SLR - November 2019 - Chandler P. Hubbard
Reference: Malekian, A., Djavid, G., Akbarzadeh, K., Soltandallal, M., Rassi, Y., Rafinejad, J., Foroushani, A., Farhoud, A., Bakhtiary, R., Totonchi, M. (2019). Efficacy of Maggot Therapy On Staphylococcus Aureus And Pseudomonas Aeruginosa In Diabetic Foot Ulcer: A Randomized Controlled Trial, Journal of Wound, Ostomy and Continence Nursing. 46(1), 25-29.Scientific Literature Review
Reviewed By: Chandler P. Hubbard, DPM
Residency Program: Chino Valley Medical Center – Chino, CA
Podiatric Relevance: The use and popularity of medical maggot therapy has made a return to the world of medicine in that the treatment of wounds with fly larvae is increasing in many countries. Maggot debridement therapy has profound efficacy in debriding necrotic tissue with relative safety, simplicity, and cost effectiveness. In the face of a world of antimicrobial resistance stands a creature of “filth” that can overcome them all. Podiatry is known for managing difficult to treat wounds due to poly-microbial environments in challenging locations that can ultimately threaten loss of limb and/or life. This study was conducted to evaluate the antimicrobial effects of medical maggots on S. aureus and P. aeruginosa on diabetic foot ulcers.
Methods: The study design was that of a randomized controlled. Fifty adult patients with one diabetic foot ulcer (Wagner stage 2 or 3) present for at least 12 weeks were selected into two groups (treatment or control). The treatment group received maggot therapy in addition to conventional treatment (sharp debridement, antibiotic therapy, offloading), while the control group received conventional treatment alone (sharp debridement, antibiotic therapy, offloading). A culture using the swab technique was collected before and immediately after each maggot application. Outcome measures included weight of dressing before and after use as well as sampling of wounds of control and treatment groups with culture swabs.
Results: Maggot therapy (MT) on the wounds of the nine cases infected with S. aureus resulted in a significant reduction after 48 hours in the treatment group as compared to the nine cases in the control group and was found to be statistically significant (P = 0.047). S. aureus among cases of the treatment group was significant after the first application of MT at two days (P = 0.031) and after the second application at four days (P = 0.0). Removing P. aeruginosa among cases in the treatment group was significant after the first application of MT at two days (P = 0.03), as well as after the second application at four days (P = 0.002). Drainage from the DFU treatment group was 152.2±41.4g, and in the control group was 50.6±18.8g, which was shown to be statistically significant (P<0.0).
Conclusions: The most obvious benefit of maggot therapy is the ability of medical maggots to effectively debride wounds by removing necrotic and non-viable tissues in a micro-surgical manner; this is performed and completed in a chemical and mechanical manner that can only be done on a microscopic level. Virtually all wounds are amenable to this treatment. Though some find this therapy to be displeasing, research has found it to be the physician and staff themselves that are most uncomfortable with the procedure than the patients themselves. The FDA has regulated the production of medical maggots in the United States and thus it is an accepted treatment for numerous pathologies including: pressure ulcers, venous stasis, neuropathic wounds, and trauma or post-surgical infections.