title: Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT.
abstract: OBJECTIVE
  To determine the qualitative bacteriological changes that occurred during a four-week treatment period with either manuka honey or a hydrogel dressing. This was the secondary outcome of a randomised controlled trial (RCT) that compared the efficacy of the two treatments in desloughing venous leg ulcers.
  
  
  METHODS
  This was a prospective open label multicentre RCT with blinded microbiological outcome analysis. Randomisation was conducted via remote telephone. To be included, the wound bed needed to comprise at least 50% slough. Wound swabs were taken at the start of treatment and after four weeks.
  
  
  RESULTS
  In all, 108 patients (35 males, 73 females) aged 24-89 years (mean 68) enrolled into the study. Both groups were comparable at baseline. Eighteen patients (17%) were withdrawn due to a wound infection: six in the honey group and 12 in the hydrogel group. Staphylococcus aureus was the most common isolate, being identified in 41 wounds (38%). At baseline, meticillin-resistant Staphylococcus aureus was identified in 16 wounds (10 honey versus six hydrogel). After four weeks 70% (n=7) of the manuka-honey treated wounds versus 16% (n=1) of the hydrogel treated wounds had MRSA eradicated. Pseudomonas aeruginosa was reported in 14% (n=16) of all wounds at baseline. After four weeks 33% (n=2) treated with honey and 50% (n=5) treated with hydrogel had this eliminated. The number of wounds (n=11 at baseline; n=15 at week 4) with > or =3 bacteria species remained constant over the four weeks.
  
  
  CONCLUSIONS
  Manuka honey was effective in eradicating MRSA from 70% of chronic venous ulcers. The potential to prevent infection is increased when wounds are desloughed and MRSA is eliminated. This can be beneficial to prevent cross-infection.
authors.affiliation: Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland. ggethin@rcsi.ie
authors.forename: G
authors.initials: G
authors.lastname: Gethin
authors.forename: S
authors.initials: S
authors.lastname: Cowman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047070:Bandages, Hydrocolloid; D003646:Debridement / Q000379:methods; D005260:Female; D006722:Honey; D006801:Humans; D031649:Leptospermum; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000382:microbiology / Q000517:prevention & control; D011550:Pseudomonas aeruginosa; D016037:Single-Blind Method; D017592:Skin Care; D013207:Staphylococcal Skin Infections / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000150:complications* / Q000473:pathology; D014945:Wound Healing; D014946:Wound Infection / Q000382:microbiology / Q000517:prevention & control*