The efficacy of acetic acid in burn wounds infected with Pseudomonas aeruginosa: a review of the literature
James Bozzi1, 1Concord Repatriation General Hospital, Concord, NSW, Australia
Abstract
Pseudomonas aeruginosa(P.aeruginosa) is the most prevalent Gram-negative bacteria in chronic wounds; despite meticulous infection control, evidence suggests it is found in 24-33% of infected burns.
Its proliferation within a biofilm provides protection against systemic antibiotics, thus a need for topical therapy. Some topical therapies, such as hydrogen peroxide and sodium hypochlorite, are not without risk; given in-vitro evidence for toxicity to fibroblasts and hence inhibition of cellular wound healing. Consequently, the need to identify the ideal topical antimicrobial – one which reduces colony-forming-units without inhibiting cellular repair, ensues.
Acetic acid(AA) at concentrations of 2.5%, is bactericidal to both Gram-positive and Gram-negative organisms and is capable of dissolving their associated biofilms without reducing tensile strength. 19 studies, including a single level-1 low-powered RCT and 9 level-3(observational) studies exploring the efficacy of AA in chronic wounds infected with P.aeruginosa were identified. It appears that treatment with AA(2.5-5%), daily, for 30 minutes, is likely to be effective in irradicating P.aeruginosa within 5 days, however, while it appears to be effective, there is no sound level-1 evidence to facilitate the creation of guidelines around its use. Whilst daily dressing and AA soaks were found to be the most common treatment of choice for burn wounds infected with P.aeruginosa in a recent UK survey, no research exists specifically for burns.
Given that AA is available, cheap and does not appear to have the adverse effects of some antiseptics at appropriate concentrations, the effectiveness of AA in the treatment of infected burn wounds should be confirmed.
References
Nagoba BS, Selkar SP, Wadher BJ, Gandhi RC. ‘Acetic acid treatment of pseudomonal wound infections–a review.’ J Infect Public Health. 2013 Dec;6(6):410-5.
Nour S, Reid G, Sathanantham K, Mackie I. ‘Acetic acid dressings used to treat pseudomonas colonised burn wounds: A UK national survey.’ Burns. 2022;48(6):1364-1367.
Biography
Dr James Bozzi is a Sydney unaccredited plastic and reconstructive surgery registrar with an interest in burns