Abstract
Biofilms hinder wound healing. Medical-grade honey (MGH) is a promising therapy because of its broad-spectrum antimicrobial activity and the lack of risk for resistance. This study investigated the inhibitory and eradicative activity against multidrug-resistant Pseudomonas aeruginosa biofilms by different established MGH-based wound care formulations. Six different natural wound care products (Medihoney, Revamil, Mebo, Melladerm, L-Mesitran Ointment, and L-Mesitran Soft) were tested in vitro. Most of them contain MGH only, whereas some were supplemented. L-Mesitran Soft demonstrated the most potent antimicrobial activity (6.08-log inhibition and 3.18-log eradication). Other formulations ranged between 0.89-log and 4.80-log inhibition and 0.65-log and 1.66-log eradication. Therefore, the contribution of different ingredients of L-Mesitran Soft was investigated in more detail. The activity of the same batch of raw MGH (1.38-log inhibition and 2.35-log eradication), vitamins C and E (0.95-log inhibition and 0.94-log eradication), and all ingredients except MGH (1.69-log inhibition and 0.75-log eradication) clearly support a synergistic activity of components within the L-Mesitran Soft formulation. Several presented clinical cases illustrate its clinical antimicrobial efficacy against Pseudomonas aeruginosa biofilms. In conclusion, MGH is a potent treatment for Pseudomonas biofilms. L-Mesitran Soft has the strongest antimicrobial activity, which is likely due to the synergistic activity mediated by its supplements.
Highlights
Wounds that fail to show progress in wound healing during four weeks or are not completely healed within eight weeks are generally considered to be chronic [1,2]
We demonstrated that a combination of vitamins C and E exert a strong antimicrobial activity and reduced Pseudomonas aeruginosa biofilms, both on inhibition (88.78%) and eradication (88.59%)
The antibacterial effects of vitamin C may be both bacterial strain- and concentration-dependent [50], these findings suggest a broad range of antimicrobial activity
Summary
Wounds that fail to show progress in wound healing during four weeks or are not completely healed within eight weeks are generally considered to be chronic [1,2]. Treatment costs for chronic wounds are estimated to account for approximately 1–4% of the total. Chronic wounds impact the quality of life and affect the physical and psychological well-being of the patients [4]. The number of patients and costs are expected to further grow with the aging population and increased incidence of comorbidities such as diabetes and obesity [2]. Major types of chronic wounds include diabetic ulcers, pressure injuries, and venous leg ulcers [1,5]. Such prolonged, nonhealing wounds are caused by a variety of factors, with bacterial infections and especially biofilm formation being significant contributors [2,3]. Neglected wound infections can lead to systemic infections, sepsis, and multiple organ dysfunction syndrome and become life-threatening [6]
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