Electroceutical wound dressings, especially those involving current flow with silver based electrodes, show promise for treating biofilm infections. However, their mechanism of action is poorly understood. We have developed an in vitro agar based model using a bioluminescent strain of Pseudomonas aeruginosa to measure loss of activity and killing when direct current was applied. Silver electrodes were overlaid with agar and lawn biofilms grown for 24 h. A 6 V battery with 1 kΩ ballast resistor was used to treat the biofilms for 1 h or 24 h. Loss of bioluminescence and a 4-log reduction in viable cells was achieved over the anode. Scanning electron microscopy showed damaged cells and disrupted biofilm architecture. The antimicrobial activity continued to spread from the anode for at least 2 days, even after turning off the current. Based on possible electrochemical ractions of silver electrodes in chlorine containing medium; pH measurements of the medium post treatment; the time delay between initiation of treatment and observed bactericidal effects; and the presence of chlorotyrosine in the cell lysates, hypochlorous acid is hypothesized to be the chemical agent responsible for the observed (destruction/killing/eradication) of these biofilm forming bacteria. Similar killing was obtained with gels containing only bovine synovial fluid or human serum. These results suggest that our in vitro model could serve as a platform for fundamental studies to explore the effects of electrochemical treatment on biofilms, complementing clinical studies with electroceutical dressings.

Electroceutical Treatment of Pseudomonas aeruginosa Biofilms

Harnessing Multifaceted Next-Generation Technologies for Improved Skin Wound Healing

OBJECTIVES
To describe the use of an innovative printed electroceutical dressing (PED) to treat non-healing, infected chronic wounds in one dog and one cat and report outcomes.


ANIMALS
A 4-year-old female spayed Mastiff and a 1-year-old female spayed domestic shorthair cat.


STUDY DESIGN
Short case series.


METHODS
Both cases had chronic wounds (duration: approximately 1 year for the dog and 6 3/4 months for the cat) that remained open and infected despite various wound management strategies. Both animals were treated with the PED. Observations from the records regarding wound size, antimicrobial susceptibility, and the time to healing were recorded.


RESULTS
After 10 days of PED treatment in the dog and 17 days of PED treatment in the cat, the wounds had decreased in size by approximately 4.2 times in the dog and 2.5 times in the cat. Culture of punch biopsies yielded negative results. Wounds were clinically healed at 67 days in the dog and 47 days in the cat. No further treatment of the wounds was required beyond that point.


CONCLUSION
Application of a PED led to closure of two chronic wounds and resolution of their persistent infection.


CLINICAL SIGNIFICANCE
PEDs may provide a new treatment modality to mitigate infection and promote healing of chronic wounds.

Electroceutical treatment of infected chronic wounds in a dog and a cat.

Chronic wound biofilm infections represent a major clinical challenge which results in a substantial burden to patients and healthcare systems. Treatment with topical antibiotics is oftentimes ineffective as a result of antibiotic‐resistant microorganisms and biofilm‐specific antibiotic tolerance. Use of biocides such as hypochlorous acid (HOCl) has gained increasing attention due to the lack of known resistance mechanisms. An HOCl‐generating electrochemical bandage (e‐bandage) is designed that delivers HOCl continuously at low concentrations targeting infected wound beds in a similar manner to adhesive antimicrobial wound dressings. A battery‐operated wearable potentiostat is developed that controls the e‐bandage electrodes at potentials suitable for HOCl generation. It is demonstrated that e‐bandage treatment is tunable by changing the applied potential. HOCl generation on electrode surfaces is verified using microelectrodes. The developed e‐bandage shows time‐dependent responses against in vitro Acinetobacter baumannii and Staphylococcus aureus biofilms, reducing viable cells to nondetectable levels within 6 and 12 h of treatment, respectively. The developed e‐bandage should be further evaluated as an alternative to topical antibiotics to treat wound biofilm infections.

Antibiofilm Activity of a Tunable Hypochlorous Acid‐Generating Electrochemical Bandage Controlled by a Wearable Potentiostat

In healthy skin, vectorial ion transport gives rise to a transepithelial potential which directly impacts many physiological aspects of skin function. A wound is a physical defect that breaches the epithelial barrier and changes the electrochemical environment of skin. Electroceutical dressings are devices that manipulate the electrochemical environment, host as well as microbial, of a wound. In this review, electroceuticals are organized into three mechanistic classes: ionic, wireless, and battery powered. All three classes of electroceutical dressing show encouraging effects on infection management and wound healing with evidence of favorable impact on keratinocyte migration and disruption of wound biofilm infection. This foundation sets the stage for further mechanistic as well as interventional studies. Successful conduct of such studies will determine the best dosage, timing, and class of stimulus necessary to maximize therapeutic efficacy.

Electrochemical Devices in Cutaneous Wound Healing

We report on an innovative, fabric-based conformable, and easily fabricated electroceutical wound dressing that inhibits bacterial biofilm infections and shows significant promise for healing chronic wounds. Cyclic voltammetry demonstrates the ability of the electroceutical to produce reactive oxygen species, primarily HOCl that is responsible for bacterial inhibition. In vitro investigation with the lawn biofilm grown on a soft tissue mimic assay shows the efficacy of the dressing against both Gram-positive and Gram-negative bacteria in the biofilm form. In vivo, the printed electroceutical dressing was utilized as an intervention treatment for a canine subject with a non-healing wound due to a year-long persistent polymicrobial infection. The clinical case study with the canine subject exhibited the applicability in a clinical setting with the results showing infection inhibition within 11 days of initial treatment. This printed electroceutical dressing was integrated with a Bluetooth® enabled circuit allowing remote monitoring of the current flow within the wound bed. The potential to monitor wounds remotely in real-time with a Bluetooth® enabled circuit proposes a new physical biomarker for management of infected, chronic wounds. [2020-0129]

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Printed Electroceutical Dressings for the Inhibition of Biofilms and Treatment of Chronic Wounds

Antimicrobial dressings for prevention and mitigation of biofilm and bacterial infection by an applied electric current are provided. Methods of making the dressings and methods of applying an electric current to promote the wound healing process are also disclosed.

Molly Marie Bennett

Papers

Printed Electroceutical Dressings for the Inhibition of Biofilms and Treatment of Chronic Wounds

Antimicrobial wound care dressing