Hyperbaric oxygen therapy: Antimicrobial mechanisms and clinical application for infections

Review: Hyperbaric oxygen therapy: Antimicrobial mechanisms and clinical application for infections

Mohammad Yousef Memara,^b, Mina Yekania,^c, Naser Alizadehd,^e, Hossein Bannazadeh Baghia,^b,e,⁎

^a Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

^b Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

^c Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

^d Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

^e Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

Reviews hyperbaric oxygen therapy's antimicrobial mechanisms and clinical applications for treating infections. ​

Hyperbaric Oxygen Therapy (HBOT) ​

• HBOT involves breathing 100% oxygen under pressure, enhancing oxygen delivery to tissues. ​
• It is used as a primary or alternative treatment for various infections, especially those caused by antibiotic-resistant pathogens.
• The therapy can significantly increase oxygen levels in blood, aiding in healing and reducing inflammation. ​

Clinical Applications of HBOT in Infections ​

• HBOT is effective for diabetic foot infections (DFIs), with a 78.3% increase in healing rates reported after 10 sessions. ​
• It is beneficial for necrotizing soft tissue infections (NSTIs), although studies are limited; retrospective studies suggest reduced mortality rates.
• Surgical site infections (SSIs) can be reduced with HBOT, particularly in high-risk surgeries, improving wound healing and reducing infection rates. ​
• For thermal burns, HBOT may lead to faster healing and reduced hospitalization, though results are mixed across studies. ​
• Osteomyelitis treatment shows improved outcomes with HBOT, especially in chronic cases, enhancing antibiotic effectiveness and promoting healing. ​

Antimicrobial Effects of HBOT ​

• HBOT exhibits direct bactericidal/bacteriostatic effects through the formation of reactive oxygen species (ROS). ​
• It enhances immune system functions, reducing inflammation and promoting healing by modulating cytokine expression. ​
• The therapy can have additive or synergistic effects with certain antibiotics, improving their efficacy against resistant bacteria. ​

Conclusion

• HBOT is a promising treatment for infections, particularly in the context of rising antibiotic resistance, with a favorable safety profile when guideline is followed.