Efficacy of sodium hypochlorite in overcoming antimicrobial resistance and eradicating biofilms in clinical pathogens from pressure ulcers

Giorgia Fabrizio1 , Francesca Sivori2 , Ilaria Cavallo2 ,

Mauro Truglio2 , Luigi Toma3 , Francesca Sperati4 ,

Massimo Francalancia2 , Francisco Obregon2 , Luisa Pamparau2 ,

Daniela Kovacs5 , Fulvia Pimpinelli2 * and Enea Gino Di Domenico1 *

¹Department of Biology and Biotechnology "C. Darwin", Sapienza University of Rome, Rome, Italy,

²Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy, ³Medical

Directorate, IRCCS Regina Elena National Cancer Institute, Rome, Italy, ⁴UOSD Clinical Trial Center,

Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy,

⁵Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy

Sodium hypochlorite (NaOCl) is widely recognized for its broad-spectrum antimicrobial efficacy in skin wound care. This study investigates the effectiveness of NaOCl against a range of bacterial and fungal isolates from pressure ulcer (PU) patients. We analyzed 20 bacterial isolates from PU patients, comprising carbapenem resistant Klebsiella pneumoniae (CRKP), multidrug-resistant Acinetobacter baumannii (MDRAB), methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible Staphylococcus aureus (MSSA), along with 5 Candida albicans isolates. Antibiotic resistance profiles were determined using standard susceptibility testing. Whole-genome sequencing (WGS) was employed to identify antimicrobial resistance genes (ARGs) and disinfectant resistance genes (DRGs). Genetic determinants of biofilm formation were also assessed. The antimicrobial activity of NaOCl was evaluated by determining the minimum inhibitory concentration (MIC) and the minimal biofilm eradication concentration (MBEC) for both planktonic and biofilm-associated cells. CRKP and MDRAB showed resistance to fluoroquinolones and carbapenems, while MRSA exhibited resistance to β-lactams and levofloxacin. MSSA displayed a comparatively lower resistance profile. WGS identified significant numbers of ARGs in CRKP and MDRAB, with fewer DRGs compared to MRSA and MSSA. All isolates possessed genes associated with fimbriae production and adhesion, correlating with pronounced biofilm biomass production. NaOCl demonstrated substantial antimicrobial activity against both planktonic cells and biofilms. The MIC90 for planktonic bacterial cells was 0.125  mg/mL, and the MBEC90 ranged from 0.225 to 0.5  mg/mL. For planktonic C. albicans, the MIC90 was 0.150  mg/ mL, and the MBEC90 was 0.250  mg/mL. These results highlight the challenge in treating biofilm-associated infections and underscore the potential of NaOCl as a robust antimicrobial agent against difficult-to-treat biofilm infections at concentrations lower than those typically found in commercial disinfectants.

KEYWORDS

NaOCl, biofilm, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Candida albicans, sodium hypochlorite solution, skin, ESKAPE

Periprocedural Use of Hypochlorous Acid Mist for Improving Healing and Cosmesis of the Face After Laser

Marianna Blyumin-Karasik¹ | Jessica Colon² | Sophie Gaer¹ | Isabella Vigil¹ | Sylvie Nguyen² | Jordan Rosen¹

¹Precision Skin & Body Institute, Davie, Florida, USA | ²Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, Florida, USA

Correspondence: Marianna Blyumin-Karasik (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)

Received: 12 May 2025 | Revised: 7 August 2025 | Accepted: 12 August 2025

Funding: The authors received no specific funding for this work.

Keywords: aesthetic | cosmeceuticals | hypochlorous acid | integrated skincare | laser treatment | photoaging | resurfacing laser

ABSTRACT

Background: Laser resurfacing treatments have revolutionized dermatological procedures by improving skin texture, tone, and quality. Effective periprocedural care remains essential to reduce side effects, support healing, and optimize aesthetic outcomes. Hypochlorous acid (HOCl), a naturally occurring oxidant with anti-inflammatory and antimicrobial properties, has demonstrated efficacy in promoting wound healing and minimizing scarring.

Aim: To evaluate the use of stabilized HOCl mist in the periprocedural care of patients undergoing laser resurfacing.

Methods: Ten patients underwent treatment with UltraClear, CO2RE, and/or GentleMax Pro laser devices. Stabilized HOCl mist was applied before and after the procedure, with continued application twice daily for 1week posttreatment. Follow-up assessments at 1–3weeks and 1–3months post-procedure included clinical photography, tolerability evaluation, and aesthetic outcome assessment. Outcomes measured included Clinician Erythema Assessment (CEA), 4-point Edema Scale, Investigator Global Assessment of Pigmentation Scale (IPA), and Global Aesthetic Improvement Scale (GAIS). Statistical analysis was performed using the Friedman and Wilcoxon signed-rank tests.

Results: HOCl mist was associated with accelerated recovery, including a noticeable reduction in erythema and pigmentation. Statistically significant improvements were observed in CEA (p=0.007) and IPA (p=0.012) scores, indicating reduced clinical severity and pigment alteration. Edema and GAIS scores showed no statistically significant change.

Conclusion: Stabilized HOCl mist is well-tolerated and may significantly aid post-procedural recovery by minimizing side effects and reducing discomfort. Results support the potential role of stabilized HOCl mist as a beneficial adjunct in post-laser  skincare, contributing to faster healing, reduced inflammation, and enhanced cosmetic results.

Cortical-blood vessel assembloids exhibit Alzheimer’s disease phenotypes by activating glia after SARS-CoV-2 infection

Dasom Kong^1,4, Ki Hoon Park^2,4, Da-Hyun Kim¹ , Nam Gyo Kim¹ , Seung-Eun Lee¹ , Nari Shin¹ , Myung Geun Kook¹ ,

Young Bong Kim^3✉ and Kyung-Sun Kang ^1✉

© The Author(s) 2023

A correlation between COVID-19 and Alzheimer’s disease (AD) has been proposed recently. Although the number of case reports on neuroinflammation in COVID-19 patients has increased, studies of SARS-CoV-2 neurotrophic pathology using brain organoids have

restricted recapitulation of those phenotypes due to insufficiency of immune cells and absence of vasculature. Cerebral pericytes and endothelial cells, the major components of blood-brain barrier, express viral entry receptors for SARS-CoV-2 and response to

systemic inflammation including direct cell death. To overcome the limitations, we developed cortical-blood vessel assembloids by fusing cortical organoid with blood vessel organoid to provide vasculature to brain organoids a nd obtained the characteristics of increased expression of microglia and astrocytes in brain organoids. Furthermore, we observed AD pathologies, including β-amyloid plaques, which were affected by the inflammatory response from SARS-CoV-2 infection. These findings provide an advanced platform to investigate human neurotrophic diseases, including COVID-19, and suggest that neuroinflammation caused by viral infection facilitates AD pathology.

Cell Death Discovery (2023) 9:32 ; https://doi.org/10.1038/s41420-022-01288-8

An Acid-Oxidising Solution Containing Hypochlorous Acid Reduces Staphylococcus aureus and Improves Bacterial Diversity in Epidermolysis Bullosa Wounds

Xiaolong A. Zhou1 | Michael B. Burns2 | Ziyou Ren1 | Elise Stagaman2 | Stefan J. Green3 | Lok Yiu Ashley Wu3 |

Lynna Yang1 | Stephanie Rangel1 | Lydia Rabbaa1 | Amy S. Paller¹

¹Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA | 2Department of Biology, Loyola University

Chicago, Chicago, Illinois, USA | 3Genomics and Microbiome Core Facility, Rush University Medical Center, Chicago, Illinois, USA

Correspondence: Amy S. Paller (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。)

Received: 6 February 2025 | Revised: 6 June 2025 | Accepted: 3 August 2025

Funding: This work was supported by Applied Pharma Research.

Keywords: acid-oxidising solution | epidermolysis bullosa | hypochlorous acid | microbiome | Staphylococcus aureus | wounds

ABSTRACT

Epidermolysis bullosa (EB) is a group of rare genetic skin disorders characterised by skin fragility and chronic, painful wounds that are highly susceptible to bacterial infection, particularly by Staphylococcus aureus (SA). This study evaluated the efficacy of an acid-oxidising solution containing hypochlorous acid (HOCl) in reducing SA colonisation, promoting wound healing, and restoring a healthier microbiome in EB wounds. In a 12-week open-label pilot study, 15EB patients applied the HOCl-based spray (APR-TD011) daily to chronic wounds for 8weeks, with full-length 16S rRNA sequencing of wound swabs performed before, during, and after treatment. At baseline, 87% of patients were culture-positive for SA, and sequencing revealed that SA had the highest relative abundance (34%), followed by Acinetobacter guillouiae and Pseudomonas poae. SA relative abundance decreased precipitously by Weeks 4 (to 11%) and 8 (primary endpoint; to 10%, p<0.01), and this effect persisted at 4weeks post-treatment (Week 12; to 9.7%), including for methicillin-resistant SA. Concurrently, bacterial diversity increased, and wound sizes diminished in correlation with reduced SA levels (r=0.64). Younger patients exhibited greater SA reduction trends. The treatment was well-tolerated, with minimal adverse effects and high patient satisfaction. This study underscores the role of microbial dysbiosis in EB wounds and highlights HOCl-based solutions as a promising therapy to mitigate pathogenic burden and enhance wound healing.

糖尿病足溃疡创面治疗专家共识(２０２４)

中华医学会内分泌学分会中国内分泌代谢病专科联盟

【提要】糖尿病足溃疡(diabetic foot ulcer,DFU)是糖尿病患者致残、致死的主因之一,致病因素复杂,严重危及生命,带来巨大的社会和经济负担。本共识专家组结合最新临床研究进展,总结我国糖尿病足溃疡的临床诊疗经验,从糖尿病足溃疡评估、整体治疗与创面修复治疗等方面形成共识,指导临床实践。

【关键词】糖尿病;糖尿病足溃疡;创面修复;创面敷料;共识

DO1:10.3760/cma.j.cn311282-20240625-00281

Expert consensus on wound treatment of diabetic foot ulcer( 2024)

Chinese Society of Edndocrinology , China Endocrinology and Metabolism Specialist Alliance

【Summary) Diabetic foot ulcer ( DFU) is one of the main causes of disability and death in diabeticpatients. This life-threatening condition arises from complex pathogenic factors , leading to substaintial societal andeconomic burdens. The expert group summarizes the latest research worldwide and the experience of clinical diagnosisand treatment of DFU in China. To guide clinical practice，the consensus forms from the aspects of evaluation,systemic treatment ,and DFU wound therapeutics.

【Key words】Diabetes mellitus;Diabetic foot ulcer; Wound healing; Wound dressing ; Consensus

DOI: 10.3760/ cma.j.cn311282-20240625-00281

腋臭微创清除术护理研究进展综述

利宝平，童 梅，林敏华

广州市海珠区妇幼保健院 广东广州

【摘要】腋臭微创清除术是当前治疗腋臭的常见方法，而专业到位的腋臭微创清除术护理，是提升手术效果、

加快患者康复进度的必要条件。本文主要对腋臭微创清除术的护理研究进展进行全面分析，重点阐明术前、术中、

术后等护理环节要点，以期为腋臭微创清除术护理实践提供相应指导依据。

【关键词】腋臭微创清除术；护理；研究进展

【收稿日期】2025 年 11 月 13 日 【出刊日期】2025 年 12 月 10 日 【DOI】10.12208/j.ijnr.20250621

A review of nursing research progress in minimally invasive surgery for axillary osmidrosis

Baoping Li, Mei Tong, Minhua Lin

Haizhu District Maternal and Child Health Care Hospital of Guangzhou, Guangzhou, Guangdong

【Abstract】Minimally invasive surgery for axillary osmidrosis is a common treatment for bromhidrosis. High-quality nursing care plays a crucial role in improving surgical outcomes and promoting patient recovery. This paper provides a comprehensive analysis of research progress in nursing care for minimally invasive axillary osmidrosis surgery, with a focus on preoperative, intraoperative, and postoperative nursing. The aim is to offer practical guidance for clinical nursing practice in this field.

【Keywords】Minimally invasive surgery for axillary osmidrosis; Nursing; Research progress