Email Alerts
RSS
Volume 38 Issue 3
Mar.  2022
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(3): 242-250
Liu J,Wu BL,Zhu WZ,et al.Effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli infection[J].Chin J Burns Wounds,2022,38(3):242-250.DOI: 10.3760/cma.j.cn501120-20201112-00471.
Citation: Liu J,Wu BL,Zhu WZ,et al.Effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli infection[J].Chin J Burns Wounds,2022,38(3):242-250.DOI: 10.3760/cma.j.cn501120-20201112-00471.
shu

Effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli  infection

doi: 10.3760/cma.j.cn501120-20201112-00471
  • 1.

    Department of Burns and Plastic Surgery, the First Hospital of Yulin, Yulin 719000, China

  • 2.

    Clinical Medical College, Ningxia Medical University, Yinchuan 750000, China

  • 3.

    Department of Burns and Plastic Surgery, the 940th Hospital of the Joint Logistic Support Force of PLA, Lanzhou 730050, China

  • 4.

    Department of Burns and Plastic Surgery ＆ Wound Repair Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China

  • 5.

    Intensive Care Unit, Traditional Chinese Medicine Hospital of Yulin, Yulin 719000, China

More Information
  • Corresponding author: Liu Yi, Email: liuyi196402@163.com
  • Received Date: 2020-11-12
    Abstract
  •     Objective   To investigate the effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli infection.    Methods   One strain of Escherichia coli with the strongest bacterial biofilm forming ability among the strains isolated from specimens in 25 patients (16 males and 9 females, aged 32-67 years) from five clinical departments of the 940th Hospital of the Joint Logistic Support Force was collected for the experimental study from September to December 2019. The Escherichia coli was cultured with hypochloric acid at 162.96, 81.48, 40.74, 20.37, 10.18, 5.09, 2.55, 1.27, 0.64, and 0.32 μg/mL respectively to screen the minimum bactericidal concentration (MBC) of hypochloric acid. The Escherichia coli was cultured with hypochloric acid at the screened MBC for 2, 5, 10, 20, 30, and 60 min respectively to screen the shortest bactericidal time of hypochloric acid. The biofilm formation of Escherichia coli was observed by scanning electron microscopy at 6, 12, 24, 48, 72, and 96 h of incubation, respectively. After 72 h of culture, hypochloric acid at 1, 2, 4, 8, and 16 times of MBC was respectively added to Escherichia coli to screen the minimum biofilm eradicate concentration (MBEC) of hypochloric acid against Escherichia coli. After hypochloric acid at 1, 2, 4, and 8 times of MBEC and sterile saline were respectively added to Escherichia coli for 10 min, the live/dead bacterial staining kit was used to detect the number of live and dead cells, with the rate of dead bacteria calculated (the number of samples was 5). From January to December 2020, 41 patients with infectious wounds meeting the inclusion criteria and admitted to the Department of Burns and Plastic Surgery of the 940th Hospital of Joint Logistic Support Force of PLA were included into the prospective randomized controlled trial. The patients were divided into hypochloric acid group with 21 patients (13 males and 8 females, aged (46±14) years) and povidone iodine group with 20 patients (14 males and 6 females, aged (45±19) years) according to the random number table. Patients in the 2 groups were respectively dressed with sterile gauze soaked with hypochloric acid of 100 μg/mL and povidone iodine solution of 50 mg/mL with the dressings changed daily. Before the first dressing change and on the 10th day of dressing change, tissue was taken from the wound and margin of the wound for culturing bacteria by agar culture method and quantifying the number of bacteria. The amount of wound exudate and granulation tissue growth were observed visually and scored before the first dressing change and on the 3rd, 7th, and 10th days of dressing change. Data were statistically analyzed with one-way analysis of variance, Dunnett-t test, independent sample t test, Mann-Whitney U test, Wilcoxon signed-rank test, chi-square test, or Fisher's exact probability test.    Results   The MBC of hypochloric acid against Escherichia coli was 10.18 μg/mL, and the shortest bactericidal time of hypochloric acid with MBC against Escherichia coli was 2 min. Escherichia coli was in a completely free state after 6 and 12 h of culture and gradually aggregated and adhered with the extension of culture time, forming a mature biofilm at 72 h of culture. The MBEC of hypochloric acid against Escherichia coli was 20.36 μg/mL. The Escherichia coli mortality rates after incubation with hypochloric acid at 1, 2, 4, and 8 times of MBEC for 10 min were significantly higher than that after incubation with sterile saline (with t values of 6.11, 25.04, 28.90, and 40.74, respectively, P<0.01). The amount of bacteria in the wound tissue of patients in hypochloric acid group on the 10th day of dressing change was 2.61 (2.20, 3.30)×104 colony forming unit (CFU)/g, significantly less than 4.77 (2.18, 12.48)×104 CFU/g in povidone iodine group (Z=2.06, P<0.05). The amounts of bacteria in the wound tissue of patients in hypochloric acid group and povidone iodine group on the 10th day of dressing change were significantly less than 2.97 (2.90, 3.04)×106 and 2.97 (1.90, 7.95)×106 CFU/g before the first dressing change (with Z values of 4.02 and 3.92, respectively, P<0.01). The score of wound exudate amount of patients in hypochloric acid group on the 10th day of dressing change was significantly lower than that in povidone iodine group (Z=2.07, P<0.05). Compared with those before the first dressing change, the scores of wound exudate amount of patients in hypochloric acid group on the 7th and 10th days of dressing change were significantly decreased (with Z values of -3.99 and -4.12, respectively, P<0.01), and the scores of wound exudate amount of patients in povidone iodine group on the 7th and 10th days of dressing change were significantly decreased (with Z values of -3.54 and -3.93, respectively, P<0.01). The score of wound granulation tissue growth of patients in hypochloric acid group on the 10th day of dressing change was significantly higher than that in povidone iodine group (Z=2.02, P<0.05). Compared with those before the first dressing change, the scores of wound granulation tissue growth of patients in hypochloric acid group on the 7th and 10th days of dressing change were significantly increased (with Z values of -3.13 and -3.67, respectively, P<0.01), and the scores of wound granulation tissue growth of patients in povidone iodine group on the 7th and 10th days of dressing change were significantly increased (with Z values of -3.12 and -3.50, respectively, P<0.01).    Conclusions   Hypochloric acid can kill Escherichia coli both in free and biofilm status. Hypochloric acid at a low concentration shows a rapid bactericidal effect on mature Escherichia coli biofilm, and the higher the concentration of hypochloric acid, the better the bactericidal effect. The hypochloric acid of 100 μg/mL is effective in reducing the bacterial load on wounds with Escherichia coli infection in patients, as evidenced by a reduction in wound exudate and indirect promotion of granulation tissue growth, which is more effective than povidone iodine, the traditional topical antimicrobial agent.

     

    • FullText(HTML)
  • loading
    • References(33)
  • [1]
    HanG,CeilleyR.Chronic wound healing: a review of current management and treatments[J].Adv Ther, 2017,34(3):599-610. DOI: 10.1007/s12325-017-0478-y.
    [2]
    WangL,BassiriM,NajafiR,et al.Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity[J].J Burns Wounds,2007,6:e5.
    [3]
    顾峥嵘,陈晓,翁蔚宗,等.次氯酸临床研究及使用进展[J].世界复合医学,2015,1(4):336-339.DOI: 10.11966/j.issn.2095-994X.2015.01.04.08.
    [4]
    CrewJ, VarillaR, RocasTA, et al. NeutroPhase® in chronic non-healing wounds[J].Int J Burns Trauma,2012,2(3):126-134.
    [5]
    RoyR,TiwariM,DonelliG,et al.Strategies for combating bacterial biofilms: a focus on anti-biofilm agents and their mechanisms of action[J].Virulence,2018,9(1):522-554.DOI: 10.1080/21505594.2017.1313372.
    [6]
    HassanA,UsmanJ,KaleemF,et al.Evaluation of different detection methods of biofilm formation in the clinical isolates[J].Braz J Infect Dis,2011,15(4):305-311.
    [7]
    姚泽明D-酪氨酸联合万古霉素对MRSA及其生物膜的消除作用广州广州医科大学2017

    姚泽明.D-酪氨酸联合万古霉素对MRSA及其生物膜的消除作用[D].广州:广州医科大学,2017.
    [8]
    陈东科,孙长贵.实用临床微生物学检验与图谱[M].北京:人民卫生出版社,2011:769-770.
    [9]
    李莎伊犁黑蜂蜂胶对不同状态白色念珠菌作用的实验研究乌鲁木齐新疆医科大学2017

    李莎. 伊犁黑蜂蜂胶对不同状态白色念珠菌作用的实验研究[D].乌鲁木齐:新疆医科大学,2017.
    [10]
    刘江, 刘毅. 慢性创面细菌生物膜形成机制及其诊断的研究进展 [J]. 中华烧伤杂志, 2021, 37(7): 692-696. DOI: 10.3760/cma.j.cn501120-20200327-00198.
    [11]
    戚丽华鲍曼不动杆菌耐药特性及其与生物膜的相关性研究北京解放军军事医学科学院2016

    戚丽华. 鲍曼不动杆菌耐药特性及其与生物膜的相关性研究[D].北京:解放军军事医学科学院,2016.
    [12]
    王梦婷生物活性玻璃对三种细菌及龈下菌斑的抗菌效果研究南京南京医科大学2015

    王梦婷. 生物活性玻璃对三种细菌及龈下菌斑的抗菌效果研究[D].南京:南京医科大学,2015.
    [13]
    杨宗城.烧伤治疗学[M].3版.北京:人民卫生出版社,2006:223-224.
    [14]
    YanJ, BasslerBL. Surviving as a community: antibiotic tolerance and persistence in bacterial biofilms[J]. Cell Host Microbe, 2019,26(1):15-21. DOI: 10.1016/j.chom.2019.06.002.
    [15]
    王广宁负压封闭引流联合局部氧疗促进外伤后慢性创面愈合的临床研究西安第四军医大学2016

    王广宁. 负压封闭引流联合局部氧疗促进外伤后慢性创面愈合的临床研究[D]. 西安:第四军医大学, 2016.
    [16]
    GrandeR,PucaV,MuraroR.Antibiotic resistance and bacterial biofilm[J].Expert Opin Ther Pat,2020,30(12):897-900.DOI: 10.1080/13543776.2020.1830060.
    [17]
    MarcuzzoAV,TofanelliM,Boscolo NataF,et al.Hyaluronate effect on bacterial biofilm in ENT district infections: a review[J].APMIS,2017,125(9):763-772.DOI: 10.1111/apm.12728.
    [18]
    WrightTE, PayneWG, KoF, et al. The effects of an oxygen-generating dressing on tissue infection and wound healing[J]. Journal of Applied Research, 2003, 3(4):363-370.
    [19]
    SenpukuH,TunaEB,NagasawaR,et al.The inhibitory effects of polypyrrole on the biofilm formation of Streptococcus mutans[J].PLoS One,2019,14(11):e0225584.DOI: 10.1371/journal.pone.0225584.
    [20]
    ZhangL,LiangE,ChengY,et al.Is combined medication with natural medicine a promising therapy for bacterial biofilm infection?[J].Biomed Pharmacother,2020,128:110184.DOI: 10.1016/j.biopha.2020.110184.
    [21]
    Leulmi PichotS,JoistenH,GrantAJ,et al.Magneto-mechanically actuated microstructures to efficiently prevent bacterial biofilm formation[J].Sci Rep,2020,10(1):15470.DOI: 10.1038/s41598-020-72406-8.
    [22]
    MetcalfDG, BowlerPG. Biofilm delays wound healing: a review of the evidence[J/OL].Burns Trauma,2013,1(1):5-12[2020-11-12]. https://pubmed.ncbi.nlm.nih.gov/27574616/.DOI:10.4103/2321- 3868. 113329.
    [23]
    HaeslerE,SwansonT,OuseyK,et al.Clinical indicators of wound infection and biofilm: reaching international consensus[J].J Wound Care,2019,28(Sup3b):s4-s12.DOI: 10.12968/jowc.2019.28.Sup3b.S4.
    [24]
    SchultzG,BjarnsholtT,JamesGA,et al.Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds[J].Wound Repair Regen,2017,25(5):744-757.DOI: 10.1111/wrr.12590.
    [25]
    ZhangX,SunZ,YangQ.Application of denaturing gradient gel electrophoresis to the analysis of bacterial communities associated with asymptomatic and symptomatic pericoronitis[J].J Oral Maxillofac Surg,2018,76(3):483-489.DOI: 10.1016/j.joms.2017.08.007.
    [26]
    WangLF,LiJL,MaWH,et al.Drug resistance analysis of bacterial strains isolated from burn patients[J].Genet Mol Res,2014,13(4):9727-9734.DOI: 10.4238/2014.January.22.10.
    [27]
    NakagamiG,SchultzG,GibsonDJ,et al.Biofilm detection by wound blotting can predict slough development in pressure ulcers: a prospective observational study[J].Wound Repair Regen,2017,25(1):131-138.DOI: 10.1111/wrr.12505.
    [28]
    BigliardiPL, AlsagoffSAL, El-KafrawiHY, et al. Povidone iodine in wound healing: a review of current concepts and practices[J]. Int J Surg,2017,44:260-268. DOI: 10.1016/j.ijsu.2017.06.073.
    [29]
    MorraCN,OrihuelaCJ.Anatomical site-specific immunomodulation by bacterial biofilms[J].Curr Opin Infect Dis,2020,33(3):238-243.DOI: 10.1097/QCO.0000000000000643.
    [30]
    FeiC,MaoS,YanJ,et al.Nonuniform growth and surface friction determine bacterial biofilm morphology on soft substrates[J].Proc Natl Acad Sci U S A,2020,117(14):7622-7632.DOI: 10.1073/pnas.1919607117.
    [31]
    KimHJ,LeeJG,KangJW,et al.Effects of a low concentration hypochlorous acid nasal irrigation solution on bacteria, fungi, and virus[J].Laryngoscope,2008,118(10):1862-1867.DOI: 10.1097/MLG.0b013e31817f4d34.
    [32]
    YamasakiR,KawanoA,YoshiokaY,et al.Rhamnolipids and surfactin inhibit the growth or formation of oral bacterial biofilm[J].BMC Microbiol,2020,20(1):358.DOI: 10.1186/s12866-020-02034-9.
    [33]
    CampocciaD, MontanaroL, ArciolaCR. Extracellular DNA (eDNA). A major ubiquitous element of the bacterial biofilm architecture[J].Int J Mol Sci,2021,22(16):9100. DOI: 10.3390/ijms22169100.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (291) PDF downloads(41) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return