Immersion of Debrided Diabetic Foot Ulcer Tissue in Electrochemically Generated Ph Neutral Hypochlorous Acid Significantly Reduces the Microbial Bioburden: Whole-Genome Sequencing of Staphylococcus Aureus, the Most Prevalent Species Recovered.

Background: Diabetic foot ulcer infections (DFUIs) are the leading cause of lower-limb amputations, mediated predominantly by Staphylococcus aureus. pH-neutral electro-chemically generated hypochlorous acid (anolyte) is a non-toxic, microbiocidal agent with significant potential for wound disinfection.Aims: To investigate both the effectiveness of anolyte for microbial bioburden reduction in debrided ulcer tissues and the population of resident S. aureus.Methods: Fifty-one debrided tissues from 30 people with type II diabetes were aliquoted by wet weight and immersed in 1-or 10-mL volumes of anolyte (200 parts per million) or saline for 3 min. Microbial loads recovered were determined in colony forming units/g (cfu/g) of tissue following aerobic, anaerobic and staphylococcal-selective culture. Bac-terial species were identified and 50 S. aureus isolates from 30 tissues underwent whole-genome sequencing (WGS).Findings: The ulcers were predominantly superficial, lacking signs of infection (39/51, 76.5%). Of the 42/51 saline-treated tissues yielding >105 cfu/g, a microbial threshold reported to impede wound-healing, only 4/42 (9.5%) were clinically diagnosed DFUIs. Microbial loads from anolyte-treated tissues were significantly lower than saline-treated tissues using 1 mL (1065-fold, 2.0 log) and 10 mL (8216-fold, 2.1 log) immersion volumes (P<0.0005). S. aureus was the predominant species recovered (44/51, 86.3%) and 50