Plasma-activated water hydrogel enables effective clearance of wound-associated microbial infections

Surgical site infections are among the most common postoperative complications and remain a major global health concern, further intensified by increasing antimicrobial resistance. Plasma-activated water (PAW) has emerged as a novel antimicrobial strategy, though earlier studies suggested its activity depends on an acidic pH. To overcome this limitation, we previously developed a high-strength, neutral pH–buffered formulation (hs-PAbW) optimized for human clinical use, which preserved strong antimicrobial properties. In the present work, we created a hydrogel incorporating hs-PAbW at a bactericidal yet non-cytotoxic concentration (hs-PAbW-20) and evaluated its therapeutic performance in mouse wound models. In Balb/c mice, hs-PAbW-20 gel markedly reduced Pseudomonas aeruginosa and Staphylococcus aureus loads, demonstrating efficacy comparable to neomycin and soframycin. The gel also enhanced wound closure by regulating key genes involved in tissue repair. In a diabetic C57BL/6 model, hs-PAbW-20 gel similarly lowered P. aeruginosa burden and accelerated healing. Collectively, these results highlight hs-PAbW-20 gel as a promising next-generation wound therapy capable of addressing the shortcomings of traditional antibiotic-based treatments.