A prospective, non comparative, multicenter study to investigate the effect of cadexomer iodine on bioburden load and other wound characteristics in diabetic foot ulcers

Abstract

Few studies regarding wound treatment with topical antimicrobials evaluate change in the bacterial bioburden of the wound with treatment. This study sought out to determine the in vivo effect of cadexomer iodine antibacterial dressing on diabetic foot ulcers (DFUs) that were infected or achieved a critical level of colonisation, looking specifically at wound progression in relation to bioburden. Fifteen patients corresponding to 16 total DFUs met criteria of displaying clinical signs of infection or critical colonisation and were suitable for a topical antibacterial dressing. They underwent weekly treatment for 6 weeks. Cultures were taken at week 0, 3 and 6 as appropriate. At week 6 median log10 bacterial count reduction of 1.0 was observed from baseline (p = 0·025). At week 3- a median log10 bacterial count reduction of 0.3 was observed from baseline (p = 0·049). Over the study period there was a 53.6% median reduction of the wound surface area. There were no patients that completely healed their ulcer over the 6 week study period. There was a statistically significant median reduction in the bacterial load over the 6 week period (p = 0·025) as well as 3 weeks (p = 0·049). This was accompanied by a median reduction of 53.6% in ulcer surface area and 50% in ulcer depth from baseline to final.

Effect on total microbial load and community composition with two vs six‐week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers

“…However, with an adequately powered study, a statistically significant difference may be identified. These findings are in alignment with a previous study by Schwartz et al who used conventional culture to illustrate treatment with Cadexomer Iodine resulted in a one‐two Log10 reduction (median 0.3 Log10 reduction) in DFU bioburden …”

“…The reason for excluding patients with acute clinical infection was the assumption that the behaviour of these wounds would be driven predominantly by planktonic microorganisms . Participants with contraindications to the use of Cadexomer Iodine as per the manufacturers guidelines were also excluded . Participants were randomised by coin toss on a 1:1 allocation basis to receive either two‐weeks or six‐weeks of topical antimicrobial therapy once recruited.…”

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

“…Several small studies have, however, demonstrated anti‐infective benefits for some antiseptic agents (eg, cadexomer iodine and hypochlorous solutions) in infected DFUs. There is evidence that dressings with silver, cadexomer iodine, and hypochlorous solutions reduce microbial load in the ulcers . The available evidence is insufficient to establish whether or not silver‐containing dressings or topical agents promote ulcer healing or prevent ulcer infection.…”

“…There is evidence that dressings with silver, cadexomer iodine, and hypochlorous solutions reduce microbial load in the ulcers. 180,181 The available evidence is insufficient to establish whether or not silver-containing dressings or topical agents promote ulcer healing or prevent ulcer infection. To avoid promoting the development of resistance, we suggest avoid using agents topically that can also be administered systemically.…”

Cadexomer iodine effectively reduces bacterial biofilm in porcine wounds ex vivo and in vivo

“…15 Cadexomer iodine (CI) (Iodosorb, Smith & Nephew, Hull, UK) consists of small polysaccharide beads (cadexomer starch) containing 0.9% iodine, which causes the polysaccharide beads to swell in the presence of wound exudate, allowing a slow sustained release of iodine into the wound. [21][22][23] CI has long been used effectively in chronic wounds and is supported by many clinical studies demonstrating the removal of barriers to healing, such as microbial infection, 21,[24][25][26][27] slough/debris, 21,[28][29][30][31][32] and exudate. 21,24,27,28,31,33,34 In addition, a recent meta-analysis (Cochrane review) highlighted that CI generates higher healing rates than standard care in venous leg ulcers (VLUs).…”