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

*Corresponding author for this work

Research output: Contribution to journalArticle

27 Citations (Scopus)
33 Downloads (Pure)

Abstract

Objectives: The performance of cadexomer iodine was determined against microbial populations from chronic non-healing diabetic foot ulcers (DFUs) complicated by biofilm in vivo, using molecular, microscopy and zymography methods. Methods: Chronic non-healing DFUs due to suspected biofilm involvement were eligible for enrolment. DNA sequencing and real-time quantitative PCR was used to determine the microbial load and diversity of tissue punch biopsies obtained pre- and post-treatment. Scanning electron microscopy and/or fluorescence in situ hybridization confirmed the presence or absence of biofilm. Zymography was used to determine levels of wound proteases. Results: Seventeen participants were recruited over a 6 month period. Scanning electron microscopy and or fluorescence in situ hybridization confirmed the presence of biofilm in all samples. Eleven participants exhibited log10 reductions in microbial load after treatment (range 1-2 log10) in comparison with six patients who experienced <1 log10 reduction (P=0.04). Samples were tested for levels of wound proteases pre- and post treatment. Reductions in the microbial load correlated to reductions in wound proteases pre- and post treatment (P=0.03). Conclusions: To the best of our knowledge, this study represents the first in vivo evidence, employing a range of molecular and microscopy techniques, of the ability of cadexomer iodine to reduce the microbial load of chronic non-healing DFUs complicated by biofilm. Further analyses correlating log reductions to optimal duration of therapy and 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
Early online date2017
DOIs
Publication statusPublished - 1 Jul 2017

Bibliographical note

Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • diabetic foot ulcer
  • biofilms
  • endopeptidases
  • iodine
  • sequence analysis
  • dna
  • proteolytic enzymes

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