Initial Experience Using a Broad Spectrum Antimicrobial Wound Gel to Disrupt Biofilm Integrity and Bacterial Recolonization in Diabetic Foot Ulcers

Abstract

Adhesion-force-induced surface adaption by colonizing bacteria to substratum surfaces is integral to biofilm development in chronic wounds.1-4 The extracellular polymeric substances (EPS) produced eludes host defenses and protects enclosed bacteria against antimicrobial agents.2-4 A broad spectrum antimicrobial wound gel* with a polyethylene glycol-based hydrogel, a high osmolarity solution and a surfactant has been developed to bring EPS into solution and lyse enclosed bacteria.5-9 Here, two patients received a broad spectrum antimicrobial wound gel to manage diabetic foot ulcers (DFU) containing biofilm. Common comorbidities included: diabetes, coronary artery disease, hypertension, obesity, and neuropathy. Prior treatments included: debridement, oxidized regenerated cellulose/collagen, bacteria-binding/-inactivating wound dressings and/or a cadexomer iodine wound gel. Case 1 was a 68-year-old female with Charcot foot deformity and a 380-day-old DFU (3.7 x 4.3 x .02 cm3) located on the right midfoot. The patient could not use a total contact cast. Case 2 was a 62-year-old female with a 3-year-old Wagner I plantar DFU (6.1 x 5.7 cm2 with hypergranulation) located on the right calcaneal area. The patient underwent partial calcanectomy with antibiotic-impregnated poly(methyl methacrylate) bone cement beads placed within the defect. Biopsied tissue was negative for malignancy. Patients received doxycycline (14 days) per microbial sensitivity assay, underwent excisional debridement and received the broad spectrum antimicrobial wound gel covered with 4 x 4 in2 gauze pad and secured with rolled gauze. The antimicrobial wound gel was reapplied with daily dressings changes. After debridement, antimicrobial wound gel application and coverage with wound dressings, clinical response of the wounds was assessed. After 4 weeks, reduction in wound dimensions and improvement in the clinical appearance of the DFU relative to previous treatments were noted. In these two patients, a broad spectrum antimicrobial wound gel was effective in reducing wound volume, decreasing the need for debridement and preparing the wound for closure.

*BlastX™ Antimicrobial Wound Gel (NextScience; New South Wales, Australia; Distributed by 3M; St. Paul, MN)

References
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