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Effect of a Silver Ion Containing Wound Dressing* on the Bacterial Burden of Chronic Venous Ulcers
Abstract
This is an interim report evaluating the effectiveness of a silver ion containing wound dressing* and
The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds.
Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking.
Systematic review and meta-analysis.
A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950-June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed.
Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI(95): 0.16-0.39, p < 0.001), reduced odour (CI(95): 0.24-0.52, p < 0.001) and pain-related symptoms (CI(95): 0.18-0.47, p < 0.001), decreased wound exudates (CI(95): 0.17-0.44, p < 0.001) and had a prolonged dressing wear time (CI(95): 0.19-0.48, p = 0.028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI(95): 0.04-0.33, p = 0.013) using silver dressings in wound management with no associated severe adverse events.
This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients' quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further.
The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds.
People with chronic wounds such as foot ulcers and leg ulcers and acute wounds such as surgical wounds often find their wound becomes infected. Healing the wound can be delayed by the amount of bacteria on the wound surface. Wound care involves frequent dressing changes. Silver is an antimicrobial and dressings which contain silver have been developed. The authors of this Cochrane review wanted to find evidence on whether silver based dressings reduced infection and encouraged wound healing. Three studies looking at people with chronic wounds were included in the review and found that silver-containing foam dressings did not result in faster wound healing after up to four weeks of follow-up. One study did find that the overall size of the ulcer reduced more quickly when dressed with a silver-containing foam. There is no enough evidence to recommend the use of silver-containing dressings or topical agents for treating infected or contaminated chronic wounds.
Biopsy of infected decubitus ulcers for culture disrupts tissues and may disseminate infection. Antimicrobial prophylaxis to prevent dissemination of infection may adversely affect biopsy culture results. Irrigation-aspiration to obtain submarginal specimens from draining decubitus ulcers was studied as an atraumatic, noninvasive culturing technique to serve as an alternative to biopsy in research activities. Two aspirates were obtained serially from 32 subjects; in 12 subjects, biopsies were also performed immediately. A median of 4.5 bacterial species was recovered per ulcer by irrigation-aspiration. Recent antimicrobial treatment had no evident effect on the recovery of bacterial species in general or, specifically, on the recovery of Bacteroides species. Concordance of results for both aspirates was 97.6% for aerobes and 91.8% for anaerobes, indicating no interactive methodological effect of the first irrigation-aspiration on the second. Compared with biopsy isolates for one aspirate, the sensitivity was 93% and the specificity was 99.0%; for another aspirate, the sensitivity was 94.7% and the specificity was 99.5%. The positive predictive value for either aspirate was greater than or equal to 93.9%. A weighted clinical index to score inflammatory ulcer characteristics was devised (score range, 0 to 15). In the absence of anaerobes in 15 subjects, the mean score was 6.1 +/- 3.5; in the presence of anaerobes in 17 subjects, the mean score was 9.4 +/- 3.2 (P = 0.008). The presence of aerobic gram-positive or gram-negative species did not significantly affect scores. Irrigation-aspiration for culture and clinical scoring of inflammation should permit independent serial measures of bacteriological and clinical courses of draining decubitus ulcers without patient risk or discomfort.
AFTER thermal burns local and systemic infection, especially with Pseudomonas aeruginosa , is a major cause of death. The use of soluble sodium sulfonamides in wounds and burns was investigated during World War II, 1 and in studies of extensive burns, 2 topical antibacterial therapy was combined with treatment for the burn wound by using a neutralized mixture of tannic acid and sodium sulfadiazine. Although the results were good, emphasis shifted to the role of sodium salts in systemic therapy in an era of disbelief in the efficacy of local antibacterial therapy. As predicted in 1952 by Meleney, 3 there is now a renaissance of topical antibacterial therapy with the introduction of dilute silver nitrate solutions 4 and mafenide-containing ointments. 5 Both agents are effective in burn wound sepsis, especially that caused by P aeruginosa , but both also produce characteristic fluid and electrolyte alterations. The hypotonic (29.4 millimol/liter) silver nitrate solution
Isolates (657) representing 22 bacterial species were tested for susceptibility to silver sulfadiazine. All of the strains
tested were inhibited by concentration levels of the drug which are easily achieved topically. It is suggested that silver
sulfadiazine may be useful as a broad-spectrum antimicrobial substance for the prevention and treatment of infections of burns
and wounds.
Medical applications of monomolecular films of silver
- G Colmano
Colmano, G., Medical applications of monomolecular films of silver, gold and other metals.
International Conference on Gold and Silver in Medicine. Bethesda, MD., May 13-14, 1987
Silver and its Compounds in: Disinfection, Sterilization and Preservation
- N Grier
Grier, N. Silver and its Compounds in: Disinfection, Sterilization and Preservation, ed. SS Block,
Lea and Febiger, New York, NY 1977