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Composition of Challenge Substance in Standardized Antimicrobial Efficacy Testing of Wound Antimicrobials Is Essential to Correctly Simulate Efficacy in the Human Wound Micro-Environment

ORCID
0000-0002-7344-5081
Affiliation
Department of Dermatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf (HHU), Moorenstrasse 5, 40225 Düesseldorf, Germany
Severing, Anna-Lena;
Affiliation
Department of Vascular Medicine, University Heart & Vascular Center (UHZ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251 Hamburg, Germany
Borkovic, Mia;
Affiliation
Department of Vascular Medicine, University Heart & Vascular Center (UHZ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251 Hamburg, Germany
Stuermer, Ewa K.;
ORCID
0000-0002-5176-6941
Affiliation
Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf (HHU), Moorenstrasse 5, 40225 Düsseldorf, Germany
Rembe, Julian-Dario

Current standards insufficiently acknowledge the influence of the wound micro-environment on the efficacy of antimicrobial agents. To address this, octenidine/phenoxyethanol, polyhexanide, povidone-iodine, and sodium-hypochloride/hypochlorous acid solutions were submitted to standard-based (DIN-EN-13727) or modified peptide-based challenges and compared to a simulated clinical reference using human acute or chronic wound exudate (AWF/CWF). Antimicrobial efficacy against S. aureus and P. aeruginosa was compared using a quantitative suspension method. Agreement between methods were investigated using Bland-Altman (B&A) analysis. Different substances and challenges demonstrated diverging results, depending on class and concentration of agent and challenge. Highly concentrated antiseptics maintained a high efficacy under complex challenges, while especially chlorine-based irrigation solutions showed a remarkably reduced antimicrobial effect. Composition of challenge substance proved more relevant than pure concentration. Therefore, the current standard challenge conditions did not adequately reflect the wound micro-environment with over- or under-estimating antimicrobial efficacy, whilst the modified peptide-challenge showed a higher level of agreement with simulated realistic conditions (AWF/CWF). The results emphasize that a “one-fits-all” approach is not feasible to generalize antimicrobial efficacy, as certain aspects of the complex micro-environment pose a differing influence on varying agents. Based on these results, revision and target focused adaptation of the current standards should be considered.

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