Polyhexamethylene Biguanide (PHMB): An Addendum to Current Topical Antimicrobials
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BWD-PHMB pads (XCell Cellulose Wound Dressing–Antimicrobial) measuring 3.5-in x 3.5-in were provided to 2 clinical sites and used as the primary dressing. Secondary dressings, including compression wraps (where indicated), were the standard of care for the facilities. Patients were chosen on an “as needed” basis and neither randomized nor controlled.
The 2 sites evaluated a total of 12 patients with 26 wounds of various etiologies including venous stasis ulcers (12), diabetic (4), traumatic (8), vasculitic (1), and necrobiosis diabetica lipoidica (1). Eleven of the 12 patients were unresponsive to a silver impregnated or an iodine containing dressing in the 3–4 weeks prior to use of the BWD-PHMB dressing. In these cases the wound had either increased in size or failed to progress. One patient was treated directly with BWD-PHMB.
Swabs of the wound were taken to determine if bacterial colonization was the reason for the lack of response to previous dressings. Organisms were identified in the wounds of 8 patients prior to and after BWD-PHMB application. Systemic antibiotics were not given in conjunction with the use of BWD-PHMB to ensure bacterial reductions were solely due to the PHMB.
The organisms identified included methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis, Diphtheroid gram-positive rods, beta hemolytic Streptococcus B, Enterobacter aerogenes, mixed skin flora, and Enterococcus sp. The most common was Staphylococcus (including MRSA) and Pseudomonas. Semiquantitative scores ranged from 0 to 4+ (0 represents no bacterial growth and 4+ represents the largest amount of bacterial growth on the culture). The various bacteria found in the wounds of all 8 patients and the relative abundance prior to and after application of the BWD-PHMB dressing are shown in Table 1.
Four patients (5 wounds) from 1 site were used strictly for the economic analysis below. Of the remaining 8, 1 patient (3 wounds) was lost to follow-up after 1 week of BWD-PHMB treatment. The remaining patients had BWD-PHMB applied over periods of 1 to 7 weeks. Results of the 8 patients demonstrated a decrease in wound size on average from 6.79 cm2 to 4.57 cm2 (42% reduction) in an average of 25 days (Table 2). Two of the wounds completely healed during the study, 13 improved, and 2 showed a slight increase in size.
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