The Infected Diabetic Foot: Does Negative Pressure Wound Therapy with Irrigation Reduce Bioburden and Improve Wound Healing?
Mehmet A Suludere, Matthew Malone, Michael C Siah et al.
✦ AI-curated · Sources linked
In 30 seconds
This post hoc analysis combined data from two randomized clinical trials to compare negative pressure wound therapy (NPWT) with NPWT plus polyhexamethylene biguanide irrigation (NPWTi-P) in people with diabetes undergoing surgery for moderate or severe diabetic foot infections. Tissue microbial loads were assessed by quantitative PCR after initial surgery and again before a planned second operation 48–72 hours later. The analysis found no significant between-group difference in bacterial load, wound healing, or time to healing. Re-infection was less frequent with traditional NPWT than with NPWTi-P (28.6% vs 56.3%, p = .05).
Key findings
- Bacterial loads did not differ significantly between NPWT and NPWTi-P at the assessed time points (p = .12).
- Wound healing rates were 59.5% vs 50.0% (p = .51), and time to heal was 127 ± 109.3 vs 143 ± 95.9 (p = .71).
- Re-infections occurred less often with traditional NPWT than NPWTi-P (28.6% vs 56.3%, p = .05).
Why it matters
The findings do not show that adding polyhexamethylene biguanide irrigation reduces tissue microbial burden or improves healing outcomes in surgically managed diabetic foot infections. The observed re-infection difference also cautions against assuming that irrigation provides an infection-control advantage. These results help frame the uncertainty around the added value of NPWT irrigation in this population.
What to keep in mind
This was a post hoc analysis of combined data from two trials, rather than a prospectively designed analysis focused on microbial load.