Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo

M. Malone, K. Johani, S. O. Jensen, I. B. Gosbell, H. G. Dickson, S. McLennan, H. Hu, K. Vickery

Research output: Contribution to journalArticlepeer-review

61 Citations (Scopus)

Abstract

Objectives: The performance of cadexomer iodine was determined against microbial populations from chronicnon-healing diabetic foot ulcers (DFUs) complicated by biofilm in vivo, using molecular, microscopy and zymographymethods.Methods: Chronic non-healing DFUs due to suspected biofilm involvement were eligible for enrolment. DNAsequencing and real-time quantitative PCR was used to determine the microbial load and diversity of tissuepunch biopsies obtained pre- and post-treatment. Scanning electron microscopy and/or fluorescence in situ hybridizationconfirmed the presence or absence of biofilm. Zymography was used to determine levels of woundproteases.Results: Seventeen participants were recruited over a 6month period. Scanning electron microscopy and orfluorescence in situ hybridization confirmed the presence of biofilm in all samples. Eleven participants exhibitedlog10 reductions in microbial load after treatment (range 1-2 log 10) in comparison with six patients whoexperienced <1 log 10 reduction (P"0.04). Samples were tested for levels of wound proteases pre- and posttreatment.Reductions in the microbial load correlated to reductions in wound proteases pre- and posttreatment(P"0.03).Conclusions: To the best of our knowledge, this study represents the first in vivo evidence, employing a range ofmolecular and microscopy techniques, of the ability of cadexomer iodine to reduce the microbial load of chronicnon-healing DFUs complicated by biofilm. Further analyses correlating log reductions to optimal duration of therapyand improvements in clinical parameters of wound healing in a larger cohort are required.

Original languageEnglish
Pages (from-to)2093-2101
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume72
Issue number7
Publication statusPublished - 1 Jul 2017

Bibliographical note

Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Open Access - Access Right Statement

© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected]

Keywords

  • DNA
  • biofilms
  • endopeptidases

Fingerprint

Dive into the research topics of 'Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo'. Together they form a unique fingerprint.

Cite this