Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings

Abstract

Background: Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins. Aim: Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals. Method: MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed. Results: The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. Conclusion: Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.

In vivo observations of biofilm adhering to a dialkylcarbamoyl chloride‐coated mesh dressing when applied to diabetes‐related foot ulcers: A proof of concept study

“…A recent commentary article positioned DACC-coated mesh dressings as an alternative non-antimicrobial able to prevent/reduce wound infection via the physical uptake, sequestration, and removal of microorganisms from the wound bed. 24 Here, we demonstrate using qPCR that there was no statistical difference in the mean microbial load (16 S copies) of 20 DRFUs following treatment with DACC-coated mesh dressings. A closer look at post-treatment individual-level data shows eight participants experienced a reduction in the total microbial loads (0.94 Log10), while 12 participants experienced an increase in the total microbial loads (0.65 Log10).…”

An Overview on the Recent Advances in the Treatment of Infected Wounds: Antibacterial Wound Dressings

“…[154,155] The mechanism of DACC antibacterial effect is physical binding and deletion, and therefore there is no risk of bacterial resistance. [154,156,157] Antimicrobial stewardship: Antibiotic resistance of bacteria is a growing problem with the overuse of antibiotics. Antimicrobial resistance can lead to extended infection, delayed healing, and long hospital admissions.…”

“…[ 154,155 ] The mechanism of DACC antibacterial effect is physical binding and deletion, and therefore there is no risk of bacterial resistance. [ 154,156,157 ]…”

Antimicrobial Stewardship in Wound Care

“…Wound care studies evaluating AMS interventions cover a broad range of topics, including investigating the effects of various dressings on wound infections and assessing the role of prospective audits and feedback from patients receiving antimicrobials for wound infections. A review by Rippon et al 11 looked at the evidence for bacterial-binding dressings (ie, dressings that physically retain bacteria and reduce the bioburden of pathogenic organisms in the wound bed) in both acute and chronic wounds. Significant improvements were noted for a number of outcomes, although many of the studies reviewed had limitations such as a small sample size and lack of control groups.…”