Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment
Current standards insufficiently acknowledge the influence of the wound micro-environment on the efficacy of antimicrobial agents. To address this, octenidine/phenoxyethanol, polyhexanide, povidone-iodine, and sodium-hypochloride/hypochlorous acid solutions were submitted to standard-based (DIN-EN-1...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/10/11/2751 |
| _version_ | 1797468977031544832 |
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| author | Anna-Lena Severing Mia Borkovic Ewa K. Stuermer Julian-Dario Rembe |
| author_facet | Anna-Lena Severing Mia Borkovic Ewa K. Stuermer Julian-Dario Rembe |
| author_sort | Anna-Lena Severing |
| collection | DOAJ |
| description | Current standards insufficiently acknowledge the influence of the wound micro-environment on the efficacy of antimicrobial agents. To address this, octenidine/phenoxyethanol, polyhexanide, povidone-iodine, and sodium-hypochloride/hypochlorous acid solutions were submitted to standard-based (DIN-EN-13727) or modified peptide-based challenges and compared to a simulated clinical reference using human acute or chronic wound exudate (AWF/CWF). Antimicrobial efficacy against <i>S. aureus</i> and <i>P. aeruginosa</i> was compared using a quantitative suspension method. Agreement between methods were investigated using Bland-Altman (B&A) analysis. Different substances and challenges demonstrated diverging results, depending on class and concentration of agent and challenge. Highly concentrated antiseptics maintained a high efficacy under complex challenges, while especially chlorine-based irrigation solutions showed a remarkably reduced antimicrobial effect. Composition of challenge substance proved more relevant than pure concentration. Therefore, the current standard challenge conditions did not adequately reflect the wound micro-environment with over- or under-estimating antimicrobial efficacy, whilst the modified peptide-challenge showed a higher level of agreement with simulated realistic conditions (AWF/CWF). The results emphasize that a “one-fits-all” approach is not feasible to generalize antimicrobial efficacy, as certain aspects of the complex micro-environment pose a differing influence on varying agents. Based on these results, revision and target focused adaptation of the current standards should be considered. |
| first_indexed | 2024-03-09T19:14:57Z |
| format | Article |
| id | doaj.art-32a839399d424b538285a008ebd50658 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-09T19:14:57Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-32a839399d424b538285a008ebd506582023-11-24T03:50:08ZengMDPI AGBiomedicines2227-90592022-10-011011275110.3390/biomedicines10112751Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-EnvironmentAnna-Lena Severing0Mia Borkovic1Ewa K. Stuermer2Julian-Dario Rembe3Department of Dermatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf (HHU), Moorenstrasse 5, 40225 Düsseldorf, GermanyDepartment of Vascular Medicine, University Heart & Vascular Center (UHZ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251 Hamburg, GermanyDepartment of Vascular Medicine, University Heart & Vascular Center (UHZ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251 Hamburg, GermanyDepartment of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf (HHU), Moorenstrasse 5, 40225 Düsseldorf, GermanyCurrent standards insufficiently acknowledge the influence of the wound micro-environment on the efficacy of antimicrobial agents. To address this, octenidine/phenoxyethanol, polyhexanide, povidone-iodine, and sodium-hypochloride/hypochlorous acid solutions were submitted to standard-based (DIN-EN-13727) or modified peptide-based challenges and compared to a simulated clinical reference using human acute or chronic wound exudate (AWF/CWF). Antimicrobial efficacy against <i>S. aureus</i> and <i>P. aeruginosa</i> was compared using a quantitative suspension method. Agreement between methods were investigated using Bland-Altman (B&A) analysis. Different substances and challenges demonstrated diverging results, depending on class and concentration of agent and challenge. Highly concentrated antiseptics maintained a high efficacy under complex challenges, while especially chlorine-based irrigation solutions showed a remarkably reduced antimicrobial effect. Composition of challenge substance proved more relevant than pure concentration. Therefore, the current standard challenge conditions did not adequately reflect the wound micro-environment with over- or under-estimating antimicrobial efficacy, whilst the modified peptide-challenge showed a higher level of agreement with simulated realistic conditions (AWF/CWF). The results emphasize that a “one-fits-all” approach is not feasible to generalize antimicrobial efficacy, as certain aspects of the complex micro-environment pose a differing influence on varying agents. Based on these results, revision and target focused adaptation of the current standards should be considered.https://www.mdpi.com/2227-9059/10/11/2751antimicrobialsantisepticswound infectionorganic challengewound exudateDIN-EN-13727 |
| spellingShingle | Anna-Lena Severing Mia Borkovic Ewa K. Stuermer Julian-Dario Rembe Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment Biomedicines antimicrobials antiseptics wound infection organic challenge wound exudate DIN-EN-13727 |
| title | Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment |
| title_full | Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment |
| title_fullStr | Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment |
| title_full_unstemmed | Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment |
| title_short | Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment |
| title_sort | composition of challenge substance in standardized antimicrobial efficacy testing of wound antimicrobials is essential to correctly simulate efficacy in the human wound micro environment |
| topic | antimicrobials antiseptics wound infection organic challenge wound exudate DIN-EN-13727 |
| url | https://www.mdpi.com/2227-9059/10/11/2751 |
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