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



Authors: Malone M., Johani K., Jensen S.O., Gosbell I.B., Dickson H.G., McLennan S., Hu H., Vickery K.
Publication: Journal of Antimicrobial Chemotherapy
Year:  2017
Volume: 72
Issue: 7
Start Page: 2093


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.

  • Author/s : Malone M., Johani K., Jensen S.O., Gosbell I.B., Dickson H.G., McLennan S., Hu H., Vickery K.
  • Publication : Journal of Antimicrobial Chemotherapy
  • Year : 2017
  • Volume : 72
  • Issue : 7
  • Start Page : 2093
  • Article Keywords : aged, article, clinical article, DNA sequence, drug effect, female, fluorescence in situ hybridization, human, human tissue, in vivo study, male, pilot study, punch biopsy, quantitative analysis, real time polymerase chain reaction, scanning electron microscopy, treatment outcome, wound healing, zymography