HOCl-producing electrochemical bandage is active in murine polymicrobial wound infection
Authors: Fleming Derek , Bozyel Ibrahim , Koscianski Christina A. , Ozdemir Dilara , Karau Melissa J. , Cuello Luz , Anoy Md Monzurul Islam , Gelston Suzanne , Schuetz Audrey N. , Greenwood-Quaintance Kerryl E. , Mandrekar Jayawant N. , Beyenal Haluk , Patel Robin 
Published: August 2024

Wound infections, exacerbated by the prevalence of antibiotic-resistant bacterial pathogens, necessitate innovative antimicrobial approaches. Polymicrobial infections, often involving
Pseudomonas aeruginosa
and methicillin-resistant
Staphylococcus aureus
(MRSA), present challenges due to biofilm formation and antibiotic resistance. Hypochlorous acid (HOCl), a potent antimicrobial agent, holds promise as an alternative therapy. An electrochemical bandage (e-bandage) that generates HOCl
in situ
via precise polarization controlled by a miniaturized potentiostat was evaluated for the treatment of murine wound biofilm infections containing both
P. aeruginosa
with “difficult-to-treat” resistance and MRSA. Previously, HOCl-producing e-bandage was shown to reduce murine wound biofilms containing
P. aeruginosa
alone. Here, in 5-mm excisional skin wounds containing 48-h biofilms comprising MRSA and
P. aeruginosa
combined, polarized e-bandage treatment reduced MRSA by 1.1 log
10
CFU/g (
P
= 0.026) vs non-polarized e-bandage treatment (no HOCl production), and 1.4 log
10
CFU/g (0.0015) vs Tegaderm only controls;
P. aeruginosa
was similarly reduced by 1.6 log
10
CFU/g (
P
= 0.0032) and 1.6 log
10
CFU/g (
P
= 0.0015), respectively. For wounds infected with MRSA alone, polarized e-bandage treatment reduced bacterial load by 1.1 log
10
CFU/g (
P
= 0.0048) and 1.3 log
10
CFU/g (
P
= 0.0048) compared with non-polarized e-bandage and Tegaderm only, respectively. The e-bandage treatment did not negatively impact wound healing or cause tissue toxicity. The addition of systemic antibiotics did not enhance the antimicrobial efficacy of e-bandages. This study provides additional evidence for the HOCl-producing e-bandage as a novel antimicrobial strategy for managing wound infections, including in the context of antibiotic resistance and polymicrobial infections.

IMPORTANCE

New approaches are needed to combat the rise of antimicrobial-resistant infections. The HOCl-producing electrochemical bandage (e-bandage) leverages
in situ
generation of HOCl, a natural biocide, for broad-spectrum killing of wound pathogens. Unlike traditional therapies that may exhibit limited activity against biofilms and antimicrobial-resistant organisms, the e-bandage offers a potent, standalone solution that does not contribute to further resistance or require adjunctive antibiotic therapy. Here, we show the ability of the e-bandage to address polymicrobial infection by antimicrobial resistant clinical isolates of
Staphylococcus aureus
and
Pseudomonas aeruginosa
, two commonly isolated, co-infecting wound pathogens. Effectiveness of the HOCl-producing e-bandage in reducing pathogen load while minimizing tissue toxicity and avoiding the need for systemic antibiotics underscores its potential as a tool in managing complex wound infections.