(CR-028 (GR-005)) Pseudomonas Scrub Down: Advances in Wound Imaging Objectively Confirm the Efficacy of Acetic Acid Against this Pathogen

Amit Rao, MD – Research Project Manager, Surgery, Northwell Health; Julie Isgro, MSN – Nurse Practitioner, Surgery, Northwell Health; Ann Marie Lanza-Bisciello, MSN – Nurse Practitioner, Surgery, Northwell Health; Regina Matatova, MSN – Nurse Practitioner, Surgery, Northwell Health; Kane Genser, MD – Wound Care Fellow, Surgery, Northwell Health; Christina Del Pin, MD – Physician, Surgery, Northwell Health; Marisa Ranire-Maguire, MD – Physician, Surgery, Northwell Health; Angelin Mathew, BSc – Research Assistant, Yale University

Introduction:

P. aeruginosa, S.aureus, and E.coli are opportunistic pathogens common in chronic wounds. When pathogens are not proactively detected and managed, infections progress to multidrug resistance due to increased virulence and antibiotic-resistant biofilm formation. This is especially challenging for patients in remote areas with resource limited hospitals where expensive cleansers and techniques are inaccessible. Few clinical studies have quantified the effectiveness of simple cleansing techniques and commonplace cleansing agents. To address this gap, we studied the efficacy of acetic acid as a cost-effective, bactericidal cleanser in reducing bacterial loads.

Methods:

Using a handheld bacterial fluorescence (FL) imaging device*, we identified 25 wounds with high bacterial loads. We performed a targeted thirty-second scrub using acetic acid for 10 patients with Pseudomonas presence (Cyan FL) and 15 patients with other bacterial species presence (Red FL). Impartial FL-imaging experts (blinded to the pre/post image as well as cleanser type) masked the FL+ areas, which were then quantified using a custom image analysis algorithm. To determine efficacy, we calculated the average change in Cyan or Red FL+ areas pre- and post-cleansing. Statistical comparisons were then performed to compare acetic acid efficacy against Pseudomonas versus other bacterial species.

Results:

Wound areas were comparable with an average size of 8.31 cm². Following a thirty-second, scrub with acetic acid, we discovered a statistically significant (p=0.05) 50.28% reduction in the average Cyan+ areas, yet for red FL+ areas an 8.70% increase was noted. Further, the variance (spread of data) in FL+ area change after acetic acid cleansing was significantly lower in the Pseudomonas+ wounds than other bacterial species+ wounds (4.52% and 14.00% respectively, p=0.02).

Discussion:

Acetic acid is a promising, low-cost cleanser that can be used to target P. aeruginosa infected wounds. Our findings are especially significant for advancing evidence-based care in resource limited settings where solely low cost cleansers are available.

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