Approximately three million people in the US have hard-to-heal
pressure ulcers (
PUs), including 10% of hospitalised patients. Healing depends on
ulcer stage and patient comorbidities. Despite advances in nutrition and
wound care,
PUs can take months or years to reach complete closure. To date, clinical studies have focused on single modality
therapy. However, there is no one
therapy that can address all of the deficits in these complex, hard-to-heal
wounds. A commonly used treatment for
PUs,
negative pressure wound therapy (NPWT), has demonstrated improved healing in Stage 3 and 4
PUs. NPWT entails applying suction to a porous sponge fitted into the
wound cavity and sealed with an
occlusive dressing. Negative pressure facilitates wound healing by removing
wound fluid containing harmful
proteases, stimulating the formation of granulation tissue and promoting
wound contracture. However, it does not affect biofilm formation. We hypothesised that adding an antibiofilm agent might increase the effectiveness of NPWT in recalcitrant
PUs.
METHOD: A prospective case series was conducted in outpatient
wound care centres and a skilled nursing facility to examine the combination of a biofilm-disrupting
antimicrobial agent (Blast-X, Next Science, US) in combination with NPWT (VAC, 3M, US) in healing and reducing bacterial burden in treatment-resistant
pressure ulcers. Patients consented to application of the antibiofilm agent and NPWT three times per week for four weeks. The
wounds were measured, imaged for bacteria and tested for host and bacterial
protease activity weekly.
RESULTS: Of the 10 patients, four dropped out of the study before the end of the four weeks. Of the remaining six, four patients experienced a reduction in
wound surface area and volume, reduced
protease activity and lower bacterial levels.
CONCLUSION: The results of this study showed that multimodal
therapy, including NPWT and biofilm disruption, may restart the healing of stagnant treatment-resistant
PUs.