Wound management in an era of increasing bacterial antibiotic resistance: A role for topical silver treatment

doi:10.1053/ic.1998.v26.a93527

American Journal of Infection Control

Volume 26, Issue 6, December 1998, Pages 572-577

Parts of this work were presented at the Symposium on Advanced Wound Care and Medical Research Forum on Wound Repair, April 18-22, 1998, Miami Beach, Fla.

https://doi.org/10.1053/ic.1998.v26.a93527 Get rights and content

Abstract

Background: Antibiotic-resistant bacteria represent an increasing concern in wound infections. Wound colonization with these organisms normally results in aggressive management of the wound complicated by a greatly limited choice of therapeutic antibiotics. Silver and other noble metals are recognized as potential allies in combating these organisms in wounds. Methods: Three types of topical silver applications were tested to determine their bactericidal efficacies against clinical isolates of antibiotic-resistant organisms. The silver-based applications represent 3 methods of applying silver to wounds: as a liquid (silver nitrate), incorporated in a cream (silver sulfadiazine) and as a dressing coating (silver-coated dressings). The reduction in the viable bacterial population recovered from test articles after exposure to silver provided a comparative measure of the bactericidal efficacies of these silver applications. Results: All of the products demonstrated an ability to reduce the number of viable bacteria. However, the methods varied in their efficacy against antibiotic-resistant bacteria, with the silver-coated dressing being the most efficacious and silver nitrate the least efficacious. Conclusions: Silver was demonstrated to be effective at killing the antibiotic-resistant strains tested. The silver-coated dressing was particularly rapid at killing the tested bacteria and was effective against a broader range of bacteria. Silver may be a useful prophylactic or therapeutic agent for the prevention of wound colonization by organisms that impede healing, including antibiotic-resistant bacteria. (AJIC Am J Infect Control 1998;26:572-7)

Section snippets

Bacteria

The bacterial strains were clinical isolates obtained from either Calgary (Alberta, Canada) Laboratory Services or from the University of Toronto Hospital (Toronto, Ontario, Canada). The bacteria are listed in Table 1, with the antibiotics to which they have tested resistant.table

. Antibiotic-resistant clinical isolates, their sites of isolation, and the antibiotics to which they were found to be resistant (as determined by the clinical laboratory in which they were identified)

Organism	Isolation

Bactericidal assay

The bactericidal assay chosen to demonstrate the efficacy of topical silver treatments allowed for accurate determination of the effect of the silver. Rather than describing an inhibitory effect on bacteria, this assay allowed for the determination of the ability of the silver protocols to kill the bacterial inocula. In addition, the method provides the ability to determine the rate of bacterial killing, thereby providing another index of efficacy against the isolates described.

Efficacy against antibiotic-resistant bacteria

The 3 different

DISCUSSION

Bacterial resistance to antibiotics is becoming a major challenge in all parts of the world with the impact on the practice of medicine being seen most acutely. At an increasing frequency, organisms are being isolated that have minimal antibiotic sensitivity or that are sensitive to an increasingly narrow range of antibiotics. Colonization of wounds by antibiotic-resistant organisms provides a significant challenge to the health care community, particularly in patients who may be

References (18)

MC Robson
Wound infection. A failure of wound healing caused by an imbalance of bacteria
Surg Clin North Am
(1997)
SM Modak et al.
Binding of silver sulfadiazine to the cellular components of Pseudomonas aeruginosa
Biochem Pharmacol
(1973)
SJ Isenberg et al.
Povidone-iodine for ophthalmia neonatorum prophylaxis
Am J Ophthalmol
(1994)
DG Klein et al.
Wound infection following trauma and burn injuries
Crit Care Nurs Clin N Am
(1995)
A Griffith-Jones
Methicillin resistant Staphylococcus aureus in wound care
J Wound Care
(1995)
CA Kaufman et al.
Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment
Am J Med
(1993)
N Kapoor et al.
Susceptibility of multidrug-resistant isolates of Klebsiella pneumoniae to silver nitrate
Folia Microbiol (Praha)
(1989)
JM Hamilton-Miller et al.
Silver sulphadiazine: a comprehensive in vitro reassessment
Chemotherapy
(1993)

There are more references available in the full text version of this article.

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Wound management in an era of increasing bacterial antibiotic resistance: A role for topical silver treatment☆

Abstract

Section snippets

Bacteria

Bactericidal assay

Efficacy against antibiotic-resistant bacteria

DISCUSSION

Surg Clin North Am

Biochem Pharmacol

Am J Ophthalmol

Crit Care Nurs Clin N Am

Methicillin resistant Staphylococcus aureus in wound care

J Wound Care

Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term-care facility with the use of mupirocin ointment

Am J Med

Susceptibility of multidrug-resistant isolates of Klebsiella pneumoniae to silver nitrate

Folia Microbiol (Praha)

Silver sulphadiazine: a comprehensive in vitro reassessment

Chemotherapy