Finding the Sweet Spot for Treating Pressure Ulcers with Clostridial Collagenase Ointment: Results from the U.S. Wound Registry

Objectives: The objective of this study was to assess the clinical effectiveness of enzymatic debridement with clostridial collagenase ointment (CCO) as an adjunct therapy to sharp debridement compared to sharp debridement alone for the management of PU in the hospital outpatient department setting.

Methods: Using datasets from the U.S. Wound Registry from 2007-2013 at the patient, wound, and visit encounter levels, 3,594 PU received CCO and 16,745 PU did not. Applying sharp debridement criteria and propensity score matching resulted in 1074 wounds belonging to each group. Propensity score results showed that characteristics of the group were reasonably matched.

Results: Mean patient age was 67-69 years. The majority of the PU were stage III (56-59%) with stage IV wounds being the next most common. When PU were analyzed by PU stage, it was found that the proportion of wounds closed at any time (e.g., at 1 year or 2 years) was double for stage IV PU who received CCO compared to those not treated with CCO. Furthermore, Kaplan-Meier analysis showed that time to wound closure at 1 year was significantly faster (and clinically meaningful) for PU treated with CCO versus PU not treated with CCO. When groups were matched by number of CCO applications versus number of debridements (no CCO) when the number was ≥ 5 (i.e., 5 or more CCO applications, or 5 or more debridements and no CCO) the proportion of PU closed at 1 or 2 years was significantly different with more CCO–treated PU being closed than non-CCO–treated PU.

Conclusion: CCO as an adjunct therapy to sharp debridement yielded better clinical outcomes, providing faster rates of closure for the treatment of stage IV PU relative to sharp debridement alone. Healthcare providers should consider CCO as an effective adjunct therapy to sharp debridement.