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RESULTS
Zone of inhibition: Both the buckwheat honey impregnated
dressing and the multi floral honey impregnated
dressing (5 and 6) showed no zones of inhibition against
any species of bacteria. The Leptospermum honey impregnated
dressings (1-4) gave zones of inhibition against all
three species of bacteria (Figure 1). The staphylococci were
more sensitive to this honey than the Pseudomonas aeruginosa
(Figure 2).
Barrier effect of Dressings: There was no observed growth
of either strain of Staphylococcus on the upper surface of
the calcium alginate dressings, indicating that all three
dressings were acting as a barrier preventing migration
of bacteria from the surface of the TSA plate to the upper
surface of the dressing (Table 1). The buckwheat and
multi floral honey impregnated dressings allowed some
translocation of bacteria from the surface of the plate to the
upper surface of the dressings, indicating these dressings
were not such an effective barrier (Table 1). The Pseudomonas
aeruginosa penetrated through to the upper surface
of all the dressings (Table 1). This experiment showed
that mode of action was mainly bacteriostatic, dressings
which had shown large zones of inhibition all allowed
growth of organisms from the underside of the dressing
once transferred onto fresh agar plates (Figure 3). The
exception to this was Leptospermum honey impregnated
calcium alginate number two which did not give rise to
any colonies once transferred onto fresh plates, it therefore
demonstrated a bactericidal mode of action against
S. aureus (Figure 4) and (Table 2).
DISCUSSION
Health care associated infections continue to be a major
problem in the health care environment, especially with
an increase in the prevalence of antibiotic resistance. These
infections can lead to delayed healing and increased morbidity,
higher hospital costs and increased risk of spread
of infection.
References:
1. Cutting, K. F. (2007). “Honey and Contemporary
Wound Care: An Overview.” Ostomy Wound Management
53(11): 49-54.
2. Al-Waili, N. S. and K. Y. Saloom (2004). “Topical
honey application vs acyclovir for the treatment of
recurrent herpes simplex leisons.” Medical Science
Monitor 10(8): mt94-98.
3. Cooper RA, Molan PC, Harding KG (1999). “Antibacterial
activity of honey against strains of Staphylococcus
aureus from infected wounds.” Journal of the
Royal Society of Medicine 92(6): 283-285.
4. Cooper R A, Molan PC, Harding KG (2002). “The
sensitivity to honey of Gram-positive cocci of clinical
significance isolated from wounds.” J Appl Microbiol
93(5): 857-63.
5. Willix D J, Molan PC, Harfoot CG. (1992). “A comparison
of the sensitivity of wound-infecting species of
bacteria to the antibacterial activity of manuka honey
and other honey.” J Appl Bacteriol 73(5): 388-94.
6. Simon, A., K. Traynor, et al. (2008). “Medical Honey
for Wound Care – Still the ‘Latest Resort’?” eCAM
Advance Access: 1-9.
14
7. Gethin, G. and S. Cowman (2008). “Case series of
uses of Manuka honey in leg ulceration.” International
Wound Journal 2(1): 10-15.
8. Weyden, V. D. (2003). “The use of honey for the
treatment of two patients with pressure ulcers.” British
Journal of Community Nursing 8(12): S14-20.
9. Thomas, S. and P. McCubbin (2003). “A comparison
of the antimicrobial effects of four silver-containing
dressings on three organisms.” Journal of Wound
Care 12(3): 101-107.
10. Bogdanov S, Ruoff K, Oddo LP. (2004). “Physicochemical
methods for the characterisation of unifloral
honeys: a review.” Apidologie 35: S4-S17.
11. Thomas, S. and P. McCubbin (2003). “An in vitro
analysis of the antimicrobial pro perties of 10 silvercontaining
dressings.” Journal of Wound Care 12(8):
305-308.
12. Edwards-Jones, V. (2006). “Antimicrobial and barrier
effects of silver against methicillin resistant Staphylococcus
aureus.” Journal of Wound Care 15(7):
285-290.
This in vitro study was designed to allow comparison
of efficacy between the selected dressings as antibacterial
devices and barriers.
The results of this study demonstrate that all of the
Leptospermum honey impregnated dressings possessed sufficient
antimicrobial activity to inhibit the growth of all the
organisms tested. This result is not surprising in view of the
known broad spectrum activity of Leptospermum honey.
The lack of zones of inhibition from the buckwheat and
the multi floral honey impregnated dressings reinforces the
importance of selecting the appropriate dressing for each
wound individually. Not all honey impregnated dressings
make antibacterial claims, and have greater potential for
stimulating healing rather than having antiseptic properties.
The importance of careful dressing choice is again emphasized
by the results of the barrier test; the Leptospermum
honey impregnated tulle gave large zones of inhibition
similar to those of the alginates, however only the alginates
prevented migration of the staphylococci through the
dressing therefore making honey impregnated alginates a
more appropriate dressing if trying to prevent the spread
of antibiotic resistant staphylococci into the environment
or between individuals 12 . There could be several reasons
why the other three dressings did not provide a barrier:
the concentration of honey within the dressings may
have been low, the antibacterial activity of the honey may
have been too low, and the dispersal of honey within the
dressings may have been inconsistent. In the case of the
motile bacteria they could have penetrated from around
the edges in.
The methods described here using zone of inhibition
and barrier tests gave us semi quantifiable data (no kill
rates) but allowed us to see that the honey impregnated
dressings had differing modes of action on the bacteria
tested 13 . Both bactericidal and bacteriostatic modes of
action were observed, this again is probably due to the
differing formulations and concentration of honey used
within the dressings.
13. Thorn, R. M. S., J. Greenman, et al. (2005). “In
vitro method to assess the antimicrobial activity and
potential efficacy of novel types of wound dressings.”
Journal of Applied Microbiology 99: 895-901.
14. Holland, K. T. and W. Davis (1985). “A note on an in
vitro test system to compare the bactericidal properties
of wound dressings.” J. Appl. Bact 59: 61-63.
15. Cooper, R. A. (2007). “Iodine revisited.” International
Wound Journal 4: 124-137.
16. Cooper, R. A. (2008). “Using honey to inhibit wound
pathogens.” Nursing Times 104(3): 46-49.
17. Molan, P. and J. A. Betts (2004). “Clinical usage of
honey as a wound dressing: an update.” Journal of
Wound Care 13(9): 353-356.
18. Maeda, Y., A. Loughrey, et al. (2008). “Antibacterial
activity of honey against community-associated methicillin-resistant
Staphylococcus aureus (CA-MRSA).”
Complementary Therapies in Clinical Practice 14:
77-82.
EWMA Journal 2008 vol 8 no 3