Abstract
BackgroundIn armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. Material and methods50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. ResultsTopically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 – 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0–67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p<0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. ConclusionAt the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non-inferior to intramuscular gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.
Highlights
In armed conflicts infected wounds are common and contribute to a significant portion of the surgical workload [1,2]
Prior to initiation of treatment, all wounds exhibited S. aureus counts consistent with infection (>5 log10 colony-forming units per gram of tissue (CFU/g) tissue), with geometric means 5.85 ∗÷ 0.55 (GSD) log10 colony-forming units (CFU)/g (n = 6) and 5.59 ∗÷ 0.37 (GSD) log10 CFU/g (n = 3) for wounds subsequently treated with topical honey or systemic gentamicin, respectively (Figs. 2 and 3)
There was no difference in the bacterial count at the terminal endpoint when comparing topical honey treatment, IM Gentamicin treatment with saline treatment
Summary
In armed conflicts infected wounds are common and contribute to a significant portion of the surgical workload [1,2]. Applied Manuka honey could be noninferior to intramuscular gentamicin in reducing S. aureus colonization on the wound’s surface, but not Abbreviations: ANOVA, analysis of variance; ATCC, American type culture collection; CFU/g, colony forming units per gram of tissue; °C, degree Celsius; CCD, chargedcoupled device; CD68, protein highly expressed in macrophages and other cells in the monocyte lineage; EDTA, ethylenediaminetetraacetic acid; EMEA, European agency for evaluation of medical products; FDA, US federal drug administration; H&E, haematoxylin and eosin staining; GSD, geometric standard deviation; IM, intramuscular; LMIC, low- and middle-income countries; MDR, multidrug-resistance; MIC, minimum inhibitory concentration; MGO, methylglyoxal, MRSA, methicillin-resistant S. aureus; PBS, phosphate-buffered saline; RPM, revolutions per minute; SAA, serum amyloid A; SD, standard deviation; UMF, Unique Manuka factor, a measurement of methylglyoxal concentration; WHO, World Health Organization; W/v, weight by volume
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