Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers

Borges, Eline Lima; Frison, Susiane Sucasas; Honorato‐Sampaio, Kinulpe; Guedes, Antônio Carlos Martins; Lima, Vera Lúcia de Araújo Nogueira; Oliveira, Olga Maria Medeiros de; Ferraz, Aidê Ferreira; Tyrone, Ana Carolina

doi:10.1097/won.0000000000000455

Cited by 20 publications

(26 citation statements)

References 19 publications

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“…Regarding the reduction of bacterial load, in order to minimize critical colonization and possible infection, the importance of a careful cleaning of the wound is highlighted. It can be done using physiological solutions or composed of antimicrobials such as polyhexamethylene biguanide (PHMB); and, when available under pressure, in the form of a jet (43) , it helps to minimize the risk of infection.…”

Section: Descriptive N = 126 Culture and Antibiogrammentioning

confidence: 99%

Microbiological profile of leg ulcer infections: review study

et al. 2021

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Objectives: to analyze the microbiological profile of leg ulcers of patients treated at outpatient clinics and hospitals regarding the type of microorganism, microbiological selection of antibiotics, and techniques for the collection of culture material. Methods: literature review performed on LILACS, IBECS, MEDLINE, and CINAHL databases, resulting in a descriptive analysis of 27 studies. Results: 35.7% of the studies occurred in an outpatient care scenario; and 64.2% in hospitals. There was a predominance of swab (100%) in outpatient care and biopsy (55.5%) in the hospital. Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were more common at both levels of assistance. Methicillin-resistant Staphylococcus aureus was isolated in both. Conclusions: the microbiological profile of infections was similar, with the presence of resistant bacteria in both environments. This fact causes concern and raises the need for research to elucidate it. The studies did not compare the effectiveness between biopsy and swab.

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Section: Descriptive N = 126 Culture and Antibiogrammentioning

confidence: 99%

Microbiological profile of leg ulcer infections: review study

et al. 2021

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“…In addition, comparable efficacy of PHMB to chlorhexidine (CHG) was demonstrated against P aeruginosa biofilm grown in routinely used microtitre plates and on silicone materials in vitro in artificial wound fluid 96 . However, although PHMB was equally as effective as saline solution in reducing the bacterial load in venous leg ulcers, neither treatment was able to eliminate biofilm from the wound tissue 97 . Furthermore, conflicting evidence exists regarding the activity of PHMB against S aureus biofilms 98,99 …”

Section: Resultsmentioning

confidence: 99%

“…96 However, although PHMB was equally as effective as saline solution in reducing the bacterial load in venous leg ulcers, neither treatment was able to eliminate biofilm from the wound tissue. 97 Furthermore, conflicting evidence exists regarding the activity of PHMB against S aureus biofilms. 98,99…”

Section: Polyhexanidementioning

confidence: 99%

Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm

Alves

Barreto

Barrois

et al. 2020

International Wound Journal

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Biofilms play a major role in delaying chronic wounds from healing. A wound infiltrated with biofilm, or “critically colonised” wound, may become clinically infected if the number of microbes exceeds a critical level. Chronic wound biofilms represent a significant treatment challenge by demonstrating recalcitrance towards antimicrobial agents. However, a “window of opportunity” may exist after wound debridement when biofilms are more susceptible to topical antiseptics. Here, we discuss the role of antiseptics in the management of chronic wounds and biofilm, focusing on povidone‐iodine (PVP‐I) in comparison with two commonly used antiseptics: polyhexanide (PHMB) and silver. This article is based on the literature reviewed during a focus group meeting on antiseptics in wound care and biofilm management, and on a PubMed search conducted in March 2020. Compared with PHMB and silver, PVP‐I has a broader spectrum of antimicrobial activity, potent antibiofilm efficacy, no acquired bacterial resistance or cross‐resistance, low cytotoxicity, good tolerability, and an ability to promote wound healing. PVP‐I represents a viable therapeutic option in wound care and biofilm management, with the potential to treat biofilm‐infiltrated, critically colonised wounds. We propose a practical algorithm to guide the management of chronic, non‐healing wounds due to critical colonisation or biofilm, using PVP‐I.

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“…10 The comparators • In an RCT conducted in venous leg ulcers (VLUs, n= 27 analysed) that had biofilm presence confirmed by microscopy, cleansing with a PHMB-iodine solution statistically significantly reduced overall bacterial count compared to baseline, but this was not significantly different from saline cleansing (p > 0.05). There was a statistically significantly greater reduction in bacterial count in relation to wound size in the PHMB-iodine group (p = 0.07) 11 (Level 1).…”

Section: Clinical Evidence Reduction In Local Infectionmentioning

confidence: 87%

“…of RCTs and other study designs 23 1.c RCT 11,14 Level 2.c Quasiexperimental prospectively controlled study 12 Level 3.e Observational study without a control group 15 4.c Case series 19 4.d Case studies [16][17][18]24 5.a Systematic review of expert opinion 25 5.b Expert consensus 13,26,27 5.c Bench research [1][2][3][4][5][6][7][8][9] and single expert opinion literature search combining search terms related to PHMB and wounds. Only studies that reported on the use of PHMB for a chronic wound were included in the clinical evidence summary.…”

Section: B Systematic Reviewmentioning

confidence: 99%

Evidence Summary: Polyhexamethylene biguanide for chronic wounds

University¹

2020

WPR

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Polyhexamethylene biguanide is an antiseptic available as solution, gel or impregnated in wound dressings. Level 5 1-9 bench research indicates that PHMB products have broadspectrum antimicrobial activity against gram positive and negative bacteria (including biofilms), methicillin-resistant Staphylococcus aureus (MRSA), fungus and viruses. Level 1 10, 11 and Level 2 12 evidence reports mixed findings on the effectiveness of PHMB in delivering significant reduction in bacterial load in chronic wounds, with some studies reporting superiority compared to control cleansers and others finding no statistically significant differences. However, this evidence is generally of low quality. Level 5 13 expert opinion supports the use of PHMB in combination with debridement for managing infection, particularly biofilm. Level 1, 10, 14 Level 3 15 and Level 4 [16][17][18][19] evidence indicates PHMB is associated with improvements in wound healing outcomes, 10, 15-18 reduction in wound pain 10,14 and management of wound odour. 14,19 CLINICAL PRACTICE RECOMMENDATIONSPolyhexamethylene biguanide (PHMB) can be used to reduce local infection and promote healing in chronic wounds (Grade B).

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Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers

Cited by 20 publications

References 19 publications

Microbiological profile of leg ulcer infections: review study

Microbiological profile of leg ulcer infections: review study

Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm

Evidence Summary: Polyhexamethylene biguanide for chronic wounds

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