Silver absorption and toxicity evaluation of silver wound dressings in 40 patients with chronic wounds

Brouillard, C.; Bursztejn, A.‐C.; Latarche, Clotilde; Cuny, J.-F.; Truchetet, F.; Goullé, Jean-Pierre; Schmutz, J.‐L.

doi:10.1111/jdv.15055

Cited by 30 publications

(29 citation statements)

References 23 publications

(68 reference statements)

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“…After 3 weeks of treatment, the level of silver in blood was 194 µg/L (Chaby et al, 2005). In 40 patients with chronic wounds treated with different silver preparations, serum silver was observed to correlate to wound area (Brouillard et al, 2018). Pigs with scalds were applied 1 g of 1% silver sulfadiazine cream for 48 h; Absorption of silver was less than 1%, but silver was detected in the eye, kidney, lung, stomach, adrenal, aorta, muscle, spleen, intestine, thyroid, and brain (Lazare et al, 1974).…”

Section: Absorption Over Skin Compromised By Other Wounds and Scaldingmentioning

confidence: 99%

Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review

Hadrup

Sharma

Loeschner

2018

Regulatory Toxicology and Pharmacology

237

178

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Silver is used in different applications that result in contact with skin and mucosal surfaces (e.g., jewelry, wound dressings, or eye drops). Intact skin poses an effective barrier against the absorption of silver. Mucosal surfaces are observed to be less effective barriers and compromised skin is often a poor barrier. Silver can deposit as particles in the human body causing a blue-gray discoloration known as argyria. Urine and feces are reported pathways of excretion. Acute human mortality has been observed following an abortion procedure involving the intrauterine administration of 7 g silver nitrate (64 mg silver/kg body weight). Localized argyria has been reported with exposure to silver ions, metallic surfaces, and nanocrystalline silver. Generalized argyria was observed with ionic and nanocrystalline silver in humans at cumulative doses in the range of 70-1500 mg silver/kg body weight. Silver is observed to have a low potential for skin irritation. Eye irritation and some cases of allergic contact dermatitis have been reported. Silver may cause genotoxicity, but additional data are required to assess its carcinogenic potential. Other reported toxicities include hepatic, renal, neurological, and hematological effects.

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Section: Absorption Over Skin Compromised By Other Wounds and Scaldingmentioning

confidence: 99%

Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review

Hadrup

Sharma

Loeschner

2018

Regulatory Toxicology and Pharmacology

237

178

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“…is can be explained by bacterial resistance due to overuse or inappropriate use and cytotoxicity of antibacterial molecules, which are barriers to healing and harmful for the patient [21]. ese products are also expensive [5,[21][22][23]. Few occurrences of resistance to silver have been reported in the medical literature, and the cellular sensitivity is correlated with the level of silver release and exposure [14,15,24,25].…”

Section: Introductionmentioning

confidence: 99%

New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration

Blanchette

Belosinschi

Lai

et al. 2020

BioMed Research International

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Aim. To evaluate in vitro the antibacterial effect of a paper made of silver phosphate cellulose fibers (SPCF) on Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products. Methods. The antibacterial activity of SPCF samples was evaluated through time with cell counting on agar plates. SPCF samples were then compared with commercial wound care products currently in use in DFU treatments (Silvercel™, Acticoat 7, and Aquacel Ag ExtraTM) through time on agar plates (growth inhibition zones). Results. After 6 hours, there was no viable bacterial cell detected on either plate (p<0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p<0.05) and superior to Aquacel AG ExtraTM and Silvercel™ at lower silver concentrations (p<0.001). Conclusions. These results have shown the efficiency of SPCF paper to eliminate Staphylococcus aureus in these conditions. SPCF papers are effective when compared with other common commercial products and could have an industrial potential in wound care. Infected DFU could benefit from the antibacterial effectiveness of SPCF, but more relevant experimentations related to foot ulcers are needed.

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“…For example, it has been reported that at a higher concentration of silver nanoparticles, undesirable side effects, including argyria and limited proliferation and metabolic activity of keratinocytes, were observed. [22][23][24] As indicated earlier, the motivation behind inclusion of silver in the ROCF-ciNPT skin interface layer is to minimize the microbial growth within the dressing itself, and not to induce a localized antimicrobial effect (i.e., at the wound site or incision site) to prevent and/or manage the infection at the surgical site. Thus, we set to determine the effect of silver present in the ROCF-ciNPT skin interface layer on microbial growth when it is placed in direct contact with a microbial colony.…”

Section: Limited Silver Mobility and Subsequent Zone Of Inhibitionmentioning

confidence: 99%

Assessment of Silver Levels in a Closed-Incision Negative Pressure Therapy Dressing: In Vitro and In Vivo Study

Kharkar

Osborne

Stern

et al. 2020

Advances in Wound Care

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In recent years, reticulated open-cell foam-based closed-incision negative pressure therapy (ROCF-ciNPT) has shown effectiveness in management of various postoperative incisions. These dressings consist of a skin interface layer that absorbs fluid from the skin surface and reduces the potential for microbial colonization within the dressing by means of ionic silver. This study examines the ability of silver to reduce the bioburden within the dressing as well as the localized effect due to potential silver mobility. Approach: Ability of silver to reduce bioburden within the ROCF-ciNPT dressing was assessed using Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp. Furthermore, silver mobility was assessed using an in vitro skin model to study the zone of inhibition along with released silver quantification. Using a porcine model, diffusion of silver into blood and tissue was studied using emission spectrometry and histology. Results: Microbial growth in the ROCF-ciNPT dressing was significantly reduced (*2.7-4.9 log reduction) compared to a silver-free negative control. No zone of inhibition was observed for microbial colonies for up to 7 days with minimal localized silver release (<5.5 ppm release). In vivo studies demonstrated no measurable concentration (<0.2 lg/g) of silver in the blood, urine, feces, kidney, and liver tissue biopsy. Innovation: This study provides an important insight into silver concentration and mobility within the ROCF-ciNPT dressing, given emerging concerns associated with potential silver cytotoxicity. Conclusion: These results indicate the concentration of silver (0.019% silver by weight) in the ROCF-ciNPT dressings has been adequate to reduce bioburden within the skin interface layer, while severely limiting the amount of silver leaching out.

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Silver absorption and toxicity evaluation of silver wound dressings in 40 patients with chronic wounds

Abstract: Both long-term application and iterative treatments with silver dressings should be discouraged, especially in the elderly, who often suffer from malnutrition and anaemia to avoid potential cumulative toxicity.

Cited by 30 publications

References 23 publications

Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review

Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review

New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration

Assessment of Silver Levels in a Closed-Incision Negative Pressure Therapy Dressing: In Vitro and In Vivo Study

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