The subject of Pseudomonas overgrowth/wound infection comes up often in our patient population. Acetic Acid is an effective treatment for many of these cases and can prevent the need for antibiotics, with their attendant costs and potential complications. Below, find a billet point summary of one of the many papers on this topic. One thing I want to highlight is that the duration of Acetic Acid treatment can be very short.

I sometimes see clinicians continuing antiseptic regimens like this much longer than needed. There are many downsides to this, including the fact that, while Acetic Acid does kill Pseudomonas, any regimen involving liquid-soaked gauze is going to potentially damage peri-wound skin due to excessive moisture and basically functions as a wet-to-dry dressing on the wound bed, which as Wound Care Consultants, we know to be an inefficient and outmoded treatment. So, by all means, use Acetic Acid-soaked gauze as an effective anti-pseudomonal strategy, but only for 4-5 days. That’s all it takes. You get all the benefits but minimize the disadvantages.

Madhusudhan VL. Efficacy of 1% acetic acid in the treatment of chronic wounds infected with Pseudomonas aeruginosa: prospective randomized controlled clinical trial. Int Wound K. 2016 Dec;13(6):1129-1136. doi: 10.111/iwj.12428. Epud 2015 Apr 8. PMID: 25851059; PMCID: PMC7949569.

SUMMARY:

• Topical agents minimize the risk of microorganism resistance.
• Pseudomonas aeruginosa is a Gram-negative pathogen resistant to many antibiotics, a significant issue in economically disadvantaged areas.
• Dilute acetic aid, being affordable and readily available, proves effective for chronic wounds.
• This 6-month prospective study tested 1% acetic acid’s efficacy against P. aeruginosa in chronic wounds, with a control group using saline.
• Twice daily dressings were applied, aiming for wounds free of ). aeruginosa
• Acetic acid cleared P. aeruginosa on average 7 days faster than nsaline, with a P value <0.001.
• In the acetic acid group, Pseudomonas was eliminated in 4.5 days regardless of antibiotic sensitivity.
• In the saline group, susceptible strains took 11.5 days to clear, while multidrug-resistant strains took 15.5 days.
• 1% acetic acid is an effective, safe, and simple antiseptic for eliminating O. aeruginosa from chronic wounds.

Marcus Gitterie, MD, FACCWS
Chief Medical Officer