Antimicrobial Activity of Cold Atmospheric Plasma on Bacterial Strains Derived from Patients with Diabetic Foot Ulcers

Bacterial infections or their biofilms in diabetic foot ulcer (DFU) are a key cause of drug-resistant wounds and amputations. Cold atmospheric plasma (CAP) is well documented for its antibacterial effect and promoting wound healing. In the current study, we built an argon-based, custom CAP device and investigated its potential in eliminating laboratory and clinical bacterial strains derived from DFU. The CAP device performed as expected with generation of hydroxyl, reactive nitrogen species, and argon species as determined by optical emission spectroscopy. A dose-dependent increase in oxidation reduction potential (ORP) and nitrites in the liquid phase was observed. The CAP treatment eliminated both gram-positive (<i>Staphylococcus aureus</i>, <i>Entrococcus faecalis</i>) and negative bacteria (<i>Pseudomonas aeruginosa</i>, <i>Proteus mirabilis</i>) laboratory strains. Clinical samples collected from DFU patients exhibited a significant decrease in both types of bacteria, with gram-positive strains showing higher susceptibility to the CAP treatment in an ex vivo setting. Moreover, exposure to CAP of polymicrobial biofilms from DFU led to a notable disruption in biofilm and an increase in free bacterial DNA. The duration of CAP exposure used in the current study did not induce DNA damage in peripheral blood lymphocytes. These results suggest that CAP could serve as an excellent tool in treating patients with DFUs.