title: Enzymatic debriding agents are safe in wounds with high bacterial bioburdens and stimulate healing.
abstract: BACKGROUND
  Debridement is essential for successful wound management. Enzymatic debridement is commonly utilized in wound care but has been reported to be unsafe in wounds with significant bacterial bioburden, unless used in conjunction with topical antimicrobials. We examine this hypothesis with 2 commercially available, commonly used preparations of enzymatic debriding agents.
  
  
  METHODS
  Using a standard rodent model of a chronically infected granulating wound with bacterial levels greater than 1 x 10(5) Colony Forming Units per gram of tissue, commercially available preparations of collagenase and papain-urea were utilized to investigate the response of infected wounds to these preparations, and to evaluate their ability to overcome the inhibition of infection on wound healing. Quantitative bacteriology of tissue biopsies and wound healing trajectories were used to compare the preparations to saline-treated negative controls.
  
  
  RESULTS
  Collagenase- and papain-urea-treated wounds demonstrated a reduction in bacterial burden of wounds to < 10(5) colony forming units/gram of tissue (P < .05). This decrease in bacterial bioburden occurred rapidly, allowing wounds to achieve bacterial balance in a short period of time. Wounds treated with enzymatic debriding agents healed significantly faster and to greater extent than saline-treated controls (P < .01); a direct reflection of the decreasing bacterial load of the wound.
  
  
  CONCLUSIONS
  Collagenase and papain-urea appear beneficial and safe even in wounds with high bacterial loads, and appear to significantly aid extent and rate of healing, probably by lowering bacterial burden through their positive enzymatic actions on bacteria and necrotic tissue.
authors.affiliation: Institute for Tissue Regeneration, Repair, and Rehabilitation, Bay Pines VA Medical Center, Bay Pines, FL, USA. wyattgpayne@yahoo.com
authors.forename: Wyatt G
authors.initials: WG
authors.lastname: Payne
authors.forename: R Emerick
authors.initials: RE
authors.lastname: Salas
authors.forename: Francis
authors.initials: F
authors.lastname: Ko
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Naidu
authors.forename: Guillermo
authors.initials: G
authors.lastname: Donate
authors.forename: Terry E
authors.initials: TE
authors.lastname: Wright
authors.forename: Martin C
authors.initials: MC
authors.lastname: Robson