Oxygen and ROS Delivery for Infected Wound Healing and Future Prospects

Bacterial infection remains a primary cause of delayed wound healing. It is one of the leading causes of post-surgical hospital readmission and is a major burden on global health systems. In light of the growing threat of antibiotic resistance, improving efficacy of traditional antimicrobials, such as the broad‑spectrum oxidizing biocide hydrogen peroxide, is of growing importance. In particular, solid peroxy-compounds can offer prolonged action and sustained delivery of both oxygen and reactive oxygen species, offering both infection control and microenvironmental modulation. This review presents the current progress on antimicrobial dressings, comprehensively covering the application of solid peroxide-releasing compounds in the treatment of infected wounds for antimicrobial control and acceleration of wound healing. Calcium peroxide (CaO₂) loaded biomaterials are found to be the most studied solid peroxide in the literature (90%; 30 studies), and the average improvement in healing of these reports was 26 ± 14%. However, biomaterial formulations are often complex with multiple ingredients, and an analysis of 17 studies that included peroxide-free but otherwise complete formulations identified that the improvements in wound healing attributable to peroxide loading itself were significant, P < 0.05, in 8 of 17 studies. Additionally, infected wound healing, the potential biological roles of metal ions, strategies to control ROS/O₂ release, and the translational outlook/market readiness of peroxide materials are discussed.