{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T15:50:20Z","timestamp":1788018620664,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This proof\u2010of\u2010concept study sought to determine the effects of standard of care (SOC) and a topically applied concentrated surfactant gel (SG) on the total microbial load, community composition, and community diversity in non\u2010healing diabetic foot ulcers (DFUs) with chronic biofilm infections. SOC was provided in addition to a topical concentrated SG, applied every 2\u2009days for 6\u2009weeks. Wound swabs were obtained from the base of ulcers at baseline (week\u20020), week 1, mid\u2010point (week 3), and end of treatment (week 6). DNA sequencing and real\u2010time quantitative polymerase chain reaction (qPCR) were employed to determine the total microbial load, community composition, and diversity of patient samples. Tissue specimens were obtained at baseline and scanning electron microscopy and peptide nucleic acid fluorescent in situ hybridisation with confocal laser scanning microscopy were used to confirm the presence of biofilm in all 10 DFUs with suspected chronic biofilm infections. The application of SG resulted in 7 of 10 samples achieving a reduction in mean log10 total microbial load from baseline to end of treatment (0.8\u2009Log10 16S copies, \u00b10.6), and 3 of 10 samples demonstrated an increase in mean Log10 total microbial load (0.6 log10 16S copies, \u00b10.8) from baseline to end of treatment. Composition changes in microbial communities were driven by changes to the most dominant bacteria. <jats:italic>Corynebacterium<\/jats:italic> sp. and <jats:italic>Streptococcus<\/jats:italic> sp. frequently reduced in relative abundance in patient samples from week 0 to week 6 but did not disappear. In contrast, <jats:italic>Staphylococcus<\/jats:italic> sp., <jats:italic>Finegoldia<\/jats:italic> sp., and <jats:italic>Fusobacterium<\/jats:italic> sp., relative abundances frequently increased in patient samples from week 0 to week 6. The application of a concentrated SG resulted in varying shifts to diversity (increase or decrease) between week 0 and week 6 samples at the individual patient level. Any shifts in community diversity were independent to changes in the total microbial loads. SOC and a topical concentrated SG directly affect the microbial loads and community composition of DFUs with chronic biofilm infections.<\/jats:p>","DOI":"10.1111\/iwj.13546","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T20:27:03Z","timestamp":1611260823000},"page":"457-466","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Efficacy of a topical concentrated surfactant gel on microbial communities in non\u2010healing diabetic foot ulcers with chronic biofilm infections: A proof\u2010of\u2010concept study"],"prefix":"10.1111","volume":"18","author":[{"given":"Matthew","family":"Malone","sequence":"first","affiliation":[{"name":"South West Sydney Limb Preservation and Wound Research South West Sydney Local Health District  Sydney Australia"},{"name":"High Risk Foot Service, Liverpool Hospital South West Sydney LHD  Sydney Australia"},{"name":"Infectious Diseases and 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