Evidenz von Silber in der Wundbehandlung – Metaanalyse der klinischen Studien von 2000–2015

Dissemond, Joachim; Böttrich, Johannes Georg; Braunwarth, Horst; Hilt, Jörg; Wilken, Patricia; Münter, Karl-Christian

doi:10.1111/ddg.13233_g

Cited by 10 publications

(9 citation statements)

References 48 publications

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“…Silver ions, which are transported into the cell, interfere with numerous cell functions by binding to proteins and interfering with energy generation, enzyme function, and cell replication. Thanks to these diverse points of attack, the development of resistances against silver ions has to date only been rarely described [190. ]…”

Section: Silver Ionsmentioning

confidence: 99%

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Consensus on Wound Antisepsis: Update 2018

Krämer

Dissemond²,

Kim³

et al. 2017

Skin Pharmacol Physiol

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243

215

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Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

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Section: Silver Ionsmentioning

confidence: 99%

“…After this period, a critical reevaluation of the usefulness of silver-ion therapy should be performed. However, an extensive, long-term and prophylactic use was not recommended [190]. …”

Section: Silver Ionsmentioning

confidence: 99%

Consensus on Wound Antisepsis: Update 2018

Krämer

Dissemond²,

Kim³

et al. 2017

Skin Pharmacol Physiol

Self Cite

243

215

View full text Add to dashboard Cite

show abstract

“…Zudem erfolgte bei der Bakterienbestimmung mit Hilfe membranartiger Nitrozellulosefi lter eine Art mechanisches Debridement. Ein weiterer wichtiger Unterschied bestand darin, dass in dieser Studie ein überwiegender Anteil der Patienten eine Antibiotikatherapie erhalten hat [ 9 ] , während in unserem Studiendesign strikt auf jegliche antimikrobielle Therapie verzichtet wurde [25][26][27] . Mit Hilfe der Auswertung von Gram-Färbung im Debris konnte jedoch auch in unserer Studie bei Gruppe 1 eine Bakterienreduktion um 50,4 % und bei Gruppe 2 um 35,0 % festgestellt werden.…”

Section: Diskussionunclassified

Pilotstudie zum Einfluss von kaltem atmosphärischem Plasma auf bakterielle Kontamination und Heilungstendenz chronischer Wunden

Moelleken

Jockenhöfer

Wiegand

et al. 2020

J Deutsche Derma Gesell

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Hintergrund : Wöchentlich dreimalige Anwendung kalten atmosphärischen Plasmas (KAP) wurde bereits erfolgreich zur Wundbehandlung eingesetzt. Jetzt sollte untersucht werden, ob mit nur einmal wöchentlicher Behandlung vergleichbar gute Ergebnisse erzielt werden können. Patienten und Methodik : In dieser randomisierten klinischen Pilotstudie (RCT) wurden Patienten mit therapierefraktären chronischen Wunden über maximal zwölf Wochen 1 x/Woche (Gruppe 1) oder 3 x/Woche (Gruppe 2) mit KAP behandelt. Patienten der Gruppe 3 erhielten 1 x/Woche eine Placebotherapie. Ergebnisse : Die Wundfläche nahm in Gruppe 1 (n = 14) signifikant um 63,0 % (P = 0,005) und in Gruppe 2 (n = 13) um 46,8 % (P = 0,007) ab. In Gruppe 3 (n = 10) wurden die Wunden durchschnittlich 17,5 % größer. In den beiden mit KAP behandelten Gruppen konnte eine signifikante Schmerzreduktion (Gruppe 1: P = 0,042; Gruppe 2: P = 0,027) gemessen werden. Ausschließlich in der Gruppe 2 zeigte sich eine signifikante Verbesserung der wundspezifischen Lebensqualität (P = 0,005). Nach der zwölfwöchigen KAP-Behandlung konnte eine Reduktion der Bakterienlast um durchschnittlich 50,4 % (Gruppe 1) beziehungsweise um 35,0 % (Gruppe 2) im Vergleich zum Tag des Studieneinschlusses nachgewiesen werden. Schlussfolgerungen : Unserer RCT zeigt, dass durch die Behandlung mit KAP verschiedene Parameter der Wundheilung bei Patienten mit therapierefraktären, chronischen Wunden verbessert werden. Hierbei waren die Ergebnisse bei der Anwendung 1 x/Woche der Anwendung 3 x/Woche nicht unterlegen. Die Behandlung 1 x/Woche ist im klinischen Alltag leichter und wirtschaftlicher zu implementieren.

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“…Микробиостатические антисептики, однако, обладают переносимой (между бактериями) устойчивостью, и к ним может проявляться перекрестная резистентность с некоторыми антибиотиками. Примерами являются хлоргексидина диглюконат и некоторые соединения четвертичного аммония, молекулы которых "выводятся" бактериями через откачивающие насосы благодаря активации определенных генов, а также антисептики на основе ионов серебра, которые инактивируются генетически модифицированным периплазматическим белком бактерий, связывающим одновалентные катионы Ag [15,16].…”

Section: дискуссияunclassified

Comparison of the effectiveness of preventive systemic administration of antibiotics with topical use of decamethoxin during clean surgical interventions

Hlaholieva

2019

prmd

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Introduction. The lack of generally accepted standards of perioperative antimicrobial prophylaxis leads to the inadequate preventive use of antibiotics associated with development of microbial resistance, changes in the natural biota and sensitization of the patient’s body. Prevention of infectious complications after surgery with topical antiseptic is an appropriate alternative to antibiotic prophylaxis. The purpose of this study was to evaluate the efficacy and safety of topical antiseptic prophylaxis of infectious complications with a 0.02 % decamethoxin solution compared to systemic antibiotic prophylaxis with cefuroxime (beta-lactam antibiotics) during clean surgeries. Materials and methods. In the first group of patients (n = 25), the operative field was treated with decametoxin, the abdominal cavity was irrigated through an irrigator during laparoscopic interventions after trocart placement or with a syringe in case of open surgeries (50–150 ml). In the second group (n = 22), cefuroxime was administered at a single dose of 1.5 g 30 to 60 minutes before surgery. Patients underwent inguinal hernia repair (Lichtenstein and laparoscopic transabdominal preperitoneal repair), thyroidectomy, parathyroidectomy, laparoscopic adrenalectomy, cholecystectomy, cystectomy of the spleen and ovaries for uncomplicated cysts. Results. Microbiological analysis of the inoculation material taken from the bottom and walls of the surgical wound before suturing (before the wound was treated with an antiseptic agent in the decamethoxin group) revealed no growth of pathological microbiota at clinically significant levels. Conclusions. The antimicrobial effect of a 0.02 % decamethoxin solution when applied topically during clean surgical interventions is comparable to that of cephalosporin antibiotics. Perioperative antiseptic prophylaxis can reduce the incidence of antibiotic-resistant strains of microorganisms in surgical departments.

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Evidenz von Silber in der Wundbehandlung – Metaanalyse der klinischen Studien von 2000–2015

Cited by 10 publications

References 48 publications

Consensus on Wound Antisepsis: Update 2018

Consensus on Wound Antisepsis: Update 2018

Pilotstudie zum Einfluss von kaltem atmosphärischem Plasma auf bakterielle Kontamination und Heilungstendenz chronischer Wunden

Comparison of the effectiveness of preventive systemic administration of antibiotics with topical use of decamethoxin during clean surgical interventions

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