Treating Infected Wounds in the Era of Antibiotic Resistance: Non-Thermal Plasma Safely and Rapidly Treats MRSA-Infected Wounds
Sarah J. Karinja, BA1, Jaime L. Bernstein, BS1, Rachel Akintayo, MD1, Julia Jin, BS1, Xue Dong, BA1, Omer Kaymakcalan, MD1, Andrew Abadeer, MEng1, Kerry A. Morrison, BA1, Lars F. Westblade, PhD, D(ABMM)1, Czeslaw Golkowski, Ph.D.2, Jason A. Spector, MD1.
1Weill Cornell Medical College, New York, NY, USA, 2Cornell University, Ithaca, NY, USA.
PURPOSE: Steri-lysisTM is a novel disinfection and sterilization technology which synergistically combines non-thermal plasma (NTP) containing reactive oxygen and nitrogen species (RONS) with vaporized hydrogen peroxide (H2O2) to create a bactericidal effluent within a closed loop system. Unlike other plasma-utilizing sterilization devices, Steri-lysisTM can deliver the effluent to a remote target, making this technology uniquely capable of clinical translation. Given the increasing burden of chronic wounds, especially with rising rates of diabetes and obesity, and the rising danger of antibiotic resistant organisms, we sought to investigate the application of Steri-lysisTM in the treatment of soft tissue infections. Herein, we investigate the effectiveness of Steri-lysisTM treatment of methicillin-resistant Staphylococcus aureus (S. aureus; MRSA)-infected wounds in an in vivo murine model.
METHODS: Full-thickness 6 mm-diameter wounds were excised from the dorsa of C57bl/6 mice, splinted, and inoculated with 3.75 x 106 colony forming units (CFU) of MRSA. Mice were randomized into 3 treatment groups: none, 10 minutes or 20 minutes Steri-LysisTM. They were treated on post-operative days 3, 5, and 7, with aseptic swabbing before and after. On day 7, the wounds were harvested. The right wound was homogenized, serially diluted, plated, incubated and CFU enumerated to quantify the bacterial load per wound. The left wound was processed for histology and immunofluorescence with anti-S. aureus antibody, then imaged with confocal microscopy.
RESULTS: Wounds treated with 3 treatments of 20 minutes Steri-lysisTM demonstrated a 90% reduction in S. aureus CFU (p = 0.0441) compared to untreated wounds. Efficacy of 20 minutes Steri-lysisTM treatment was confirmed by lack of S. aureus immunofluorescence on wounds. Furthermore, assessment of gross tissue and hematoxylin and eosin-stained sections demonstrated no evidence of tissue injury, aberrant architecture, cellular infiltration, inflammation or residue.
CONCLUSION: This novel treatment system disinfects infected wounds in an in vivo murine model, without evidence of toxicity to the wound or surrounding tissues. Given these results, and the unique germicidal mechanism, NTP holds the promise to treat wounds infected by a wide variety of pathologic organisms, without the risk of developing antibiotic resistance. Steri-lysisTM is an innovative, low cost, portable technology that has the potential to revolutionize device sterilization and shift the paradigm of wound treatment.
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