Non-healing wounds are usually colonised by various types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical-grade honey (MGH), which favourably affects the healing process with its antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory properties. The objective of this study was to evaluate the effect of MGH therapy on the healing process of non-healing wounds of various aetiologies and different wound colonisations. Prospective, observation-intervention case studies (n = 9) of patients with wounds of various aetiologies (venous leg ulcers, diabetic foot ulcers, surgical wound dehiscence) are presented. All wounds were treated with MGH and the healing trajectory was rigorously and objectively monitored. In all cases, pain, odour, and exudation were quickly resolved, which led to an improvement in the quality of life of patients. Despite the proven bacterial microflora in wounds, antibiotic treatment was not necessary. The effects of MGH alleviated the signs of local infection until their complete elimination. In eight out of nine cases, the non-healing wound was completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in wounds of various aetiologies and forms an effective alternative for the use of antibiotics for treating locally infected wounds.

Department of Health Sciences College of Polytechnics Jihlava 586 01 Jihlava Czech Republic

Department of Nursing and Midwifery Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

DiaPodi Care spol s r o 392 01 Soběslav Czech Republic

Faculty of Health and Social Sciences University of Bohemia 370 11 České Budějovice Czech Republic

Triticum Exploitatie BV 6222 NK Maastricht The Netherlands

See more in PubMed

World Union of Wound Healing Societies (WUWHS) Florence Congress, Position Document. Advance in Wound Care: The Triangle of Wound Assessment. [(accessed on 27 July 2020)];Wounds Int. 2016 Available online: https://www.coloplast.sg/Documents/Wound/WUWHS_POSITION%20DOCUMENT.pdf.

Pokorna A., Benesova K., Muzik J., Jarkovsky J., Dusek L. Data Sources for Monitoring of Non-healing Wounds in a National Heal Information System—Epidemiology of Non-healing Wounds Analysis of the National Register of Hospitalized Patients in 2007–2015. Cesk. Slov. Neurol. 2017;80:8–17. doi: 10.14735/amcsnn2017S8. DOI

Deufert D., Graml R. Disease-specific, health-related quality of life (HRQoL) of people with chronic wounds—A descriptive cross-sectional study using the Wound-QoL. Wound Med. 2017;16:29–33. doi: 10.1016/j.wndm.2017.01.006. DOI

Krupova L., Pokorna A. Quality of life in patient with non-healing wounds, with particular focus on assesment tools-a literature review. Cent. Eur. J. Nurs. Midwifery. 2020;11:94–103. doi: 10.15452/cejnm.2020.11.0010. DOI

Woo K.Y., Krasner D.L., Kennedy B., Wardle D., Moir O. Palliative wound care management strategies for palliative patients and their circles of care. Adv. Skiin Wound Care. 2015;28:130–140. doi: 10.1097/01.ASW.0000461116.13218.43. quiz 140–132. PubMed DOI

Gray L. Standardising accurate wound assessment and documentation. J. Community Nurs. 2020;34:14.

McGuckin K.R., IMI National Guidelines A Guide to Good Practice Wound Management Photography Institute of Medical Illustrators. [(accessed on 10 May 2021)];2019 Available online: https://www.imi.org.uk/wp-content/uploads/2019/04/2019_Apr_IMINatGuidelines_Wound-Management.pdf.

Anghel E.L., Kumar A., Bigham T.E., Maselli K.M., Steinberg J.S., Evans K.K., Kim P.J., Attinger C.E. The Reliability of a Novel Mobile 3-dimensional Wound Measurement Device. Wounds. 2016;28:379–386. PubMed

Pokorna A., Leaper D. Assessment and documentation of non-healing, chronic wounds in inpatient health care facilities in the Czech Republic: An evaluation study. Int. Wound J. 2015;12:224–231. doi: 10.1111/iwj.12372. PubMed DOI PMC

Schreml S., Szeimies R.M., Prantl L., Karrer S., Landthaler M., Babilas P. Oxygen in acute and chronic wound healing. Br. J. Derm. 2010;163:257–268. doi: 10.1111/j.1365-2133.2010.09804.x. PubMed DOI

Guo S., Dipietro L.A. Factors affecting wound healing. J. Dent. Res. 2010;89:219–229. doi: 10.1177/0022034509359125. PubMed DOI PMC

Dowsett C., Hallern B. The Triangle of Wound Assessment: A holistic framework from wound assessment to management goals and treatments. Wounds Int. 2017;8:34–39.

Cremers N., Belas A., Santos Costa S., Couto I., de Rooster H., Pomba C. In vitro antimicrobial efficacy of two medical grade honey formulations against common high-risk meticillin-resistant staphylococci and Pseudomonas spp. pathogens. Vet. Derm. 2020;31:90–96. doi: 10.1111/vde.12811. PubMed DOI

Smaropoulos E., Cremers N.A.J. Treating severe wounds in pediatrics with medical grade honey: A case series. Clin. Case Rep. 2020;8:469–476. doi: 10.1002/ccr3.2691. PubMed DOI PMC

Bianchi T., Wolcott R.D., Peghetti A., Leaper D., Cutting K., Polignano R., Rosa Rita Z., Moscatelli A., Greco A., Romanelli M., et al. Recommendations for the management of biofilm: A consensus document. J. Wound Care. 2016;25:305–317. doi: 10.12968/jowc.2016.25.6.305. PubMed DOI

Sibbald R.G., Williamson D., Orsted H.L., Campbell K., Keast D., Krasner D., Sibbald D. Preparing the wound bed--debridement, bacterial balance, and moisture balance. Ostomy Wound Manag. 2000;46:14–22. PubMed

Strohal R., Dissemond J., Jordan O’Brien J., Piaggesi A., Rimdeika R., Young T., Apelqvist J. EWMA document: Debridement. An updated overview and clarification of the principle role of debridement. J. Wound Care. 2013;22:5. doi: 10.12968/jowc.2013.22.Sup1.S1. PubMed DOI

Lumbers M. Wound debridement: Choices and practice. Br. J. Nurs. 2018;27:S16–S20. doi: 10.12968/bjon.2018.27.15.S16. PubMed DOI

Stryja J. The Importance and Limits of the Pressure Ulcer Surgical Debridement. Česká A Slov. Neurol. A Neurochir. 2016;79:S25–S27. doi: 10.14735/amcsnn2016S25. DOI

Manna B., Nahirniak P., Morrison C.A. StatPearls [Online] StatPearls Publishing; Treasure Island, FL, USA: 2021. [(accessed on 10 June 2021)]. Wound Debridement. Available online: https://www.ncbi.nlm.nih.gov/books/NBK507882/ PubMed

Nair H.K.R., Tatavilis N., Pospisilova I., Kucerova J., Cremers N.A.J. Medical-Grade Honey Kills Antibiotic-Resistant Bacteria and Prevents Amputation in Diabetics with Infected Ulcers: A Prospective Case Series. Antibiotics. 2020;9:529. doi: 10.3390/antibiotics9090529. PubMed DOI PMC

Hermanns R., Mateescu C., Thrasyvoulou A., Tananaki C., Wagener F.A.D.T.G., Cremers N.A.J. Defining the standards for medical grade honey. J. Apic. Res. 2020;59:125–135. doi: 10.1080/00218839.2019.1693713. DOI

Nolan V.C., Harrison J., Cox J.A.G. Dissecting the Antimicrobial Composition of Honey. Antibiotics. 2019;8:251. doi: 10.3390/antibiotics8040251. PubMed DOI PMC

Gethin G., Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: An RCT. J. Wound Care. 2008;17:241–244. 246–247. doi: 10.12968/jowc.2008.17.6.29583. PubMed DOI

Hermanns R., Cremers N.A.J., Leeming J.P., van der Werf E.T. Sweet Relief: Determining the Antimicrobial Activity of Medical Grade Honey Against Vaginal Isolates of Candida albicans. J. Fungi. 2019;5:85. doi: 10.3390/jof5030085. PubMed DOI PMC

Oryan A., Alemzadeh E., Moshiri A. Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis. J. Tissue Viability. 2016;25:98–118. doi: 10.1016/j.jtv.2015.12.002. PubMed DOI

Yilmaz A.C., Aygin D. Honey Dressing in Wound Treatment: A Systematic Review. Complement. Med. 2020;51:102388. doi: 10.1016/j.ctim.2020.102388. PubMed DOI

Olsson M., Jarbrink K., Divakar U., Bajpai R., Upton Z., Schmidtchen A., Car J. The humanistic and economic burden of chronic wounds: A systematic review. Wound Repair. Regen. 2019;27:114–125. doi: 10.1111/wrr.12683. PubMed DOI

Kelechi T., Prentice M., Madisetti M., Brunette G., Mueller M. Palliative Care in the Management of Pain, Odor, and Exudate in Chronic Wounds at the End of Life: A Cohort Study. J. Hosp. Palliat. Nurs. 2017;19:17–25. doi: 10.1097/NJH.0000000000000306. DOI

Lu J., Turnbull L., Burke C.M., Liu M., Carter D.A., Schlothauer R.C., Whitchurch C.B., Harry E.J. Manuka-type honeys can eradicate biofilms produced by Staphylococcus aureus strains with different biofilm-forming abilities. PeerJ. 2014;2:e326. doi: 10.7717/peerj.326. PubMed DOI PMC

Pleeging C.C.F., Coenye T., Mossialos D., De Rooster H., Chrysostomou D., Wagener F.A.D.T.G., Cremers N.A.J. Synergistic Antimicrobial Activity of Supplemented Medical-Grade Honey against Pseudomonas aeruginosa Biofilm Formation and Eradication. Antibiotics. 2020;9:866. doi: 10.3390/antibiotics9120866. PubMed DOI PMC

Biglari B., Moghaddam A., Santos K., Blaser G., Buchler A., Jansen G., Langler A., Graf N., Weiler U., Licht V., et al. Multicentre prospective observational study on professional wound care using honey (Medihoney) Int. Wound J. 2013;10:252–259. doi: 10.1111/j.1742-481X.2012.00970.x. PubMed DOI PMC

Halstead F.D., Webber M.A., Oppenheim B.A. Use of an engineered honey to eradicate preformed biofilms of important wound pathogens: An in vitro study. J. Wound Care. 2017;26:442–450. doi: 10.12968/jowc.2017.26.8.442. PubMed DOI

Wu Y.K., Cheng N.C., Cheng C.M. Biofilms in Chronic Wounds: Pathogenesis and Diagnosis. Trends Biotechnol. 2019;37:505–517. doi: 10.1016/j.tibtech.2018.10.011. PubMed DOI

Burmolle M., Thomsen T.R., Fazli M., Dige I., Christensen L., Homoe P., Tvede M., Nyvad B., Tolker-Nielsen T., Givskov M., et al. Biofilms in chronic infections—A matter of opportunity—Monospecies biofilms in multispecies infections. FEMS Immunol. Med. Microbiol. 2010;59:324–336. doi: 10.1111/j.1574-695X.2010.00714.x. PubMed DOI

Smaropoulos E., Cremers N.A.J. The pro-healing effects of medical grade honey supported by a pediatric case series. Complement. Med. 2019;45:14–18. doi: 10.1016/j.ctim.2019.05.014. PubMed DOI

Combarros-Fuertes P., Fresno J.M., Estevinho M.M., Sousa-Pimenta M., Tornadijo M.E., Estevinho L.M. Honey: Another Alternative in the Fight against Antibiotic-Resistant Bacteria? Antibiotics. 2020;9:774. doi: 10.3390/antibiotics9110774. PubMed DOI PMC

de Groot T., Janssen T., Faro D., Cremers N.A.J., Chowdhary A., Meis J.F. Antifungal Activity of a Medical-Grade Honey Formulation against Candida auris. J. Fungi. 2021;7:50. doi: 10.3390/jof7010050. PubMed DOI PMC

Smaropoulos E., Cremers N.A.J. Medical grade honey for the treatment of extravasation-induced injuries in preterm neonates—A case series. Adv. Neonatal. Care. 2020 in press. PubMed

Lu J., Cokcetin N.N., Burke C.M., Turnbull L., Liu M., Carter D.A., Whitchurch C.B., Harry E.J. Honey can inhibit and eliminate biofilms produced by Pseudomonas aeruginosa. Sci. Rep. 2019;9:18160. doi: 10.1038/s41598-019-54576-2. PubMed DOI PMC

Sochor M., Slama O. Management of chronic and acute pain in patients with cancer diseases. Klin. Onkol. 2015;28:94–98. doi: 10.14735/amko201594. PubMed DOI

Juric Vukelic D., Juric J. Hydrocolloid Dressing Application in the Treatment of Chronic Wounds and Relation to Quality of Life. Acta Clin. Croat. 2017;56:544–549. doi: 10.20471/acc.2017.56.03.22. PubMed DOI

Rosenbaum C. An overview of integrative care options for patients with chronic wounds. Ostomy Wound Manag. 2012;58:44–51. PubMed

Edwards J. Dealing with wound-related pain at dressing change. J. Community Nurs. 2013;27:36–42.

Upton D., Solowiej K., Hender C., Woodyatt K.Y. Stress and pain associated with dressing change in patients with chronic wounds. J. Wound Care. 2012;21:53–54. doi: 10.12968/jowc.2012.21.2.53. 56,58 passim. PubMed DOI

Alam F., Islam M.A., Gan S.H., Khalil M.I. Honey: A potential therapeutic agent for managing diabetic wounds. Evid. Based Complement Altern. Med. 2014;2014:169130. doi: 10.1155/2014/169130. PubMed DOI PMC

Yapucu Gunes U., Eser I. Effectiveness of a honey dressing for healing pressure ulcers. J. Wound Ostomy Cont. Nurs. 2007;34:184–190. doi: 10.1097/01.WON.0000264833.11108.35. PubMed DOI

Molan P.C. Re-introducing honey in the management of wounds and ulcers—theory and practice. Ostomy Wound Manag. 2002;48:28–40. PubMed

Labban L. Honey as a promising treatment for diabetic foot ulcers (DFU) J. Med. Soc. 2014;28:64–68. doi: 10.4103/0972-4958.141064. DOI

Angel D.E., Lloyd P., Carville K., Santamaria N. The clinical efficacy of two semi-quantitative wound-swabbing techniques in identifying the causative organism(s) in infected cutaneous wounds. Int. Wound J. 2011;8:176–185. doi: 10.1111/j.1742-481X.2010.00765.x. PubMed DOI PMC

Singhal N., Kumar M., Kanaujia P.K., Virdi J.S. MALDI-TOF mass spectrometry: An emerging technology for microbial identification and diagnosis. Front. Microbiol. 2015;6:791. doi: 10.3389/fmicb.2015.00791. PubMed DOI PMC

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