Wound infections with antibiotic-resistant bacteria,
particularly
the Gram-negative strains, pose a substantial health risk for patients
with limited treatment options. Recently topical administration of
gaseous ozone and its combination with antibiotics through portable
systems has been demonstrated to be a promising approach to eradicate
commonly found Gram-negative strains of bacteria in wound infections.
However, despite the significant impact of ozone in treating the growing
number of antibiotic-resistant infections, uncontrolled and high concentrations
of ozone can cause damage to the surrounding tissue. Hence, before
such treatments could advance into clinical usage, it is paramount
to identify appropriate levels of topical ozone that are effective
in treating bacterial infections and safe for use in topical administration.
To address this concern, we have conducted a series of in vivo studies
to evaluate the efficacy and safety of a portable and wearable adjunct
ozone and antibiotic wound therapy system. The concurrent ozone and
antibiotics are applied through a wound interfaced gas permeable dressing
coated with water-soluble nanofibers containing vancomycin and linezolid
(traditionally used to treat Gram-positive infections) and connected
to a portable ozone delivery system. The bactericidal properties of
the combination therapy were evaluated on an ex vivo wound model infected
with Pseudomonas aeruginosa, a common
Gram-negative strain of bacteria found in many skin infections with
high resistance to a wide range of currently available antibiotics.
The results indicated that the optimized combination delivery of ozone
(4 mg h–1) and topical antibiotic (200 μg
cm–2) provided complete bacteria eradication after
6 h of treatment while having minimum cytotoxicity to human fibroblast
cells. Furthermore, in vivo local and systemic toxicity studies (e.g.,
skin monitoring, skin histopathology, and blood analysis) on pig models
showed no signs of adverse effects of ozone and antibiotic combination
therapy even after 5 days of continuous administration. The confirmed
efficacy and biosafety profile of the adjunct ozone and antibiotic
therapy places it as a strong candidate for treating wound infection
with antimicrobial-resistant bacteria and further pursuing human clinical
trials.