial and non‐antimicrobial agents 33,35‐38 …”

“…31 To support our in vitro observation that bacterial attachment has minor effects on the bacterial load in challenge suspensions, we refer to two clinical studies that have demonstrated that DACC-coated mesh dressings do not reduce the bacterial load in human wounds using a molecular microbiology approach. 32,33 Additionally, Malone et al 33 performed an ecological analysis of diabetes-related foot ulcers to demonstrate that the use of DACC-coated mesh dressings did not alter the microbiota or community composition of ulcers posttreatment. Previous research in this area has shown that microbiota community instability was associated with faster healing and improved outcomes 34 and these observations have been seen in other in vivo studies testing the effectiveness of topical antimicrobial and non-antimicrobial agents.…”