title: Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo.
abstract: The performance of cadexomer iodine was determined against microbial populations from chronic non-healing diabetic foot ulcers (DFUs) complicated by biofilm in vivo , using molecular, microscopy and zymography methods.
  
  
  
  Chronic non-healing DFUs due to suspected biofilm involvement were eligible for enrolment. DNA sequencing and real-time quantitative PCR was used to determine the microbial load and diversity of tissue punch biopsies obtained pre- and post-treatment. Scanning electron microscopy and/or fluorescence in situ hybridization confirmed the presence or absence of biofilm. Zymography was used to determine levels of wound proteases.
  
  
  
  Seventeen participants were recruited over a 6 month period. Scanning electron microscopy and or fluorescence in situ hybridization confirmed the presence of biofilm in all samples. Eleven participants exhibited log 10 reductions in microbial load after treatment (range 1-2 log 10 ) in comparison with six patients who experienced <1 log 10 reduction ( P  =   0.04). Samples were tested for levels of wound proteases pre- and post-treatment. Reductions in the microbial load correlated to reductions in wound proteases pre- and post-treatment ( P  =   0.03).
  
  
  
  To the best of our knowledge, this study represents the first in vivo evidence, employing a range of molecular and microscopy techniques, of the ability of cadexomer iodine to reduce the microbial load of chronic non-healing DFUs complicated by biofilm. Further analyses correlating log reductions to optimal duration of therapy and improvements in clinical parameters of wound healing in a larger cohort are required.
authors.forename: M
authors.initials: M
authors.lastname: Malone
authors.affiliation: Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Johani
authors.affiliation: Molecular Medicine Research Group, Microbiology & Infectious Diseases, School of Medicine, Western Sydney University, Sydney, Australia.|Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia.
authors.forename: S O
authors.initials: SO
authors.lastname: Jensen
authors.affiliation: Molecular Medicine Research Group, Microbiology & Infectious Diseases, School of Medicine, Western Sydney University, Sydney, Australia.|Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia.
authors.forename: I B
authors.initials: IB
authors.lastname: Gosbell
authors.affiliation: Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Medical Research, Sydney, Australia.|Ambulatory Care Department (PIXI), Liverpool Hospital, South West Sydney LHD, Sydney, Australia.
authors.forename: H G
authors.initials: HG
authors.lastname: Dickson
authors.affiliation: The University of Sydney, Charles Perkins Centre, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: McLennan
authors.affiliation: Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Hu
authors.affiliation: Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Vickery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000235:genetics; D058491:Bacterial Load / Q000187:drug effects* / Q000235:genetics; D018441:Biofilms / Q000187:drug effects*; D015331:Cohort Studies; D017719:Diabetic Foot / Q000150:complications* / Q000382:microbiology; D005260:Female; D014644:Genetic Variation / Q000187:drug effects; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007466:Iodophors / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D007466:Iodophors; C038634:cadexomer iodine