Author(s) Geng RSQ, Sibbald RG, Slomovic J, Toksarka O, Schultz G, et al.

Journal Advances in skin & wound care. Date of publication 2025 Jan 1;volume 38(1):10-18.

Abstract 1. Adv Skin Wound Care. 2025 Jan-Feb 01;38(1):10-18. doi: 10.1097/ASW.0000000000000233. Epub 2024 Oct 3. Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review. Geng RSQ, Sibbald RG, Slomovic J, Toksarka O, Schultz G. GENERAL PURPOSE: To review the therapeutic indices of topical antiseptics for bacterial species commonly isolated from chronic wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Explain the mechanisms underlying chronic wound physiology and their implications for effective wound healing and management.2. Evaluate the role of therapeutic index values for topical antiseptics in chronic wound management.3. Apply evidence-based treatment strategies for chronic wound management. Plain Language Summary: Chronic wounds place a heavy burden on healthcare systems and reduce patients’ activities of daily living. Increased bacterial bioburden (local infection, covert infection) impairs wound healing. With increased antimicrobial resistance, alternative antimicrobial strategies are important. To determine the topical antiseptic therapeutic index values for common wound bacterial species. The therapeutic index is a ratio comparing lowest concentration that causes mammalian cell cytotoxicity to the minimum bactericidal concentration; higher values indicate greater safety / clinical benefit. MEDLINE and EMBASE databases were searched from conception to June 2023. Common wound bacterial species and their in-vitro minimum bactericidal concentrations were compared to the minimum mammalian cell cytotoxicity concentration. The authors identified 37 qualifying articles. Antiseptic, bacterial organism, mammalian cell type, minimum bactericidal concentration, and mammalian cell cytotoxicity concentration values. The therapeutic indices for the topical antiseptics were generally low, with most ranging between 0.5 and 3.0. The highest therapeutic index values for Escherichia coli (5.49), Staphylococcus aureus (6.31) and Pseudomonas aeruginosa (8.81) were achieved by hypochlorous acid. The highest therapeutic index value for methicillin resistant S aureus (12.1) was achieved by polyhexamethylene biguanide. Antibiotic stewardship principles need to be applied to topical antiseptics due to some isolated topical antiseptic resistance and cross-resistance to oral antimicrobials. The choice of antiseptic should not be made solely based on therapeutic index values but individualized with the wound healing condition including covert infection. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/ASW.0000000000000233 PMID: 39355996 [Indexed for MEDLINE]

Source ID (e.g. PMID): 39355996