Antimicrobial effects of an acidified nitrite foam on drip flow reactor biofilm

Abstract

Background. Nitric oxide (NO) plays critical roles in wound healing, including stimulating vasodilation, angiogenesis and broad antimicrobial activity. Aim. To measure the effect of an acidified nitrite foam (ANF) on biofilms created by six different microbes. Methods. A novel method of generating, delivering and topically applying NO gas at the point of care was developed using ANF in a mixed bubble foam and was tested in vitro against six common microbial wound pathogens. Results. A single 5-minute topical exposure of the NO bubble gas formulation generated a 5.8-log10 reduction of mature biofilm of Pseudomonas aeruginosa, a 5.1-log10 reduction of Staphylococcus aureus biofilm, a 4.0-log10 reduction of Staphylococcus epidermidis biofilm, a 3.2-log10 reduction of Proteus mirabilis biofilm, a 2.7-log10 reduction of Acinetobacter baumannii biofilm, and a 1.5-log10 reduction of Candida albicans biofilm. Conclusion. The efficacy of a 5-minute treatment of ANF used on biofilms of P. aeruginosa, A. baumannii, S. aureus, C. albicans, P. mirabilis and S. epidermidis was confirmed. The treatment resulted in a significant reduction in colony-forming units per square centimetre (CFU/cm2) comparable to or surpassing other methods of NO gas application, suggesting NO containing foam’s utility as a point of care solution for chronic wounds with elevated bioburden and biofilms where levels of endogenously produced NO may be insufficient for wound healing completion.