Real-World Experience of Anacaulase-bcdb Debridement in Burns

Enzymatic debridement with anacaulase-bcdb was approved by the US Food and Drug Administration in 2023. The purpose of this study is to compare outcomes from our first cohort of patients treated with this novel enzymatic agent. We compared patients treated with anacaulase-bcdb at our burn center from November 2023 to August 2024 to a 1:1 matched control group. Demographic, clinical, and photographic data were collected to ensure appropriate matching. Outcomes included: hospital length of stay, number of surgeries, time to first surgery, autograft size, total opioid and benzodiazepines received for wound care over the first 5 days, pain/sedation scores during wound care, time to wound closure, and readmission data. Descriptive statistics were used to assess anacaulase-bcdb treatment practices, while non-parametric tests were used for all comparisons. 13 patients treated with anacaulase-bcdb were identified. Median (interquartile range) cohort age, total body surface area, and mechanism of injury were 46 years (33.5, 59.5), 4.5% (2, 10.2), and flame (46.2%). No baseline differences were identified between groups. Anacaulase-bcdb was used before day 3 with regional anesthesia in all but 2 cases and successful eschar removal in 12 patients (92%). Patients treated with anacaulase-bcdb had a shorter time to first surgery from admission (4 days [3, 5] vs 6 [5, 7], P = .017) and higher average maximum wound care pain scores during the first 5 days (7 [6, 8] vs 5 [3, 7], P = .047). There was no difference in length of stay, area grafted, number of surgeries, total opioids/benzodiazepines received, or sedation scores.